Reducing risk: How Peoria County helps save the lives of drug users

Dec. 02--PEORIA -- The death toll of opioid addiction may be finally turning a corner in central Illinois.

Efforts in the past year to make opioid use safer for addicts has led to a nearly 30 percent reduction in overdose deaths, said Peoria County Coroner Jamie Harwood.

Harwood said Peoria County's efforts -- clean needle exchanges, distributing the overdose-reversing drug naloxone and offering fentanyl test strips -- have made drug use safer for addicts and resulted in a drop in overdose deaths. This mirrors other areas in the United States. Harwood cited articles from medical journals such as Public Health Reports and International Journal of Drug Policy, which argue that those kinds of efforts go a long way to helping reduce the death toll in the ongoing opioid epidemic.

Last year, there were 67 overdose deaths in Peoria County involving all types of drugs. This year, through Thursday, there have been 49. Barring an abnormal December, Harwood said it's unlikely we'll reach last year's totals. In December 2017, 10 people died from drug overdoses in Peoria County.

According to the Peoria Police Department, 32 people died in from drugs in 2017. This year, so far, there have been 19 deaths, 18 of which are related to opioids, said Amy Dotson, the department spokeswoman.

Harwood said those numbers reflect what he thought.

"What we are seeing directly correlates with the research that I have done," he said. "Harm reduction, while not eliminating usage, does reduce the number of overdoses. You can just see that in the numbers."

But the coroner also acknowledged that some might view such tactics as enabling users and condoning the use of illegal drugs. He and other experts disagree.

"We do harm reduction all the time in our daily lives," said Chris Schaffner, with the Human Service Center and JOLT Foundation. "We use helmets when we ride motorcycles, we use condoms, we put covers on wall outlets when there are toddlers in the house. Those are all there to minimize the potential of harm.

"Why is it OK in those settings but not in this type of a setting?" Schaffner asked.

Michael Hufford, co-founder of Harm Reduction Therapeutics in Pittsburgh, who wants to see low-cost naloxone in every pharmacy across the United States put it far more bluntly.

"At the end of the day," Hufford said, "the only people who can recover from an opioid dependency, which is the goal, are the people who are alive."

Dr. Tamara Olt, founder of the JOLT Foundation and a Peoria physician who lost her son to opioid overdose in 2012, is working to reduce the stigma attached to opioid use and in the process, hopes to help those who want help.

"Drug users are not unintelligent people," she said. "They don't want to die. They want to stay as healthy as they can ... and we are here to help them get what they need to do that.

"We know from a lot of data and syringe exchanges being around for years, that if people come to some kind of harm reduction (program) or syringe access service, they are five times more likely to enter treatment than if they didn't."

What is harm reduction?

Harm reduction is a phrase for methods to reduce injury associated with some type of activity. It's using a bike helmet or wearing a seat belt. And when it comes to opioid use, it's ways to minimize the injury associated with drug use as opposed to focusing exclusively on eliminating drug use. The theory is that if people are healthier while they are using, there is a better chance they can survive and possibly get into treatment. There's also the public health implications. Those involve, in the case of needle exchanges, the reduction of infectious disease transmissions.

"We look at things like the spread of transmittable diseases like hepatitis or HIV by the use of needles," Harwood said."There is more than just the death, which is important obviously, but then there is the treatment on the outside of that of transmitting those communicable diseases. That's expensive to public health departments. It's expensive on the federal and state levels that are supporting health care in this crisis. It's way beyond just losing a person. It's the ones who maybe have survived an overdose and continue to use and continue to use bad or dirty needles and spread diseases."

"We have more people who have died from this crisis than the HIV crisis in the 1980s, so it's pretty significant," he said. And that's backed up by data released Thursday by the Centers for Disease Control and Prevention which reported that last year, more than 72,000 people died from overdoses in the United States. Of that number, 48,000 died from opioids. At its peak in the mid-1990s, 40,000 people a year died from HIV, a number that has dropped considerably due to the creation of antiviral drugs.

Research by addiction medicine specialists and others have shown that such strategies tend not to lead to an increase in drug use.

Hufford and Schaffner liken their efforts to that of consumer safety advocates more than 50 years ago when seat belts were made mandatory for passenger vehicles.

"Seat belts aren't going to make you stop speeding," Hufford said. "But they can reduce the injury that you could have if you are in a crash."

That is the idea behind what's being done here in Peoria. The JOLT Foundation's center on Adams Street offers a place for users to get clean needles and to swap out their own ones. There are clean bandages, alcohol swabs, clothing, naloxone more commonly known as Narcan, and even some snacks and a couch.

The mission of the JOLT Foundation is to get people into the building and then talk to them about their lives. By giving people dignity, it's the hope that some people will make the attempt to get off drugs and enter recovery. And for those who don't, the efforts are a way to keep them healthy enough to function and live. Schaffner says it's not just physical treatment but mental treatment as well.

"It's like diabetes. As much as I want to change, and I don't want the uncontrolled debilitating effects of diabetes, it's hard. But that doesn't mean that I don't try, but it's hard," he said. "So what we do is try to reduce the harm. In the case of diabetes, it's the kind of food that I would consume so instead of having one Twinkie, I'd have just a half."

He admits there's a difference between illegal drug use and eating foods that are unhealthy. But he also says the contemplation on the part of the user is the same.

"The idea is to start to move towards significant changes or really any positive change. Any single positive change usually snowballs within enough time to more change," Schaffner said. "A lot of people start off in denial. They can't see the negative impact, but when someone becomes aware of the negative impact, then they are contemplating. They then enter the determination stage, where the goal might not be abstinence but its management."

One of the final steps is taking action, he said, adding that efforts like the JOLT Foundation "empower an individual to make choices in their lives."

The next steps

Harwood believes that Good Samaritan laws, which offer immunity from prosecution if someone calls in a drug overdose, go a long way. Drug users might not be alone when they are using drugs. So offering someone a chance to call authorities for help without fear of prosecution is vital to saving lives.

Dr. Olt says saving lives also protects the community.

"This is really a public health intervention. We are trying to prevent the spread of diseases," Olt said, pointing to a 2015 outbreak of HIV in southeastern Indiana where several drug users were infected with contaminated needles. According to media reports, more than 200 people were diagnosed with the virus. A CDC report released earlier this year found that by providing clean needles for addicts, needle sharing dropped greatly and in turn, so did the spread of the virus. HIV testing went up and so did the overall awareness of the disease in the community, according to CDC reports.

Harwood is a big proponent of medication assisted treatment (MAT) for those who suffer from opioid addiction. Many in the addiction medicine field believe that MAT is the best way to treat someone who is trying to stop using as it allows someone to avoid the painful withdrawals.

"The evidence is clear that these medications can help stop the disease, cause remission and save lives," said Yngvild K. Olsen, medical director for the Institutes for Behavior Resources Inc. in Baltimore.

Harwood considers MAT a logical extension of harm reduction. Providing more access to those forms of treatment as well as more over-the-counter access to naloxone can help get more people into treatment, off the streets and out of the throes of drug use. That reduces the burden, both in time and money, on the public sector, he said.

"This is the elite standard of care ... way after we have done harm reduction, this is the next step to reduce our deaths," he said.

In the end, Olt said, it's about people helping people and showing compassion. Reducing overdoses is a main goal, but so is treating users like human beings and trying to improve their quality of life.

"We have had several of our people ask if they can get into treatment," she said. "That's definitely what we talk about."

Andy Kravetz can be reached at 686-3283 or akravetz@pjstar.com. Follow him on Twitter @andykravetz.

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