Local efforts to combat heroin-related deaths
Written by Izzy Smith
Illustrated by Jasmine Salgado
Designed by Gabrielle Vidal
Programmed by Gabrielle Vidal
“Through the grace of God I’ve never been hooked on heroin, but I’ve had some bad experiences with the drug,” says Orlando J., 61, of Chicago (who asked that his last name not be used). He began occasionally using heroin, an opioid, in the mid-1970s, until quitting for good in 2019. Over that 40-year period, he has seen several waves in heroin and other opioid use, including the introduction of fentanyl–a powerful synthetic opioid responsible for a surge in overdose deaths since 2016. He understands the intense effects that heroin can have on users, both casual and addicted.
Chicago has experienced high opioid-related overdose deaths since the early 1990s, constituting an ongoing public health crisis. Harm reduction strategies, such as needle exchanges and distribution of naloxone–a drug that can reverse overdoses–have become increasingly crucial to the prevention of overdose deaths.
Opioid addiction in Chicago grew exponentially in the 1990s. By 1998, spurred on by cheaper and more potent heroin, the number of users in Chicago was five times the rate of total users in the rest of the United States, according to the National Drug Intelligence Center. Since then, drug usage as a whole has caught up to Chicago’s previous disproportionately high numbers. The U.S. The Department of Health and Human Services reported a total of 8.9 million opioid users nationwide in 2023.
Around 2016, the use of heroin stabilized, but another synthetic opioid took off: fentanyl, which severely increased the chances of overdose because it is 50 times as strong as heroin.
“We didn’t know what [fentanyl] was,” Orlando recalls, “but we called it ‘that stuff.'” Even those who are aware of fentanyl often disregard the risk it poses to their health and safety, including Orlando’s brother, who died in 2021. “The active addict that uses every day, they live to use and use to live," Orlando says. "No matter what.”
In response, federal, state and local agencies adopted harm reduction techniques. These included needle exchanges to prevent the spread of disease, naloxone to reverse overdoses and test strips to detect levels of fentanyl and contaminated drugs.
In Chicago, local organizations have played a large role in harm reduction. The Chicago Recovery Alliance (CRA) began distributing naloxone to users in the late 1990s when it was mainly available to medical and emergency personnel. Other organizations on the local and national level have followed suit.
John Werning, executive director of the CRA, says co-founder Dan Bigg pioneered the expansion of naloxone access in Chicago and across the United States. “[Dan] spent a large chunk of his time before he passed in 2018 going around the country and promoting harm reduction while getting other states and municipalities to adopt naloxone access and bring or expand naloxone to vulnerable populations,” Werning says.
In addition to preventing overdoses, CRA aims to reduce the use of opioids and the spread of disease through dirty needles, smoking and snorting devices. “As an organization, we are a harm reduction and syringe exchange program, at least historically,” said Werning. The CRA has expanded to provide safer sex resources, HIV counseling and treatment referrals.
Harm reduction, the intentional effort to supply drug users with tools and information to prevent physical harm and legal consequences, has become an effective strategy in overdose prevention. Used internationally, this method was pioneered in the 1980s to prevent the spread of HIV due to the injection of opioids. Harm reduction has since expanded into an umbrella term, referring to multiple facets of disease spread and prevention, as well as safe administration and overdose prevention methods.
In order to reach users, the CRA travels to locations around Chicago. “We are a mobile service. We go out into the community seven days a week in our mobile vans and try to bring those supplies,” Werning says. CRA, other harm reduction organizations and the City of Chicago are anticipating an influx of money from the Illinois Opioid Settlements Agreement. The settlements have occurred as a result of lawsuits filed against pharmaceutical agencies for contributing to the opioid epidemic.
Funding comes with strings attached, however. “We have historically gotten a decent amount of money from the Illinois Department of Human Services for overdose prevention, but the bulk of that money has to be spent on naloxone, which is good. But harm reduction isn't just overdose prevention,” Werning says.
Chicago and local harm reduction agencies are at a pivotal moment after the 2024 election. Previous Trump Administration policies addressed the opioid crisis as a border issue, without ever mentioning harm reduction. There are also questions about whether users caught with harm-reduction drugs and paraphernalia will be charged with possession.
To help protect them, CRA provides users with an identification card that allows law enforcement to verify their legal use of exchanged needles and other materials. However, law enforcement doesn't always recognize the CRA card as legitimate, Werning says, and pushback from Illinois state representatives continues to threaten the work they do.
“Our participants, law enforcement, politicians, the public, people are not informed about syringe service programming. They're not informed about the laws that protect them," he says.
"[Participants] certainly aren't knowledgeable enough to be able to express those protections in a crisis or an emergency.”
Still, CRA continues to provide materials that encourage safe drug use, overdose and disease prevention. “It’s a lot of work but I think it’s really worth it to invest in,” Werning says. And in doing so, he argues that the total cost to Chicago decreases because there are fewer calls to emergency services, fewer emergency room visits and fewer deaths. “At the end of the day," he says, "despite pushback, it really saves lives and saves everybody a lot of money.”
