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State action plan in effect

Daily Ledger - 9/13/2017

Sept. 13--SPRINGFIELD -- The State of Illinois on Sept. 6 released its Opioid Action Plan, marking a collaboration between government and the many stakeholders impacted by the national opioid crisis.

"The opioid epidemic knows no neighborhood, no color, and no class. It is not confined to alleys in urban settings, nor isolated in rural communities," Lt. Gov. Sanguinetti said. "Illinois needs a comprehensive opioid strategy that de-stigmatizes addiction and appropriately aligns resources across state agencies in partnership with community priorities."

Part of de-stigmatizing dependency on opioids includes referring to opioid dependency or addiction as "opioid-use disorder." This term has been substituted for the word "addiction" nationally, according to Melaney Arnold, public information officer for Illinois Department of Public Health.

"Opioid use disorder is being used in place of addiction, in Illinois and nationally," Arnold told the Voice.

"There is a negative stigma associated with the word addict/addiction. People tend to think of addicts or people who are addicted as having done something wrong and it's their fault. We're trying to educate the public that opioid use disorder is a chronic, complicated medical problem requiring treatment."

In figures presented by Gov. Bruce Rauner's office, the number of heroin deaths in Illinois has nearly doubled, and the number of prescription opioid deaths has almost quadrupled. Last year, there were 1,889 opioid overdose deaths, an increase of 76 percent from 2013. Recent analyses of death records in Illinois show that overdose deaths involving synthetic opioids have increased more than any other category of opioids. The largest increase was in the number of deaths involving fentanyl, and drugs similar to fentanyl, which led to a tenfold increase in synthetic opioid overdose deaths between 2013 and 2016.

On Sept. 6, Gov. Rauner signed an Executive Order creating the Opioid Overdose Prevention and Intervention Task Force.

A statement from Rauner's office indicates: "The task force will look at strategies to prevent expansion of the opioid crisis, treat and promote the recovery of individuals with opioid-use disorder (OUD), and reduce the number of opioid overdose deaths. The task force will be co-chaired by Lt. Gov. Sanguinetti and Dr. Nirav D. Shah, director of the Illinois Department of Public Health.

The governor, lieutenant governor and Department of Public Health are joined by the state Criminal Justice Information Authority, Department of Financial and Professional Regulation, Human Services, Juvenile Justice, Corrections, Healthcare and Family Services, Insurance, Law Enforcement and Training Standards Board and Illinois State Police.

"The death toll continues to rise exponentially, and, if left unchecked, estimates show that more than 2,700 people in Illinois will die from opioid overdoses in 2020," Dr. Shah said. "The opioid crisis is not something that can simply be solved with more treatment, increased prevention, or more arrests. It will take all of us, in all capacities to end the crisis."

The goal is to reduce the anticipated number of opioid-related deaths by 33 percent over the next years. The plan identifies three areas of focus: prevention, treatment/recovery, and response.

To address those three areas of focus, the state has identified six priorities:

? Safer prescribing and dispensing of opioids.

? Education and stigma reduction.

? Data monitoring and communication.

? Increasing access to care.

? Supporting justice-involved populations.

? Increasing naloxone access and use.

The Plan

"Years of scientific research on the effects of substance use on the brain show us that substance-use disorders should be treated the same way we treat other chronic diseases," Illinois Department of Human Services Secretary James Dimas said.

"In order to impact the opioid crisis, we need to work together to eliminate the stigma that accompanies substance use disorders and create a society focused on treatment and prevention."

Although the State of Illinois Opioid Action Plan is focused on reducing the number of opioid overdose deaths, working with and supporting individuals battling opioid-use disorder, and the people in their lives, is important. Recovery from opioid-use disorder is a long and difficult process, and may require lifelong support and access to care.

The opioid epidemic developed out of many complex and interacting factors over several decades, and it will require a great deal of sustained collaborative effort to turn the tide. The state will collaborate actively with other key stakeholders, including the Illinois Opioid Crisis Response Advisory Council, to build on the plan's framework.

According to the action plan, "physical tolerance to opioids can begin to develop as early as two to three days following the continuous use."

The language prepared by the department of health also notes that those with OUD are at greater risk of dropping out of school, losing jobs, becoming homeless, losing custody of children or getting arrested for a criminal offense. The Centers for Disease Control and Prevention estimate that for every unintentional opioid overdose death, there are 161 people who report drug misuse or having dependency.

The action plan language further states: "Applying this to Illinois, we estimate that there may be more than 300,000 people in Illinois who misuse or are dependent on opioids."

A sidebar within the action plan spotlights Neonatal Abstinence Syndrome. NAS, not unlike Fetal Alcohol Syndrome, is a collection of signs and symptoms that occur when a newborn has been prenatally exposed to opioids and experiences withdrawal.

"Although the long-term consequences of NAS are not yet well-established, recent research has revealed evidence of adverse outcomes throughout childhood, including mental health and behavioral problems, as well as visual disorders."

Recent data for Illinois shows that there was an increase of 52 percent between 2011 and 2016 for newborns with NAS. In 2016, here were 391 reported instances of NAS. The rate in Illinois is highest among non-Hispanic white infants, infants on Medicaid and "infants residing in urban counties outside the city of Chicago and rural counties."

Synthetic Opioids and the "Third Wave" of the Opioid Epidemic

"The U.S. is now entering the "third wave" of the opioid epidemic and the largest increases in overdose deaths in recent years have been attributable to synthetic opioids such as fentanyl. According to the CDC, the death rate from synthetic opioids nationwide increased 72.2 percent from 2014 to 2015. In Illinois, that percentage increase was 120 percent.

Fentanyl is a powerful synthetic opioid usually used for surgical anesthesia as well as to manage post-operative and severe chronic pain. It is similar to morphine, but 80 times more potent. Fentanyl is also fast acting, meaning that overdoses can occur in seconds to minutes (rather than the longer periods associated with heroin and other opioid overdoses). Overdoses with fentanyl and other synthetics can be more difficult to reverse than with other types of opioids and often require multiple doses of the opioid reversal medication naloxone to treat. Heroin and/or cocaine sold on the street is frequently mixed with illicitly manufactured fentanyl to increase the drug's effects, which can be a lethal combination. Because of its potency and quick onset of action, an individual who is unaware that the drugs they've been sold have been mixed with fentanyl can easily overdose and die on what they mistakenly believe is a "regular" dose of heroin. Even more recently, carfentanil, a fentanyl analogue 100 times more potent than fentanyl and 10,000 times more potent than morphine, has been increasingly making its way into street drugs over the past year and has been implicated in a number of overdose deaths in Illinois and nationwide.

As we move forward with our overall goal of reducing opioid overdose deaths, we will need to take the increasing impact of synthetic opioids into account and be responsive to future shifts and trends that emerge from the epidemic."

-- From Illinois Opioid Action Plan

The Illinois Opioid Action Plan can be found in PDF format here: http://


Reach Jared DuBach by email at jdubach@mcdonoughvoice.com.


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