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As COVID-19 kills thousands in Chicago and across Illinois, the opioid epidemic has intensified its own deadly siege away from the spotlight, engulfing one public health crisis inside another.
More than twice as many people have died or are suspected to have died of opioid overdoses in the first five months of the year in Cook County, when compared with the same period last year, according to a ProPublica Illinois analysis of medical examiner’s office death records. There have been at least 924 confirmed or suspected overdose deaths so far in 2020; there were 461 at this time last year. And much like the coronavirus outbreak, the opioid epidemic has disproportionately affected African Americans on Chicago’s West and South Sides.
Statewide, opioid deaths also are outpacing 2019 numbers, largely due to the increase in Cook County.
The deadly surge comes at what was supposed to be a turning point for Illinois. A 2017 state action plan from then-Gov. Bruce Rauner vowed to halt the “explosive growth” of opioid deaths and reduce the projected number of opioid-related deaths this year by a third.
Based on the number of overdose deaths so far in Cook County alone, it’s highly unlikely the state can meet that goal.
While the spike in deaths began several months before the first known case of the coronavirus appeared in Illinois, COVID-19 appears to be exacerbating the crisis.
“This is going to make it so much worse,” said Kathleen Kane-Willis, a researcher with the Chicago Urban League who has studied the opioid epidemic for more than a decade, adding that the true impact of the pandemic on drug overdoses likely won’t be known for some time.
“It’s going to wear on people. It’s going to make them more anxious and depressed,” she said. “Being thrust into poverty is such a stressor, and people do turn to substances to get through that stress.”
The rise in opioid-related deaths in Cook County echoes a pattern seen in other areas of the country, from Milwaukee to Memphis and in Virginia and western New York. The American Medical Association recently sounded an alarm, noting news reports from 28 states on increases in opioid-induced overdoses and issuing a series of recommendations to state governments.
Coroners in at least nine Illinois counties — ranging from Lake County north of Chicago to Peoria County in central Illinois and Madison County near St. Louis — have noted increases, though the number of overdose deaths is far lower than in Cook County. DuPage County Coroner Dr. Richard Jorgensen said he was so startled this month to see 22 overdose deaths in three weeks that he called local rehabilitation clinics and advocates to see if they could explain what was happening.
“They’ve been seeing the same thing — a lot of people calling with problems, having trouble staying sober, having relapses,” said Jorgensen, who worries that more people are using drugs alone because of the state’s stay-at-home order. “If you’re alone, there’s nobody to give you the Narcan,” he said, referring to the drug that can reverse overdoses. “That’s a problem.”
A Complicating Factor
Even before the pandemic hit, state officials, medical experts and drug recovery workers began to notice an increase in overdoses. State officials said they issued an alert in January warning the public about an increase in opioid-related overdoses.
A sustained climb in the number of opioid-related deaths over the previous year began in November, according to a ProPublica Illinois analysis of data from the Cook County Medical Examiner’s Office.
An increase in more dangerous blends of opioids hitting Cook County, including drugs laced with fentanyl and other synthetic additives, is likely partially to blame, several experts and city and state officials said.
“One thing we know for sure: The violent drug cartels and distributors have not stopped trafficking deadly fentanyl,” Robert Bell, the special agent in charge of the Chicago Field Division of the Drug Enforcement Administration, said in a statement. “The recent spike of overdose deaths emphasizes that the opioid and fentanyl epidemic has not paused — in fact, it has intensified in many places.”
In Cook County, fentanyl is listed as one of the primary causes of death in 81% of the confirmed opioid-related fatalities this year, up from 74% last year, according to ProPublica Illinois’ analysis. The majority of the cases involve fentanyl combined with other substances, such as heroin.
Still, the sheer number of opioid-related fatalities in Cook County this year has left some experts disheartened. As of Friday, the medical examiner’s office had confirmed nearly 500 deaths involving opioids. An additional 614 deaths are still under investigation, typically pending toxicology results. Of those, some 70% to 80% are expected to come back positive for opioids, according to the county’s chief medical examiner, Dr. Ponni Arunkumar. (Pathologists often ask for toxicology screenings when there is evidence of an overdose, such as white powder near the body or a needle in the arm, a spokeswoman for the medical examiner’s office said.)
That projection would put the year’s total at at least 924, more than double the number in the first five months of 2019.
“Oh, goodness. That’s insane,” said Dr. Steven Aks, an emergency room physician at John H. Stroger Jr. Hospital of Cook County and chief of toxicology for Cook County Health, when told about the increase. “This is something that we were very nervous about when the pandemic hit.”
In addition to the rise in deaths, state officials say there have been increases in nonfatal overdoses involving opioids in the first four months of this year. In February, the numbers jumped by more two-thirds, to 2,047 when compared with the average over the previous three Februaries. In Chicago, emergency calls related to overdoses were up by more than a third from January through mid-April this year compared with the same period in 2019, according to an analysis of police and fire department call data.
Dani Kirby, director of the division of substance use prevention and recovery for the state’s Department of Human Services, said in a statement that COVID-19 has complicated both the state’s response to the overdose crisis and the lives of those who use drugs.
“The stress of unemployment, isolation, and general uncertainty are all risk factors for a return to substance use or an escalation of existing patterns of use,” Kirby said. “There is an additional concern that, due to the risk of exposure to COVID-19, people may be more reluctant to call 911 or go to a hospital when an overdose occurs.”
Some overdose prevention strategies “directly contradict” strategies that are meant to prevent the spread of COVID-19, she added.
“We know that human connection is a fundamental element of service delivery — whether a program is linking someone to harm reduction supplies (clean syringes, naloxone, safer smoking supplies, etc) or providing treatment and recovery services — and COVID-19 makes it more difficult for people to access these services,” Kirby said in the statement. Naloxone is an overdose-reversal drug.
Matthew Richards, deputy commissioner of behavioral health for the Chicago Department of Public Health, echoed those challenges. “Sometimes persons that are at highest risk for overdoses, part of the effort is really meeting people where they are in community with peer services or community health educators and building rapport,” he said. “What that looks like right now in terms of social distancing and whatnot is really complicated.”
