II. Drug Offenses
Recently, particularly in the light of the opioid epidemic, the issue of substance abuse has been begun to be recast as a public health issue, prompting calls for sentencing reform and treatment.
If you are elected, how would you address the opioid epidemic? How will you ensure equitable use of federal and state opioid-related and other substance abuse funding in suburban, rural and urban areas of the state will be based upon demonstrated needs?
Through the 80s and 90s, the crack epidemic hit hard across the U.S., particularly in major cities. We witnessed the deteriorating effects that resulted from government inaction as crime rates and poverty rates rose in correlation with the presence of crack cocaine. We cannot repeat the mistakes of our past by failing to address what has become a new epidemic in the modern day - opioid addiction and abuse.
Drug abuse is an illness and should be treated as such through our public health system. We cannot marginalize or condemn those who choose to abuse dangerous drugs when we’ve done nothing to steer them away from continued abuse. I would work to reform drug sentencing so as to treat the possession of small amounts of drugs as a misdemeanor and decrease sentences for drug offenses by one or more felony class while repealing mandatory minimum sentences.
Opioid abuse is on the rise in Illinois. Between 2008 to 2014, deaths resulting from opioid abuse nearly tripled in Illinois. To prevent these deaths, there are three key areas we need to address
- equipping our law enforcement with training and guidance
- providing abusers with treatment within their communities and in our jails and
- preventing a new generation from becoming opioid users.
The first thing I would do to improve how we address our opioid crisis is equip our law enforcement with training to identify clear signs of opioid abuse and administer an antidote (i.e. naloxone). We need to make law enforcement able to readily address extreme instances where an overdose is possible and medical professionals are not immediately available.
Second, I would address the underlying issues that contribute to a vicious cycle of addiction through expanded mental health services and I would address drug abuse through treatment and recovery programs. According to NAMI, nearly 40% of Illinois residents age 18 or older have reported poor mental health, 16% are reported as living with mental illness and around 3.5% are living with a severe mental illness. That’s more than half our population who identify as needing mental health support. Those struggling with their mental health are more vulnerable to drug use and abuse as well as crime. We know that Cook County Jail has become Illinois’s largest mental health provider. We need to provide more mental health care services within our communities rather than in our jails or through institutional care. In Illinois, we have favored institutional care over lower-cost community care facilities, which has resulted in 10% of Medicaid behavioral health members accounting for up to 70% of all Medicaid behavioral health spending. I would charge our Department of Health to do a full audit of services and determine a plan to maximize our state resources so as to expand locally based mental health services.
I would also borrow from the practices of other places in the country where they are effectively keeping low-level drug offenders out of jail and in treatment toward a more productive, safer future, such as Buffalo, New York, which has started a dedicated opioid court where addicts with criminal charges can sign up for treatment instead of jail. Treatment involves one-on-one counseling and group therapy, regular drug testing, and curfews. The program is young, having operated less than a year to date, but among their about 140 participants, only 4 have fallen out of the program. We should look to models like this to redirect the resources we spend on housing drug abusers and low-level criminal offenders away from our jail system and into therapeutic, recovery support services.
Lastly, I recognize that painkillers are a gateway drug to more dangerous opioids, including heroin. We need to assist doctors and hospitals from avoiding opioids prescriptions for chronic pain except in necessary circumstances. I will support expanding access to alternative pain treatments including broadening access to medical marijuana under the guidance of medical professionals and adopting holistic therapy practices across all hospitals.
Increasing opioid abuse is a nationwide epidemic and it should be met with significant federal resources. I will stand together with other governors across the country to call for a federal investment through our Department of Human Services and the Department of Justice. Regardless of federal resource, here in Illinois, I will maximize our public health and criminal justice funding, moving resources away from convicting addicts and housing low-level drug offenders in our jails and steer more dollars toward addiction prevention, treatment, and recovery.
There is an opioid crisis in Illinois that is ending too many lives and devastating too many families. This crisis is only getting worse, with a 44.3 percent increase in drug-related overdoses from 2013 to 2016. Last year, there were 2,278 drug-related deaths in Illinois, and over 80 percent of drug overdoses are now caused by opioids. The super-opiate, Fentanyl, took 562 lives in Cook County alone in 2016, up from 20 in 2014.
Unfortunately, Governor Bruce Rauner is once again failing to lead. In 2015, bipartisan members of the General Assembly came together to pass the Heroin Crisis Act, a forward-thinking and comprehensive bill to combat the epidemic. Rauner vetoed the bill, forcing legislators to override his veto — the only override of that legislative session. Rauner also proposed slashing funding for addiction treatment by 20 percent, with Illinois already in the bottom three states for providing publicly funded addiction treatment. Rauner’s 736-day manufactured budget crisis only made the problem worse, devastating the state’s addiction and mental health treatment services and forcing 27 public health departments to reduce staff or services just as the opioid crisis spiraled out of control.
We can’t afford to ignore this crisis. We need a governor who will recognize this emergency and prioritize addressing it. My plan is focused on five key priorities:
1. Focus on Youth Mental Health and Substance Use Disorder Prevention and Education. Opioid use can be particularly dangerous among children and adolescents. Between 1994 and 2007, the prescribing rates for opioids among adolescents and young adults almost doubled. In 2015, more than a quarter of a million adolescents were using pain relievers without a medical purpose. Children often access opioids from prescriptions of family members, while most adolescents who abuse opioids were first prescribed them by a doctor. Moreover, children and adolescents with a higher risk for substance use disorder are more likely to be prescribed opioids.
As Governor, I will work with the medical and mental health communities to make sure that pediatricians discuss the serious dangers of opioids with parents and patients, both during routine check-ups and when writing prescriptions. I will also encourage regular mental health screenings, and work to ensure that psychiatrists discuss drug abuse with adolescent patients, given the increased danger of drug addiction in patients with mental illness. Finally, I support a greater public health campaign in schools. This will allow for the dangers of opioids to be taught in an age appropriate manner and ensure the stigma of addiction will not prevent those who need it from seeking treatment.
2. Reduce the Risks of Prescription Opioids. Opioids have legitimate medical purposes, but they are not without substantial risks. Nationally, nearly 80 percent of heroin users reported using prescription opioids first. Patients can also shop doctors and pharmacies, leaving little way to monitor their prescriptions. While Illinois currently has a prescription monitoring program that tracks prescription opioids, the program is optional for physicians.
To combat prescription opioid abuse, I will work with physicians to put in place measures that help keep people safe. I will fight to strengthen Illinois’ prescription monitoring program so that physicians and pharmacies will have access to accurate information about the quantity of opioids their patients are receiving. I will also work to ensure that physicians are better trained in the dangers of opioid addiction and treatment options as part of continuing medical education. Finally, as called for in the updated prescribing guidelines from the Centers for Disease Control and Prevention, I will support legislation to implement comprehensive prescribing guidelines that further limit the number of days of an initial opioid prescription, which can reduce the risk for addiction.
3. Remove Barriers to Mental Health and Substance Use Disorder Treatment and Recovery. Too often, those suffering from opioid addiction only receive treatment once they go to emergency rooms. Intermediate treatment and medication-assisted treatment are hard to find, especially in central and southern Illinois. This makes long-term recovery harder and leaves Illinoisans most at-risk without the tools they need to build healthy lives.
As governor, I will use a multi-pronged approach to remove barriers to addiction and mental health treatment and recovery. I will restore the treatment, housing, and workforce development supports that were decimated under Bruce Rauner and look for ways to expand capacity across the state for treatment services. Additionally, I will facilitate coordination between hospitals and social service agencies to ensure that individuals who receive emergency treatment for drug use are directed to treatment programs upon discharge. We also need to expand jail and prison substance use disorder case management systems to connect individuals to community treatment upon release. This coordination will give those suffering from drug addiction the tools they need to transition into recovery.
4. Work with the Criminal Justice System to Prioritize Treatment Over Incarceration. We know that incarcerating Illinoisans who are addicted to opioids is more expensive and less effective than providing medical treatment. The average cost of methadone maintenance treatment is about $4,700 per patient. A year in prison costs Illinois over $22,000 per inmate. Every dollar invested in addiction treatment programs yields a return of between $4 and $7 in reduced drug-related crime and criminal justice costs. Methadone treatment for just 2,500 people could save Illinois up to $100 million dollars in reduced crime and health care outcomes.
As governor, I will work to increase access to problem-solving drug courts, ensure that judges understand the available treatment options, and ensure those options are more readily available. That means having enough space to meet demand in rehabilitation programs, including both inpatient or medication-assisted treatment programs. Providing access to this treatment will help formerly incarcerated people ease back in to the community, increasing their chances to rehabilitate their lives and reducing the likelihood of recidivism.
5. Ensure Health Insurance Companies Cover Addiction Treatment Fairly. Healthcare is a right, not a privilege, and all Illinoisans deserve access to quality care. That includes treatment for opioid addiction. Quality treatment is easier with insurance coverage, and Illinois has strong laws on the books to ensure that insurance companies cover treatment for mental health and substance use disorders, given the strong correlation between the two. However, a recent report found that 75 percent of Medicaid managed care organizations (MCOs) denied coverage for a range of treatments. This is in addition to almost half of commercial insurance companies that deny coverage for inpatient treatment and nearly one-third that deny coverage for partial hospitalization, intensive outpatient, and medication-assisted treatment. The report also found that both Medicaid MCOs and commercial insurance companies regularly utilize other barriers to care for mental health and substance use disorder treatment short of outright denial.
As governor, I will work to ensure that insurance companies provide the coverage for mental health and substance use disorder treatment that they are lawfully required to cover. I will strengthen enforcement of the state’s parity laws and close loopholes that still allow insurance companies and MCOs to partially deny coverage based on a range of non-quantitative treatment limitations. I will also work to expand healthcare across our state, through my first-in-the-nation public option health insurance program, Illinois Cares.
6. Leverage Federal Funding Opportunities to Fight the Opioid Epidemic Locally. To root out the opioid epidemic, we also need to do the work at the local level. There is positive work happening in some of our communities where law enforcement, social services, and schools work together and apply for federal grants. These resources are then used to fund locally-directed prevention and drug take-back programs at the community level. The state should assist every community in Illinois to form coalitions and compete for these critical grants.
As governor, I will fight to ensure that the state is capturing as much federal funding as possible. I will focus on matching opportunities, where a modest state investment can unlock federal funding. I will also find ways for the state to assist local governments and non-profit organizations in taking advantage of federal grant opportunities. This is especially true for many of our small and rural communities that may need more technical assistance on grant applications. Finally, I will help local governments form intergovernmental task forces, so that police departments, schools, and public health departments can work together to combat opioid abuse across our state.
We must address the opioid crisis as a public health problem by looking at the root causes of addiction, supporting rather than alienating those who are suffering, considering the effects of the marketing and prescription of opiates, enacting sentencing reform, creating diversion programs to prevent crimes spurred by addiction, and more. Our response must be coordinated across local, state, and federal programs; guarantee statewide geographic representation; and integrate human services, public health and law enforcement.