The city of Chicago is preparing to elect their next mayor, and local stakeholders wanted to know their candidate’s thoughts on several key drug policy-related issues impacting the city. In order to do so, members of the Drug Users Health Collective of Chicago and the Chicago Drug Users Union drafted a survey of seven questions and received sign-on support from the Chicago Recovery Alliance, Students for Sensible Drug Policy, The Chicago Urban League, Men and Women in Prison Ministries, Clergy for a New Drug Policy, Above & Beyond Family Recovery Center, and Sex Workers Outreach Project of Chicago.
The survey was sent to all 14 mayoral candidates, who had two weeks to respond to the survey. Of those 14, nine indicated their intent to complete the survey, but only four were able to do so by the deadline. Candidates Willie Wilson, Toni Preckwinkle, Susana Mendoza, and LaShawn Ford completed the survey in full. Once the survey responses were collected, the group shared the responses with local media, resulting in coverage by the Chicago Tribune.
The following are the mayoral survey questions and includes responses from those candidates who sent them.
Illinois 2019 Mayoral Candidate Questionnaire: Rethinking Drug Policy & Public Health Solutions for Chicago’s Overdose Crisis
When answering these questions, please consider how you might approach these issues differently from or similar to the current mayor. We are looking to understand your positions on drug policy and public health.
Expanding Access to Naloxone & Overdose Prevention Education
- Since August 1996, the Chicago Recovery Alliance (CRA) has been distributing the life-saving overdose reversal medication naloxone directly to individuals best positioned to respond in the event of a fatal overdose, that is people who use drugs (PWUD) as well as friends, family members, and providers of PWUD. Under the Illinois Drug Overdose Prevention Program Law (PA 096-0361, 2010), laypersons are permitted to carry and administer naloxone in the event of an overdose. In 2018, CRA distributed nearly 100,000 doses of naloxone, trained roughly 3300 people, and received reports of more than 1,000 nonmedical, peer-facilitated overdose reversals. Despite the numerous lives saved by naloxone, numerous barriers persist in accessing this life-saving medication in Chicago. Some of these barriers include the prohibitive cost of the medication, lack of training on how to use it, lack of knowledge around overdose risk, not knowing how to access it, and simply not knowing that the antidote exists.
How will you support naloxone distribution and overdose education for the City of Chicago?
- Ensure all city pharmacies can dispense naloxone without a provider’s prescription per the Illinois Department of Public Health Director’s standing order, including training for pharmacists if needed.
- Work to make Chicago the most insured city in the United States to reduce barriers to obtain naloxone
- Work with state policymakers and managed care organizations to minimize barriers such as copayments in obtaining naloxone
- Determine which city of Chicago locations and city employees (Community Service Centers, police stations, CTA station booths, police squad cars, etc.) in which parts of the city should be trained and equipped to use naloxone, and then provide naloxone in those locations
- Train and equip police in hard-hit areas on the importance and use of naloxone
- Train and equip street peer educators and recovery coaches in areas of highest consumption and overdose death rates on the use of naloxone
- Ensure that patients who experience overdose and go to emergency departments or are seen in emergency departments with withdrawal symptoms are provided naloxone on discharge (along with a referral for ongoing MAT)
- Encourage co-prescribing of naloxone with MAT or longer-term opioid prescriptions
- Reinforce Cook County Jail’s efforts to distribute/give naloxone to high-risk inmates at their discharge (any inmate with a known OUD and/or risk for overdose)
- Use public education campaign on CTA buses and trains and other locations and through social media on the use of naloxone – people are still confused about use of naloxone and MAT
- Use money generated from any city lawsuits against pharmaceutical companies to promote naloxone and MAT
We have long had a serious opioid overdose problem in Chicago—long before the media started paying attention to it a few years ago as suburban populations began feeling the effects. The Chicago Recovery Alliance and other community-based organizations have spent decades doing critical work to reduce overdose deaths. Dan Bigg, in particular, was a champion of harm reduction before his tragic passing last year. We are lucky to have had him in Chicago and must build on the work he pioneered.
Such work is needed now more than ever. The death toll from heroin, fentanyl, and other opioids is rising fast and now exceeds homicides. A critical part of preventing overdose deaths is naloxone, an evidence-based medication that saves lives by reversing an overdose on the spot. It must be widely understood and accessible across the city—especially among people who use drugs, since this population is more likely than anyone else to see someone overdosing and save a life.
To start, the City must increase its current funding for naloxone distribution. This work, which is being done by the Chicago Recovery Alliance, has been effective at reaching key populations, especially those involved in needle exchanges. We must also invest in reaching populations in other settings since many users do not inject opioids. These settings may include churches, community centers, and any other locations in which people congregate, especially on the south and west side neighborhoods where overdose deaths are most prevalent. The City has recently funded community health workers to provide naloxone and educate residents about the medication while connecting them to ongoing treatment; this program must be expanded and made sustainable. Providers, too, must be educated so that patients in treatment are offered naloxone. Finally, we must ensure that as police become equipped with naloxone, the effort is implemented effectively and in a way that saves lives while improving police-community relations.
As Mayor, I would direct the Chicago Department of Public Health to spearhead a program of public education and training regarding drug overdoses and Naxelone [sic]. The need for this training is great and we should begin with high priority populations. For example, as not for profit housing agencies are being directed to implement harm reduction strategies as they admit new tenants, their staff fear accepting responsibility for tenants who may relapse and overdose. Appropriate education and training will help staff and supporting volunteers serve a vulnerable population safely. Peer counselors and people with lived experience who work on street engagement must have this training. If this education and training is successful it will strengthen the case for Medicaid reimbursement for peer support workers and other paraprofessionals.
From there education and training should be offered to increasing numbers of professionals, paraprofessionals and volunteers with an ever-broadening reach. Many overdoses occur in public restrooms, in parks, and on public transit. While the general public cannot be realistically armed with Naxelone, they should understand it, support it’s use and know how to get help. A good analogy is the embrace of the Heimlich Maneuver now understood by millions.
As we all know, the decision about who may administer any particular drug is regulated by a number of government agencies. Any change in this permission needs to be carefully considered by medical professionals and pharmaceutical experts. My personal feelings or outlook needs to be second to those professional judgements [sic]. I will encourage my Commissioner of Health to do whatever is possible to make these lifesaving drugs available to the lowest point of use possible.
Expanding Access to Medication-Assisted Treatment
- Medication-Assisted Treatment (MAT), also known as Opioid Substitution Therapy (OST) consists of combining medication and behavioral therapy in order to support individuals with opioid use disorder (OUD) achieve recovery. These evidence-based treatment interventions include FDA-approved medications such as buprenorphine and methadone. When combined with behavioral therapy, these medications are associated with a number of positive outcomes including but not limited to decreased overdose risk, decreased infectious disease transmission, increased positive birth outcomes for women who are pregnant, decreased use of illicit substances, and increased employability. A third FDA-approved medication exists that is known as naltrexone or Vivitrol. Naltrexone is a newer medication and unlike buprenorphine and methadone functions solely as an opioid antagonist and has yet to demonstrate its efficacy in preventing opioid-related mortality. For this reason, we do not recommend the use of naltrexone to treat people with OUD. Despite the overwhelming evidence in favor of methadone and buprenorphine, tremendous obstacles stand in the way of people accessing these interventions, not the least of which is stigma and misconceptions about MAT.
How will you support expanded access to MAT?
- Work to make Chicago the most insured city in the United States to reduce barriers to expand access to MAT
- Work with state policymakers and managed care organizations to minimize barriers such as copayments and preauthorization requirements to obtain medications in MAT (obstructions still occur)
- Make city funding for residential treatment for substance use disorder contingent on allowing MAT
- Work with Illinois DHS/HFS and federal agencies to bring additional resources for expanding access to MAT, including recovering homes and residential support
- Convene an MAT Summit including Illinois DHS/HFS, managed care organizations, and all interested parties to work together to drive policy including patient-level, hospital/residential level, and system-level quality measures in MAT that can be incentivized – this summit should also suggest concrete changes so SUPR-licensed programs can charge for prescribing medication like buprenorphine in MAT, and office-based MAT can be reimbursed for increased behavioral health services like IOP, care management, recovery coaches and other needed services that MAT patients state that they need to achieve their goals
- Support training for emergency department-based treatment of opioid withdrawal with buprenorphine with linkage to on-going outpatient MAT
- Work with HFS and interested stakeholders to reform hospital-based “detox” programs to incentivize evidence-based initiation and follow-up with MAT rather than rapid taper and weaning which often does not help patients in their efforts in recovery
- Pilot a “low threshold” center that could run 24/7 like a “detox” unit but would allow people to come in and have a bed, get their initial buprenorphine dose(s) and link them to ongoing care
- Work with Cook County Jail to expand MAT, especially for those entering jail already on MAT
- Expand linkage to outpatient MAT for those with OUD being discharged from Cook County Jail, as this one of the most vulnerable times for deaths due to overdose
- Increase training and support for recovery coaches working with MAT patients
- As MAT includes behavioral health services, expand resources for trauma-informed patient-centered behavioral health/mental health services, including [sic]
- Encourage MAT providers to link MAT patients to community support by those with lived experience who accept MAT, including 12-step groups, Rational Recovery, community groups, churches, mosques, synagogues, temples, and other groups
- Launch an MAT public education campaign on CTA buses and trains and other locations, and through social media
- Use money generated from any city lawsuits against pharmaceutical companies to promote MAT
Medication-assisted treatment (MAT), especially with methadone or buprenorphine, is an evidence-based approach to tackling opioid use disorder. The barriers to access—and the stigma against this practice—must end. No one would think to stigmatize someone for taking medication to treat other health conditions. Substance use disorders should be no different.
The goal of expanded access requires progress at the city, state and federal levels. We must explore alternative delivery models to help foster immediate access, such as through pharmacies and mobile vans. Zoning barriers, too, which are inevitably linked to stigma, must be assessed. The City should also advocate for better reimbursement at the state level to allow providers to offer MAT services at cost, and for recovery homes to accept patients who are on MAT instead of excluding them from services. Other steps the City can take include:
- Offering grants to offset the cost of essential services not covered by Medicaid, such as recovery homes.
- Funding programs at emergency departments to provide SBIRT (screening, brief intervention, and referral to treatment) to all patients while offering naloxone and buprenorphine induction to those who are brought in for an overdose. We could explore adapting models such as those in New Haven and elsewhere.
- Expanding educational work for physicians and other healthcare providers so they obtain waivers to prescribe buprenorphine and, most importantly, integrate it into their practices.
- Expanding funding for community health workers who provide naloxone, educate residents, and link people with opioid use disorder to treatment. This funding must be made sustainable.
- Supporting pre-arrest diversion and deflection programs to help more people get treatment instead of a criminal record.
As County Board President I championed providing behavioral health care, supported by physical health care, in every community. The expansion of Medicaid through County Care changed lives and brought vulnerable people out of the criminal justice system where they had never belonged. Supporting access to MAT is the natural extension of this work because it gives every person struggling with addiction a realistic path to health and recovery. The barriers to MAT go beyond access to treatment and issues of cost and service delivery because many people have misconceptions about MAT. My role as mayor will provide me with a prominent platform for addressing these dangerous prejudices.
I will help the treatment community make the case for MAT where and when it is appropriate.
Again, medical professionals will need to submit their expert recommendations regarding the proper administration of drugs that are used to combat drug addiction. I support the highest and best treatment for our citizens and I know that those standards will change over time. We can commit to choosing the best medical professionals in the country and directing them to ensure we have top-notch treatment to reduce healthcare costs and save lives.
Legalizing Syringe Services Programs
- Syringe services programs or SSPs (also known as needle/syringe exchange programs or N/SEPs) provide community-level access to sterile syringes as well as safe disposal services for used equipment. SSPs are cost-effective, public health interventions that prevent the spread of infectious diseases such as HIV and hepatitis and reduce the presence of bacterial and other infections often related to injection drug use. These interventions also function as drop-in centers where PWUD can go to get support for other critical needs such as substance use and mental health treatment referrals, housing resources, and STI and hepatitis screening and linkage to care. Despite all the evidence supporting these programs, SSPs remain illegal in the state of Illinois and therefore can only operate via research exemption, thus greatly impeding the full-scale impact of these programs.
How will you support the legalization of sterile syringe access for Chicago as well as statewide? How will you ensure that the City of Chicago continues to publicly fund sterile syringes for distribution?
- I will support the legalization and continued public funding of sterile syringe access linked with other harm reduction services including trauma-informed engagement and counseling and MAT. We will use money generated from any city lawsuits against pharmaceutical companies to promote these services, as well as state and federal funding.
Syringe exchanges should not have to keep hiding behind the guise of a research exemption. The data is in, and these efforts work. Legislation acknowledging this reality by allowing more robust avenues for syringe exchanges would be a statement against stigma as well as a concrete opportunity for expanding access and advancing harm reduction, beyond what is already occurring. In my administration, the City of Chicago will not backtrack on funding this important work.
As Mayor, I would work to insure [sic] that sterile syringe access is legal throughout Illinois. It is important to build a statewide consensus. To that end, I would ask the Illinois Criminal Justice Information Authority to sponsor sterile syringe access sites across Illinois to demonstrate their efficacy. I believe demonstration sites that yield both good immediate results and careful longer-term studies would convince many stakeholders of the usefulness of this approach. I would look to our new Governor J.B. Pritzker to introduce statewide legislation to support sterile syringe access. I would reach out to my counterparts throughout the state to gather support for this legislation.
Promoting good health is a process, not a single decision. Accepting that IV drug users are going to re-use needles until and if they have another option, is the first reality check. One realistic option is to work collaboratively with a professional program that will help in the streamline and efficiency of this issue. It makes sense to me that we help residents that are in need of this type of medical equipment to stay healthy, first, and avoid the diseases that can come from re-using disposable supplies. To enforce this concept while they commit themselves to the work of recovery from their addiction, supplying clean needles and syringes can lead to saving lives and showing much-needed compassion towards this population and its challenges.
Supporting Overdose Prevention Centers
- An overdose prevention center or OPC (also referred to as safer consumption sites or drug consumption rooms) is a protected location where PWUD can consume their drugs safely under the supervision of trained personnel. OPCs are evidence-based interventions used to reduce drug overdoses as well as other drug-related harms. These interventions exist in a variety of models such as fixed site, mobile, and temporary pop-up units and have been in operation for over 30 years around the world. More than 100 such sites exist worldwide, and all research indicates significant benefits. They are associated with a decrease in overdose, public drug use, incarceration, drug litter, HIV and Hepatitis C transmission, increased drug treatment admission, and no increase in drug use. While no such program has ever legally existed in the United States, several U.S. cities have declared their support for this intervention and others have secured municipal approval to proceed with opening OPCs in their cities. OPCs have been endorsed by a number of professional bodies including the American Public Health Association, the Law Enforcement Action Partnership, The International Narcotics Control Board, the American Medical Association (AMA), the International Drug Policy Consortium, and the European Monitoring Centre for Drugs and Drug Addiction.
Due to federal drug laws, such sites would ideally be placed on city property.
What will you do to support the creation of a publicly-funded pilot OPC in the City of Chicago?
Even though there may be some evidence that these centers may be working in other locations, we need more information about whether this would be right for Chicago. We need to survey patients about their needs and what will help to achieve their goals. We need to address the many public misgivings and misunderstandings. We would need to address where the sites would be located, how they would operate, how they would be regulated, and how they would also address trauma-informed, harm-reduction-oriented care with social supports and options for MAT.
My administration will embrace the principle of harm reduction. I will also be open to practices that are not commonly employed in the United States but hold the potential to stop overdose deaths—even if the Trump administration opposes them. Overdose prevention centers (OPCs) constitute one such approach that deserves to be explored in Chicago. OPCs may be able to reverse overdoses and draw high-risk populations that can be offered naloxone and treatment. New York, Seattle, Philadelphia, and San Francisco have all committed to opening OPCs or conducting a feasibility study. No site has yet opened, but we must explore every practice that can reduce the city’s unacceptably high number of overdose deaths.
As Mayor, I would support a review of existing research and assessment of having an Overdose Prevention Center (OPC) in a city-owned site. It would be necessary to locate an appropriate location for the OPC that is away from vulnerable populations including young people and senior citizens. The location would have to be chosen to discourage the concentration of street dealing near the OPC which would create public safety challenges. The community would have to be a willing partner that receives substantial support in recognition of importance [sic] and potential risk that come [sic] with this endeavor. I believe an OPC will be more likely to be welcomed if the city has demonstrated through the expansion of treatment options the ability to truly tackle the opiod [sic] and opiate epidemic.
This question combines all of my answers above plus the issue of legal liability. The law department of the city would need to be certain we are protecting our citizens and not exposing them to lawsuits that could cause taxpayers to become responsible for others’ poor decisions. As I said above, I am open to the concept but the implementation will require professional medical involvement of many experts with the focus of always saving lives.
- We advocate for the decriminalization of all drug use and possession. The War on Drugs has failed to address drug-related harms while having a disproportionate impact on incarceration rates in Black and Latino communities. To that end, we support the elimination of legal penalties for drug-related infractions. A study by the World Health Organization found that countries such as the U.S. that uphold punitive drug laws did not achieve lower levels of drug use amongst their populations when compared to countries with less criminally punitive laws. Several countries and some U.S. municipalities have or are beginning to support a variety of decriminalization measures that recognize substance use as a public health matter rather than a law enforcement one. In 2001, for instance, Portugal simultaneously decriminalized drug use and possession via a reclassification of penalties, while also increasing access to harm reduction and treatment services. This combination of criminal justice reforms coupled with aggressive public health investments reduced drug-related mortality, problematic substance use and arrests, rates of infectious diseases, and also increased drug treatment participation.
What will you do to support decriminalization of all drug consumption and possession city-wide, particularly in communities hardest hit by the War on Drugs? Furthermore, how will you ensure Black and Latino-led organizations are included in all decision making?
- Because Black and Latinx communities have been greatly affected by the criminalization of possession of especially marijuana, two years ago I introduced in the 100th General Assembly House Bill 4059 which would amend the Cannabis Control Act and would delete the provision that the knowing possession of more than 30 grams but not more than 100 grams of any substance containing cannabis is a Class 4 felony if the offense is a subsequent offense – this legislation did not advance, but I will continue to advocate for this change. I strongly support the decriminalization of cannabis. It is hard enough to advocate for the decriminalization of cannabis – however, the issue of decriminalization of other now illegal substances would have to be taken to the public for review of the evidence and debate – only through the will of the people could this major change be advanced. I would be active in listening to the debate.
- One of my first pieces of legislation was passing House Resolution 468 (96th GA) with bipartisan sponsorship urging that social justice be the guiding principle in decision making in the House of Representatives. I was the Chief House Co-Sponsor of legislation that became law creating the Racial and Ethnic Impact Research Task Force to determine a practical method for the standardized collection and analysis of data on the racial and ethnic identity of arrestees by State and local law enforcement agencies (Public Act 097-0433). I was the Chief House Sponsor of legislation that became law as the Criminal Identification Act that requires ethnic and racial data be gathered at many points when a person encounters the criminal justice system (Public Act 098-0528). I introduced and passed House Resolution 396 (99th GA) that directs the Illinois Juvenile Justice Commission review the current practice of restorative justice in juvenile justice systems in Illinois. I have also passed legislation that became law which gives returning citizens/ex-offenders the opportunity to seal criminal records for certain Class 3 and 4 non-violent offenses, including drug-related charges. I also introduced legislation that became law that provides that records of charges that result in an acquittal or dismissal with prejudice, except for minor traffic offenses, may be immediately sealed after the final disposition of the case (Public Act 100-0282). I also introduced legislation that became law which limits bail bond costs to $100 (in Chicago) when the accused is cleared of a crime or if charges are dropped, rather than the previously required 10% (Public Act 99-0412). I introduced and passed a House Resolution urging the governor and the Department of Corrections to discourage prosecutors from recommending and judges from sentencing low-level drug offenders to the county jail or the Department of Corrections (HR163, 99th GA and HR5, 100th GA). Hopefully, all of these laws will help those charged with possession of substances. Too many people in minority communities have been disproportionately involved with the criminal justice system.
- To address the true causes of the epidemic of deaths due to opioid overdoses, we also need to work to stem the flow of fentanyl and other synthetic opioids into our minority neighborhoods.
- I currently work with many minority-led organizations in the formation of legislation, and I will continue this practice as mayor. In fact, this is one of the most important reasons I am running for mayor – to give people who have been shut out of the system a voice in their own futures.
The sad reality is that the War on Drugs has racist origins. The prohibition of marijuana was linked to the perception that Mexicans were the ones who used it. The War on Drugs declared by President Nixon capitalized on white fears of minority communities, mainly African American men. To this day, the drug war continues to perpetuate racial disparities. Whites use drugs at about the same rate as black and brown populations but are punished for it less often. We must start to treat drugs more as a public health issue and less as a criminal one. I favor several steps to help Chicago move in that direction:
- Legalize marijuana. Sale and use of cannabis must be regulated and researched to provide for public health and safety, but the time of prohibition of this drug must end.
- Make possession of small amounts of other drugs a misdemeanor.
- Support pre-arrest diversion and deflection programs to help people who use drugs obtain treatment before getting caught up in the criminal justice system.
This approach would help make our criminal justice system more cost-effective and humane while leading to outcomes that are less racially disparate. Allowing law enforcement to focus on other crimes would be fairer to police and communities alike. We must reduce our reliance on police officers as the first line of response to behavioral health issues.
I have consistently and publically [sic] supported the decriminalization of all drugs for decades and have been severely criticized for taking this stand. I believe the tide of public opinion is turning and we are ready to take some basic first steps. I will work to ensure the organizations that truly represent black and brown residents play a central role in dismantling the harsh systems that penalized drug use and that their guidance is relied upon to build a new rehabilitative system. Whenever possible income from legal drug sales should be used to rebuild struggling communities who have been the hardest hit by the War on Drugs. In addition to investing in supportive services, community infrastructure, and economic opportunity, expungement and related relief must be available to every resident and their families who have been affected by harsh drug laws.
Here again, I am not personally qualified to decide which drugs are dangerous and which ones are not. Taking one at a time, professionals will study each one and provide their expert opinion/recommendation for a position for decriminalization, like in the case of marijuana. I support the notion that enforcement of drug laws disproportionately hurts our minority communities and should be eliminated for that reason alone. But the reality is that some of these drugs need study by medical professionals before we make such an important decision with increasing safety as our primary focus.
- Drug-induced homicide laws have been used to criminalize anyone who uses, shares, and/or sells drugs. These laws are often applied when an individual calls 911 for assistance in the event that someone they are with experiences a fatal overdose after using illicit substances. This often results in an arrest of the individual who responds to the life-threatening emergency simply because they had shared drugs with or sold drugs to the individual who overdosed and died. Drug-induced homicide laws only weaken 911 Good Samaritan laws designed to prevent overdose fatalities and persist despite any evidence that they actually reduce drug use or sales. Unfortunately, these laws result in further disengaging PWUD from emergency medical services in the event of an overdose, further exacerbating the risk of death.
In what ways will you support the elimination of drug-induced homicide laws?
- People trying to save other people’s lives should not be arrested. I will work with my colleagues in the General Assembly to strengthen Good Samaritan laws.
No one who sees someone overdosing should fear legal repercussions if they call 911. Saving a life must be the priority. Yet many people who use drugs will not make the emergency call, knowing there are many loopholes in the Good Samaritan protections. Even social service providers are often reluctant to give a full-throated recommendation to call for emergency assistance. I favor state legislation that closes loopholes in these protections. And while I am strongly opposed to dispensing or dealing drugs, most Chicagoans would agree that neither is the same as homicide, except in the most unusual and egregious of cases. We must bring together healthcare providers, people who use drugs, community members, law enforcement, and experts to develop ways to root out drug trafficking without harming the very populations that need the most help.
As Mayor, I would work with allies and partners to further educate the public and legislators regarding the unintended negative impacts of drug-induced homicide laws. I believe with further education and awareness we can work in Springfield to eliminate such laws that jeopardize not only the individual who may be over-dosing but also those who attempt to intervene to assist. Locally, I would meet with the State’s Attorney Office and other criminal justice stakeholders to find common ground that balanced prosecutorial discretion with the need to ensure we are not imposing greater harm and risk of death to those struggling with addiction.
This is a very important discussion and debate that has barely just begun. I believe we need to bring this issue to the table of medical professionals, community health experts and other applicable specialists and authorities to have a candid exchange of data and information to frame a comprehensive strategy that can be presented as best practices for the recovery and betterment of our citizens with these particular challenges. With this at the forefront, more lives can be saved.