Cory Small has overdosed and nearly died 13 times during his seven years of using heroin. He lost his best friend in 2015 and his longtime girlfriend earlier this year. And he figures he probably will live to see opioids kill even more friends and acquaintances.

It’s a statistical likelihood, he says.

But he believes he will live. He wants to find love again and even have children someday. The 37-year-old Springfield resident has hope, even if mixed with worry, that he won’t return to heroin, that he will survive the nationwide opioid crisis.

“I’m scared, but fear is a good thing,” said Small, an inpatient in his 34th day at Gateway Foundation’s Springfield Treatment Center as part of his sixth attempt at recovery. “I’ve used up my nine lives and then some.”

In many ways, Small is the face of a public health emergency that some experts say hasn’t been seen since the AIDS crisis in the 1980s. He became addicted to heroin after first getting hooked on legitimately prescribed pain pills. He's been saved from overdoses by Narcan. He has struggled to find treatment and returned to using when he couldn't get it.

There are efforts underway at the federal, state and local level to better address the growing crisis through life-saving efforts, treatment and prevention rather than a “War on Drugs”-type focus on arrests and incarceration. But officials acknowledge many challenges ahead, including a lack of funding.

This crisis, like AIDS, comes with plenty of stigma but is killing more people and, compared with other drugs, affecting a broader segment of the population when it comes to race, income, education and locale.

The widespread nature of the crisis stems from the addiction to prescription painkillers that often developed after surgeries and injuries, medical and addiction experts say.

When patients are cut off from those prescriptions by their doctors or they find the purchase of pills from street dealers too expensive, they often turn to heroin that can be snorted or injected for an hours-long high at $5 to $20 a pop, experts say.

The people becoming addicted and dying outside the inner city are more likely to be white and middle class, said social worker Michael Reeves, a recovering heroin addict who owns and operates an outpatient treatment service in Springfield called Rebound Health Care Systems. And rightly or wrongly, that reality has galvanized support among policy-makers and lawmakers to do something about the epidemic, he said.

“The reason heroin got attention is because it started killing the ‘right’ populations,” Reeves said.

A skyrocketing number of deaths

Those involved say the number of tragedies indicate the magnitude of the challenge.

Opioid overdose deaths in the United States quadrupled between 1995 and 2015, reaching 64,000 in 2016, according to the U.S. Centers for Disease Control and Prevention.

In Illinois, opioid-related deaths hit 1,946 in 2016, an increase of more than three-quarters since 2013.

Heroin deaths in the state doubled during that time period, while prescription opioid deaths quadrupled and deaths from synthetic opioids, mainly fentanyl, increased tenfold.

Sangamon County’s confirmed opioid-related deaths currently stand at 39 for 2017, county coroner Cinda Edwards said. That number is likely to meet or exceed the most recent high total — 41 in 2015 — by the end of the year because of toxicology results pending for several cases, she said.

This year could mark the county’s highest death toll from opioids since Edwards began keeping track in 2012. She is particularly concerned about the rise in deaths related to fentanyl, a more powerful drug than heroin and a substance often mixed in with heroin by people who process and sell drugs.

There have been 11 fentanyl-related deaths so far this year, compared with four, at most, in previous years.

Edwards called fentanyl “an additional game-changer. It really is adding a new level of danger to an already dangerous habit.”

Kerry Henry, executive director of Gateway’s Springfield site, said the opioid crisis brought a change in what used to be Gateway’s mostly alcoholic clientele. Now 85 percent of the nonprofit’s clients have addictions to heroin or other opioids. And fatalities among former clients have risen, Henry said.

“I’ve never seen so much death in the 20 years I’ve been here,” she said.

In Sangamon County, one analysis showed that a majority of opioid victims died from heroin, 95 percent were white (in a county where 13 percent of residents are black), almost 50 percent were 40 or older, and 35 percent had education beyond high school, including associate’s, bachelor’s or master’s degrees.

Those breakdowns emerged from a demographic study by the coroner’s staff for 112 deaths from early 2014 through mid-May 2017.

The opioid epidemic is tearing apart families and affecting all taxpayers and citizens, experts say. Drug users often seek prescriptions or are treated in hospital emergency rooms or steal and commit other crimes that lead to arrests and prosecutions filling up jails and prisons.

Those death totals might be even higher, were it not for the use of the drug Narcan, an inhaled or injected medicine that can intervene in an opioid overdose.

Paramedics for LifeStar Ambulance, one of three ambulance companies serving Springfield, use Narcan to revive an average of one or two opioid overdose victims each day, LifeStar operations manager Kris Daughtrey said.

Dr. Janda Stevens, assistant director of the emergency department at HSHS St. John’s Hospital, said the availability of Narcan doesn’t make addicts more comfortable with opioid abuse.

“I don’t think they think that far ahead,” she said. “I don’t think we’re promoting drug use when we’re using Narcan.”

She said she has cared for addicts who juggle full-time jobs and heroin. Some do pay attention when they are revived with Narcan and regain consciousness, she said.

“I say, ‘You were just dead.’ It really hits home at this point,” she said.

Other people who are revived aren’t pleased because Narcan can trigger the return of heroin withdrawal symptoms that users were trying to eliminate, at least temporarily, with the high that led to the overdose.

“They’re angry because you killed their buzz,” said Sgt. Gerry Castles of the Springfield Police Department.

Narcan seen as temporary aid

One focus of efforts to deal with the crisis involves making Narcan more available and training people on how to use it.

Illinois’ landmark Heroin Crisis Act, passed by the General Assembly in 2015 over Gov. Bruce Rauner’s amendatory veto, required police in Illinois to have access to Narcan, also known as naloxone. Another law gives non-medical people the ability to give Narcan without risking criminal or civil liability.

Between 2010 and the present, more than 90,000 people in Illinois have been trained to administer Narcan, resulting in more than 11,000 overdose reversals, according to Meghan Powers, spokeswoman for the Illinois Department of Human Services.

The Sangamon County health department helps local police agencies buy inhaled Narcan. Since February 2016, police throughout the county have given Narcan 34 times, with 31 “saves” recorded and three cases in which people didn’t survive.

In November alone, Springfield police used Narcan to save at least five people going through overdoses, police Lt. Carl Crawford said.

In addition, Springfield firefighters gave 55 doses of Narcan in 2015, 124 in 2016 and at least 121 so far this year, according to fire chief Barry Helmerichs.

Narcan, Crawford said, is “a solution for right this moment, but obviously it does not solve the problem.”

Cory Small, the Gateway client, said his girlfriend revived him 13 times with Narcan over the past 10 years before she died of a heroin overdose this spring in Springfield when he was in treatment at another facility.

Narcan is available from drug stores without a prescription, but it can cost $100 or more. Small said his girlfriend obtained the Narcan for free through a clean-needle program offered by Springfield’s Phoenix Center, 109 E. Lawrence Ave.

He said he has known at least 15 people he has been in treatment with over the years who later died from overdoses. And he said he often wanted to die himself.

“I was so miserable from feeling the withdrawals and the shame of stuff I have done,” he said. “I would be mad at my girlfriend when she’d shoot me up with Narcan when I was overdosed or whatever. I would pray to God I wouldn’t wake up. … I hated myself that much.”

From painkillers to heroin

Small grew up and graduated from high school in Mason County. He said he first became addicted to opioids at age 21 when recovering from complications from oral surgery to remove wisdom teeth.

He said he comes from a middle-class family and worked in construction, landscaping and other jobs, all while buying painkiller pills on the street that he sometimes would grind up and inject. He used cocaine at times, too.

He said he eventually began using heroin because of its relatively cheaper cost. Painkillers could cost $2 to $40 on the street for a single pill, but a six-hour high from heroin cost $20, he said.

When he wasn’t in treatment, Small said he would use heroin almost every day from 2010 through October 2017. He said he, like many users, has a felony conviction connected with drug use. He was convicted of heroin possession in Sangamon County in 2006; he also has a 2004 misdemeanor conviction in connection with a forged opioid prescription.

Small's best friend died in a suicide related to the depression surrounding addiction, he said. And in 2014, when he sought treatment from Gateway but couldn’t get in right away, he said he went back to heroin after waiting two or three weeks.

He continued using, he said, to avoid withdrawal symptoms that he described as “the worst flu you’ve ever had times 10. Your bones hurt. There’s diarrhea and vomiting.”

Small is now going through treatment with the help of Suboxone, a prescription drug that helps him deal with opioid cravings.

He said heroin “pretty much destroyed my life. It took away people I loved. It hurt my family, it hurt me.

“When you first start doing it, you feel good. You get hooked on it, and you have to have it or you’re sick. You keep chasing that high so you feel better. There’s no way out, man, except to come to a place like this and get help. The only other way out is death.”

A 'sore need' for more treatment

Jim Stone, director of the Sangamon County health department, said the local opioid task force is beginning to examine potential responses to the opioid crisis. The shortage of inpatient treatment beds is a “sore need in the community,” he said.

Gateway, for example, has 110 inpatient beds for adults and adolescents, but the beds are almost always full, and it’s expensive to support bed capacity expansion, Henry said.

People sometimes have to wait weeks to get in, she said. Gateway recently expanded its outpatient program to help accommodate the need.

Gateway this year began a medication-assisted treatment program in cooperation with the Sangamon and Macon county jails in which inmates about to be released volunteer to receive monthly injections of Vivitrol, a drug that blocks a person from getting high from opioids or alcohol.

Funded with a one-year federal grant, the program also provides “recovery coaches” to participants, who must commit to undergoing treatment, as well as help with finding employment and housing.

So far, 14 former Sangamon County Jail inmates and 13 former Macon County inmates have joined the program and said they are grateful, according to Gateway program supervisor Tyrone Wilkins.

“They’re taking this as a heaven-sent thing for them,” he said, adding that no one who has participated in treatment has re-offended.

“They’ve said they’ve never been able to stay clean this long,” he said. “To me, that’s success.”

Julie Williams, 36, another Gateway client, has used heroin six years and said she is having success with Vivitrol, though she isn’t part of the jail program.

The former waitress and bartender from East Peoria said she is living at a Springfield sober house for recovering addicts while looking for a job and taking part in outpatient treatment.

She said she used to shoplift from Walmart and then receive fraudulent refunds on the stolen goods to help feed what could be a $200-per-day habit. She was revived three times with Narcan.

Williams, who is on parole for a felony burglary conviction in Champaign County, said she sought out Vivitrol treatment from Gateway at the suggestion of a probation officer connected with her theft convictions in the Peoria area.

The Sangamon County health department has a $225,000 federal grant to use for the opioid epidemic, and the state has received a total of $24 million in federal money, but the overall amount is “paltry compared to the size and scope of the problems in front of us,” said Dr. Rajesh Govindaiah, chief medical officer for Memorial Health System.

Illinois’ lack of treatment facilities may be somewhat self-inflicted.

The state’s two-year budget impasse, resolved last summer after years of spending cuts for substance-abuse treatment, reduced the capacity of treatment providers and interfered with funding for prevention efforts, according to officials from the Illinois Association for Behavioral Health. The Wells Center in Jacksonville closed its doors in May because of the funding problems.

“Providers are working to increase access to services, but it's still challenging given the current fiscal environment," said Eric Foster, the behavioral health association’s vice president for substance abuse.

Medication-assisted treatment options are expected to expand in Springfield early next year through the city’s two federally qualified health centers.

Both the SIU Center for Family Medicine, 520 N. Fourth St., and Central Counties Health Centers, 2239 E. Cook St., will begin to offer their Medicaid, uninsured and other patients Suboxone as well as counseling, officials said.

Both nonprofit clinics received federal grants to begin the outpatient programs.

The state is working to increase treatment options, including inpatient services, but not all patients need inpatient treatment, said Dr. Nirav Shah, director of the Illinois Department of Public Health.

“To be sure, resources are a challenge, not just in Illinois, but nationally,” he said.

Shah, who is helping to carry out Rauner’s opioid action plan, said he wants the public to know that recovery from opioid addiction is possible. And he hopes to reduce the stigma surrounding addiction so more people are willing to seek treatment.

Addiction isn’t a moral failing, he said.

“We shouldn’t shame people with opioid disorder, just like we wouldn’t shame a diabetic for having an extra doughnut,” he said. “It’s a chronic disease.”

Contact Dean Olsen: dean.olsen@sj-r.com, 788-1543, twitter.com/DeanOlsenSJR.

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