Among US counties containing the nation’s 10 largest cities, Cook county, Illinois – where Chicago is located – has seen the largest reduction in overdose deaths since the national peak of the crisis in 2023, by 37%, according to an exclusive Guardian analysis.
Chicago has one of the most robust drug supply surveillance and overdose prevention response systems in the nation. Jenny Hua, medical director for the Chicago department of public health, hesitated to take full credit for the progress, explaining that many factors influencing overdose deaths are beyond any one health department’s control. It’s also easier to have a coordinated response in a big city, where people and resources are concentrated. Changes to the drug supply are also affecting regions differently.
Hua said that in order to respond to the crisis, the city has adopted a “multifactorial approach to a multifactorial problem”. Even libraries have become part of the city’s arsenal in the fight against drug overdose deaths. Chicagoans can get free drug test strips at the city’s public libraries – as well as naloxone nasal spray, which can reverse an opioid-induced overdose.
“We actually visited every library to provide education, because the librarians are a source of information for the community,” Hua said.
Bar chart of the change in overdose deaths among the largest US counties
Since 2023, Chicago has rapidly expanded its overdose surveillance, in part with funds from the Centers for Disease Control’s overdose data to action program. According to Hua, this helped the department to build on the foundation already established by local organizations, such as the Chicago Recovery Alliance, which has provided sophisticated drug checking services for years.
“Credit where credit is due,” Hua said. “Before the health department got involved, there was this grassroots effort to make sure that both users and low-level suppliers have a bit more insight into what they’re consuming, because the drug supply has always been volatile, and in the past couple years it’s been increasingly volatile.”
More recently, the city of Chicago acquired new mass spectrometers, the state of the art in drug checking, which can provide details on the purity of drugs and identify newer adulterants that might otherwise be overlooked.
“Now we test dope samples that contain upwards of 10 to 12 different components,” Hua said. “Getting that information to people really helps empower them … When you tell people that the quality of the thing you’re purchasing is really shitty, that is actually a deterrent, believe it or not, that is a huge deterrent.”
Thanks to this technology, Chicago has been able to respond to new adulterants quickly. It was the first place in the country to detect medetomidine, a powerful veterinary tranquilizer, in street drugs. The health department has also issued alerts about nitazenes – a more recent class of synthetic opioid that can be many times more potent than fentanyl.
These adulterants might already be taking a hidden toll in other parts of the country. “A lot of this stuff just isn’t being tested for,” said Jim Crotty, former deputy chief of staff at the US Drug Enforcement Administration. “It’s a big blind spot.”
Understanding what’s in the drug supply is also critical for helping hospitals and emergency departments respond. It’s not just about preventing fatal overdoses, but other kinds of health problems as well. The tranquilizer xylazine, another recent contaminant, can lead to painful skin wounds that do not easily heal. When emergency departments have up-to-date information about the drug supply, “they can get these patients out quicker because they know that they’re treating something that they have an antidote for”, Hua said.
Hua and her team also use ambulance data to identify overdose spikes on a hyper-local level and respond to them quickly. “You need to constantly be looking at the data” to figure out where and when to respond, Hua said. “A general response does not work.”
