January 23, 2019
Dear Susana Mendoza,
As mayor of Chicago, you would be responsible for the fair and equitable enforcement of
ordinances for all residents of our city. As such, we have created a questionnaire to gather your
opinions on a range of drug policy initiatives to reduce drug overdose fatalities and other
drug-related harms in the city.
Drug overdose is now the leading cause of accidental death in the United States.1 This crisis has
not spared our city. The latest available data show an increase in opioid-related overdose
fatalities from 285 in 20142, to 796 by 2017.3 Chicago’s fatal opioid overdose rate is higher than
the national rate, and nearly double national rate for Black/African American Chicagoans.4 In
comparison, the number of homicides in Chicago in 2017 was 659.5
The City of Chicago can and should do more to implement and support drug policy measures
that have been proven to save lives.
As community members, individuals with lived experience, and professionals who support
evidence-based approaches to drug use, we recognize that all societies consume drugs and that
our work should aim to reduce negative outcomes. For this reason, we advocate for
research-supported interventions such as syringe exchange, overdose prevention centers, and
universal access to the life-saving overdose reversal medication naloxone. Furthermore, given
the mass incarceration produced by our nation’s War on Drugs combined with the
well-demonstrated fact that drug enforcement has severely and disproportionately compromised
the health of Black and Latino communities, we support the decriminalization of all drugs as
well as a reinvestment in Black and Latino-led organizations.

American Society of Addiction Medicine. (2016). ​Opioid addiction 2016 facts and figures.​ Retrieved from
https://www.asam.org/docs/default-source/advocacy/opioid-addiction-disease-facts-figures.pdf
2
Illinois Department of Public Health. (2017). ​Drug Overdose Deaths by Sex, Age Group, Race/Ethnicity,
and County, Illinois Residents 2013-2016.​ Retrieved from
http://www.dph.illinois.gov/sites/default/files/publications/Drug-Overdose-Deaths-March-2017-031617.pdf
3
Rushovich, T, Arwady, A., Salisbury-Afshar, E., Arunkumar, P., Kiely, M., Aks, S., Prachand, N. (2018,
October). Annual opioid surveillance report – Chicago 2017. Retrieved from
https://www.cityofchicago.org/content/dam/city/depts/cdph/CDPH/Healthy%20Chicago/ChicagoOpioidRep
ort2018.pdf
4
Ibid.
5
Chicago Police Department (2019). Chicago Police Department CompStat. Retrieved from
https://home.chicagopolice.org/wp-content/uploads/2019/01/1_PDFsam_CompStat-Public-2018-Week-52
.pdf
1

 As Mayor, you would have the opportunity to focus our great city on efforts that increase safety,
reduce healthcare costs, and quite literally save lives; we hope your answers to these questions
can clarify how you plan to support those efforts.
Please send your responses and any questions to Vilmarie Narloch at​ vilmarie@ssdp.org.
Please have all responses submitted no later than Wednesday, February 6th by 5 pm.
Both responses -- and non-responses -- will be made available to the public in order for voters to
understand your positions on these issues.
Sincerely,
Drug User Health Collective of Chicago
Chicago Recovery Alliance
Chicago Drug Users Union
Students for Sensible Drug Policy
Clergy for a New Drug Policy
Above & Beyond Family Recovery Center
Sex Workers Outreach Project Chicago
Men & Women In Prison Ministries

 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
1. 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.6 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?

Illinois General Assembly. (2010, January, 1). ​Public Act 096-0361.​ Retrieved from
http://www.ilga.gov/legislation/publicacts/fulltext.asp?Name=096-0361
6

 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.
Expanding Access to Medication-Assisted Treatment
2. 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.7 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

7

Substance Abuse and Mental Health Services Administration (SAMHSA). (2015, September, 28).
Medication and counseling treatment​. Retrieved from
https://www.samhsa.gov/medication-assisted-treatment/treatment#medications-used-in-mat

 who are pregnant, decreased use of illicit substances, and increased employability.8 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 mortality9.
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.10
How will you support expanded access to 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.

​Ibid.
National Institutes of Health. (2018, June 19). ​Methadone and buprenorphine reduce risk of death after
opioid overdose.​ Retrieved from
https://www.nih.gov/news-events/news-releases/methadone-buprenorphine-reduce-risk-death-after-opioid
-overdose
10
​Ibid.
8
9

 ● Supporting pre-arrest diversion and deflection programs to help more people get
treatment instead of a criminal record.

Legalizing Syringe Services Programs
3. 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.11 SSPs are cost-effective,12 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.13 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?
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.
Supporting Overdose Prevention Centers
4. 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.14 OPCs are evidence-based interventions

​Division of HIV/AIDS Prevention​, ​National Center for HIV/AIDS, Viral Hepatitis, STD, and TB
Prevention​, & ​Centers for Disease Control and Prevention​. (2018, December 13). Syringe services
programs. Retrieved from ​https://www.cdc.gov/hiv/risk/ssps.html
12
Frakt, A. (2016, September 2). ​Effectiveness and cost-effectiveness of syringe exchange programs​.
Retrieved from ​https://www.academyhealth.org/node/2211
13
Ibid.
14
Reynolds, A. (2016, September 27-28). Safer consumption spaces in the United States: Uniting for a
national movement. Retrieved from
https://www.projectinform.org/wp-content/uploads/2017/06/SCS-Think-Tank-Report.pdf
11

 used to reduce drug overdoses as well as other drug-related harms.15 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.16 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.17 While no
such program has ever legally existed in the United States, several U.S. cities have declared
their support for this intervention18 and others have secured municipal approval to proceed
with opening OPCs in their cities.19 ​OPCs have been endorsed by a number of professional
bodies including the American Public Health Association,20 the Law Enforcement Action
Partnership,21 The International Narcotics Control Board,22 the American Medical
Association (AMA),23 the International Drug Policy Consortium,24 and the European
Monitoring Centre for Drugs and Drug Addiction.25
Due to federal drug laws, such sites would ideally be placed on city property.

15

Ibid.
Ibid.
17
European Monitoring Centre for Drugs and Drug Addiction (2017). Drug consumption rooms: an
overview of provision and evidence. Retrieved from
http://www.emcdda.europa.eu/system/files/publications/2734/POD_Drug%20consumption%20rooms.pdf
18
Cunningham, P. W. (2018, April 30). The health 202: Supervised injection facilities are illegal in the
United States. These cities want to open them anyway. ​The Washington Post​. Retrieved from
https://www.washingtonpost.com/news/powerpost/paloma/the-health-202/2018/04/30/the-health-202-sup
ervised-injection-facilities-are-illegal-in-the-united-states-these-cities-want-to-open-them-anyway/5ae5dbc
630fb043711926901/?noredirect=on&utm_term=.27577cd292ac
19
Neuman, W. (2018, May 3). De Blasio moves to bring safe injection sites to New York City. ​The New
York Times​. Retrieved from
https://www.nytimes.com/2018/05/03/nyregion/nyc-safe-injection-sites-heroin.html
20
American Public Health Association. (2013, November 5). ​Defining and implementing a public health
response to drug use and misuse​. Retrieved from
https://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2014/07/08/
08/04/defining-and-implementing-a-public-health-response-to-drug-use-and-misuse
21
Law Enforcement Action Partnership. (n.d.). ​Harm reduction​. Retrieved from
https://lawenforcementactionpartnership.org/our-issues/harm-reduction/
22
The International Narcotics Control Board. (2016). ​Report 2016.​ Retrieved from
https://www.incb.org/documents/Publications/AnnualReports/AR2016/English/AR2016_E_ChapterIII-Euro
pe.pdf
23
American Medical Association. (2017, June 12). ​AMA wants new approaches to combat synthetic and
injectable drugs. ​Retrieved from
https://www.ama-assn.org/ama-wants-new-approaches-combat-synthetic-and-injectable-drugs
24
Schatz, E. & Nougier, M. (2012, June). ​Drug consumption rooms: Evidence and practice​. Retrieved
from​ ​https://www.drugsandalcohol.ie/17898/1/IDPC-Briefing-Paper_Drug-consumption-rooms.pdf
25
European Monitoring Centre for Drugs and Drug Addiction. (2018, June). ​Drug consumption rooms: An
overview of provision and evidence.​ Retrieved from
http://www.emcdda.europa.eu/system/files/publications/2734/POD_Drug%20consumption%20rooms.pdf
16

 What will you do to support the creation of a publicly-funded pilot OPC in the City of
Chicago?
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.
Decriminalization
5. 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.26 To that end, we support the
elimination of legal penalties for drug-related infractions.27 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.28 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.29 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.30 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.31

Drug Policy Alliance. (2015, February). ​Approaches to decriminalizing drug use and possession.
Retrieved from
https://www.unodc.org/documents/ungass2016/Contributions/Civil/DrugPolicyAlliance/DPA_Fact_Sheet_
Approaches_to_Decriminalization_Feb2015_1.pdf
27
Ibid.
28
Degenhardt L, Chiu W-T, Sampson N, Kessler RC, Anthony JC, et al. (2008) Toward a global view of
alcohol, tobacco, cannabis, and cocaine use: Findings from the WHO World Mental Health Surveys.
PLoS Med 5(7): e141. doi:10.1371/journal. pmed.0050141
29
Ibid.
30
Drug Policy Alliance. (2015, February). ​Approaches to decriminalizing drug use and possession.
Retrieved from
https://www.unodc.org/documents/ungass2016/Contributions/Civil/DrugPolicyAlliance/DPA_Fact_Sheet_
Approaches_to_Decriminalization_Feb2015_1.pdf
31
Ibid.
26

 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?
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.
Drug-Induced Homicide
6. Drug-induced homicide laws have been used to criminalize anyone who uses, shares,
and/or sells drugs.32 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.33 Unfortunately, these laws result in further
disengaging PWUD from emergency medical services in the event of an overdose, further
exacerbating the risk of death.34

32

Drug Policy Alliance. (2017, November). An overdose death is not a murder: Why drug-induced
homicide laws are counterproductive and inhumane. Retrieved from
https://www.drugpolicy.org/sites/default/files/dpa_drug_induced_homicide_report_0.pdf
33
Ibid.
34
Ibid.

 In what ways will you support the elimination of drug-induced homicide 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.