Every two weeks, Abby Hampton gets a delivery to her home in rural Amboy, a little more than 100 miles west of Chicago’s Loop.
On a recent Wednesday, she was able to choose from the supplies neatly packed into a minivan run by an organization called The Perfectly Flawed Foundation: syringes, boxes for used needles, fentanyl testing kits, the overdose reversal drug naloxone, alcohol wipes, shampoo and gum.
Hampton said since she doesn’t have to buy her own syringes, “I can just switch out every time I use now.” While she’s been off heroin for eight years, she continues to use drugs including cannabis and occasionally methamphetamines, she said. A friend introduced her to Perfectly Flawed two or three years ago, she said.
“I definitely think that there’s a lot of people you’re not going to get to go into recovery, so putting forth some effort into trying to keep it as safe as possible, and making it easier for us to be safe about it, and cleaner and all that — it’s definitely a big deal,” Hampton said, wearing bedazzled wraparound sunglasses in the yard of her three-flat apartment complex.
Perfectly Flawed’s services are part of a growing community-based harm reduction approach to drug addiction and overdoses, helping Hampton and others who use drugs across a wide swath of Illinois avoid reusing needles, unintentionally ingesting fentanyl and dying from overdoses.
Organizations providing those services often operate on shoestring budgets from private and government funding, and struggle to keep up with the demand as the nation continues to suffer from tens of thousands of opioid overdose deaths per year.
Now, groups in Illinois providing harm reduction services are set to receive at least $15 million from settlements between states and prescription drug companies.
Providers across the state say they could do much more with additional funding, but getting money from the remediation fund is complicated.
“Unrestricted settlement dollars could really — I mean, there needs to be an investment in harm reduction supplies across the state of Illinois. People are desperate for them,” John Werning, executive director of the Chicago Recovery Alliance, said.
Settlements from multistate agreements with prescription painkiller manufacturers, distributors and sellers have put Illinois in line for well over $1 billion in payouts to help with the crisis.
Of more than $115 million that’s been allocated from the fund, $15 million over three years has specifically been set aside for harm reduction services. None of that money has gone out yet, according to a state-run dashboard last updated in May, though at least one organization said it has been granted some funding through a different allocation.
Much of the rest of the money is still being sorted out through a complex bureaucratic process overseen by a number of entities intended to make sure it’s used responsibly.
Nationwide, more than $50 billion is expected from the settlements. Other states have used the funds for syringe exchange programs, treatment centers and supporting law enforcement.
Perfectly Flawed, for its part, would use the money to expand from a minivan to something bigger, founder and executive director Luke Tomsha said. That upgrade could allow for more privacy in discussions, medical care or drug testing, he said.
The overdose problem has a hold in many rural areas and is especially acute in some Chicago neighborhoods. The West Side is home to some of the highest overdose rates in the state, the Illinois Department of Public Health said in 2020.
“Next to the gun violence, this may be the number one problem on the West Side of Chicago,” state Rep. La Shawn Ford said. The Democratic lawmaker has supported harm reduction and recovery efforts in his district, including pushing legislation for an overdose prevention site, where people could use drugs in a supervised setting on the West Side.
One local organization trying to deal with that crisis has set up a mobile shower unit distributing harm reduction supplies and said it would use additional funds for a drop-in location and case management services.
While advocates credit the state for making harm reduction a priority in its ideals for addressing the crisis, smaller organizations without much administrative infrastructure say they’re worried about being able to win grants and feel they are at risk of losing out to larger rehabilitation and recovery-based groups.
And a wide range of organizations have raised concerns about the speed at which the massive settlements are being distributed.
Werning of the CRA believes the settlement money is relatively unrestricted — compared with federal funds, for example — and could be used for a wide range of services. But exactly how it will be used is unclear, because little has gone out so far to organizations like his, he said.
“It’s such a complicated system, and it doesn’t seem to me like they’re prioritizing harm reduction at all, so we keep funneling more money into the same type of interventions we’re always, we’ve always funneled money towards, so it’s a disheartening process to say the least,” Werning said.
A spokesperson for the Illinois Department of Human Services, the state agency most directly involved with overseeing the allocation of the remediation fund, noted in a statement that harm reduction “is a priority for the State as outlined in the State Opioid Action Plan,” a document that sets priorities for mitigating the crisis.
Werning said the Chicago Recovery Alliance is the oldest opioid education and naloxone distribution organization in the country. But it still doesn’t receive much government funding for harm reduction supplies, he said.
The CRA, which mostly serves the South and West sides, has about a dozen employees, including some that are part time, he said, and could reach more people with more staff and supplies.
A minivan is the main office for Matt Rowlee, an outreach specialist at Perfectly Flawed who delivers supplies to Hampton’s home. The organization is based in a converted train station in La Salle, sandwiched between the rural town’s main street and the tracks, just a few miles from Starved Rock State Park. The group offers walk-in services and support groups at this location, but the van offers a solution for people who don’t drive in an area with few public transit options.
On a recent day, Rowlee took the van to at least three locations some 20 or 30 minutes apart. In tiny La Moille, population about 700, a school wanted a delivery of naloxone to keep on hand. In Amboy, he met with Hampton, the twice-monthly regular for Perfectly Flawed’s services.
And at a train station parking lot in Princeton as temperatures crept above 80 degrees, he approached people experiencing housing insecurity and homelessness, and walked supplies over to them in the shade.
Rowlee said he has abused drugs in the past. A 42-year-old who spent years incarcerated, he wanted to “try something different” after being released, he said.
While the organization doesn’t approach people with the goal of getting them into recovery, they offer resources if those using their services decide to take that step themselves.
“There’s a lot of people that never got to the point where I got to, where I was like, ‘All right, I want to try something different.’ You know what I mean? … I just hope that it gives — everybody has the opportunity to make that choice for themselves, or not,” Rowlee said.
His rounds take him across LaSalle, Henry and Woodford counties and into all hours of the night, he said.
“I remember when I was on the other side of the van,” Rowlee said. “It’s — I don’t know if it’s any more welcoming or inviting, but it’s always — someone, if there’s someone on the other side, that has been there, had those experiences, can relate to a lot of things, people that we serve, there’s no shame.”
Individuals in contact with Perfectly Flawed self-reported more than 300 overdose reversals from January to July of this year, Tomsha said.
Princeton police Chief Tom Kammerer said he and his department are also practicing harm reduction strategies as part of a “multilayered approach” and rejected the idea that only certain groups would be equipped to do the work.
“There is enough work out there to go around, and there are plenty of people out there suffering who need help, and all these organizations need to work with one another to make sure that these people are getting the help that they need,” said Kammerer, who keeps tabs on people who are homeless in some of the same areas as Rowlee.
Harm reduction is not just about supplies or grant applications but about relationships, Tomsha and other advocates said.
Tomsha, who said he used heroin “chaotically” for 14 years, said at the time he was using he would have preferred to turn to someone like Rowlee than risk getting “stigmatized at the front desk of an ER or a clinician’s office.”
“People say, ‘You’re just giving out — you’re empowering people to use.’ Like, you’re actually empowering life and autonomy,” Tomsha said. “Stigma does kill.”
People have also developed close relationships through The Puerto Rico Project, which distributes food, supplies, showers and other services to people who are homeless in Chicago.
In Humboldt Park, project director Melissa Hernandez with the help of volunteers, staff and people who are homeless set up a table of harm reduction supplies — naloxone vials, boxes of syringes, snorting kits, cookers, condoms, xylazine test strips and other items — a few feet from a spread of hot dogs and drip coffee.
The project regularly brings a mobile shower unit with two stalls, fresh clothes and a small medicine cabinet with over-the-counter medications to the site near the corner of North and California avenues.
Angel Echevarria, Jose Echevarria and Tammy Huisel, who regularly use the showers, were among the first to arrive at the mobile site on a warm recent Monday.
But before they used any of the services, they helped Hernandez with setting things up.
They weren’t there for the harm reduction supplies, Jose Echevarria said, gathering with Huisel under Humboldt Park’s leafy late summer foliage next to a collection of tents for homeless people. But they helped out because of the sense of community and care that the site brought to them, they said.
“This is a blessing. God provided this for us. … You’ll scratch my back, I’ll scratch yours,” Angel Echevarria said.
Only access to smoking supplies is somewhat restricted, Hernandez said, because of the high cost for those kits. Other drug use supplies were out on a table for people to take as they pleased.
People who gathered from the nearby tent encampment at The Puerto Rico Project’s site in many cases hung around for longer than just their shower slot, making conversation in the grass and drinking coffee.
The whole setup is a form of harm reduction, Hernandez suggested, allowing people to gather in a community where they feel safe.
One of the people who took supplies for drug use, Joe Gonzalez, said he was staying in Humboldt Park, describing the neighborhood as his home.
“It’s beautiful that so many people even care, and care about everybody that’s out here, you know what I mean? And — the government, you know what I mean, and other people don’t get it. They won’t do it. But these people out here care,” he said.
Still, the government-distributed remediation fund could soon be funding some of the services at the site.
Additional funding could support salaries, supplies, food or a truck to tow the shower unit when the current lease runs out, Hernandez said. In its current setup, shower services will also be limited in the winter because of cold weather, she said.
The annual budget for Hernandez’s operation, which has four part-time employees, is $130,000, she said.
At Perfectly Flawed, Rowlee is one of five full-time employees, Tomsha said. The organization also has five part-time workers.
At that organization, a $300,000 grant from the opioid remediation fund is expected to fund an additional van and community outreach work; however, it’s not a harm reduction-specific grant and can’t be used for supplies like syringes, Tomsha said.
A larger grant could go to expanding mobile services, Tomsha said.
“We’re part of the public health,” Hernandez said. “People are actually wanting to take care of themselves … Even though we’re harm reduction, we’re always something else too.”