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The Opioid Crisis
Opioid addiction: Who's responsible? How do addicts, doctors and providers move forward?

CARBONDALE — Jacob Dellinger was awakened by a police officer at about 12:40 a.m. on Sept. 8 outside of a Burger King in Marion County. The officer asked Dellinger what he was doing. Dellinger's simple response: “Going to jail.”

Dellinger was passed out in a vehicle because he was high on heroin, and looking at going to jail, again, on a drug charge. His initial thought when he was handcuffed and placed in the back of a police car was how hard of a week it was going to be, because he wouldn’t have access to drugs, and the withdrawals were going to be tough.

However, once he was being transported to the Marion County Jail, he told himself to surrender to the legal system and take this opportunity to put the life of a drug addict behind him.

Dellinger, 32, used heroin for the first time just after high school. He said he grew up in a household where several family members, including his parents, would use narcotics regularly. At the time, he did what he could to stay away from them, which led to getting a job on the Mississippi River as a deckhand for American Commercial Barge Line in Jeffersonville, Indiana.

With the barge company, he worked 28 days on the job and had the next 28 days off. During one of his off cycles, he attended a party where he tried a drug he thought was cocaine, but it turned out to be heroin. His rationale toward trying the drug was, “If I couldn’t beat ‘em, I might as well join ‘em,” referring to his family.

“Within two weeks, it went from why somebody would do this, to this is the warmest blanket on the coldest day,” Dellinger said. “Like it was the answer to all my problems.”


“It was a euphoria to not have to think about all the stuff that happened at home,” Dellinger said of how he felt after he started using.

Dellinger said he went from doing no drugs at all to snorting heroin.

He continued to work on the boat for a couple months afterward, but soon the withdrawals got to be too much, and he knew he was putting himself at risk. He said he never took drugs while working. Eventually, he just quit the job. No two weeks’ notice — he just left the job abruptly.

Dellinger returned home to continue using heroin until 2007, when he joined the Army in another attempt to come clean. During basic training, he said life was great and he was staying clean. He was stationed in Fort Lewis, south of Tacoma, Washington, when he learned of a fellow soldier’s death. This sent him spiraling, and he obtained OxyContin — a brand-name opioid used to treat pain.

He continued to use the pills until he was discharged from the Army for other personal reasons he says were not related to drugs.

'It always falls away'

Upon returning home from the military, Dellinger said the shame of his life started to overshadow him.

“Every time I get something good, it always falls away,” he said.

He said he has been in a number of county jails in Washington, Florida, Arizona and Illinois. This included a stint in prison on a possession charge; he was released this past March.

Since 2010, Dellinger said his life had been “insanity.” He called it a vicious cycle of using drugs, going to jail, getting clean, saying he will change his life ... and the cycle repeats itself.

During the time of his interview with The Southern, Dellinger was a client with The Gateway Foundation in Carbondale. According to A'nna Jurich, the foundation’s executive director, he left the foundation on Feb. 20 and went directly to ARCH Houses in Granite City, another treatment center for men seeking recovery from substance abuse. She said he is still there as of Wednesday.

This is his third stint in a rehab center — and his second at Gateway. Dellinger said he was court-ordered to attend a facility in northern Illinois and volunteered to come to Gateway another time. On his first trip to Gateway, he didn’t give the treatment a fair shot.

“I didn’t engage because I didn’t think anybody could understand what I went through,” he said.

Final rehab trip

After his arrest on Sept. 8, he was charged with possession of a controlled substance. He was originally facing three years in prison.

“I wrote a six-page letter — front and back — to the Marion County State’s Attorney asking him to find it in his heart to send me to Gateway,” Dellinger said. “Just one more time. All I needed was one more opportunity to let me try to beat this and apply the program to my life.”

Instead of proposing a prison sentence, the state’s attorney accepted his request.

This time, he said he has a new attitude and is engaged in the process. He asked to go to the ARCH House because he said he hasn’t been in treatment long enough for him to be back on the streets. He said he needs more time in the program.

“I have overdosed 13 times in my life and I don’t think I’ll ever have another shot at it,” he said.

He said the hardest part of an active opioid addiction is the withdrawal period, because it is so intense.

“Four or five days seem like an eternity when you have nothing to come off of it,” Dellinger said.

He said taking the treatment route was the only option. If he had gone to prison for three more years, he would have been in contact with more drug dealers, gained more street knowledge and spent a lot more taxpayer dollars.

bhetzler / Byron Hetzler, The Southern 

Jacob Dellinger talks about his addicition to opioids and his road to recovery during an interview at the Gateway Foundation in Carbondale.

“The cycle would have repeated itself,” he said. “I’d be dead. Without a doubt. Or, I would be getting ridiculous amount of time in jail for running with the wrong people.”

Getting help

When a person addicted to opioids decides it is time to get help, there are some options available in Southern Illinois just by walking into a clinic.

Centerstone has offices in Carbondale and Marion with walk-in hours for anybody needing treatment. Angela Manns, Centerstone’s medical services director, said individuals have to be screened because there are federal guidelines in order to be treated in a methadone clinic.

Those seeking treatment need only meet one of the following criteria: being addicted to opioids for a year or having failed detox three times in the past year, having been addicted in the past and started using again, being recently released from prison and using again, or being pregnant. 

If a person needs inpatient treatment, Manns said Centerstone attempts to link him or her to a treatment facility, but if there isn’t room, the provider will refer him or her to other outpatient treatment facilities right away.

“Right now, since the need is so big, we don’t have enough room to admit as many who come in every day,” Manns said. “We do have a waiting list for all of our clinics and we are going as fast as we can.”

She said there is a fine line when identifying whether or not a person needs inpatient or outpatient treatment. Usually, she said, there are a lot of coexisting factors, like using multiple substances or a person being court-ordered to seek treatment.

The outpatient client will receive information about three forms of medication assisted treatment (MAT), Manns said.

There is suboxone, a sublingual film that requires the patient to be free of all opioids for seven to 14 days before getting the shot. Manns said this is usually the best for individuals getting out of a correctional institution or who have a history of addiction, because it gives them time to get into a facility.

She said suboxone partially covers up the brain’s receptors in order to get rid of the cravings and withdrawals, but is only given 24 milligrams at a time. Manns said any more than that would be wasting the medication.

“So, if you don’t cover up all those receptors with 24 milligrams, you are still going to have a person who is sick and won’t fully engage with treatment,” she said.

Vitriol is a brand-name treatment that is a nonaddictive, once-a-month injection. Manns said it is best used in inpatient treatment because patients get really sick when experiencing withdrawal. The drug blocks the effects of opioids, including pain relief or feelings of well-being that can lead to abuse. She said it is the hardest method, especially for outpatient treatment, because patients don’t want to be sick during recovery.

Methadone treatment is available for clients walking in off the street, up to 30 milligrams, even if that person used opioids the night before, Manns said.

She said methadone gets the patients to the point where the withdrawals and cravings for more drugs stop and the euphoric feeling is gone, which should allow a patient to focus on treatment.

“That is where you can focus on counseling, therapy, group, primary health care to address the root cause of addiction,” Manns said. “It covers the opioid receptors completely and it keeps all other opioids off the receptor so it won’t let you get high after you get to your therapeutic dose.

“There is no ceiling effect either. If you come in using massive amount of fentanyl, methadone will be able to cover that withdrawal where other forms won't.”

She said there is a large misconception about methadone, as well.

“A lot of people think methadone is just another medication to get high from. You are just switching one drug for another. That is completely not true,” she said. “You don’t get high off methadone. You use a therapeutic dose to keep you from going into withdrawal.”

She said methadone has done a lot more good for people than bad.

Ending treatment

It’s up to the patient to assert when he or she is ready to come off treatment, Manns said. However, it’s not a good practice to take somebody off medication before they are ready.

“If you push somebody to come off medication before they are ready, you are condemning them to relapse,” she said.

Manns said that less than 15 years ago, opioid addicts were expected to be on medication for a year. The expectation was that they were rehabilitated in that time.

“When they were doing that, they were noticing a high relapse rate because they weren’t ready,” Manns said. “Some people will never come off medical assisted treatment.”

Today, she said for those people in treatment at Centerstone, relapse rates are low — maybe 2 to 3 percent, she said. Also, she said when people detox voluntary, about 95 to 97 percent of those patients are successful.


Having the means to pay for treatment can be a barrier for some. Jurich, at Gateway, says the foundation does its best not to let that be an obstacle for those needing help.

“We really try to work with everybody and their individual situations,” she said, adding that Gateway takes all commercial insurance.

Also, she said that if there is no insurance, grant funding is available with income verification. She admitted it could be expensive with a high deductible, but a deal can be struck based on the patient’s income.

“We really try to not let that be a barrier,” she said.

Another problem can be if a person isn’t using at the moment but is still struggling with addiction, some insurance agencies will say it can’t pay for treatment.

Annie Gunn, Gateway Foundation admissions director, said she doesn’t take "no" from the insurance companies very lightly. She said she will present several factors as to why a person has been clean, including being in jail or being locked in the room by family before coming to treatment.

“It is my job to educate them a bit more and help them see there is a bit more to it than just they haven’t used in five days,” she said. “We see people who have come out of the hospital after experiencing a medical detox, and if we don’t get them into treatment quick enough, they are going to go out and use.”

Prescribing opioids

Opioids have a place in the world, said Dr. Jeffrey Ripperda from Shawnee Health Care, who has an office in Murphysboro.

“That place needs to be more limited than it has in the past 15 years,” he said.

He says responsible prescribing means verifying a patient’s diagnosis. If a person has pain, he or she better have something that proves it, he said. Meaning, if a person has severe back pain, there needs to be a MRI or a nerve test to prove it.

Also, he said over-prescribing is a problem, even though physicians going through medical school in the early 2000s were taught there was no limit to how much opioids to give a person.

“If the person is still in pain, you aren’t giving enough opiates, you should consider going higher,” Ripperda said he was taught in medical school. “You give as much as the person needs to alleviate their pain.”

In hindsight, this is terrible advice, he said.

Physicians need to have hard limits when it comes to prescribing opioids and be sure patients are taking the drugs responsibly, he said. This could be done by doing a random drug screen to make sure the patient isn’t taking other narcotics.

“Odds are if the drug screen shows other illicit drugs, there is a chance they are abusing opiates as well,” Ripperda said.

Other treatment options

Requiring patients to seek other treatment options rather than pills is something providers should consider, Ripperda said.

“I have never met anybody who got completely out of pain from just taking a pill,” he said. “Pills should be a last resource for somebody who has tried everything else and has not gotten better.”

Those other treatment options take work and commitment, Ripperda said. Yoga, quitting smoking and making a commitment to weight loss are all things that help, he said, but it doesn’t get better right away.

Marci Moore-Connelly, chief medical officer at Southern Illinois Healthcare, said antidepressants, anticonvulsants and anti-inflammatory medications are other options. Additionally, occupational therapy, osteopathic manipulation, and acupuncture are options of which providers need to inform patients, she said.

At SIH, Moore-Connelly said there is a policy discouraging narcotic prescribing in its emergency department, except in rare occasions. In cases where a patient is already on opioids, the goal is to get them back to their primary doctor as soon as possible. In those rare occasions where narcotics are used, the provider uses the lowest dose possible.

“We are trying to move away from that as much as we can,” she said.

Ripperda said physicians need to remember that opioids have side effects, even in people who take them responsibly.

“If we take 200 people who are taking opiates exactly how they are supposed to — one of those people (is) going to die who otherwise wouldn’t,” he said.

A lot of pills on the streets

Ripperda said the impact from doctors prescribing an overabundance of pain pills resulted in those opioids finding different homes than just the medicine cabinet.

“We have put a ton of pain pills on the streets and created a large number of opiate addicts,” he said. “There is a simple law of supply and demand in drug abuse — when the pills became harder to get, a lot of people turned to heroin because it was cheaper and easier to get.”

He called for tighter regulations on the number of opioids a doctor can prescribe, because he doesn’t trust some physicians in the medical field to get it right each time.

“I have lost of a little bit of faith in my profession in terms of the ability to self-regulate,” he said.

Ripperda said he doesn’t believe physicians are acting nefariously.

“There were people who thought they were doing the right thing and just didn’t recognize the problem that we were creating,” he said.

Today, he said 80 percent of opioid addicts are addicted to pills. That number has actually gone down from the 90-95 percent range. Now, he said 20 percent of people are using heroin at first contact.

“Every single pill is coming from a doctor somewhere,” Ripperda said. “There is a doctor writing a prescription for that medication, which is then finding its way to the street and in the hands of an addict.

“To say that medical providers have no culpability in the opioid crisis is silly and disingenuous.”

Moving forward

“One of the things that led to the opioid crisis is that it took too long for doctors and providers to change their mind (about prescribing),” Ripperda said. “I think the medical field and in the practice of medicine in general, we are just a little bit stuck and don’t like to change what we are doing.”

He said younger physicians are much savvier about the crisis, and the prescribing habits of those doctors are much different than 15 years ago.

In Ripperda’s office, he can offer patients opioid treatment through a program he is licensed to run. However, he said for physicians who don’t have that option, it becomes difficult because all they can do is give the patient information on how to get into a program. Also, once a doctor recognizes a patient may have a problem, prescribing them pills is no longer an option, he said.

“Once they realize they are addicted to opioids, they can no longer prescribe opiates to that person,” he said. “At that point, you have basically become their drug dealer.

“You have to cut that person off and say, 'Here are some places you can go get help' and 'Good luck.'”

Moore-Connelley said SIH is working to make it easier for its physicians to know who can help and where to send a person when problems do occur.

“I would venture to say a lot of our physicians are unaware of the resources out there,” she said. “We are trying to get them in a place where it is easy for doctors or their staff to find those resources.”

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Officials say law enforcement, faith, education, health care all must be part of opioid crisis solution

Franklin County Sheriff Don Jones calls the opioid addiction a public health crisis — one that has to be addressed.


"We can’t solve this by ourselves. We are working as hard as we can,” Jones said.

Opioids are defined by the National Institute on Drug Abuse a class of drugs that include the illegal drug heroin, synthetic opioids such as fentanyl, and pain relievers available legally by prescription such as oxycodone, hydrocodone, codeine, morphine and others.

“It’s unbelievable. I cannot express my amazement at what’s happened. We almost always have over 100 people in our jail these days, and the vast majority of them are linked to those kind of addictions,” Jones said. “When I first started in this business, we would have less than 20 people in jail all the time — usually young, white males with substance abuse problems. Now we have over 100.”

Jones is learning from the people in the jail that an increasing number of methamphetamine cases are related to the opioid crisis as well. Several addicts have told Jones that crystal meth has become a substitute for opioids because it is prevalent, cheap and easy to get.

Jones said the department answers a lot of calls that can be linked to addiction, like burglaries or domestic violence.

Williamson County State’s Attorney Brandon Zanotti is dealing with similar issues.

“When you look, give or take 40 percent of the felonies on the docket are drug-related, and at least half of those are opioid-related,” Zanotti said. “In a big percentage of theft and burglary cases, the motive for those crimes are related to someone trying to get heroin or opioids.”


Williamson County State's Attorney Brandon Zanotti is shown in his office in 2017 in the Williamson County Courthouse in Marion.

Zanotti added that the people who are addicted are not what are typically think of when  hearing the term 'addict.' They are people who used to have a good job, have an injury where prescription opioids are prescribed, and it all went downhill from there.

“I think that’s why we’re seeing a large spike in heroin usage,” Zanotti said.

As pain medication has become harder to get, people turn to heroin, which is more dangerous, and sometimes even fatal.

Jones believes the crisis will have to be addressed from many different angles, including law enforcement, city and county officials, the faith community and education leaders.

“We have formed a committee here of local officials and community leaders, and we are going to explore our options,” Jones said. “We are going to try to address (it) in juveniles.”

Zanotti said his office is working with judges and public defenders to create an opioid diversion program. They currently have 10 open files they are considering for the program.

To qualify, an offender must be charged with possessing a relatively small amount of drugs, have no criminal history such as a history of selling opioids, and must want to get treatment.

“We have been working with public defender on some cases. It offers a chance before a case goes to trial to get treatment. Successful completion of treatment results in lowering charges or dismissing them,” Zanotti said.

The hardest part is choosing which cases to target. 

They also offer a similar program geared toward veterans called Veterans Drug Court. It gives offenders who are veterans a chance to complete treatment before going to court, with a payoff of reduced or dismissed charges.

“The goal is that the person gets better, and because of that, does not get the normal punishment as in a traditional court setting,” Zannotti explained.

Zanotti said the programs are seeing some success, but there is more to do.

Much like Sheriff Jones in Franklin County, he is trying to attack the problem from as many different angles as possible.

Within a month, Zanotti expects to file a lawsuit against opioid manufacturers much like the suit filed by Union County State’s Attorney Tyler Edmonds.

On June 26, 2017, Edmonds filed a lawsuit against five manufacturers of prescription opioids and their related companies. The lawsuit alleges the pharmaceutical companies made numerous misrepresentations about the risks, benefits and adverse effects of opioids for the purpose of increasing profits, in violation of Illinois Consumer Fraud and Deceptive Practices Act and the Uniform Deceptive Trade Practices Act.

“Opioid manufacturers through a coordinated, sophisticated and deceptive marketing campaign have led prescribers and consumers to believe that opioids were not addictive, addiction was easy to overcome, and prolonged use of opioids was appropriate for even low-level pain. The representations of the opioid manufacturers are not supported by, and in most instances are directly contrary to, the scientific evidence,” Edmonds said in June.

Zanotti also believes there is a lot of evidence that there was clear wrongdoing on the part of manufacturers, in marketing to the doctors who then prescribed opioids.

“I think if this is successful, we could see a lot of money earmarked for treatment in Southern Illinois and Williamson County,” Zanotti said.

One problem that the opioid crisis has brought to light is the amount of unused prescription opioids that sit in home medicine cabinets. Those medications are then shared with a friend or relative who is in pain, or stolen by a visitor or family member.

Many people, according to Zanotti, do not understand that sharing their prescription medication with another person is illegal. Others may not understand the importance of securing medication. To help reduce the amount of opioids available, he is working with law enforcement to expand medication takeback programs.

“How I envision it is, using federal drug funds or grants to expand the takeback,” Zanotti said.

On March 5, Southern Illinois Healthcare announced it would accept unused prescription medication at four locations in Jackson and Williamson counties.

According to a press release from Greg Smith, SIH community health coordinator, more than 40 percent of teens who have misused or abused a prescription drug obtained it from a family medicine cabinet. SIH hopes the takeback program will reduce the availability of those medications. 

Memorial Hospital of Carbondale and Herrin Hospital will accept medication seven days a week, from 7:30 a.m. to 6 p.m. Sunday through Saturday.

St. Joseph Memorial Hospital in Murphysboro will accept medication from 6 a.m. to 4:30 p.m. Monday through Friday and 7 a.m. to 2:30 p.m. Saturday and Sunday.

SIH Cancer Institute in Carterville will accept medication from 7:30 a.m. to 3:30 p.m. Monday through Friday. It is closed Saturday and Sunday.

Angie Bailey, community benefits manager at SIH, said the move is a way the organization can help combat the opioid crisis.

Jones, Zanotti, Edmonds, Bailey and their colleagues are trying to make a difference, but they will need help.

“It’s an enormous problem. It will take a lot of money to get a handle on it,” Jones said. “We need more services. A lot of folks have underlying health conditions. It has to be addressed either before or at the same time. We need more services for mental health and addiction.”

“This is such a massive crisis for all of us — law enforcement, health care and the general public. I’m willing to listen to anyone and employ any rational idea,” Zanotti said. “Not everything will work, but the important thing is we all keep trying.”

If you or someone you are about is addicted, call the Illinois Helpline for Opioids and Other Substances at 1-833-2FINDHELP.