CHICAGO -- Malachi Castner, 23, said he didn’t always sleep on the Blue Line train to avoid the cold and rain. He didn’t always start his day early by shooting up. He was once a teenager on his high school’s wrestling team.

But it was after he tweaked his back while wrestling an opponent as a junior in high school and a doctor prescribed him OxyContin that he descended into addictive patterns that stuck.

He sat inside West Suburban Medical Center on a recent Tuesday morning, scarfing down a sandwich and using shaking hands to open cartons of apple juice. He said he felt chills, his nose was running and his body ached. Over the next few hours, he was just anticipating worse withdrawal.

“I was tired of being on the streets,” he said as he waited. “So today, I decided I wanted to do my hustle and get some better drugs.”

By better, Castner means drugs that may put him on the road to recovery.

Cook County recorded the deadliest year for opioid overdoses in 2022, according to the Cook County medical examiner’s office. Last year, there were 2,000 deaths, surpassing 1,935 deaths in 2021 — a large majority involving fentanyl, a synthetic opioid that is 100 times more potent than morphine and 50 times more potent than heroin. For comparison, nearly 3,000 people died in the 9/11 attacks, memorialized this month.

To respond to the increase, a new program at PCC Community Wellness Center and West Suburban Medical Center called Project LIFE, which stands for Long-acting Injectable for Ending Overdose, is offering injectable medication to patients in an emergency room setting. The injectable drug — a 28-day treatment called Sublocade, or buprenorphine — helps patients manage cravings and withdrawal symptoms of opioid use disorder.

“Administering long-acting injectables in the emergency room, immediately after people have had an overdose or are in severe withdrawal, can have lifesaving implications,” said Dr. Ruchi Fitzgerald, service chief of inpatient addiction medicine at PCC Community Wellness Center.

Withdrawal symptoms — nausea, vomiting, a runny nose, anxiety and more — occur as the body responds to the absence of opioids. Though less serious than alcohol withdrawal, the initial phase of opioid withdrawal begins eight to 48 hours after the most recent drug use, and can lead to serious health complications.

Stanford psychiatry and behavioral sciences professor Keith Humphreys said this is the first time he’s heard of the long-lasting injection medication being administered in an emergency room setting to help patients.

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