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Has Virginia’s opioid epidemic peaked?
Emergency departments across the state are seeing fewer people who have overdosed, and the state is projecting a drop in overdose deaths for the first time since 2012, according to the Fatal Drug Overdose Quarterly Report from the Virginia Department of Health, which was updated in July.
Overdose deaths skyrocketed from 2012 through 2016, but slowed last year. Opioid overdose deaths increased 7.6 percent from 2016 to 2017, and the state reports 343 fatal drug overdoses for the first quarter of 2018, the lowest since 2015. Projections point to 1,456 drug deaths for the year, 82 fewer than in 2017.
“[I’m] hesitant to say it’s really good, but it’s encouraging,” says Statewide Forensic Epidemiologist Kathrin Hobron.
Emergency room treatments for overdoses show a 17 percent drop in the first six months of 2018 compared with the first half of 2017, according to a Virginia Department of Health report. Highest rates were reported in the Central Health Planning Region, which includes metro Richmond.
Heroin overdoses resulting in emergency department visits in Virginia declined by 19 percent for the first half of 2018 compared with a similar period the previous year.
Overdoses have killed more people in Virginia than vehicle wrecks or guns since 2013. Last year, drugs were involved in 1,538 deaths. Guns killed 1,028 Virginians last year, and 957 died in vehicle wrecks.
Overdose deaths involving benzodiazepines declined in the first quarter of 2018, but there’s been a rise in cocaine overdose deaths, which are projected at 416 through year’s end, the highest death rate through the reporting period that began in 2007, according to the state. There were 398 overdose deaths involving cocaine last year, and 292 in 2016.
Overall, prescription opioids are the culprit in more of the deaths in Virginia’s rural communities, while heroin and illicit fentanyl kill more residents of metro Richmond and other urban areas. “The nature of the disease is that it varies by part of state,” says Dr. Samuel Hughes Melton, commissioner of the Department of Behavioral Health and Developmental Services.
Virginia has taken numerous steps to combat addiction and overdoses, from increased availability and training in the use of Naloxone, a medication that can reverse an overdose, to increasing access to comprehensive treatment programs. State officials are cautiously optimistic, including Jodi Manz, assistant secretary for health and human services and staff director for the Governor’s Executive Leadership Team on Opioids and Addiction. She says the state is happy to see the rate has decreased, and that the interventions that are in place are helping bring the numbers down.
Naloxone is a proven life-saver that is available out in the community where it’s needed, from first responders to lay people. Access to prescribed opioids has also changed through initiatives that include e-transmission of prescriptions to pharmacies.
The state also allows for needle exchange programs, and set up the Addiction and Recovery Treatment Services Program (ARTS). That program beefed up Medicaid coverage for treating addiction, boosting payment to providers as an incentive for more doctors to accept people covered through Medicaid. Earlier in the year, the state also approved a Medicaid Waiver that will further enhance access to drug addiction treatment for eligible state residents.
The state initiative is expected to make Medicaid coverage available for some 400,000 people in lower-income households in the state. “We expect to see more individuals in treatment,” says Melton.
Virginia Commonwealth University will evaluate the initiative's impact, a service the university is already providing in assessing the ARTS program. An evaluation of ARTS' first year has recently been completed.
They reported a 54 percent increase in the number of Virginians covered by Medicaid receiving treatment for addiction through ARTS, says Dr. Katherine Neuhausen, chief medical officer for the Virginia Department of Medical Assistance Services. Much of that increase, she says, stems from an increase in providers, which rose from 1,087 in 2016 to 2,965 last year. The greatest increase in providers was seen in Central Virginia, she says, a 41 percent increase.
“It’s really reflecting a lot more accessing treatment,” she says.
The state also reported that prescriptions for opioids to manage pain dropped by about a third.
Neuhausen says ARTS built a foundation for a successful rollout of the expansion, and that she expects to see another boost in treatment numbers through the expansion. She cites metro Richmond as a success because its providers worked together to build new programs in a coordinated fashion. She also notes progress in Northern Virginia as well. More providers are needed in other areas, such as the Southside, Fredericksburg, Martinsville and Petersburg.
EMERGENCY VISITS FOR OPIOID OVERDOSES
Total for first quarter rate
Chesterfield 36 9.3
Crater Health District 17 10.7
Henrico 42 12.8
City of Richmond 35 15.9
State total 623 7.4
(rate per 100,000 population)
Source: Virginia Department of Health
CAUSE OF DEATH IN VIRGINIA BY YEAR
2011 2012 2013 2014 2015 2016 2017 2018*
Drug Overdose 819 799 914 994 1,028 1,428 1,538 1,456
Firearms 863 835 852 901 940 1,057 1,028 1,032
Vehicular 878 877 832 808 879 890 957 971
(* projected)
Source: Virginia Department of Health
