Health Brigade needle exchange/harm mitigation workers include (from left) Dziko Singleton, Jeanette Hall, Edward Peters, Colin King and Arthur Ware. (Photo by Jay Paul)
In 2022, for the first time in three years, drug overdose deaths are projected to decline in Virginia.
Overdoses claimed 642 lives in Virginia in the first three months of the year, 46 fewer than in the first quarter of 2021. The state recorded 643 overdose deaths in the fourth quarter of 2021. If the trend holds for all of 2022, the state projects 2,608 overdose deaths in Virginia through December, according to the Virginia Department of Health’s office of the chief medical examiner in a report released in late July.
Drug overdose deaths declined throughout 2021, but the state still notched its worst-ever year in terms of drug overdose deaths, with 2,667 for the year.
Dr. Brandon Wills, associate professor in emergency medicine at the VCU School of Medicine, says the numbers are cause for cautious optimism. Anecdotally, he notes that there seems to be a leveling off of people seeking treatment for opioids in his emergency rooms, but no drastic swing one way or the other. “I hope it’s going down,” he says. But there is variability in such statistics from one quarter to the next. “It’s just too soon, really, to make a final determination.”
There are multiple reasons for tempered expectations.
Even if the projected decline occurs, 2022 would still be second on the list of most overdose deaths in a year in Virginia. Since 2012, overdose deaths rose each year except in 2018. There were 690 deaths from drug overdoses in 2010.
Locally, several metro Richmond areas have the highest rates of fatal overdoses. The city of Petersburg sustained the highest per capita rate of drug overdose deaths in Virginia last year, with a range of 111.7 to 137.9 per 100,000 people. The cities of Richmond and Hopewell were in the next highest range, at 85.3 to 111.6 deaths per 100,000 population. Henrico and Chesterfield counties were in the 58.9 to 85.2 range per 100,000.
Dziko Singleton and Colin King are coordinators of the needle exchange program for Health Brigade, a nonprofit that provides medical services to Richmond’s underserved communities. Their work involves visiting sites around the city several times a week to help people by providing face-to-face services, including offering supplies such as Narcan, which can reverse an opioid overdose. They also provide information on safer drug use and other health information, direct care and referrals.
Singleton doesn’t question the numbers as reported but says it’s not the reality they are seeing on the streets. “It’s like [that’s] not super-accurate for us,” she says in an interview in late July. “Each and every time [we’re out there], someone tells us about a roommate, a family member, somebody at the gas station or sometimes themselves, who they just had to use Narcan, sometimes the day before and sometimes the same day. Most of the time the outcome is favorable, the person survived an overdose, but a lot of time, it’s not.
“Three folks who I know had funerals this week because of fatal overdoses.”
The patient load has been continuous at the OB Motivate Clinic, which works with women with substance-use disorders, according to Dr. Caitlin Martin, an obstetrics and gynecology physician at VCU School of Medicine and a founder of the clinic.
The clinic reached a peak in its client load during the earlier days of the COVID-19 pandemic and has seen no significant decrease in women using its services. Dr. Martin notes that the pandemic brought added pressures, and challenges hindered recovery for clinic participants. But shutdowns have ended, beds and resources are available, social networks are more accessible, and women are better able to access services successfully.
The coronavirus pandemic apparently was a culprit in the extreme surge in opioid overdoses nationwide. The number of people seeking treatment for a nonfatal opioid overdose more than doubled from March-June 2020, the first wave of the pandemic, compared with the number treated in March-June 2019, according to a September 2020 report from VCU researchers in the Journal of the American Medical Association.
But the reopening of society as attitudes have changed toward the novel coronavirus may have played a part in reducing the overdose fatalities in Virginia. Dr. James Thompson, chief medical officer for the Master Center for Addiction Medicine, notes an upward trend in calls to the clinic and more patients coming in for the first half of 2022. “I guess I’m holding my breath a little bit to see what happens next,” he says.
For now, any changes in drug usage levels are not being seen at the treatment level, he says, “It doesn’t see or feel any different,” he says.
Fentanyl Kills
The synthetic opioid fentanyl was involved in three quarters of fatal drug overdoses and continues to fuel the opioid crisis in Virginia and in the nation. Fatal overdoses involving cocaine are also rising, increasing 24% in Virginia from 2020 to 2021. Overdose deaths from methamphetamine use increased 42% in the same period. Fentanyl is also a culprit in cocaine overdose deaths, reported as involved in 84.3% of the reported fatalities.
Heroin fatalities have declined, and that trend is expected to continue downward in 2022. Of the 351 fatalities in the first three months of the year, 76 involved heroin, projecting out to 351 for the year. That compares with 408 deaths involving heroin in 2021.
The prevalence of fentanyl is evident in patients Thompson has worked with. He notes that many patients who are tested had thought they had used heroin, but tests showed pure fentanyl. When told they were positive for fentanyl, “they were only moderately surprised,” he says.
Thompson says he also suspects that most of the deaths from cocaine or methamphetamine overdose are truly fentanyl overdoses instead. The people likely would have lived if it was just cocaine or methamphetamine alone, he says. “That’s the tragedy of it, it’s so deadly and so ubiquitous.”
Fentanyl has lingered as a problem and a killer because it’s so lucrative for those who profit from the illicit drug trade and it’s so enticing to users. “People are still attracted to the deadliest drug out there,” Thompson says.
The Long View
Wills and other frontline workers say much remains to be done before there’s an end to the epidemic.
“It’s a Herculean problem, so it will require a Herculean solution,” he says.
That will mean a multifaceted approach.
“It’s going to take a full-blown effort to make a difference,” says Jim Newton, chief operating officer for the Tucker Pavilion at Chippenham Hospital, which provides mental health care for all ages. He says that will include policing, from law enforcement interdiction to prosecution; health measures such as making Narcan easily accessible and other harm mitigation efforts; tracking medical care; and prescription monitoring. “The solution is not a single source, it’s all of us,” Newton says.
A key is expanding access to treatment and timely follow-through in providing access to services. VCU researchers in a report published in July in the Journal of Substance Abuse Treatment noted the importance of follow-through contact and work with people treated in emergency rooms for overdoses.
Wills says that as of early August, VCU began to supply discharged patients at risk for overdoses with Naloxone, a medication that can reverse an overdose. He’d also like to see emergency rooms do a better job at discharge and having room and resources to get patients into follow-up treatment immediately instead of being placed on a waiting list.
Health Brigade’s King says that getting Narcan to the people in need works; that people who are with people who overdose can revive friends without being criminally involved. “That puts a lot of power in people’s hands,” he says.
King says there are no easy answers, but many efforts have failed or made matters worse, including criminalizing drug usage, incarcerating people for use and stigmatizing people who are coping with addiction. “It would take a big overhaul of what we do,” he says.
The needle exchange program was started after state laws were eased in 2018. The Health Brigade program is the busiest of its kind in the commonwealth, according to King. It’s grown, mostly through word of mouth. In addition to safer use and safer sex information and materials, the team also provides cold water, clothing and food.
Singleton, who is in recovery, says she knows the program is effective and that it works. She says that what they do helping people deal with substance abuse is just as crucial as providing supplies and aid to people with diabetes. “It’s just as necessary,” she says. “We really do believe in what we do.”
Any decline is good news for the people working to curb the overdose epidemic, but it’s difficult to predict trends. The number of drug overdose deaths declined from 2017 to 2018, only to soar again in the ensuing years.
Treatment and enhanced access to treatment programs and other forms of assistance help, but there are other factors involved, too. Thompson says he hopes it’s part of the reason for change, but history says otherwise.
It will take years to get a clear picture of all the factors involved in the resolution of the current epidemic. Thompson notes how various groups claimed victory in stemming the cocaine and crack wave of the 1980s and ’90s, such as crackdowns cited by police and politicians at the time that proved to cause more problems than they solved. He contends that the cocaine wave waned more through social stigma and changes in society.
He also notes that people who profit from the drug trade adapt over time: “They learn to sense when the drug is becoming too negative, too deadly, and they change drugs — they change products.”
