Photo by Matthew T. Rader/Unsplash
Year-to-year fatal drug overdoses in Virginia declined in 2018, for the first time since 2012, but there was a notable increase in drug overdose deaths in the first quarter of 2019, according to an updated report from the state’s Office of the Chief Medical Examiner.
There were 395 overdose fatalities through March, compared with 346 in the first quarter of 2017. That projects out to 1,546 deaths through the end of 2019, according to the Fatal Drug Overdose Quarterly Report for 1st Quarter 2019, which was updated in July. There were 1,486 drug overdose deaths in 2018. That would represent about a 4% increase in drug fatalities from 2018 to 2019 if the projections play out. Virginia recorded its most overdose deaths in 2017, with 1,536.
Heroin and fentanyl account for most of the fatalities. Illicit fentanyl and its analogues, which are exponentially more powerful than heroin, have often been mixed in with heroin and other street drugs with unpredictable, and often fatal, results. Fentanyl, both prescription medication and illicit variants, killed 813 people in Virginia in 2018, and is projected to be involved in 852 overdose deaths through 2019. There were 558 heroin overdose deaths in 2018, 556 in 2018, and 577 are projected through year’s end 2019.
Fatal overdoses from cocaine abuse have been rising in the commonwealth; from 84 in 2012 to 445 in 2018, and are projected to be implicated in 450 overdose deaths through year’s end. Almost 82 percent of all overdose deaths involve opioids or opioids in combination with other drugs.
The state has undertaken several initiatives to mitigate the opioid epidemic that has engulfed Virginia and the nation in recent years. Those efforts include include Medicaid expansion, which allows for access to medical care including addiction treatment; a program to monitor prescriptions; and an effort to increase access and distribute medications including naloxone, which can reverse an overdose. The state has seen enrollment increase by 300,000 adults through the expansion, and 16,100 of those adults have sought treatment for substance abuse disorders, according to a release Wednesday from Gov. Ralph Northam’s office.
“This is going to be a marathon, it’s not a sprint," says Melissa Viray, deputy director of the Richmond and Henrico County Health Districts. “The issues are going to take time to address."
A Comprehensive Harm Reduction program underway in Richmond works to head off overdose deaths and blood-borne infections including HIV and hepatitis C that can occur with intravenous drug use by providing guidance, counseling and tools for safer use of the drugs. The program is operated through Health Brigade. Research shows that people who participate in harm reduction programs are five times more likely to seek treatment than other drug users. The program seeks to provide first contacts and build trust with participants that may lead to less frequent drug use and entry into treatment programs.
“We celebrate and give credit for the work Virginia has done to keep the overdose fatalities from increasing at the rate they were in 2015-2016, yet we know that the reasons for the increase still pose an ongoing challenge,” says Emily Westerholm, Health Brigade's program coordinator, via email. “This report confirms what we see from our participants: The product on the street for the last few years increasingly has become unpredictable, and poly-substance use continues to rise.”
The immediate goals are to provide education; make naloxone available, including in places where it can be used when needed; and build a network of resources to link people who are suffering with substance abuse to the care that they need. It takes time to build that up, says Viray, and that’s why programs such as harm mitigation are needed, to give people the time to work their way into receiving the treatment that they want and need.
That includes practical, targeted education, Westerholm says, such as advising people to keep naloxone not just on hand but in view when using drugs, and to perform a “tester shot” to gauge the potency of a drug.
Naloxone can reverse an overdose, but Viray notes that its effects are temporary and may wear off while someone still has deadly amounts of a substance in their body. The concern, she says, is that people may be using naloxone and not calling 911 after it is administered.
“This is most safely managed in an emergency department setting,” according to Viray.
Westerholm and Viray also note a need for a greater awareness that addiction is a chronic disease, not a failure in character. “We feel that engaging family members and the community to de-stigmatize the condition and its treatment interventions can potentially have the greatest impact in reducing unintentional overdoses,” says Westerholm.
The Richmond Harm Mitigation program has initiated numerous outreach efforts since its beginning late last year. Westerholm says most of its growth has been through referrals from current clients, “which speaks to the value of the services we provide as measured by the participants themselves.”
Richmond and other communities will mark International Overdose Awareness Day on Aug. 29. An event will be sponsored by Health Brigade that day from 3 to 6 p.m. at Lucks Field in Richmond's East End to provide naloxone in the community.
