State Health Commissioner Marissa J. Levine on Monday declared Virginia’s opioid addiction crisis a public health emergency and issued an order allowing anyone to walk into a pharmacy and buy naloxone, a drug that treats overdoses without a prescription.
The state is grappling with a crisis that has gripped the nation; the number of overdose deaths in Virginia averages three daily, and hospital admissions continue to spike, Levine said in announcing her decision to escalate the administration’s response.
“The consequences of opioid addiction in Virginia have risen to unprecedented levels and can now be classified as an epidemic,” Levine said.
The emergency declaration comes days after U.S. Surgeon General Vivek Murthy released a landmark report declaring drug and alcohol abuse among the nation’s most pressing health crises on equal footing with AIDS and cancer.
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It also comes as increasing numbers of Virginia families prepare for a Thanksgiving meal that a loved one won’t be around to enjoy, state officials noted.
More than 1,250 people in Virginia will likely die of a drug overdose this year, according to projections from the state health department. Drug overdoses surpassed car crashes as the leading cause of unnatural deaths in 2013, and the numbers have only increased, thanks in large part to a surge in opioid abuse. Young adults are the hardest-hit group, a Richmond Times-Dispatch analysis found.
People ages 25 to 44 accounted for more than half of all drug-related deaths from 2007 to 2014 — in large part casualties of the intersection between genetic predisposition to substance abuse and the widespread availability of prescription painkillers, treatment experts say.
“Too many Virginia families have lost someone to opioid addiction,” Levine stated. “These actions today will not diminish their loss, but we owe it to them and each other to work together, watch out for each other and continue to combat the seriousness of this crisis.”
Addressing an issue that affects about one in seven Americans over the course of their lives is “a moral test” for the country, Murthy concluded in the federal report. Only one in 10 of those with substance abuse issues receives treatment, his office found.
Virginia’s overdose death rate has historically trailed those of neighboring states such as Kentucky and West Virginia, “but it’s been increasing in recent years, with recent increases particularly driven by rises in overdose deaths involving heroin and/or illicitly manufactured fentanyl,” said Daniel Raymond, policy director of the Harm Reduction Coalition.
The decision to declare a state of emergency is not unprecedented but is unusual, said Raymond, who advocated for Virginia policymakers to go a step further and establish a safe needle exchange program.
“The public health emergency declaration and statewide standing order is a good move by Virginia to expand access to naloxone and try to reverse overdose mortality trends,” Raymond said. “Syringe exchange programs are highly effective at overdose prevention. ... The lack of legal programs in Virginia makes it challenging to reach those at high risk.”
State officials last year enacted measures to expand substance abuse treatment, but waiting lists at the community services boards that serve as the local point of entry for Virginia’s public system of mental health remain lengthy in many places.
“Obviously, there’s an enormous amount of work that needs to be done — especially for (those without insurance),” said Dr. Jack Barber, interim head of the state Department of Behavioral Health and Developmental Services.
Anything policymakers can do to boost access to comprehensive care that includes counseling and, when needed, medication-assisted treatment, would move the needle in the right direction, said professor Warren Bickel, director of the Addiction Recovery Research Center at the Virginia Tech Carilion Research Institute.
“I see this only as a first step; obviously saving someone from overdosing is great but, unless they have treatment options, they may overdose again,” Bickel said.
The McAuliffe administration said the state’s move comes in response to a growing number of opioid overdoses and evidence that carfentanil, described as “a highly dangerous synthetic opioid used to sedate large animals such as elephants,” has made its way into Virginia.
The incidence of carfentanil has thus far been largely confined to the Hampton Roads area, but Richmond-area authorities are eyeing its emergence with caution, said Richmond police Capt. Michael Zohab.
“It’s so potent it kills people almost immediately,” Zohab said of the substance. “It’s terrifying, but it’s where we are these days.”
More than two dozen people are treated for drug overdoses daily in Virginia and three die, on average, according to state officials. Of those, many have sought help previously, Bickel said.
“One of the things to remember about addiction is that it’s a chronic disease,” he said. “Too often, we treat them acutely and then turn them away.”
The standing order on access to naloxone acts as a prescription for the general public, removing a barrier to access. Those with insurance will be charged the cost of a co-pay. Those without may expect to pay upward of $120 depending on which version of the antidote is on hand, officials said.
The medicine can be injected intravenously, administered through a nasal spray or injected straight into a muscle.
“As we see the nature of drug addiction shift, from prescription opioids to heroin and synthetic fentanyl, we must be vigilant and ready to respond quickly,” said Secretary of Health and Human Resources Bill Hazel.
Authorities welcomed the move but cautioned that applications of the reversal drug should be followed up whenever possible with medical care. Sometimes, emergency responders working in the Richmond area have needed to administer two doses to an overdose victim.
Levine said emergency room visits for heroin overdoses are 89 percent higher for the first nine months of 2016 compared with the same period last year. Drug overdoses were likewise 35 percent higher in the first six months of 2016 than they were in 2015. By the end of this year, the number of fatal drug overdoses is expected to be 77 percent higher than it was five years ago.
State officials also said they have seen a 28 percent increase in the number of hepatitis C cases reported from 2010 to 2015, which they suspect may be driven by a boost in intravenous drug use.
The declaration of emergency was welcomed Monday by the Virginia Hospital and Healthcare Association, which called the proclamation “an important and appropriate step in the ongoing campaign to combat this issue.”
“The human costs of this epidemic are staggering,” association spokesman Julian Walker said in a statement highlighting the health sector’s partnerships with public officials and community groups.