NORFOLK, Va. — The number of people who died from drug overdoses rose to 2,656 deaths in Virginia in 2021, setting a record for the state for the second year in a row, and fentanyl continued to be the driving force behind the spike.
In 2020, overdose deaths jumped 42% from the year before. While 2021 didn’t quite keep up with that pace, overdose deaths increased by another 15%, or 347 deaths, according to a report released by the Virginia Department of Health.
Fentanyl, a powerful synthetic opioid, caused or contributed to 76.5% of all overdose deaths in 2021, up 4.4% from 2020.
Fentanyl has proven a particularly deadly problem in part because a small amount can be very potent and drug traffickers are mixing it in other drugs to make them easier and cheaper to manufacture and transport, said Rosie Hobron, the statewide forensic epidemiologist with the Office of the Chief Medical Examiner and the author of the VDH report.
“If you look at it from a drug dealer perspective ... putting it into pills and selling it as other things or mixing them with other drugs is a very cheap addition to make your drugs very potent,” Hobron said.
In Hampton Roads, Norfolk and Virginia Beach reported the highest number of drug overdose deaths last year but Portsmouth had the highest fatal overdose rate in the region. It also saw the biggest yearly increase in the rate of overdose deaths attributable to opioids — from 52.6 deaths per 100,000 residents in 2020 (the highest in the region) to 95.7 in 2021.
Portsmouth’s rate of fatal overdoses from just fentanyl increased from 48.3 per 100,000 residents in 2020 to 90.4 in 2021 — both the highest rates in Hampton Roads.
The total number of fatal drug overdoses in 2021, fentanyl overdoses, and the city’s total drug overdose rate per 100,000 residents are included below:
—Chesapeake - 52 deaths, 45 fentanyl deaths, 21.1 drug overdose rate.
—Hampton - 52 deaths, 48 fentanyl deaths, 38.4 drug overdose rate.
—Isle of Wight County - 6 deaths, 2 fentanyl deaths, 15.9 drug overdose rate.
—James City County - 6 deaths, 4 fentanyl deaths, 7.7 drug overdose rate.
—Newport News - 75 deaths, 66 fentanyl deaths, 41.9 drug overdose rate.
—Norfolk - 127 deaths, 114 fentanyl deaths, 52.3 drug overdose rate.
—Poquoson - 4 deaths, 3 fentanyl deaths, 32.6 drug overdose rate.
—Portsmouth - 94 deaths, 86 fentanyl deaths, 98.8 drug overdose rate.
—Suffolk - 29 deaths, 27 fentanyl deaths, 30.9 drug overdose rate.
—Virginia Beach - 119 deaths, 86 fentanyl deaths, 26.4 drug overdose rate.
—Williamsburg - 2 deaths, 1 fentanyl deaths, 13.1 drug overdose rate.
—York County - 6 deaths, 5 fentanyl deaths, 8.7 drug overdose rate.
Charles Wilcox, regional vice president and board member of the Northern Region Virginia Association of Addiction Professionals, said lack of access to mental health and addiction treatment facilities is the largest predictor of outsized impacts of the opioid crisis.
“If the mental situation is getting worse, people are going to try to get help,” Wilcox said, pointing to the COVID-19 pandemic as a major factor in worsening mental health across the board. “And the help they’re going to get is the help they can afford, so the rich people are going to go to addiction treatment centers, and the poor people are going to go to the street and get drugs. And if the drugs are laced with fentanyl, they’re going to die.”
Jesalyn Moore, a former substance abuse counselor with the Portsmouth Naval Hospital and now the clinical director at Pyramid Healthcare in Newport News, said that lack of access is one reason for the higher overdose death rates attributable to opioids in Portsmouth. Structural racism and health inequities also exacerbate the effect of the opioid crisis in communities of color, she said.
“If you go into Portsmouth you will see some pretty depressed neighborhoods, there’s an incredibly devastated amount of resources, the resources that they have are completely maxed out,” Moore said. “Some of the other facilities don’t take Medicaid, which is going to make up a huge portion of Portsmouth residents.”
Portsmouth did see an uptick in substance use during the pandemic — and has been working to fight the opioid crisis in a number of ways, including increasing access to mental health services, according to Nathan Woodard, director of Behavioral Healthcare Services for the city. One option available is the Same Day Access program — offered in cities across Hampton Roads and the commonwealth — which allows residents to walk in off the street to see a licensed clinician, see how compatible they are with various services, and charges them on a sliding scale based on what they can afford.
Staffing and hiring are also part of the ongoing addiction treatment challenges. Moore explained that she’s had trouble hiring peer support specialists — people recovering from drug addiction who have taken the steps to be able to treat others — because of strict state laws on “barrier crimes” that keep people from being hired if they have certain past offenses. Staffing shortages have been caused in part by the increase in demand since the pandemic and less students going into related fields, Woodard said, though the city is taking steps to attract and retain new staff.
“Just because we were still in a pandemic, the opioid crisis never went anywhere,” Woodard said. “Persons started to lose jobs, had family members die, there was a sense of hopelessness as a result of COVID and not knowing what tomorrow may bring which brought on a lot of other mental health issues.”
The potency of illicit drugs being sold on the street is also a factor of concern, according to Hobron. Of particular note are illicitly pressed pills, which Hobron said are “indistinguishable” from legitimate prescription opioid pills and are being sold on the street as drugs like Xanax or oxycodone. She added that these illicitly produced pills often do not contain the same amounts of ingredients within the same batch, so just because one pill does not have fentanyl in it doesn’t mean that another won’t have a lethal amount.
Fentanyl is frequently detected in other drugs. Of the 801 fatal cocaine overdoses in 2021, 84% also involved fentanyl (2.5% more than in 2020), and of the 549 fatal methamphetamine overdoses, 66% involved fentanyl (1% more than in 2020), according to Hobron.
Experts have theorized the instability in unemployment and lack of access to in-person addiction treatment — in addition to the myriad other challenges brought on by the pandemic — caused the uptick in drug usage, but Hobron noted there has not been a corresponding uptick in suicides. This, she said, suggests that it may not be the rate of drug use that is changing, but rather the potency of the available drugs.
“People were very stressed and had a lot of struggles during the pandemic and you would assume that there would be an increase in suicide, but we didn’t see that,” Hobron said. “It was relatively flat ... and suicide has many of the same risk factors as drug use.”
Traditional remedies for overdoses are proving less effective against fentanyl, making it more difficult to save those who overdose, Hobron said. She explained that it can take multiple doses of the opioid overdose reversal treatment Narcan to bring someone out of a fentanyl overdose because it has a half-life that is longer than that of Narcan.
“So you’ll see people that are overdosing, they get a dose of Narcan, they come out of it, and then a little bit of time passes and they go back into an overdose because the Narcan has worn off,” she said.
One way to address the fatalities caused by fentanyl is to distribute fentanyl test strips which would let drug users know if the substance they’re about to consume contains traces of fentanyl, but state leaders have been reluctant to employ harm reduction strategies, Moore said.
Woodard said Portsmouth is working on distributing fentanyl test strips and educating the public on using them in the same way they have with Narcan, but could not provide a specific timeline on when that would begin.
“I’ve seen a lot of hardened hearts against [drug users from people saying] ‘Well, it’s a behavior, why would we enable them with harm reduction strategies?’” Moore said. “The perception is that it’s a ‘them’ issue so to those in charge and in power it’s not an ‘us’ issue.”
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