Four times as many people died from opioid, heroin and cocaine overdoses in Roanoke last year as in 2016, and fentanyl was implicated in more than half of those deaths, according to preliminary figures released by the Virginia Department of Health.
“Wow, that’s pretty dramatic,” Dr. John Burton, chairman of emergency medicine for Carilion Clinic, said Monday. “My impression is that we would see some plateauing or a slight increase.”
Statewide, the number of fatalities rose, but at a much slower rate than in previous years. Rates for localities in the New River Valley tracked similarly to 2016, while those in the Roanoke Valley showed significant spikes in deaths.
“As deaths go up, you’d expect the number of resuscitations would go up as well,” Burton said. But Carilion Roanoke Memorial Hospital’s emergency department did not see the same dramatic increase in overdose patients who were revived.
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Burton suspects the potency of fentanyl — an extremely powerful opioid that has been showing up mixed with heroin and other drugs — shortens the time to save someone.
“Depending on the severity of the overdose, if they stop breathing and go into respiratory arrest, the window of time is so small, six to 10 minutes,” he said. “By the time EMS gets there, nothing can be done.”
Fatal drug overdoses in Virginia in 2017
Deaths are counted in the locality in which they occurred. Rates are per 100,000 population.
Source: Virginia Department of Health
Roanoke Fire-EMS Chief David Hoback said he was not surprised by the death rates.
“Sometimes we have three, four, five, six overdoses a day. It’s everywhere in our community,” he said.
People are overdosing in their homes with an infant near to them, in the intersections of streets, in the bathrooms of restaurants or stores, in parking lots.
“They’ll get their fix anywhere they can, and it’s just so sad, because it’s such a strong addiction that you can’t even comprehend the risk they’re willing to take to get high,” Hoback said.
The rise in deaths occurred during the same period that Virginia’s public health officials made naloxone, an antidote to overdoses, available to anyone without a prescription and as the Department of Medical Assistance Services launched a program called Addiction and Recovery Treatment Services to increase the number of providers and types of treatment programs available for Virginians enrolled in Medicaid.
Virginia Secretary of Health and Human Resources Dr. Daniel Carey and DMAS Director Dr. Jennifer Lee on Monday held a news conference to release the results of a Virginia Commonwealth University study that looked at the impact of ARTS in its first five months.
The number of outpatient opioid treatment services that accept Medicaid patients increased from six providers to 108. Some 350 new providers are prescribing medication-assisted treatment, but the report found some areas of the state lacked enough providers to offer the recommended counseling component.
Nearly 14,000 Medicaid clients, a 40 percent increase from the previous year, used addiction-related services.
“The ARTS benefit has expanded the number of service providers in the area that offer medication-assisted treatments,” said Steve Ratliff, division director of adult and family services for Blue Ridge Behavioral Healthcare, the region’s public mental health agency.
“By increasing the reimbursement rates for substance abuse treatment, more providers are available for clients with Medicaid,” he said. “Clients without a pay source still are generally only serviced by public sector agencies.”
Cost has been cited as a barrier for those who cannot afford long-term treatment, the price of medication and residential stays. Gov. Ralph Northam is pushing to expand Medicaid eligibility to another 400,000 Virginians. While the House of Delegates has agreed to expansion, the Senate has yet to concur.
Nancy Hans, executive director of the Prevention Council of the Roanoke Valley, said that there are not enough treatment facilities and they don’t all operate the same way. Some require patients to complete the detox process before entering, for instance. She said it can take weeks before someone finally gets to the top of the wait list. The Hope Initiative, a program in Roanoke that helps people suffering from addiction get into treatment, has had about 150 people sign up, but only a handful actually reached treatment.
Burton said people are often anxious to leave the emergency department out of fear the police will be notified, and that lessens the opportunity for social workers or counselors to reach them.
Carilion, the Virginia Tech Carilion Research Institute and VCU are seeking FDA approval to begin a trial in which patients who do want treatment can start on a long-acting medication to keep them from using while waiting to get into a program.
The trial was developed after VCU looked at 400 opioid patients seen in its emergency room in 2015. Of those who survived an overdose, one in 10 had a repeat overdose or died within six months.
The 2017 drug death numbers released by the Health Department’s Office of the Chief Medical Examiner are preliminary and could rise, as 40 cases from last year are pending final lab results.
Last year, 1,534 Virginians died from any type of drug overdose; of those, 1,227 were opioid-related. The report said that more than half of the deaths involved fentanyl.
The pace of the increase in drug deaths slackened from the previous year. In 2015, 812 Virginians died from opioids. In 2016, that number had jumped to 1,138.
Roanoke, however, logged much higher increases. Overall drug deaths jumped from 17 in 2016 to 49 last year. Opioid deaths went from 10 to 39. Fentanyl contributed to 27 deaths and was involved in seven the prior year. Heroin deaths rose from three to 16.
The number of deaths from drug overdoses that occurred in Roanoke County rose from 16 to 24, and in Salem from six to nine.
“I can’t really say I’m surprised because it’s what I see and do every day,” said Roanoke police Sgt. Andrew Ashby, who oversees the narcotics and organized crime unit. “We’re doing so much with prevention and other efforts like drug takebacks and the Hope Initiative, with the numbers being so high, it’s like, ‘Geez, what’s going on?’ ”
He attributes the increase in fatalities to fentanyl, which is 30 to 50 times more powerful than heroin.
“I think we do a pretty good job of targeting suppliers bringing it in, but it’s just that there are so many that for every one you take off, there are 10 others you didn’t get,” Ashby said.
“Our biggest frustration is when people overdose, they just want to move on,” he said. “They don’t want to tell us where they got it and give up their supplier because they want more, and they’re distrustful of police.”
While the emergency department has not seen a spike on overdose patients, Roanoke Fire-EMS has.
Hoback said overdose calls were up nearly 21 percent last year, and cardiac arrest calls were up more than 30 percent, which he attributed partly to opioid overdoses.
The number of times naloxone was administered was up 167 percent last year compared to 2016, he said.
Sometimes the person will go to the hospital, other times they won’t, he said. For more potent drugs, such as fentanyl, more than one dose might be required.
Hoback said giving naloxone in those cases is similar to “giving aspirin for people in cardiac emergencies.”
“It’s disheartening and discouraging to see people like this, because it’s been building the past few years and I haven’t seen any signs of it slacking off. I don’t know what the solution is,” he said.