‘Flattening the curve’ of overdose deaths in Virginia

By Eisha Jain, Hunter Hewlett, Natalina Contoreggi, Caitlin Womack, Kevin Parham

Since the emergence of the novel coronavirus, Americans have been subjected to a crash course in epidemiology. Phrases like “percent positivity” and ‘flattening the curve,’ once academic, are now common vernacular. Given our community’s newfound education in public health science, we should be gravely concerned about another growing epidemic: a profound rise in drug overdose-related deaths in the United States, and in Virginia, over the last several years.

For the first time in history, annual overdose deaths in the United States reached 100,000 last year, marking a 28.5 percent increase from 2020 to 2021. In Virginia, fatal fentanyl and/or heroin overdoses increased 58.6 percent from 2019 to 2020, with 2021 numbers predicted to be even higher. If this trend continues, the Virginia Department of Health predicts Virginia to suffer the loss of over 2,600 residents from overdose deaths annually.

The federal government and localities across the US have been directing resources towards this epidemic by improving access to substance use facilities, medication-assisted treatment and overdose reversal agents. Naloxone is a life-saving medication that instantly reverses opioid overdose by displacing opiates from their receptors in the human brain, preventing death from overdose. Virginia has developed a program called REVIVE! that trains first responders and community members across the state in Naloxone administration and, in collaboration with the Virginia Department of Health and local pharmacies, distributes naloxone for free or little cost.

We are a group of students at the Virginia Commonwealth University School of Medicine who have seen the efficacy of naloxone in the hospital and emergency room to rapidly reverse overdose events. By introducing this life saving medication into the hands of the most vulnerable across our state, we feel confident in the REVIVE! Program’s potential to help combat the opioid epidemic in Virginia.

An evaluation of the REVIVE! Program was published in 2020 by the Virginia Association of Chiefs of Police and the Center for Urban and Regional Analysis at L. Douglas Wilder School of Government and Public Affairs. This study and its 2021 update found that the REVIVE! Program has likely contributed to a slowed rate of growth in statewide overdose deaths from an average yearly growth rate of 8 percent from 2012-2015 to only 5 percent from 2017-2019, when the REVIVE! Program took flight, and prior to the COVID-19 pandemic. Even steeper reductions were found in the localities with the greatest numbers of REVIVE!-trained first responders.

The findings of this report also suggest that there are clear areas of opportunity for improvement of the REVIVE! Program. Several Virginia localities with high rates of overdose deaths have low numbers of REVIVE!-trained first responders. Just as we learned of the value of COVID-19 testing resources in communities of greatest transmission, communities at greatest risk of overdose events need access to resources like naloxone to save lives. Naloxone administration training and distribution events directed towards communities with the highest rates of overdose events could be one of the most impactful ways to reduce overdose events in Virginia. In other words, better resource allocation could save lives.

Finally, the VACP report also reveals that there is a scarcity of data to assess one of the biggest public health disasters of our time. COVID taught us of the importance of robust data-gathering mechanisms in identifying and addressing at-risk communities. Likewise, we need improved data collection to identify communities that are most vulnerable to the spread of illicit opioids. Only then can we develop effective interventions on a statewide level.

As medical students, we have seen firsthand the effects of these twin epidemics on our hospitals. To combat this, we ask our policymakers to escalate their response. The VACP’s impact evaluation is one of the few pieces of evidence-based analysis we have in our arsenal. We hope to amplify its finding that the REVIVE! Program works, but only where there are sufficient training events. The brisk pharmacologic utility of naloxone must be met by increased availability and more trained administrators who are confident in using the lifesaving antidote successfully and in areas of greatest need.

We ask both civilians and politicians to put further pressure on the new Virginia administration to treat this problem like the disaster it is. As Americans grow weary of the ongoing COVID-19 pandemic, we risk oversight of another that also demands our attention. We ask that our community use the lessons learned from COVID-19 to “flatten the curve” of overdose deaths.

The authors are medical students at VCU School of Medicine in Richmond.