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Opioid Epidemic

Drug Overdoses Are Decreasing. It May Be Thanks to Naloxone.

Harm reduction groups have been working to distribute naloxone and expand public health services for people who use drugs, contributing to the decrease in deaths.

Lawson Koeppel of Virginia Harm Reduction Coalition assembles naloxone kits in Roanoke, Virginia. The group distributes the kits so people at risk of overdose have access to naloxone, which can save lives if administered quickly. (Photo by Stephanie Klein-Davis for Direct Relief)
Lawson Koeppel of Virginia Harm Reduction Coalition assembles naloxone kits in Roanoke, Virginia. The group distributes the kits so people at risk of overdose have access to naloxone, which can save lives if administered quickly. (Photo by Stephanie Klein-Davis for Direct Relief)

In 2018, life expectancy rose 0.1 years in the United States after three years of declines, thanks largely to a 2.2% decrease in cancer mortality rates, according to new reports from the Centers for Disease Control and Prevention. The CDC data also shows that drug overdoses have decreased for the first time in 28 years, falling from 70,237 deaths in 2017 to 67,367 deaths in 2018, a 4.1% decrease.

The top three leading causes of death in the U.S. remain, in descending order, heart disease, cancer, and unintentional injuries, including car accidents and drug overdoses.

For those on the frontlines fighting the U.S. opioid crisis, the news is welcome, if overdue.

“‘Finally’ was my reaction when I heard about the news,” said Lawson Koeppel, who runs the Virginia Harm Reduction Coalition along with Tanya Segura. “The resources have been there since the 1990s,” he said, referring to naloxone, a drug that reverses the effects of an opioid drug overdose.

Koeppel’s group is one of many throughout the country that has been created during the opioid crisis with the goal of giving out naloxone, which is available as an injectable and as more costly nasal spray known as Narcan, to drug users and those who are close to them.

“Naloxone is the one silver bullet we have for opioid overdoses,” he said.

The Virginia Harm Reduction Coalition has managed to bring down opioid deaths by 42.5 percent over the last 2 years, according to the Virginia Department of Health — news that Koeppel got while sitting in traffic, and which made him cry.

“It was amazing to see a data point that recognized the work that people who use drugs are doing,” he said, deflecting credit from himself and his group.

“We can get naloxone and Narcan out to teachers and nurses all day long, but the vast majority of medicine usage comes from people in the room with people using drugs. People finally have the resources to save their friends,” he said.

Expanding Access and Distribution

But it has not always been easy for groups like Koeppel’s to get the life-saving drug into the hands of those who need it most. Restrictions at the federal and state levels previously limited who could prescribe and distribute naloxone. But today, loosening these restrictions is an official policy U.S. Surgeon General Dr. Jerome Adams. 

“Expanding the awareness and availability of this medication is a key part of the public health response to the opioid epidemic,” reads a 2018 U.S. Surgeon General’s Advisory on the subject.

Koeppel believes that growing support for harm reduction activities has been an outgrowth of the sheer extent of the epidemic.

“It hit so many lives and so finally people knew that their son had died, or they knew a family member or good friend that died [from opioids.] Unfortunately, it takes a crisis to make change sometimes,” he said, citing the AIDS outbreaks in the 1980s as a similar example.

Koeppel also pointed out that reduced drug use and cancer could be linked, citing the connection between hepatitis C and hepatocellular carcinoma. He also noted the “huge overlay” with injection-related drug use and the spread of diseases like hepatitis C, hepatitis A, and HIV.

One example is Scott County, Indiana, where 215 people were diagnosed with HIV between 2011-1015, according to a 2018 Lancet study. Koeppel said 36% of drug users they’ve tested in Appalachian Virginia have hepatitis C. Nationally, a CDC estimate says 1% of the U.S. population has hepatitis C. A 2018 University of Virginia study found links between rising injection drug use and endocarditis, an infection of the heart chamber lining.

Naloxone is packed into kits for distribution by the Virginia Harm Reduction Coalition. The group has contributed to significantly reduced overdose death rates in the state over the past two years. (Photo by Stephanie Klein-Davis for Direct Relief)
Naloxone is packed into kits for distribution by the Virginia Harm Reduction Coalition. The group has contributed to significantly reduced overdose death rates in the state over the past two years. (Photo by Stephanie Klein-Davis for Direct Relief)

Koeppel also argued that sustainable improved outcomes in his field will necessitate further changes in government policy to broaden access to health care for drug users, who are often reluctant to go to clinical settings.

In Virginia, House Bill 791 allowed for needle exchanges, but required the buy-in of local municipalities and police departments. The result was that only four programs were approved, which served 450 people. However, the total number of drug users who injected drugs last year is estimated at 25,000. His group is working to eliminate the local approval element.

Koeppel called these exchanges “entry ramps” for drug users to access health care for themselves. The cost savings for engaging with such at-risk individuals would be substantial if only considering the difference in cost between a syringe — just a few cents — and a heart valve replacement, which often costs six figures.

“This population doesn’t go to the hospital until it’s life-threatening,” he said.

Assessing the national picture, Koeppel said some states are poised to take steps backward, such as West Virginia and Indiana. West Virginia, which has the nation’s highest drug overdose rate, is expected to pass a bill that would place restrictions on syringe distribution, even to the point of making sure the serial number for a given syringe matches a drug user’s identification card. Given recent developments, Indiana could let their syringe bill expire altogether in 2021.

Even as he is buoyed by recent successes in Virginia, as well as nationally, these kinds of restrictive state-level policies frustrate Koeppel, who has seen the life and death stakes of such decisions made by legislators.

“People are dying not just because of drug use, but because of how our society treats people who use drugs,” he said.


Direct Relief, through a donation from Pfizer, has donated 19,100 doses of naloxone to Virginia Harm Reduction Coalition, and 657,920 doses nationwide since 2017.

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