Include a byline with the reporter’s name and Direct Relief in the following format: "Author Name, Direct Relief." If attribution in that format is not possible, include the following language at the top of the story: "This story was originally published by Direct Relief."
If publishing online, please link to the original URL of the story.
Maintain any tagline at the bottom of the story.
With Direct Relief's permission, news publications can make changes such as localizing the content for a particular area, using a different headline, or shortening story text. To confirm edits are acceptable, please check with Direct Relief by clicking this link.
If new content is added to the original story — for example, a comment from a local official — a note with language to the effect of the following must be included: "Additional reporting by [reporter and organization]."
If republished stories are shared on social media, Direct Relief appreciates being tagged in the posts:
Unless stated otherwise, images shot by Direct Relief may be republished for non-commercial purposes with proper attribution, given the republisher complies with the requirements identified below.
Maintain correct caption information.
Credit the photographer and Direct Relief in the caption. For example: "First and Last Name / Direct Relief."
Do not digitally alter images.
Direct Relief often contracts with freelance photographers who usually, but not always, allow their work to be published by Direct Relief’s media partners. Contact Direct Relief for permission to use images in which Direct Relief is not credited in the caption by clicking here.
Do not state or imply that donations to any third-party organization support Direct Relief's work.
Republishers may not sell Direct Relief's content.
Direct Relief's work is prohibited from populating web pages designed to improve rankings on search engines or solely to gain revenue from network-based advertisements.
Advance permission is required to translate Direct Relief's stories into a language different from the original language of publication. To inquire, contact us here.
If Direct Relief requests a change to or removal of republished Direct Relief content from a site or on-air, the republisher must comply.
For any additional questions about republishing Direct Relief content, please email the team here.
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.
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.