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Opioid Overdose Deaths Plunge in Virginia Counties After Influx of Naloxone

Harm reduction has worked, but causes for concern during pandemic remain.


Opioid Epidemic

A vial of naloxone, which can temporarily reverse an opioid drug overdose. (Photo by Stephanie Klein-Davis for Direct Relief)

Opioid overdose deaths in Roanoke, Virginia, and neighboring counties fell last year, in some cases by more than 66% compared to 2018, after a local harm reduction group received tens of thousands of doses of naloxone — a drug that is able to reverse the effects of opioid overdoses.

The decreases in western Virginia came amidst overall increases in that state of almost 9%, totaling 1,617 deaths, according to preliminary data from Virginia’s Office of the Medical Examiner which was first reported by the Roanoke Times.

Roanoke City saw a 35.29% decrease, Roanoke County saw a 31.25% decrease, while the surrounding countries of Franklin, Botetourt, and Bedford saw decreases of 53.85%, 66.67%, and 20%, respectively. This news follows a 42.5% drop in Roanoke over the last 2 years.

“Those results are amazing. It was impressive to see how big that footprint was,” said Lawson Koeppel, who runs the Virginia Harm Reduction Coalition with Tanya Segura. “Naloxone has changed the conversation and lives in our community,” he said.

For Jarrett Zigon, a professor of anthropology and chair in biomedical ethics at the University of Virginia, the result follows a well-established correlation.

“It’s not surprising at all. Basically, any place that I’ve ever seen data for, where there’s an increase in naloxone access and the distribution of it, the data show a strong correlation to the lowering of overdoses. The surprising thing is that people do not accept this,” Zigon said.

The director of the National Institutes of Health, Dr. Francis Collins, wrote of the same correlation, based on two-year NIH-funded study that examined the association between state laws governing the availability of naloxone and fatal overdoses across all 50 U.S. states and the District of Columbia.

Lawson Koeppel, 42, Executive Director/Co-founder. Virginia Harm Reduction Coalition, loads kits with Naloxone in his Roanoke office located in an old motel, to pass out to the community to help save lives. Lawson describes a way to check someone who has overdosed by rubbing them hard on the sternum before using the Naloxone. (Photo by Stephanie Klein-Davis for Direct Relief))
Lawson Koeppel, executive director and co-founder of the Virginia Harm Reduction Coalition, loads kits with naloxone in his Roanoke office located in an old motel, to pass out to the community to help save lives. Lawson describes a way to check someone who has overdosed by rubbing them hard on the sternum before using the naloxone.  Photo taken on August 23, 2019. (Photo by Stephanie Klein-Davis for Direct Relief)

One of the key reasons for the success of the Virginia Harm Reduction Coalition, beyond being the foremost distributor of free naloxone in the Roanoke area, has been its ability to do mobile outreach. However, because of the Covid-19 pandemic, the group has been hampered in its ability to connect with drug users at the locations where they tend to use drugs.

“That’s what the fun part is, going out and meeting people, and being engaged with the community,” Koeppel said. “It’s just not responsible for us to do that now.”

While they are unable to do mobile outreach, Koeppel said his group has been able to pivot, and now ships out packages across the state. For those who are experiencing homelessness, Koeppel said the group ships to volunteers who then distribute the lifesaving drug to those who need it.

In addition to continuing its core mission, the Virginia Harm Reduction Coalition has also taken on a new role during the pandemic, working with health department officials in the New River Valley region to conduct Covid-19 testing. The group has a Clinical Laboratory Improvement Amendments Certificate of Waiver from the CDC for their mobile van, which is now being used to do serology blood tests to check for Covid-19 antibodies.

The nonprofit also started administering nasal swab tests in Roanoke last week. The tests have been given to people who use drugs and people experiencing homelessness. They have done 111 tests to date. One person has tested positive.

Though his group has shifted to help in a new way, Koeppel said, the opioid crisis is still “totally” in effect, and that new problems have emerged. Because Covid-19 has shut down transport hubs, Koeppel theorizes that drug strength as increased, to make up for the reduced quantity — something he referred to as the “bootlegger’s formula.”

“We’ve got stronger drugs in the state now,” he said.

Zigon believes that, pandemic or not, a key to combating the opioid crisis remains in pursuing harm reduction policies, which he said enables drug users to make connections with harm reduction providers who can give the users information, naloxone, and an entry path to further care options.

“Harm reduction’s goal is to get people to use safely, to meet them where they’re at,” Zigon said. “What it doesn’t do is get people to stop using, however, statistics suggest that abstinence-based programs have a strong correlation with drug overdoses.”

“This is the best there is,” Zigon said, referring to harm reduction programs.

Like Koeppel, Zigon sees reason for concern as the opioid crisis gets drowned out by the Covid-19 crisis.

“It seems like we go from one crisis to the next these days, except that the opioid crisis didn’t go away, it’s just getting ignored now,” he said, noting that funds that were once earmarked for opioid abuse treatment will likely be diverted to other, pandemic-related uses. “I suspect it’s only going to get worse. Addiction is often called a disease of loneliness and there are a lot of lonely people now.”

In his community, Koeppel has hope that the positive trends will continue, assuming access to naloxone continues.

“The saturation of naloxone, at a base level, is what saved lives. Two years ago when I said naloxone, no one knew what I was talking about. Now, it’s part of our culture here.”

He also credited a local hospital’s bridge program with helping reduce deaths. Under the program, people who come to the emergency room after an overdose are immediately treated with suboxone. They are also scheduled with an appointment for outpatient services. Koeppel said the hospital’s bridge program has contributed to an increase in buprenorphine, a drug that helps combat opioid addiction.

While harm reduction and bridge programs in Roanoke have been successful in recent years, Zigon believes that a different perspective is needed to remedy the opioid crisis longterm.

“The real cause of the opioid crisis is peoples’ lives have become lonely, have become meaningless, and they have lost connections with the community. Only when those things are addressed will the opioid crisis come to an end,” Zigon said.

Direct Relief has supported the Virginia Harm Reduction Coalition with 28,100 doses of naloxone to date, including 12,900 doses in 2019. Direct Relief shipped 451,650 doses of naloxone nationally in 2019. 

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