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In Colonial Heights, 93 Opioid Pills For Every Resident Each Year

VCU CNS | December 24, 2019

Topics: Chris Herren, Colonial Heights, Mark Herring, opioid addiction, opioid crisis, opioids, Purdue Pharma

From 2006 to 2012, pharmacies and physicians in Colonial Heights received 93 opioid pills per person per year — the highest amount in the Richmond metro area.

Between 2006 and 2012, more than 71 million opioid pills flowed into Henrico County. For the county’s 320,000 residents, that represented about 32 pills per person per year.

During the same time period, pharmacies in Petersburg, whose population is 32,000, received more than 10 million opioid pills — or about 45 pills annually for each city resident.

But Colonial Heights ranked No. 1 in opioid sales in the Richmond metropolitan area. From 2006 to 2012, nearly 11.4 million flooded into the city of about 17,500 people. That works out to 93 pills per capita each year.

Those numbers, computed by Capital News Service from data put online by The Washington Post, illustrate the widespread availability of highly addictive pain medication. That was a major contributor to the opioid epidemic that has gripped Virginia and the U.S., according to critics of the pharmaceutical industry. Since 2007, more than 5,400 people in the commonwealth have died from overdoses of prescription opioids.

Virginia Attorney General Mark Herring is taking legal action against pharmaceutical companies. He is part of a multistate investigation to determine if drug distributors and manufacturers engaged in unlawful practices in marketing and selling opioids.

The Washington Post went to court to get the U.S. Drug Enforcement Administration’s Automation of Reports and Consolidated Orders System database. The newspaper is fighting to get more recent data. It is unclear whether the DEA has data after 2014.

Among other things, the data available showed that two Virginia cities — Norton and Martinsville — received the most opioid pain pills per capita in the country between 2006 and 2012. (On an annual basis, Norton got 306 pills per person, and Martinsville received 242 pills per person.)

“This new data just reinforces what we’ve long known: The roots of this crisis run through American medicine cabinets into the boardrooms and marketing offices of pharmaceutical companies, and they need to be held accountable,” Herring said after the newspaper posted the data.

“So many families in Virginia and around the country have experienced unimaginable loss because of the negligence and greed of opioid manufacturers and distributors. In Virginia, we have taken a multifaceted approach to the crisis that has emphasized treatment and prevention alongside enforcement and accountability for pharmaceutical companies and traffickers.”

Statewide, nearly 1.6 billion prescription pain pills were supplied to pharmacies and doctors in Virginia from 2006 to 2012 — about 29 pills per person per year.

The Richmond metro area as a whole was around the state per capita. The population in 2010 was 1.2 million, and the area received almost 238 million opioid pills — about 28 pills per person annually over the seven-year period.

But the per capita numbers varied widely among the four cities and 13 counties that make up the metropolitan area:

  • Colonial Heights (93 pills per person per year) and neighboring Hopewell (52 pills) had the highest numbers.
  • Chesterfield County (29 pills) and Richmond (23 pills) were in the middle.
  • Dinwiddie and Prince George counties had the lowest numbers (about 4 pills per person per year).

About 46 percent of all pills sold in the Richmond area were manufactured by SpecGx, according to a CNS analysis of the data. Actavis Pharma made about 28 percent of the pills, and Par Pharmaceutical 12 percent.

The Richmond market was dominated by three sellers: CVS and Walgreen, which each dispensed about 53 million pills, and Rite Aid, which sold 25 million. Combined, pharmacies operated by these three companies sold 55 percent of the opioid pills in the Richmond metro area, the data showed.

In 2018, Herring sued Purdue Pharma, the makers of OxyContin, saying the company had helped create and prolong the opioid epidemic in Virginia. Herring said the lawsuit, which is still active, produced evidence that Purdue “pushed nearly 150 million opioid pills and patches into the Commonwealth of Virginia between 2008 to 2017.”

Herring’s suit alleges that Purdue Pharma misrepresented the risk of addiction to prescription opioid and launched a “multifaceted campaign of deception” to promote its products. The company knew many doctors were overprescribing opioids, the suit claimed, and yet “Purdue sales representatives continued to aggressively and deceptively market opioids directly to them.”

In addition to Herring’s lawsuit, dozens of cities and counties in Virginia have sued Purdue Pharma on grounds that opioid abuse has cost local governments millions of dollars. Facing thousands of lawsuits nationwide, the company declared bankruptcy in September.

None of the localities in the Richmond area has joined in taking legal action against opioid drug manufacturers, distributors or sellers.

However, Colonial Heights is addressing the issue in another way — by annually holding a Regional Heroin and Opiate Summit. The fifth iteration of the event was Oct. 15 and featured former basketball star Chris Herren.

Herren got hooked on OxyContin and other opioid painkillers while playing for the Boston Celtics. That led to his use of heroin — and to the end of his NBA career. Herren went through rehab and now travels the country, warning about the dangers of opioid abuse.“This crisis doesn’t discriminate. It’s in every community. It’s in every neighborhood,” Herren has said. “My whole purpose in this is to break that stigma … and eliminate the rock bottoms.”

Written by Andrew Riddler and Sravan Gannavarapu, Capital News Service. Top Photo by Haley Lawrence on Unsplash.

As Hospitals Monitor Drugs, Opioid Deaths See Decline

VCU CNS | May 6, 2019

Topics: addiction, drugs, HEALTH, hospitals, News, opioid, opioid crisis, opioid death, overdose, overdose in virginia, politics, virginia hospitals

Virginia hospitals are monitoring painkiller prescriptions more closely and taking other steps to curb the opioid epidemic, and the efforts may be paying off: Drug overdoses in Virginia have dropped for the first time in six years.

In 2016, the opioid epidemic was declared a public health emergency in Virginia. Fatal opioid overdoses increased steadily from 572 in 2012 to 1,230 in 2017. Last year, however, the number of deaths dipped, to 1,213, according to preliminary statistics released this week by the Virginia Department of Health.

The decrease coincided with data from the U.S. Centers for Disease Control and Prevention showing a decline in overall prescriptions of opioids — and with moves by Virginia officials and physicians to apply more scrutiny before issuing such prescriptions.

Dr. Charles Frazier, senior vice president at Riverside Health System in Newport News, said his medical practice and others across Virginia are prescribing narcotics in a more controlled and efficient way.

Frazier was involved in the creation of Virginia’s Emergency Department Care Coordination program.

Established by the General Assembly in 2017, the EDCC’s purpose is to “provide a single, statewide technology solution that connects all hospital emergency departments in the Commonwealth” for the purpose of extending and improving patient care, according to ConnectVirginia, a statewide health information exchange.

“The purpose of the EDCC is to integrate alerts,” Frazier said. “It shows us alerts of whether or not they (patients) have been in other emergency departments, information on how they were treated, with the idea being if a patient came in: Who is their primary care doctor? Who can we connect them to?”

Frazier said that in the program’s first phase, all hospitals in Virginia were required to submit a year or two of historical patient visit data to the EDCC information exchange by June 2017.

“The system is set up to alert emergency department providers and staff if the patient is a frequent emergency department patient, and also if they have been aggressive or abusive to staff,” Frazier said.

Frazier said that most of the time, the system is used to direct patients to proper care.

“I think part of the problem is if people have a hard time with transportation, they go to the ER for basic health care,” Frazier said. “If you go to the emergency room for a sore throat, for example, that can be expensive.”

The second phase of the EDCC, which was implemented last July, involves notifying primary care doctors if their patient is in the emergency department. If the system can identify a patient’s primary care doctor, it will send an alert.

“One thing we are starting to see are health systems collaborate on patients,” Frazier said. “There was a patient at Bon Secours who kept going to various emergency departments around Richmond — VCU, St. Francis, and others. With the EDCC program, they could see where they had been to, and the health systems worked together, along with the insurance company, to help the patient get the primary care they needed.”

PHOTO: VCU CNS

Virginia’s Prescription Monitoring Program

Gov. Ralph Northam, a physician himself, helped create the EDCC. He also has been an advocate for the state’s Prescription Monitoring Program.

Under that program, Frazier explained, “Every time a pharmacy prescribes a controlled substance, they need to submit the information to the state — the duration, the dosage — and the system tracks how many times and how many providers have prescribed to the patient.”

Virginia Board of Medicine regulations require seeing chronic pain patients every 90 days and conducting drug screens to make sure patients are taking their medications and not taking illicit substances. Regulations also require prescribing an opioid antidote in certain high-risk situations.

“If you’re treating someone with higher dosages, the regulations outline preventative measures for overdose,” Frazier said.

Opioid overdose fatalities decline

Health officials’ concerns about opioids have grown as fatal overdoses spiked over the past decade. Preliminary numbers show that 1,484 people died from drug overdoses in Virginia in 2018. That is more deaths than from guns (1,036) and traffic accidents (958).

The total number of overdose fatalities was down slightly from 1,536 in 2017.

The vast majority of drug overdose deaths involve opioids. Of the 1,230 opioid-related fatalities last year, about 460 involved prescription medications and the rest involved heroin and/or fentanyl.

The number of prescription opioid deaths dropped from 507 in 2017 to 457 last year. On the other hand, deaths from heroin and/or fentanyl jumped from 940 to 977.

‘These numbers should give us some optimism’

In a press release, Attorney General Mark Herring thanked “advocates, families, doctors, recovery communities, elected officials, public health professionals and others who have helped reduce Virginia’s number of fatal drug overdoses for the first time in six years.”

Herring has been a strong advocate for fighting the opioid epidemic. He has taken a range of actions — from pushing to expand the Prescription Monitoring Program, to producing a documentary titled “Heroin: The Hardest Hit,” to suing Purdue Pharma, the creator of Oxycontin, on grounds that it helped create and prolong the opioid epidemic in Virginia.

“We should be heartened and hopeful to see that overdose deaths seem to have plateaued and may be starting to decline, but nearly 1,500 overdose deaths, mostly from opioids, is still a staggering number that shows this epidemic is far from over,” Herring said.

“But these numbers should give us some optimism that Virginia’s comprehensive approach — emphasizing treatment, education, and prevention, along with smart enforcement — can produce results and save lives.”

PHOTO: Virginia Department of Health via VCU CNS

New controls on opioid prescriptions

Frazier said the biggest impact on the opioid epidemic might stem from rules imposed last year by the Virginia Board of Medicine.

“Across the state,” Frazier said, “we’ve seen a decrease in the number of opioid prescriptions and the duration of treatment for acute pain — a tremendous difference.”

Frazier said opioids sometimes are appropriate and sometimes aren’t.

“There are people who break their leg and need it for a few days, but for people who have chronic pain, they may require ongoing opioids for a long time,” he said. “While we first try non-opioid therapies, the reality is sometimes opioids are the most effective treatment for chronic pain.”

Patients can self-administer pain relief

When opioids are appropriate for treatment, health care professionals want to ensure that patients can receive their medication safely and easily. Virginia Commonwealth University Medical Center Hospitals have a specific technique allowing patients to self-administer drugs.

Samantha Morris, a care partner at the center’s Emergency Department, said narcotics can be administered directly to a patient, by the patient, with the press of a button. This involves a device called a patient-controlled analgesia pump.

“Fentanyl is usually what I see being prescribed the most, and that one is usually administered through a PCA pump,” Morris said. “It delivers some form of narcotic, usually fentanyl, and the patient presses a button to administer themselves a dose every five to ten minutes, depending on the drug.”

The amount of time a dosage from the PCA pump can be administered is based on the strength of the drug prescribed.

“I see patients mostly in the burn victim unit because they’re in a lot of pain,” Morris said.

Morris said she sees patients come in for opioid-related incidents all the time.

“It’s really difficult, because if a patient is addicted to any kind of substances, whether it’s amphetamines or any kind of narcotic to begin with, we can’t administer pain management, because it’s not going to affect the same pathway.”

Health Brigade Establishes Virginia’s Second Needle Exchange Program in Richmond

George Copeland, Jr. | October 17, 2018

Topics: addiction, community resources, health brigade, needle exchange, opioid crisis

Richmond’s newest campaign to offer intravenous drug users safer resources and greater care quietly kicked off this week, on Monday night in the Museum District. Led by Health Brigade, the group began its Comprehensive Harm Reduction Program, which includes a needle exchange program — the second of its kind in Virginia so far.

Established in 1970 as Virginia’s first free clinic, Health Brigade (originally Fan Free Clinic) will now provide drug users with clean equipment to ensure that fatal diseases transmitted through the blood aren’t spread. Besides this service, Health Brigade will also be collecting and disposing of used needles, referring drug users to substance use treatments and testing for HIV and Hepatitis C, among other services. Health Brigade’s needle exchange program joins 185 similar programs, operating in 38 states across the US.

The treatment and prevention of HIV and Hepatitis C was a focal point of Health Brigade’s recent news release. Noting the opioid crisis that “continues to impact Richmond metro region, and the State of Virginia,” the release stressed the importance of the program — not just for the safety of drug users, but “for first responders, law enforcement, and community members.”

Hepatitis C infections in Virginia have risen to nearly 11,500 cases, an increase of almost 56 percent since 2013, according to data released by the Virginia Department of Health in 2017. It was this rise in infection that led to Virginia’s first needle exchange program being set up in Wise County this summer, after legislation authorizing the creation of these programs was approved in the General Assembly last year.

To date, only 55 localities in the Commonwealth are eligible to apply, thanks in part to resistance by state law enforcement agencies, who serve a critical role in the application process.

Harm reduction programs have proven to be a boon for the communities they’re introduced in. Contrary to concerns from local law enforcement, data has shown that these programs don’t increase drug usage, but instead increase the possibility of users seeking treatment, in addition to decreasing potential harm for officers from needle stick injuries.

How Richmond’s drug users will ultimately respond to the program remains to be seen, with Health Brigade Communications Coordinator Julie Sulik saying that it’ll be awhile before they’ll be able to share the results of their efforts with the public. 

Fighting the Opioid Crisis in Southwest Virginia

Jo Rozycki | July 30, 2018

Topics: governor ralph northam, naloxone, narcan, opioid addiction treatment, opioid crisis, remote area medical

“Hi, would you like to be trained in administering Naloxone?”

The pharmacy student was standing under the bleachers of the Wise County Fairground during the Remote Area Medical clinic, held last weekend, with a blue medical kit in hand. Admittedly, I had never heard of Naloxone, the opioid overdose emergency medication sold under the brand name Narcan. My interest was piqued and 15 minutes later, I gained the knowledge of how to recognize someone in an overdosed state, how to administer the lifesaving drug either intranasally or intramuscularly, and was also given two free doses of Naloxone.

For reference, a single dose of the injectable Naloxone costs upwards of $4,000 out of pocket.

Photo by Jo Rozycki

Sarah Melton, professor of pharmacy practice at the Gatton College of Pharmacy at East Tennessee State University brought her students from the pharmacy school to train healthcare professionals, volunteers, and patients about Naloxone through a program called Revive! where the pharmacy students provide training. With guidance from Michele Thomas, pharmacy services manager at the Department of Behavioral Health and Developmental Services, over 300 people were trained over the weekend on how to save someone’s life with Naloxone.

Melton and Thomas explained the importance of the overdose-reversing drug, additionally providing some important numbers surrounding the epidemic.

“It works essentially by competitive inversion,” said Thomas. Once they enter the body, opioids attach to the receptors in your brain and mimic natural opioids produced in your body. These powerful connections made by the artificial opioids are hard to disconnect because they “fool” the brain into releasing dopamine, the brain’s pleasure, and reward neurotransmitter.

This basically creates a powerful addiction due to the overwhelming release of dopamine. “[Naloxone] has a higher adherence to the receptor than an opiate or pain medication does,” said Thomas, thus knocking the opiate off the brain receptor and giving a bystander precious minutes to call emergency services. Narcan starts to take effect within 30-45 seconds of administration and lasts for around 30-45 minutes.

Gov. Ralph Northam’s appearance at the RAM clinic posed as an excellent opportunity to address the crisis. With the year almost halfway through, Northam has to look ahead at the coming months to lower the rate for 2018. “Number one is to have the resources to be able to staff our community service boards and make sure that people can get into same-day access,” he said in a one-on-one interview with RVA Mag. He acknowledged that this is an issue that demands public awareness, not strictly professional or administrative. “One last thing I would say is making sure that we have access for families, for first responders to Narcan or Naloxone.”

Governor Ralph Northam with RAM founder Stan Brock. Photo by Sarah Kerndt

After the state health commissioner announced the opioid crisis a public health emergency, a growing concern within the opioid crisis conversation is that the rate of use and the subsequent fatality rate is growing. Compared to 2016, the number of lives lost to opioid use in 2017 grew from 1,138 to 1,227. Virginia received a $9.7 million grant to combat the opioid crisis in May of this year, according to a press release from Gov. Northam. Virginia was also selected for the National Governor’s Association project to combat the opioid crisis.

Although exact numbers are still coming in, it has been confirmed that more than 10,000 cases of Hepatitis C were reported in Virginia. In 2015, Virginia reported 8,138 cases of chronic Hepatitis C, and 956 new HIV cases, all attributed alone to injectable drugs, such as heroin. According to the surgeon general, “over 40 percent of people with a substance use disorder also have a mental health condition, yet fewer than half (48.0 percent) receive treatment for either disorder.”

Southwest Virginia, specifically Wise, has seen a spike in opioid cases. In the last year, fatalities rose by more than 33 percent in the county. When asked about why the region has such a high epidemic rate, Melton answered frankly. “Southwest Virginia is kind of unique because we have a lot of coal mining industry workers, so we have a lot of chronic pain injury,” she said. “But when Purdue Pharma came out with Oxycontin in the early 2000s, it was very much marketed in Southwest Virginia as a medicine that would be effective for pain that wouldn’t cause addiction.”

Within a week of it entering the market, pharmacists knew Oxycontin was addictive. Melton added that several factors play into the high addiction rate specifically for the southwestern area, including genetic disposition for addiction, sociocultural linkage with poverty and unemployment, and the rate of chronic pain due to common industries. It is important to note, however, that these aren’t the only factors that contribute to the chance of addiction: addiction can happen anywhere and to anyone.

“The recognition that this is a disease,” said Thomas, helps legitimize the addressing of this problem and disqualifies it simply as a social choice. “This is not something people do purposefully.”

Photo by Sarah Kerndt

The personal aspect of addiction rings loudly within the community. “We hear one story after the other about ‘If I had had this training six months ago, I could have saved my husband,’” said Melton. “It is heartbreaking when you hear that.” That is why, she said, they want to come to clinics like RAM and provide free training and doses for anyone to obtain. “We’re trying to make sure people have access to the Naloxone at no cost.”

An epidemic of this magnitude seemingly has countless solutions. But Melton and Thomas broke it down to two: education and training. “We have to educate people, train them, and then provide the resources that folks need,” said Thomas. “Our goal is once they’re safe from an overdose, if they have an overdose, when they get treated in the emergency room, they have peer recovery specialists there or case managers that are able to integrate them into treatment the next day,” added Melton.

Obviously, wrap-around services like this require financial resources, but, Melton said, they are working to address that through legislation. “We work closely with the legislators, especially on medication-related bills. We now have safe syringe exchange in Virginia. Who thought we’d ever have that this soon?”

If you or someone you love is battling an opiate addiction, visit the Virginia Department of Behavioral Health and Developmental Services office of recovery services or mental health services. To find out more about Naloxone training and how to receive Naloxone, visit here. If you happen upon someone who has overdosed, please call 911.

The Rise of an Epidemic: Opioids, Their Impact on Virginians, and Efforts to Combat the Growing Crisis

Nidhi Sharma | November 28, 2017

Topics: and hydro/oxymorphone, codeine, drug abuse, Drug addiction, fentanyl, hydrocodone, irginia Department of Health, opiates, opioid, opioid addiction in Virginia, opioid crisis, overdose, oxycodone, pain killers, Percocet, prescription opioids, University of Richmond, Virginia Center for Addiction Medicine

Kim grew up on the west end of Richmond, a young girl with big blue eyes living in the nice part of town — bad things didn’t happen to girls like her, not in the suburbs.

By 14, though, she had started experimenting with weed and alcohol. As a freshman at Hermitage High School, Kim moved onto bigger and better drugs. Forget her school colors of red and blue, she’d found white — in prescription opiate pills and powdery bleached cocaine.

At 19, her mother dropped her off at a twelve-step program in Richmond. She walked in the front door and straight out the back.

Kim started shooting up heroin. Her biological mother had died of a heroin overdose weeks before Kim was born, but those things didn’t seem to matter at the time. Kim was addicted. There was no choice but to leave her family, leave her life behind. Until July 8, 2010.

Kim was living in a recovery home with 13 other women, sandwiched between one addict reading from the bible and another woman blasting Eminem. It was then that she decided she’d finally had enough.

So she got help, and she got out. Today, she works at the Virginia Center for Addiction Medicine (VCAM). Unfortunately,  not everyone’s as lucky as Kim, though. Only two weeks ago, President Trump declared the opioid crisis plaguing the nation a public health emergency, and the number of opioid overdoses has only increased since then.

“Every three weeks, 3,000 people die from this opioid epidemic,” said Chantal Thompson, a representative of VCAM. “There’s a 9/11 that happens every three weeks. Think about that. Every three weeks, the same number of people who died on September 11, 2001, die in the US because of an opioid overdose.”

And yet, doctors regularly prescribe opioids for pain relief. According to the Virginia Department of Health, 1,268 people in Virginia died in 2016 from overdosing on opioids. 465 of those deaths were caused by prescription opioids.

With statistics like these, it’s  important to know the science behind the drugs. Moreover, it is especially important to question why doctors are prescribing opioids so willingly in the first place, knowing the associate risks. 

“The number, the recklessness, with which doctors have started prescribing opiates began in the late 1990s,” said James Thompson, the CEO of VCAM. “Traditionally, doctors were careful not to overprescribe opioids because of the risk of addiction.”

A movement generated by concern for those suffering from chronic pain, Thompson said, changed the way doctors prescribed opioids for good. “People were living longer and surviving diseases, but then going on to live lives of chronic pain,” he said. “So doctors began routinely prescribing opioids for pain.”

Drug deaths in Virginia
Infogram

According to Thompson, doctors were also encouraged by pharmaceutical companies like Purdue that released self-funded studies in the 1990s, suggesting that the risk for opiate addiction was not high, not for patients that were truly in chronic pain.

Opioids, the drugs in question, are all derived from the natural opium poppy. The old standby derivative is morphine, and morphine has been modified to make products such as codeine and heroin. Then there are the synthetic opiates that are similar to morphine molecules, like oxycodone, hydrocodone, and hydro/oxymorphone.

“What happens is that opioids, after they are administered inside your body, they bind to something called a receptor, which are proteins usually found on the membrane of a cell,” said Shannon Jones, a biology professor at the University of Richmond. “They are able to recognize different substances and activate specific pathways that create a response in the body by activating specific genes.”

In the case of opioids, after binding to the receptor called GPCR, the opioids recruit a protein within the pathway called a G-protein. These G-proteins can affect either an activating or an inhibitory pathway.

Adrenaline, for one, binds to GPCR receptor proteins and recruits the G-protein that ultimately activates a fight or flight response within the body. Opioids also bind to the GPCR receptor, but they recruit a structurally different G-protein that ultimately inhibits pain receptors, enabling the body to feel little to no pain.

That’s why prescription opioids became so popular with both doctors and patients during the opiate movement — they block out our biological capacity to feel pain at all. Sore limbs, old wounds, nagging toothaches; it all just fades away.

Thompson, as a young doctor in the early 2000s, experienced this shift firsthand. “When I was in medical school, we were kind of taught that if we were underprescribing opiates, we were undertreating pain and that we were basically guilty of malpractice.” He went on to say, “In the past, some opiates were prescribed only for brief periods of time after injury or surgery. It was rare to have someone prescribed opiates for a long period of time. By 2001, it became okay to give someone who had something as common as say, arthritis or fibromyalgia, a prescription for lifelong opiate use.”

All this may seem like a gift for patients with arthritis, migraines, and other diseases that cause chronic pain. Underneath the pretty wrapping paper, however, is something far more sinister.

“There are three types of opioid receptors in our bodies,” said Jones. “Two of those receptors lead to pain relief. One of the receptors overstimulates a pathway that can cause respiratory depression — it slows down your breathing.” 

And that’s where, Jones said, the danger of overdosing lies. “You’ve slowed down your breathing so much that you could die,” she said.

So opioids have become the quintessential example of a double-edged sword. No pain, no hurt, but an extra pill or two slipped unthinkingly into the back of your throat could leave you breathless.

Despite this, hospitals and medical practices in the 1990s continued and still continue to prescribe opioids daily, all across the US. Why? Because along with moral motivations to eradicate pain, doctors also had a monetary incentive to keep prescribing opiates.

“This movement began to grow at around the same time hospitals and medical practices began using the internet to get feedback,” said Thompson. “There were people who would give bad reviews to doctors who weren’t joining in on the prescribing frenzy.” 

Thus, doctors had a strong incentive to prescribe painkillers. According to Thompson, getting good reviews meant getting making more money. Reimbursements were connected to customer satisfaction and pain relief was linked to customer satisfaction, so there was a huge draw to prescribe opioids.

This paradox is explored famously by Sam Quinones in his book, Dreamland: The True Tale of America’s Opiate Epidemic.

In his book, he describes this situation, “Our desire as American health consumers to have an easy solution to a complicated problem has played a role in the opioid crisis,” he said.“Sometimes pain is only fixable if you, as a patient, do a lot of the work yourself but we as a country, culturally, have not made those choices.” 

It is Quinones’ opinion that doctors have come to rely on prescription drugs because of the relative ease of prescribing a pill as opposed to suggesting that the patient work out, eat better, sleep better, drink more water.

Undeniably, the saturation of opiate prescriptions in American society is alarming enough when all you are considering is the threat of overdose — but there are still more layers. Opioid addiction, which has devastated the lives of so many, is another risk that looms ominously over our heads.

In November 2016, Governor Terry McAuliffe released a statement declaring the opioid crisis a public health emergency. According to the press release, in the first half of 2016, the total number of fatal drug overdoses in Virginia increased 35 percent from 2015, and fatal drug overdoses became the number one cause of unnatural death in the state.

One of the most popular opioids, Percocet, is a combination of oxycodone and acetaminophen. In 2015, more than 4 million Americans reported abuse of oxycodone-containing pain relievers like Percocet.

Musicians across the US have been waxing poetic about the inconceivable high these drugs give you for years, but what does that high really entail, and why is it so addictive?

“Biochemically speaking, synthetic opioids mimic natural opiates your body produces, like endorphins,” said Jones. “These opioids bind to the reward pathways in your brain that bring about that feeling of euphoria commonly associated with these drugs.” 

According to Jones, opioids have the highest rate of addiction out of any drug group in existence.

When you take an opiate, your body is flooded with the drug, and your cells try to cope with the onslaught– they pull their receptors away from the surface so that the opiates can’t bind and create their effect, a dangerous mix of euphoria and breathlessness.

Jones explained this further, “Drug users will take more and more drugs, trying to achieve the high they had the first time they took an opiate.” He also explained how taking opioids is about diminishing returns, once your body’s cells have adapted and become desensitized to the drug, “still, people keep trying and trying anyways, constantly chasing a high they’ll never feel again.”

It’s the reason drug cartels buy heroin from processors that make it out of morphine and mix it with powerful synthetics like fentanyl. Because, in Thompson’s experience,  it makes for an attractive product — and addicts with hollow eyes and bruised veins will come from all over, will search for the powerful high born from a mixed, street-made drug that has caused many an overdose.

It’s also the reason that Thompson will have weekends in Virginia when he ends up with a bunch of overdoses caused by the same product, sold by the same person, to people just trying to get their fix.

“Your brain informs you of your decisions constantly, whether you’re conscious of it or not, and it is a powerful learner,” he said. “Using opiates over and over changes the impulses and drives you have. It can make it so that your desires, wishes, goals, they all revolve around the drug. Even if you can’t admit that to yourself.”

Still, Thompson has made it clear that the solution to this nationwide opioid crisis does not lie in banning the drug. For him, education, not restriction, is the solution.

“About half of the patients I see started out being prescribed opiates for a medical issue, and quickly became addicted from their first exposure,” he went on to say. “That doesn’t mean doctors should never prescribe opiates — it just means we should help people to better understand the risks of addiction and that doctors should be more mindful of what may happen if they prescribe opioids.”

In October, US Senator Tim Kaine introduced a bill that would invest $45 billion into prevention, detection, surveillance, and treatment of opioids. Should the bill pass, it would also include nearly $5 billion for substance abuse programs in individual states from 2018 through 2027.

Over the last few years, focus on policies concerning the opioid crisis has expanded exponentially, both nationwide and in Virginia specifically. In an exclusive interview with RVA Mag, Attorney General Mark Herring discussed his efforts over the years to curb the epidemic, and provide the public understanding of opioid addiction that Thompson advocates.

Attorney General Mark Herring. Photo by Landon Shroder

“I have known from the very beginning that this is not a problem we are going to solve with arrests,” Herring told Landon Shroder, RVA Mag’s editorial director, in the interview. “Many of our drug policies of the past have not worked well and we need to take a fresh look at [the issue]. Drugs are not going after one particular demographic. It isn’t an urban, suburban, or rural problem. It’s happening everywhere.”

And according to Herring, Virginia is trying its best to solve the problem everywhere — it is part of a 41-state investigation into pharmaceutical manufacturers, to see if they are engaging in any unlawful practices regarding their marketing and distribution.

“These drugs are incredibly powerful, and devastating the lives of so many families,” Herring said. “The opioid crisis is a national tragedy and a problem that is decades in the making — and it has its roots in the medicine cabinet much more than it does in the streets.”


Virginia Politics Sponsored by F.W. Sullivans

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