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A Tale of Two States

When people think of Virginia they tend to think of its rich colonial history, dating back to Jamestown in 1607, and the many presidents it birthed. In fact, the state is often referred to as the “Mother of Presidents” and its state nickname is Old Dominion, an allusion to its status as a dominion of the British Crown. There is also an aura of affluence that the state gives off, especially the suburbs surrounding Washington D.C. and the cluster of cities in the mid-coastal region of the state headlined by Richmond. Backing that aura up, is the fact that Virginia is in the top ten richest states in the country.

However, the wealth discrepancy in Virginia between the prosperous cities of the so-called “Urban Crescent” and the relative poverty of the rural extremities of the state. One unifying factor between these areas is the state’s opioid crisis, which has gotten so dire that the state health commissioner recently declared a public health emergency. Where the discrepancy remains is in the ability to access quality treatment for opioid addiction.

Rural Health Lags Behind

While there is opioid abuse in both segments of the population, the health outcomes are notably worse for those living in rural Virginia. The most likely explanation for this phenomenon is that many people in rural Virginia cannot afford health insurance or drug treatment. Life expectancy in these parts of the state are markedly lower than in more wealthy and populous areas, such as Richmond, Fairfax, and Hampton Roads. The premature death rates in these areas are more than double the national average. Clearly something is amiss for such a well-to-do state to have such a large public health threat in its margins.

Heroin Replaces More Expensive Opioids in Rural VA

In rural Virginia, like elsewhere, a climate of overprescription and abuse of prescription opioids led to many people developing crippling opioid addictions. Yet, in these areas where income is much lower than in the more densely populated areas of the state, users are more likely to turn to the cheaper alternative of heroin. Heroin is more potent than these prescription opioids and its potency is variable instead of controlled. On top of that, heroin is often cut with other – more dangerous – drugs, such as fentanyl and carfentanil, which makes the risk for overdose terrifyingly high. In fact, last year fentanyl overtook heroin as the deadliest opioid in Virginia, killing 618 of the 1,233 people who died of opioid overdoses. All of this has contributed to the rate of overdoses being nearly five times as high today as it was in 2010. Additionally, the spike in heroin addiction in the rural parts of the state have contributed to a rise in HIV/AIDS cases in the region caused in large part by needle sharing.

Heroin Hits the Urban Crescent

Many experts have noted that the people of Virginia generally don’t take notice of a problem until it reaches the crescent-shaped cluster of large cities on the eastern coast. This cluster includes cities like Richmond, Fairfax, and Hampton Roads. Therefore, it might not be surprising that the emergence of a devastating heroin and fentanyl problem in these cities coincides with the state ramping up its efforts (more on this in the next section) to fight the opioid epidemic.

In Hampton Roads, one user claims that heroin can be found anywhere if you have money and are looking for it. Heroin has ravaged the major metropolitan area, composed of seven cities, with more opioid overdoses occurring there than anywhere else in the state. As of the first three months of 2016, 116 people in Hampton Roads had died of heroin, fentanyl, or prescription overdoses, which accounted for nearly a quarter of all the overdose deaths in Virginia over that period.

Meanwhile, Fairfax County, the prominent suburb of the nation’s capital and one of the richest areas in the country, is also struggling with heroin and other opioids. The county suffered from 103 overdose deaths in 2016, which was more than any other county in Virginia.

Richmond, Virginia’s capital city, is also not immune to the ravages of opioid abuse, as the city had more overdose deaths than any singular city in the state last year, with 94.

Lawmakers Rush to Address Crisis

Lawmakers in Virginia are not oblivious to this problem in the rural areas of this state. This past summer, the governor, Terry McAuliffe, participated in a town hall with the then Secretary of Agriculture on the prevalence of opioid abuse in rural parts of the country.

McAuliffe has also signed bills into law that provide increased access to naloxone (overdose reversal drug) and needle exchange programs. Virginia is also looking to receive a waiver in order to expand treatment options under Medicaid, despite the new Republican ACHA cutting back on access to treatment. The state has also received 10 million dollars in funding that it will use to combat the opioid crisis. Yet, as the author of the book “Extremes of Virginia,” August Wallmeyer, states “I think of these wonderful, helpful government efforts as Band-Aids: urgently needed now to address severe crises and problems; to stop the bleeding. But, for all their good, we know that such Band-Aids are temporary fixes, not permanent or long-lasting solutions or improvements.” Progress needs to be achieved through continued action and Virginia’s politicians cannot rest on their laurels when it comes to this ever-evolving opioid crisis the state faces.

Virginia Taking First Steps, But the Road is Long

Lawmakers in Virginia may be taking positive steps in the fight against opioid addiction and overdose deaths, but there is no end in sight for the state’s struggles with the dangerous drugs. New analogue strains of fentanyl and other powerful synthetic opioids like it appear everyday, ensuring that the opioid crisis will remain in full swing in both Virginia and the United States. The distributors of these drugs are crafty and ruthless when it comes to profiting of the death and destruction of Virginia’s communities, therefore, law enforcement, politicians, and citizens alike must try to stay a step ahead in the fight against the epidemic now facing us. Our solutions need to get more and more creative, and our resolve to help those in need must remain unwavering.

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