Opi­oid epi­demic in Vir­ginia hits ‘in­no­cent by­standers’

Of­fi­cials see surge in chil­dren ex­posed in womb; over­all deaths climb, too


Vir­ginia saw an un­prece­dented in­crease in ba­bies born with ex­po­sure to dan­ger­ous drugs in 2016, state health of­fi­cials told a panel of law­mak­ers Thurs­day morn­ing.

The num­ber of chil­dren ex­posed to drugs in utero in­creased 21 per­cent to 1,334 in fis­cal year 2016, said Carl Ay­ers, di­rec­tor of the Divi­sion of Fam­ily Ser­vices in the Depart­ment of So­cial Ser­vices.

“These are the in­no­cent by­standers,” Ay­ers told the Joint House Com­mit­tee on Health, Wel­fare and In­sti­tu­tions and Se­nate Com­mit­tee

1,334 The num­ber of chil­dren in Vir­ginia who were ex­posed to drugs in utero in fis­cal year 2016 822 Opi­oid over­dose deaths in Vir­ginia through Septem­ber 2016, up from 811 in all of 2015

on Ed­u­ca­tion and Health.

Of the ones who were born with drug ex­po­sure, seven later died be­cause of a lack of care in their homes, Ay­ers said. Eighty of the ba­bies were placed in fos­ter care in the first six months of the year.

The grow­ing num­ber of ba­bies born with ex­po­sure to drugs is just one of many in­di­ca­tors that the

433 Num­ber of opi­oid deaths in the first nine months of last year linked to fen­tanyl

opi­oid epi­demic is spread­ing in Vir­ginia. More peo­ple died of over­doses from opi­oids — a drug type that in­cludes pre­scrip­tion painkillers as well as heroin — in the first nine months of 2016 than in all of 2015, ac­cord­ing to Vir­ginia Depart­ment of Health data.

Ay­ers was among nine of­fi­cials

rep­re­sent­ing myr­iad agen­cies who out­lined the epi­demic and what’s be­ing done about it dur­ing Thurs­day’s joint com­mit­tee meet­ing.

“Try­ing to ad­dress this prob­lem is re­ally a multi-faceted ap­proach, and all hands are on deck,” Bill Hazel, sec­re­tary of health and hu­man re­sources, told the panel.

Hazel, Ay­ers and oth­ers gave the panel an over­view of bills that will be filed to ad­dress the prob­lem in the 2017 ses­sion of the Gen­eral Assem­bly, which started Wed­nes­day.

One bill, for ex­am­ple, would make it eas­ier for the Depart­ment of So­cial Ser­vices to iden­tify and sup­port moth­ers who are abus­ing drugs.

The num­ber of over­dose deaths linked to opi­oids has been in­creas­ing steadily since 2012, when 572 peo­ple died.

Through Septem­ber 2016, there were 822 opi­oid over­dose deaths in Vir­ginia — up from 811 in all of 2015.

More than half of the fatal opi­oid over­doses in the first nine months of 2016 were caused by fen­tanyl, a pow­er­ful painkiller that now is be­ing man­u­fac­tured and sold il­lic­itly as a po­tent al­ter­na­tive to heroin.

Of the 822 peo­ple who died in the first nine months of last year, 433 over­dosed on fen­tanyl — a 160.8 per­cent in­crease in the num­ber of fatal fen­tanyl over­doses com­pared with the same time pe­riod in 2015, ac­cord­ing to depart­ment of health data.

Since the state be­gan track­ing opi­oid deaths in 2007, more than 6,300 peo­ple have died. Opi­oid deaths are the lead­ing cause of ac­ci­den­tal death in Vir­ginia and across the na­tion, killing more peo­ple than car crashes.

“We are los­ing a gen­er­a­tion of peo­ple,” Dr. Marissa J. Levine, the state health com­mis­sioner, said dur­ing the meet­ing. “We are los­ing them lit­er­ally by the deaths that you’re see­ing, and we’re los­ing them in many other ways.”

The opi­oid epi­demic could cre­ate a rip­ple ef­fect of other public health is­sues, Levine told the panel. The in­creased rates of in­jec­tion drug use in the state could lead to a “tsunami” of hepati­tis C and HIV, she said.

Cases of hepati­tis C al­ready have in­creased, Levine said, largely in the south­west­ern parts of Vir­ginia. In 2010, the state had 2,800 cases of the virus. In 2015, that num­ber shot up to 8,000.

“And many more go un­re­ported,” she said. “This is a loom­ing is­sue.”

HIV rates have not yet in­creased to the same de­gree as hepati­tis C, but that likely is be­cause of the two blood­borne pathogens that spread through in­jec­tions, hepati­tis C trav­els faster.

Levine has spo­ken in the past in fa­vor of sy­ringe­ser­vices pro­grams, which would make clean in­jec­tion equip­ment such as nee­dles read­ily avail­able to coun­ties where the opi­oid epi­demic is strong­est. The Vir­ginia Depart­ment of Health has put for­ward leg­is­la­tion that would le­gal­ize the pro­gram in Vir­ginia.

Other state agen­cies have taken an in­ter­est in pre­vent­ing Vir­ginia providers from writ­ing opi­oid pre­scrip­tions in the first place.

The Depart­ment of Med­i­cal As­sis­tance Ser­vices — which runs the state’s Med­i­caid pro­gram — im­ple­mented new reg­u­la­tions in 2016 to lower the amount of opi­oid pre­scrip­tions its providers were writ­ing, such as mak­ing it eas­ier for them to pre­scribe drugs other than opi­oids.

In the three months af­ter those reg­u­la­tions took ef­fect, Med­i­caid saw a 50 per­cent drop in the amount of opi­oid pre­scrip­tions physi­cians were writ­ing, but only a 12 per­cent de­crease in the num­ber of mem­bers re­ceiv­ing pre­scrip­tions, said Dr. Kate Neuhausen, DMAS’ chief med­i­cal of­fi­cer.

“So this means that pre­scribers are de­creas­ing the num­ber of pills they pre­scribe to a mem­ber, which low­ers the risk of a fatal over­dose, not cut­ting pa­tients off opi­oids, which could po­ten­tially lead to in­creased use of heroin,” Neuhausen said.

David E. Brown, the di­rec­tor of the Depart­ment of Health Pro­fes­sions, ex­panded on nu­mer­ous bills pro­posed this ses­sion that would ad­dress the opi­oid cri­sis.

The bills in­clude re­quir­ing that all opi­oid pre­scrip­tions be elec­tronic to pre­vent fraud, plac­ing 3-day lim­its on opi­oid pre­scrip­tions that orig­i­nate in emer­gency rooms and cre­at­ing peer providers that will al­low trained peo­ple who have ex­pe­ri­enced ad­dic­tion to help re­cov­er­ing ad­dicts.


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