Check out my recent article for the Roanoke Times, an interview with Jodi Manz, policy director for the Virginia Secretary of Health and Human Services. Manz discusses the current opioid public health crisis and notes there is "no end in sight."
Wallmeyer: No end in sight to opioid deaths
August Wallmeyer Wallmeyer is a semi-retired lobbyist in Richmond and the author of "The Extremes of Virginia."
Jul 31, 2017
By August Wallmeyer
Wallmeyer is a semi-retired lobbyist in Richmond and the author of “The Extremes of Virginia.”
Wallmeyer, author of a recent book on the disparities between rural Virginia and the urban crescent, recently discussed the opioid epidemic with Jodi Manz, policy advisor to the state Secretary of Health and Human Resources. Here is an edited transcript.
WALLMEYER: How would you describe the current opioid situation in Virginia?
MANZ: We call it an epidemic, a public health crisis. Our commissioner of health officially declared it a public health crisis last November. We’re not just looking at prescription drugs, we’re also looking at heroin and a drug called fentanyl and fentanyl analogs. The thing that all of those drugs have in common is that they are all morphine derivatives, derived from the same plant and synthesized in different ways to become different drugs. In certain parts of the state like Southwest and Southside Virginia, we’re looking more at a prescription opioid issue. The overdoses there tend to be from prescription opioids, but oftentimes in conjunction with things like benzodiazepines, drugs like Xanax, which are often prescribed for significant anxiety, or in combination with alcohol, other depressants, the kinds of things that will just slow your system down.
We’re now seeing a decline in life expectancy that we haven’t seen before, particularly among white women in America. And it goes back to the idea of despair around economics, around job prospects, the kind of things that might exist in parts of the state that don’t have the robust economies that they used to. And we also see there’s a connection, especially among prescription opiods, to physical labor. That’s been a huge issue in Appalachia, with jobs connected to coal mining, in particular. There’s a pretty high rate of injury, and oftentimes this kind of addiction starts with a legitimate prescription for pain.
But sometimes this is just an epidemic that exists because the drugs proliferate socially. It has now become almost an acceptance that once someone has moved from opioids to heroin, which can happen very easily, heroin becomes almost more socially acceptable, particularly among young and adolescent users.
WALLMEYER: And heroin is now less expensive than a prescription opioid?
MANZ: Yeah. The numbers vary based on the area, because it’s a market and there is a cost of living issue. But in the City of Richmond, you can get high for about $15 if you buy some heroin. Whereas Oxycontin usually goes for about a dollar a milligram. So if I’m a person who has developed an addiction it’s a lot easier and cheaper for me to go to the street and find heroin.
WALLMEYER: And now if you choose heroin, isn’t it a much greater chance that your heroin will be cut with fentanyl or something else, and be much stronger and therefore even more deadly?
MANZ: Yes! This is a market, and drug dealers have caught on to the fact that the more attractive they make their product, the more likely you are to purchase it from them. One of the things that can make the product more attractive is if it is more potent, and fentanyl, which is essentially just like heroin but exponentially stronger. Once heroin dealers began putting fentanyl in their product, that’s when we started to see the overdoses increase.
WALLMEYER: Just how bad is this problem in Virginia today?
MANZ: We got the 2016 overdose data recently, and had 1,460 drug overdose deaths total. Of those, 1,133 were related to opioids or heroin. We’re not seeing these numbers go down, [even] with all the awareness and work that’s gone into this, our overdose numbers are still going up. And that’s happening in other states as well. Nobody has found the magic bullet to make this go away. Drug overdoses now kill more people than motor vehicle accidents and gun deaths in Virginia.
WALLMEYER: And as of today, no end in sight?
MANZ: No end in sight. It’s not just as public health problem. It’s not just a public safety problem. It’s not just a community problem. Virginia has taken an all hands on deck approach. We have tried to do everything we can do. [Among other things,] we have created an opportunity for local health departments to have syringe exchanges. We have also mandated continuing medical education for providers. And the prescription monitoring program has changed to mandate that all prescribers and pharmacists have to be registered. We’ve also mandated that any opioid prescription for more than seven days has to be checked through the prescription monitoring program. The goal of these regulation changes is for doctors to not go to opioids first, to not start with the highest level of treatment. Our goal is to make sure that patients get the right care, and the right amount of care, so we’re not overprescribing.
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