Virginia’s war on overdoses gained $1.1 billion. Here’s how it’s being used.
In what used to be a bank in Newport News, a sign in the drive-through window now reads:
“Dead friends
Can’t recover.
Overdose deaths
Are preventable.”
Below the window, an orange plastic bin contains a haystack of used needles and syringes.
The building on Huntington Avenue is now a harm reduction clinic, operated by the nonprofit Minority AIDS Support Services. Visitors to the drive-through, or to the clinic inside, can receive supplies that limit the risks associated with drug use, such as fatal and nonfatal overdoses, drugs contaminated with substances like fentanyl or Xylaxine, or infections or injuries from old needles or contaminated supplies.
Workers also hand out hygiene kits, snacks, resources for recovery for those who want it — and a healthy dose of care and compassion.
It’s a needed service, said Gwendolyn Ellis-Wilson, executive director of MASS. People come to the clinic from all over the seven cities, and as far south as Elizabeth City in North Carolina, she said. It’s also the type of service that’s long past due in Hampton Roads, according to some.
Overdose deaths have been on the rise in Virginia, with the death rate nearly doubling between 2018 and 2021.
But with new sources of funding available through national settlements with pharmaceutical companies, cities and community-based organizations are revamping their approaches to combating the crisis.
MASS is funded by the Virginia Department of Health, and also receives funding from the Virginia Opioid Abatement Authority — the state organization that oversees the distribution of funds from the pharmaceutical settlements.
Virginia will receive about $1.1 billion from federal lawsuits against manufacturers, distributors and pharmacies that contributed to the opioid crisis. Payments from settlements and bankruptcies began in 2022 and are expected to go until 2041.
Thirty percent of those funds are distributed directly to cities and counties, with the requirement that the funds be used for “opioid abatement.” The organization defines the specific ways the funds can be used. Fifteen percent will go to the state, and the organization will distribute the remaining 55% of funds.
In Hampton Roads, Portsmouth has been hit hardest. Ninety-one people died of drug overdoses in 2022, according to the most recent yearly data available from the Virginia Department of Health. That’s a rate of 95.7 deaths per 100,000 people — well above the statewide rate of 29 deaths per 100,000 people.
Portsmouth is also the recipient of the highest amount of funding per capita from the abatement authority. Portsmouth received $78,000 in direct distributions in 2022 and almost $500,000 in 2023, according to the abatement authority. The city will receive an estimated $2.4 million from the pharmaceutical settlements by 2041. And that doesn’t include individual distributions or Gold Standard incentives, through which cities and counties in Virginia could potentially receive more funding.
Portsmouth will receive about $25 per capita, according to an analysis by The Pilot — more than the $13 average for the rest of Hampton Roads.
Virginia Beach will receive roughly $6 million for opioid abatement from the settlements by 2039. Norfolk will receive roughly $4.2 million, Chesapeake will receive $3.6 million, Newport News will receive $2.5 million, Portsmouth will receive $2.4 million, Hampton will receive $1.9 million, Suffolk will receive $876,000, James City County will receive $756,000, York will receive $693,000 and Williamsburg will receive $106,000.
One thing the Portsmouth Health Department is doing with the funding is hiring a coordinator to oversee the city’s efforts, said Michelle Winz, epidemiologist at the health department.
The health department tracks overdoses in real-time several ways. One way is through EMS calls. Anytime someone in Portsmouth calls 911 for help with an overdose, the call is logged on a map, called the ODMAP.
Heat bloomed over certain neighborhoods in Portsmouth, depicting calls from two weeks in December.
“We can do hotspots, seeing where a majority of (EMS calls) are,” Winz said, “which is how we know which part of the city to focus our overdose prevention on.”
The map is consistent in showing trends, Winz said. The neighborhood near the health department on High Street, and other areas in the 23701 zip code, which extends east to the Elizabeth River and south to the border with Chesapeake, log the most EMS calls that show up on the map.
Saying why exactly those neighborhoods have been continually affected is hard, Winz said, but other public health measures help tell the story. The areas of the city that struggle the most with overdoses also have limited affordable housing, higher crime rates, more children in poverty and lack easy access to health care.
“All of those social determinants of health are poorer in those parts of the city,” Winz said.
Because reducing overdose fatalities requires addressing other social issues, Portsmouth formed a coalition between various city organizations in February 2023. That group is called PCOAT — the Portsmouth Coalition Overdose Action Team. The group brings together entities in the city that have a role in combating deaths due to overdoses and the effects of substance use disorder, and to address the complexities of the public health issue by focusing on primary prevention, evidence-based treatment, harm reduction services and recovery.
The acronym, PCOAT, is intended to signify warmth and an embrace, Winz said. “And empathy, and really destigmatizing substance use so that we can get to the point where we can actually make a difference.”
The city’s need for addressing overdoses is past due, said Avanti Allen-Benson, population health manager at the health department.
“But we’re moving forward,” she said, and hopes the coalition will be able to keep up with the changes the overdose crisis brings. The health department conducts trainings on how to administer naloxone — a drug that can reverse opioid overdoses that became available over-the-counter in 2023 — and added fentanyl test strips to their Revive kit when there was a need for it.
“So as soon as something comes out and other sources are available, we’ll be able to provide that as well,” she said.
Nearby on King Street, the Department of Behavioral Health Services also plays a role. The department administers medication-assisted therapy — prescribing drugs like buprenorphine and methadone that help block cravings for opiates. The department also provides counseling, and aims to help people holistically, said Nathan Woodard, director of the department.
“We have a strong belief that it takes more than just giving you the medication to help you be successful,” he said. “So we want to give you the medication and also give you the skills to be able to deal with adversity or any … issues that may come along with you continuing your recovery.”
That’s because the diagnostic criteria for substance use disorder — the clinical term for addiction — includes both physical and mental symptoms. Medication may curb a person’s physical dependence, but therapy and counseling are needed for complete treatment.
People “absolutely” recover, Woodard said.
“I think that’s one of the biggest misnomers that a lot of people have, that people that have been addicted to substances don’t recover,” he said. “But they do, and what recovery looks like is different from person to person.”
In Newport News, the harm reduction clinic at Minority AIDS Support Services started in 2022 and grew out of work the organization was already doing. MASS was started in the 1990s to help people living with HIV/AIDS. The state health department noted an uptick of HIV infections in 2020, and made funding available for the nonprofit to start offering a needle exchange program, according to Stephanie Northern, outreach supervisor at MASS.
A benefit of needle exchanges — where people return used needles and pick up new ones — is reducing the spread of infectious diseases among people who use intravenous drugs.
Harm reduction is reducing the negative health consequences of risky behaviors, explained Ellis-Wilson, executive director of MASS.
She compared it to things a person does while driving a car. Driving is not without risk, but wearing a seat belt, adhering to the speed limit and other traffic laws can reduce injury — or harm — in the event of a crash.
“You use harm reduction every day,” she said.
In the context of drug use, harm reduction inverses the typical punitive approach to people who use illicit substances, and seeks to protect people’s health and wellbeing, unconditionally.
“Harm reduction is not necessarily about getting them off drugs. That’s not our aim,” Northern said. “We are meeting them where they are. We’re here to give information. Knowledge is power. And we’re here to form relationships with people so we can have a soft handoff.”
Under Virginia code, participants in the needle exchange program are also immune from arrest or prosecution for paraphernalia charges.
MASS employees bring harm reduction to spots in Chesapeake, Portsmouth, Virginia Beach and Newport News with a mobile unit.
On a rainy morning in January, Sabrina Patterson, harm reduction coordinator, and Earl Hamlet passed out supplies in the parking lot of a behavioral health office. They handed out around 18 kits between 7 and 11 a.m. On their folding table, they also had a box of candy and a pack of cigarettes — things that help with cravings, Hamlet said.
According to Patterson, actions cities are beginning to take with funding from the Opioid Abatement Authority are long overdue.
She has had a 30-year career in public health, and remembers going to meetings in Virginia Beach years ago where grandmothers and mothers were speaking out about impacts on their kids and grandkids, and asking when someone was going to do something.
“So it worked, because we’re here,” she said. “Don’t get me wrong, I think it should have been here. But I’m glad it’s here now. And the people that we serve are glad it’s here as well.”
Cianna Morales, 757-957-1304, cianna.morales@virginiamedia.com
