The Opioid Epidemic in Lynchburg City: "It's here"
Up until early last year, Don Holman of Forest, Virginia said he did not really consider much about America’s problem with opiates.
Sometimes, he admits, he heard something about heroin on the evening news, or maybe again he would hear the term “opioid epidemic” — never, though, did Holman ever consider that the epidemic would reach his city, or his neighborhood, or his family.
Holman’s son Garrett was diagnosed with AD-HD at a young age, but Don said the condition very rarely was an issue in his younger years. Garrett was athletic; he played football throughout his childhood and grew up to be a funny, charming teenager who had little trouble with the opposite sex. The Holmans, from every view, were the stereotypical American family — two kids, a mom and a dad with a nice home in the Central Virginia suburbs.
“That’s the thing,” Don said. “Opioid addiction can affect anyone; people don’t seem to get that.”
Don still does not know when it started exactly, but expects that around the time when Garrett was in middle school, he began experimenting with marijuana to ease some of the anxiety caused by his AD-HD. From then, Garrett started hanging out with the “wrong crowd” in high school. He got in trouble with the law for minor crimes like trespassing and vandalism before getting charged with possession of marijuana and sent to the Blue Ridge Regional Jail.
It was during his brief stint behind bars when Garrett found out about kinds of opiates that users say help with depression and anxiety, both of which Garrett struggled with. When he finished serving time — in the face of his parent-mandated therapy sessions — Garrett looked up a website he had heard about while in jail that can be used to order synthetic opiates.
In November 2016, Garrett ordered to his parents’ home a white envelope filled with a lesser-known synthetic opiate named “U-47700.” It is not used medically, as it is 7.5 times more potent than morphine. In the same month, the Drug Enforcement Agency would formally classify U-47700 as a Schedule I drug, citing its lethal ability.
It was a month later when Don and his wife would wake up in the middle in the night to find Garrett laying cold and purple on the ground. He wasn’t breathing; it was Garrett’s first opioid overdose.
“I had never given CPR before,” Don said. “But I pick him up, lay him on the floor and start giving him CPR, but he wasn’t responding, and then the paramedics came and took him away. My wife and I thought for sure that we had lost him.”
But Garrett survived. He woke up in intensive care not knowing what happened. Don thought it would be a wakeup call for Garrett. They enrolled him in state-of-the-art treatment programs and had him continue to see a psychiatrist. A couple of weeks came and went without any major complications, though it was obvious Garrett was struggling with withdrawals.
In December, though, Don woke up suddenly to the same sound of Garret gurgling and gasping for breath.
“I kept thinking during the second overdose how pathetic was that I was able to so efficiently conduct CPR and call 911 by myself before the same exact medics came in to take him to the hospital,” Don said. “No parent should have to learn to do that to their child.”
When Garrett got out of intensive care a second time, it was more of the same. More jail time, more failed attempts at treatment. It was February 2017 when Don said he could begin to see a change in Garrett’s life; he thinks that Garrett could finally see he had an addiction problem.
But Feb. 6, 2017, a day after Super Bowl Sunday — Don remembers watching the New England Patriots’ comeback with Garrett, thinking things may go back to normal — the 20-year-old Holman would be sentenced again to jail for his possession of drugs.
That day would be the last time Don talked to his son.
Garrett would die two days later Feb. 9, 2017; he overdosed for the third time, despite signs of improvement. This time, he would not recover.
In the Greater Lynchburg Region, the same story
Garrett Holman is not an anomaly in Lynchburg City and its surrounding counties. Located in the foothills of the Blue Ridge Valley, Lynchburg is a metropolitan area surrounded by rural hill country — the type of regions seen in West Virginia where the opioid epidemic has been the most pervasive.
According to city public records, the Lynchburg Fire Department responded to a total of 91 overdose calls in 2017, and the Virginia Department of Health reported that 81 Lynchburg residents visited emergency departments because of opioid overdoses.
Whereas there were six deaths from opioid overdose in 2016 in Lynchburg, the VDH recorded seven deaths in the first seven months of 2017.
The steady influx of opioids into Lynchburg City over the past few years has been a sign of a larger national trend. The Center for Disease Control uncovered in its most recent study on opioid abuse that the opioid epidemic — once seemingly restricted to rural counties — has flooded into cities and metropolitan areas.
From July 2016 to September 2017, the CDC reported a large and steady increase of 54 percent in opioid overdoses in large urban areas.
In the Central Virginia region, opioid overdoses for years were largely concentrated in rural areas in Lynchburg's surrounding counties, namely Bedford and Campbell. Estimates from the National Institute of Health show that in 2016, opioid overdoses accounted for 16 percent and 14 percent of the deaths of those aged 15 to 44 in Bedford and Campbell respectively.
In the same findings, it was reported that Lynchburg City has an 11 percent death rate from opioid overdoes of residents in the same age range. The number is not only lower than its surrounding rural counties, but is especially low compared to other metropolitan areas in the state that are experiencing the same new wave of opiates — Richmond experiences an average of 19 overdose deaths per week.
Even so, Clinical Supervisor of the Lynchburg Treatment Center Lori Macasa said the somewhat underwhelming numbers in Lynchburg are not fully representative of the problem. A lower number of overdoses does not equate to a lower prevalence of opioid addiction, she said
In reality, the local problem with opioid addiction is getting worse, she said, and on the verge of a local public health emergency.
"It's here, the problem is definitely here," Macasa said. "We have seen significant growth in the number of opioid victims who visit our facility on a daily basis, and since we opened in 2015, we have not been without patients."
On any given day, sign-in sheets at the Lynchburg Treatment Center report that more than 300 patients are admitted into the facility. Most come in to receive medication that prevents withdrawal symptoms and relapses; others come in for counseling. In total, the Lynchburg Treatment Center has approximately 800 patients on file — too many people for the 20-person waiting room at the facility.
Statewide, statistics from the CDC show clearly that the epidemic has migrated from neighboring West Virginia, where 52 out of every 100,000 residents die of an opioid overdose. From 2014 to 2015, the CDC reported a 38.7 percent increase in overdose deaths linked to heroin in Virginia — the most recent data available — and a 57.1 percent increase in the overdose deaths of synthetic opioids.
“When you look at the numbers, they’re obviously bad,” Macasa said. “But I try not to lose hope.”
So, what’s being done?
Ruby Jones of the Lynchburg Department of Public Health is a firm believer of education and awareness in response to the opioid epidemic. She and her departmental staff has joined efforts with three separate opioid coalitions made up of parents, local officials and volunteers to create a broader sense of the dangers of opiates in Lynchburg public schools.
“I think the problem is the worst for the kids in the public education system,” Jones said. “These kids will try to get high off of whatever they can as long as they can get their hands on it.
Fentanyl and Carfentanil are two highly-potent, deadly synthetic opiates that are 100 times and 200 times more powerful than morphine, respectively. Doses the size of a few grains of salt from both have deadly potential — Carfentanil alone killed more than 600 people in 2017, according to a CDC report. Traces of both of the drugs have been found in the Lynchburg area.
In June 2017, the News & Advance reported that five people overdosed in Lynchburg from abusing heroin laced with Carfentainl in a 10-day period. In Jones’ opinion, it was the most gruesome and prominent case of opioid overdose the region has seen.
“It was a wakeup call,” Jones said. “People started realizing that this is a real problem in our community.”
Jones said she does not think teenagers know how deadly these opiates can be; she cited a study from the American Academy of Pediatrics that found 3,647 children nationwide were admitted into the hospital for opioid-related conditions from 2004 to 2015. The response from Jones and her department has been handing out fliers, putting up posters and engaging discussion within schools to raise awareness — both about the dangers of opioids and how students can get help their friends they know are addicted.
Don Holman, too, said there needs to be more education about the opioid crisis in schools, but also more awareness about how mental illness can be a stepping stone to drug abuse. Don said he was scared at first to follow any psychiatrist’s recommendation to put Garrett on drugs to help
“I really feel that people with AD-HD and other anxiety disorders are more susceptible to doing drugs like marijuana; they get it into their heads that it is an alternative to relieve their stress,” Don Holman said. “From there, like in my son’s case, it can snowball to using harder drugs and abusing medicine that the doc gives you.”
In response to the recently released findings from the Virginia Department of Health and CDC, the Lynchburg City School Board passed a new measure in its most recent school board meeting that will administer the reviving agent naloxone to trained teachers at its high schools.
Commonly sold under its trademarked name, Narcan, naloxone is a reversing drug that is commonly injected into the outer thigh or arm of someone who has overdosed. It is the same drug that medics used on Garrett Holman to save his life during his first two overdoses.
Although emergency services personnel are required to carry Narcan, school board officials during the meeting discussed how having the drug in schools may be able to save a life if medics are not able to get to the school in time. From 1996 to 2014, the CDC reports that approximately 27,000 lives were saved from Narcan kits.
“Everybody in this room is aware of the opioid crisis, as it’s been talked about around the nation and this state,” Benjamin Copeland, assistant superintendent of operations and administrations, said, during the meeting. “We think this is a great thing to have available in the schools. I think that the more places that this drug is available, the better off we’re going to be as a society as a whole.”
At the national level, President Donald Trump declared the opioid epidemic a national public health emergency Oct. 26 of last year. Standing next to him in the East Room at the White House was Don Holman and a handful of others who lost family member and loved ones to the opioid epidemic. It was then that Trump promised to “liberate” Americans from the “scourge of addiction.”
That declaration was set to formally expire on Jan. 23 before it was renewed by Health and Human Services Secretary Eric Hargan. Since then, Trump has escalated his rhetoric on the opioid crisis; he officially called for a three-pronged approach on March 19 that includes plans for bolstered law enforcement, prevention and education efforts. Trump even went as far as to suggest capital punishment as an option for the dealers.
The last bill out of Congress concerning the opioid epidemic was passed in July 2016, which supported programs to expand Narcan-use by emergency responders, but did not ever allocate federal funds to do so.
In the meantime, the CDC projects that 115 people in the nation die every day from opioid overdose. That is five times higher than the rate in 1999, and researchers from the CDC have stated in multiple reports that the problem will get worse before it gets better unless formal action is taken.
The fuel to the fire of the epidemic
Despite a 2017 report from the Bureau of Labor Statistics that show a statewide decrease in unemployment — Virginia has a very low 3.7 percent unemployment rate — Lynchburg is experiencing a stark increase in the amount of unemployed and impoverished. The Lynchburg City metropolitan area, BLS statistics show, has the highest unemployment rate (4.8 percent) and poverty rate (24 percent) in the state.
This is a key link to the opioid problem, Macasa said. A report published last year from the National Bureau of Economic Research established a clear link between impoverished communities and a high presence of opiates. For every percentage point of unemployment in any given city, the study finds, the opioid death rate increases by 3.6 percent, and emergency room visits rise by 7 percent.
Macasa said many of her patients are only able to afford treatment through publicly subsidized insurance plans and Medicaid. Many people that she has counseled only became addicted to heroin and other highly-potent opiates after doctors prescribed them painkillers for a separate illness or medical condition.
Medicaid only covers prescribed medicines, though; when a doctor stops prescribing a patient morphine or similar painkillers, many poor patients in Lynchburg do not have a way to pay for painkillers themselves, so they move to heroin and other harder black-market opioids because they are cheaper
“Patients we see say they became addicted when their doctor prescribed them morphine for pain relief,” Macasa said. “When a doctor cuts them off suddenly, many people experience withdrawal symptoms. Mind you not a lot of people here can pay for morphine in the black market, so they think heroin is the only option for them.”
On average, heroin costs about the same a pack of cigarettes in the state of Virginia, where cigarette prices are lowest in the country. Heroin addicts who were arrested and questioned told Virginia State Police officers that they can get a bag of heroin for just about $5, whereas the average pack of Marlboros is $4.62 in Virginia.
The internet revolution of the 21st century has contributed to the rock-bottom prices of heroin and other opiates, too, making synthetic opiates in particular much more accessible and cheaper to obtain. Drug dealers no longer have to be met in person, but in online chat rooms and websites on the dark web that can allow users to order any synthetic opioid to their choosing from anywhere around the world.
For Garrett Holman, getting his hands on U-47700 was as easy as entering his credit card information and address. Pills came in a normal white envelope, Don Holman said. It would never be considered suspicious to the everyday postal service worker.
“You would never be able to tell that that envelope is carrying black market drugs from China,” Don Holman said.
And at the Lynchburg Treatment Center, Macasa said her efforts to wean users off these deadly synthetic opiates have been met with staunch rebuttals from many doctors and health professionals in the area who are concerned about the ethics of the treatment center’s programs.
Treating opioid addiction by giving patients another type of drug that is supposed to help ease withdrawal symptoms, some doctors say, is just “treating one drug with another.” Conservative doctors who believe it is possible for patients to cut off of morphine without having to transition to another drug, Macasa said, have been very critical, though statistics from the National Institute of Drug Abuse that show this method of treatment has been the most effective and cheapest for local and state governments.
“I have heard that doctors tell their patients, ‘You can’t go to the (Lynchburg Treatment Center) anymore, or else I won’t continue to treat you,’” Macasa said. “Without support from doctors and the entire health community, it will be hard to make any lasting change in stopping this problem.”
Aside from education initiatives from the Lynchburg Department of Health and the school board’s Narcan proposal, though, no formal action has been made from city officials. The Lynchburg City Council has been nearly silent on the issue, and there is no legislation about the opioid epidemic at the local level in the works.
Still, members of the community seem to be united on fighting the crisis. On March 1, more than 200 Lynchburg-area residents gathered at the Horizon Therapeutic Day Treatment Center on Court Street to raise awareness and start a city-wide conversation about the epidemic.
During the meeting, policies were considered and talked about, and residents were told to consider what they could do about the problem. Jones, who attended the event, said that even though keynote speakers told the crowd about the issue — how things are getting worse, how there are more opioids in Lynchburg than ever before — the overall tone in the room was optimistic.
“We can do something about this problem,” Jones said. “We really can, we just have to believe we can, and believe we — once and for all — can get these drugs out of our city.”