Scraps of newspaper obituaries, photographs of the departed and handwritten notes in memory of loved ones collage the bottom third of a sectioned-off piece of the wall at the McShin Foundation’s intake office.
The delicate ensemble pays homage to lives lost to addiction – a tangible mnemonic indicative of a statewide epidemic. Inches to the right, the rest of the wall is covered with photos of smiling faces, separated from the deceased only by a faint line of demarcation.
“This is how we keep track of people when they leave housing,” said Michael Quinn, the intake specialist at the foundation, a local nonprofit recovery community organization. “If they’re doing well they’re above the line. People will come in all the time and kind of shift things around so we can keep better track of how people are doing.”
Unfortunately, not everyone’s face remains above the halfway mark – a reflection of a wave of deaths in Virginia due to fatal opiate overdoses.
Opioids – both prescription pain medications and heroin – account for most of the spike in fatalities. The number of fatal opioid overdoses increased nearly 86 percent, from 475 deaths in 2010 to more than 880 last year, a CNS analysis of data from the Virginia Department of Health found. Opioids made up more than 90 percent of the state’s drug deaths in 2015.
Quinn attributes the sharp rise in drug abuse partially to the availability of more potent heroin.
“A lot of dealers are cutting the heroin with phenobarbital, which is a deadly combination,” he said. “And the other thing is, heroin’s become more of a popular drug in suburban and upper-class neighborhoods, so it’s becoming more acceptable.”
In Richmond, the number of heroin deaths jumped from five in 2010 to 38 last year. Over the same period in Henrico County, the number rose from four to 27. In Virginia Beach, it went from three to 18. And in Fairfax County, it increased from two to 32.
Nick, a Fairfax County native who asked that his last name not be used, knows firsthand about the addiction that drives those statistics.
“It was like when I was high, I could live in this fantasy all the time that was, ‘I’m gonna go to school tomorrow, and fold my laundry, and start working out, and cook dinner,’” he said. “But as soon as I came down, my only concern was getting back to that place of contemplative productivity by getting another hit.”
Now 22 and almost a year into a treatment program in Florida, Nick tried prescription painkillers for the first time at 16.
“It progressed from whenever I could get them, to raiding medicine cabinets, to finding my own dealers for the next three years,” Nick said. “I started using every day at 19, and that continued until about 20, and then I was injecting.”
Nick said his parents were unaware of his growing addiction until his father had to cover a $500 drug debt about nine months before he went to treatment.
“It was when I started using heroin in addition to the pills, and the unmanageability during the times when I had no drugs was too much to bear, that I decided to get help or I was going to die. So I checked into treatment,” Nick said. “My parents didn’t know I was IV’ing until we got to the ER the day I asked for help.”
Quinn said he hears stories like this all too often. The McShin Foundation works to erase the stigma associated with addiction and getting help.
“When somebody says they’re an addict, people think of them as this nasty junkie person you don’t want to be with,” Quinn said. “The media always portrays the problem – the arrests and drug dealers – but they never show the solution, which is people recovering and living regular lives.”
Quinn, like all other administrators at the foundation, went through McShin’s peer-to-peer program personally. He has been clean from opioids for more than a year. The foundation’s CEO has been sober for nine; the director of operations, five; and the founder, John Shinholser, more than 30.
“It’s an everyday battle still,” Quinn said. “I have a sponsor, I go to meetings – it’s working. And people can relate to us and can’t use the excuse of ‘Oh well, you haven’t been there, you don’t know what you’re talking about,’ because yeah, I have been there, and I do know.”
The McShin Foundation is now in its 12th year. About 60 percent of its clients are addicted to opioids. Quinn said the rate of recovery is higher than at most treatment centers.He said traditional centers typically have an 18 to 20 percent success rate – which is determined by a year of sobriety – whereas success rates at McShin are closer to 50 percent.
Because the nonprofit McShin Foundation does not receive any government funding and insurance companies don’t recognize the program, Quinn said treatment must come out of pocket for individuals and families. But clients say it’s well worth the cost.
“You’re investing in someone’s life,” Quinn said. “My parents tell me all the time the best investment they ever made was getting their son back – and that’s priceless.”
For the past two years, the opioid epidemic has claimed, on average, more than two Virginians’ lives a day for the last two years. The toll has spurred state officials into action.Virginia Attorney General Mark Herring in particular is taking strides to address the rise in fatalities and opioid abuse.
Last month, Herring was awarded the Bronze Key, a national recognition presented for outstanding contributions, from the McShin Foundation at the organization’s 12th Annual Spring Awards Banquet.
“So many families across Virginia have been touched by addiction to heroin and prescription opioids, and too many have already lost a loved one to a fatal overdose,” Herring said. “In many cases, this is a problem that has its roots in the medicine cabinet, not in the streets, and that the medical community has to be part of the solution.”
Herring’s office created a documentary “Heroin: The Hardest Hit,” which features Virginians, including some from the McShin Foundation, sharing their personal stories of grappling with addiction and recovery, as well as the stories of people who died from overdoses.
Herring has also worked with local and federal authorities to prosecute more than 28 cases against dealers and traffickers involving more than 95 kilograms of heroin – which equates to 238,500 daily doses and a street value of more than $19 million.
“So often, shame, stigma or fear forces families and those with substance abuse disorders to suffer in silence,” Herring said. “But we cannot and will not let ourselves become hopeless or discouraged. We have to make sure that people who are struggling know you can beat addiction. There is life after addiction, and there is hope in recovery.”
Gov. Terry McAuliffe and state lawmakers across party lines agree have joined forces to address the problem. During the 2015 legislative session, the General Assembly made naloxone – a potentially life-saving opioid-antagonist administered in the event of an overdose – more widely accessible to law enforcement and health-care providers.
Last October, McAuliffe’s Task Force on Prescription Drug and Heroin Abuse released its recommendations, and state officials are implementing some of them. They include developing a website as an informational hub on prescription pill and heroin abuse, creating an opioid educational curriculum for law enforcement, reducing the stigma associated with addiction and increasing the availability of peer-support services.
According to a recent policy brief by the VCU School of Medicine, untreated substance abuse costs the state and local governments more than $600 million annually.
“Virginia’s opioid epidemic and untreated substance abuse are killing hundreds of Virginians and costing taxpayers more than half a billion dollars each year,” said Andrew Barnes, the brief’s lead author and an assistant professor at VCU.
For young adults like Nick and families across the state, there are emotional costs as well.
“A close friend of mine relapsed and overdosed on Dec. 18. It’s hard seeing someone give up on themselves and go back to their old ways,” Nick said. “I’m a fear-based person, but my fear of dying from this disease is the reason I keep doing what I need to in order to stay sober.”
Richmond native William “Billy” Derr, 24, passed away from a fatal overdose last month. Derr’s mother, Jenny, wrote in her son’s obituary, “As those who struggle with addiction know, it is a daily fight, hour by hour, and is ever constant. Billy had some extended periods of sobriety; those were the times when his true genuine heart shined through.”
In the obituary, Deer stated:
“To the people who don’t understand addiction, he may be just another kid who made a ‘bad choice.’ For those who do understand the disease, this was our oldest child, a brother, a friend and as his mother, my children are my everything. The disease of addiction is non-discriminatory and without mercy. It is up to us to open our minds and hearts to those suffering from the disease. We will continue to fight the fight.”
So will the McShin Foundation. It provides a rapid detox program, which tapers the individual off opioids over five to seven days. Quinn said what separates McShin from other treatment centers is that there’s no waiting list.
“If someone calls me, they can come in today, see the doctor and get put in a bed that day,” Quinn said. “If someone needs help, there’s always a bed available.”
More about the McShin Foundation
The rate of fatal opioid overdoses in the United States has quadrupled since 2000, claiming nearly a half-million lives, according to the federal Centers for Disease Control and Prevention. On average, nearly 80 Americans, including at least two Virginians, die each day from an overdose of heroin or prescription drugs.
No wonder governments at all levels, as well as health care companies and educators, have mobilized to target the problem.
In March, the U.S. Senate passed the Comprehensive Addiction and Recovery Act. State Attorney General Mark Herring praised the Senate’s action and the work of Virginia Sens. Mark Warner and Tim Kaine to advance the legislation.
“Passage of CARA is a big step forward in addressing what has become a national epidemic of prescription drug and heroin abuse and overdose,” Herring said. “If anything cried out for bipartisan action, it is this ‘all hands on deck’ moment, and my only regret is that these resources come too late for thousands of families in Virginia and throughout the country who have already lost a loved one to addiction.”
Herring said nearly every day he reads about another Virginian, often a young person, who died from a heroin or prescription drug overdose.
“It’s heartbreaking to read these stories and to talk to the parents, family and friends of these people who never thought anyone in their family would be touched by addiction, but now are trying to carry on in the face of such a tremendous loss,” Herring said.
President Barack Obama said fighting the opioid epidemic is also a priority for his administration. In March, he announced new measures to expand access to treatment. For example, Medicaid, the health care program for low-income Americans, now will cover substance abuse disorder in the same way it covers mental health issues.
The administration is also providing $11 million to states to purchase and distribute the opioid overdose reversal drug, naloxone, and to train first responders and others on its use along with other overdose prevention strategies.
Additionally, this fall, more than 60 medical schools, 50 pharmacy schools and nearly 200 nursing schools will start requiring students to take some form of prescriber education to graduate. The requirement will align with the CDC’s newly released Guideline for Prescribing Opioids for Chronic Pain.
Schools in Virginia that have signed on to the initiative include:
- Hampton University
- James Madison University
- Old Dominion University
- Radford University
- Virginia Commonwealth University
National chain pharmacies are also taking part in the effort:
- Rite Aid has trained more than 8,400 pharmacists on naloxone. In 10 states, Rite Aid also is dispensing naloxone to patients without needing an individual prescription; the company plans to expand that policy to additional states.
- Kroger currently dispenses naloxone without an individual prescription at its pharmacies in seven states, with plans to expand to at least 12 more by the end of the year.
- AmerisourceBergen/Good Neighbor Pharmacy will provide educational materials to encourage its 4,000 independently owned and operated retail pharmacy locations to provide naloxone without an individual prescription.
- Walgreens announced in February that it will install safe medication disposal kiosks in more than 500 drugstores across the country, primarily at locations open 24 hours. Walgreens also will make naloxone available without needing an individual prescription at its pharmacies in 35 states and Washington, D.C.
- Since March, CVS Pharmacy locations in 23 states have been able to dispense naloxone to patients without needing an individual prescription. This initiative will increase to 35 states by December.
- CVS Health has launched a program called Pharmacists Teach, which sends the company’s pharmacists into schools across the country to educate students about the dangers of drug abuse. To date, more than 30,000 students have participated in the program.
At the state level, Gov. Terry McAuliffe released his task force on Prescription Drug and Heroin Abuse implementation plan in October. In the 2016 legislative session, McAuliffe signed into law three bills regarding opiate abuse:
- House Bill 1059 directs the Virginia Criminal Sentencing Commission to evaluate sentencing patterns in cases involving heroin and recommend adjustments in sentencing guidelines.
- Under House Joint Resolution 45, the state will study whether to mandate health insurance coverage for “abuse deterrent formulations for opioid medications.”
- Senate Bill 556 removes certain restrictions on health care professions who treat people with opiate addiction using opioid replacements approved by the federal government. Such restrictions include the proximity of the provider to a school or daycare center.
The attorney general, however, says legislators haven’t gone far enough. Herring criticized the General Assembly for failing to pass HB 102, which would have made it a felony homicide to manufacture or provide a controlled substance that later causes a fatal overdose.
“Virginians are losing their lives every day to cheap, potent heroin, and tools to hold dealers and traffickers accountable are a critical part of addressing this problem, along with education, prevention and treatment,” Herring said.
“Too often, the parents of young people who have died from an overdose feel like no one really cares that their child was taken from them, and they’re resigned to the fact that the dealer will never really face consequences for what they’ve done.”
Herring said his office has helped prosecute a number of these cases at the federal level, but local commonwealth’s attorneys need a “proper state-level tool” to hold dealers and traffickers accountable.
HB 102 easily passed the House of Delegates but died in the Senate. It is the only opioid overdose bill proposed by Herring that has yet to pass.
In 2015, the General Assembly approved his legislation to expand the use of naloxone by first responders and make the drug available without a prescription; to create a “good Samaritan” provision to encourage the reporting of overdoses in progress; and to expand access to the Prescription Monitoring Program.
Executive Editor, Sarah King
Sarah is a junior studying political science and philosophy of law. She recently won a fourth place Hearst Award for Breaking News Writing and third place Virginia Press Association award for her Public Safety Writing portfolio. Sarah is also a copyeditor for INK Magazine and reporter for the Capital News Service wire. Last spring, Sarah worked as an editorial intern for Congressional Quarterly Researcher and SAGE Business Researcher in Washington, D.C. // Twitter | Facebook | LinkedIn