Prescription Drug Abuse and Opioid Overdose in Loudoun County, VA

This white paper was completed as a part of an 8-week internship at the Loudoun County Health Department.

The Issue

Drug overdoses have surpassed all other injuries as the leading cause of injury death in the U.S., with a 13 percent increase in Virginia, during 2013. When focusing on child poisoning deaths over a five-year span (2009-2013), 41 children aged 0-17 died as a result of drug or poison overdose in Virginia. Of these deaths, 26 were in teenagers 13-17. A review of these deaths have determined that 100% of them were definitely or probably preventable.

Several factors put teens at risk for overdose death. White teens of both genders, those with a history of substance abuse, those who grow up in substance-abusing families, and those who are already involved with the health and mental healthcare systems are more likely to die from overdose.

More heroin overdoses are occurring across Loudoun County, often as a result of prescription opioid abuse. Abusers of prescription drugs will either take too much of their own prescriptions, use them in a way they are not intended to be used, or use prescriptions that are not their own. When they lose access to these drugs, they will often turn to cheaper, addictive street drugs as an alternative.

Key Players

Approaching a viable solution to this issue requires the collaborative efforts of the Loudoun County Health Department and many other agencies.

Senior Citizens

According to the Loudoun County Sheriff’s Office, four out of five heroin users say their addiction started with prescription opioids. A 2014 study by the Partnership for Drug-Free Kids found that 70 percent of teens say it is easy to get prescriptions from a parent’s medicine cabinet. As a start, senior citizens and their families can be educated about the importance of disposing of unused prescriptions and how to do so in a way that is safe for the environment.

Education should be emphasized on older seniors, who might have a hard time getting to drug disposal drop-off boxes, and their families who may assist them. This is especially important because family members and caretakers sometimes keep unused prescriptions after a loved one has passed. Seniors and their families will need to be aware of the drug disposal drop-off box locations, so handing out flyers about these boxes at senior facilities will be beneficial. Educating seniors and families is the first step in prevention, as it keeps prescription drugs out of the wrong hands.

Pharmacies

In just one weekend (April 29 – May 1, 2016), the Loudoun County Sheriff’s Office and the Middleburg Police Department collected over 1,300 pounds of potentially dangerous prescriptions to be destroyed as a part of the DEA’s “Take-Back” initiative. Since 2010, almost 8,000 pounds of unneeded prescriptions have been taken out of Loudoun County medicine cabinets. To reduce access to unneeded prescription drugs, CVS Pharmacy grant-funded drug disposal drop-off boxes are currently located at the Leesburg Police Department and Loudoun County Sheriff’s Office locations: Dulles South Safety Center, Eastern Loudoun Station, and University Station, with a fifth box being added once the Round Hill, Virginia station is completed.

In the past, the DEA has permitted the return of prescription medications to pharmacies. Patients and relatives are able to mail unused prescriptions to authorized collectors using packages available at pharmacies. Previously, opioid painkillers, stimulants, and other such drugs could not be legally returned to pharmacies due to the Controlled Substance Act. These programs are voluntary, however, more clarification is needed on this type of program for more pharmacies to be on board. It will depend on a pharmacy’s ability to destroy the unused or expired prescription drugs on site through incineration or other methods.

DEA Museum Traveling Drug Exhibit

The public can become more aware of prescription and opioid drug abuse through the DEA museum traveling exhibit, which is part of an ongoing effort to address the increase of opioid-related overdoses in the county. This free exhibit raises awareness about the extent of this issue from a global, local, and individual standpoint and addresses environmental, societal, and public health concerns.

Many individuals incorrectly assume that drug abuse issues are only pertinent to minorities or the underprivileged. Going through the DEA exhibit can allow others to realize no community is immune to drug-related issues, and how everyone is affected on small and large scales. Literature is offered regarding various substances for a range of target audiences, including parents and teens.

Loudoun County Public Schools

Loudoun County Public Schools (LCPS) has partnered with the DEA and the Sheriff’s Office to develop a Drug Awareness program taught to parents throughout the county. Additionally, LCPS students are able to tour the DEA museum as part of their curriculum in an effort to prevent drug abuse. Prevention and Education services are available through LCPS in the form of a three-tiered structure managed by Student Assistance Programs staff.

Tier one consists of substance abuse presentations on topics such as over-the-counter meds, prescription drugs, synthetic drugs, and other such topics. A peer program also exists for teens to serve as mentors for new and at-risk students. Tier two is geared toward students who have violated drug policy and includes support group services for those committed to reducing or stopping drug use, and those concerned about loved ones using drugs. Tier three ranges from early intervention to referrals to a mental health therapist. All three levels incorporate prevention and education in an effort to reduce substance use and abuse among youth. Additionally, the D.A.R.E. program has been expanded to be taught to 8th graders.

Department of Mental Health, Substance Abuse, and Developmental Services

The Department of Mental Health, Substance Abuse, and Developmental Services (MHSADS) offers mental health education and substance abuse prevention programs to schools and to community youth regarding topics such as addiction, communication skills, grief and suicide prevention, and self-esteem. Additionally, outpatient substance abuse treatment services are offered to those individuals and families who face issues with chemical dependency. Detox, short-term inpatient and residential treatment options are available. MHSADS plays a role in both prevention of substance abuse, as well as in intervention.

Mental health education programs could be targeted on at-risk youth who might be more inclined to experiment with drugs as an attempt to fit in with peers or to cope with hardships. Emphasizing good decision-making skills and strengthening their self-esteem can prevent them from turning to drugs and empower them to make healthier choices.

Loudoun County Sheriff’s Office

According to an LCSO spokesperson, a majority of heroin is acquired from regions outside Loudoun County, such as Baltimore, Maryland, Washington D.C. and West Virginia. This year, the Loudoun County Sheriff’s Office (LCSO) has responded to 46 suspected opioid overdoses as of May 16, 2016, with 13 of these being fatal. While toxicology reports are pending, it is believed that a majority of these overdoses are heroin-related. Since January 2015, LCSO Rapid Response Unit and Tactical Enforcement unit has conducted approximately 100 heroin investigations, made 65 heroin arrests, and 71 prescription fraud arrests. Due to the increase in opiate overdoses, many law enforcement agencies have equipped their personnel with nasal naloxone, or Narcan, which can revive an individual suffering from an opioid overdose.

Part of a Heroin Operations Team initiative, the naloxone program was piloted in December 2015 and will be expanded to all patrol deputies in 2016-2017. LCSO plays a key role in proactive enforcement at all levels, as well as education and prevention in the community. LCSO can continue their participation in the Nationwide Prescription Take-Back program as well as their participation in Safer Communities with CVS to have drug collection boxes at their four locations.

EMS

In 2015, Loudoun County had a total of 35 suspected heroin overdoses according to EMS. Since January 2016, there have already been 71 overdose incidents recorded by EMS. Of these, 32 had Narcan administered and 30 appeared to involve an opiate. Of the 30 opiate incidents, 20 are assumed to be heroin. The role of EMS is reactionary, responding to the scene after an overdose occurs.

This reactionary role is crucial in reducing the number of opioid-related overdose deaths. However, this will need to be backed up by other prevention efforts. In addition to reducing deaths, the County can focus on reducing the number of people who are addicted through strategies such as drug take-back, education, and treatment.

Overall Approach

Many people incorrectly assume that drug abuse is not a pressing issue in Loudoun County, but this is an issue that cannot be denied or ignored. This complex issue requires a multifaceted approach involving prevention, education, response, and enforcement. People sometimes refuse to believe there is a drug problem or refuse to discuss it.

The D.A.R.E. program, for example, teaches young children about tobacco, alcohol, and risky behaviors early on. However, other potentially harmful drugs are mentioned minimally, if at all. While a Methadone clinic has been established in Loudoun County, local treatment options for opioid abuse are still lacking. Those in the community who stigmatize drug abuse are reluctant to have treatment clinics available in their area. However, this forces those who need help to either travel long distances for treatment or forgo treatment altogether.

In order to tackle this issue, we must also tackle the root causes:

  • Senior citizens and families can be educated about proper drug disposal and dangers of prescription abuse, especially by being made aware of the drug-disposal drop off boxes.
  • In addition to drug disposal, pharmacies can potentially assist with drug take-back.
  • Efforts can be made to bring children, parents, and seniors to the free DEA exhibit.
  • LCPS Student Assistance Programs staff can tailor programs to address the abuse of prescription drugs and the potential abuse of street drugs that follows.
  • MHSADS can focus on individuals who are at risk for drug use and adapt programs to meet their unique needs.
  • In addition to Narcan administration, LCSO can also target regional sources of heroin through their partnership with High Intensity Drug Trafficking Area (HIDTA) Task Force and the DEA.
  • Narcan can be made more accessible to drug users themselves as well as concerned loved ones for administration before EMS arrives.

It is important to prevent overdose deaths through the use of Narcan, but drug abuse and drug deaths can be further prevented by keeping prescriptions out of the wrong hands, educating the public about the harms of drugs, focusing on at-risk populations, and providing individuals suffering from addiction with the help they need.

July 7, 2016