FINDINGS IN BRIEF

Illicit fentanyl is highly addictive, readily available, and deadly

Pharmaceutical fentanyl produces a more intense high, relative to other opioids, creating an increased potential for misuse and dependence. As prescription opioids became harder to obtain, illicit manufactured fentanyl increased in availability. Illicit fentanyl is manufactured in clandestine labs and distributed through illegal drug markets. It is a profitable narcotic as it is highly potent, cheaply made, and easily transported. Inconsistent manufacturing methods, however, result in various levels of fentanyl potency that are difficult to discern and therefore increase the risk of overdose death.

The impact of illicit fentanyl has changed over time in Virginia

Illicit fentanyl represents the third wave of opioid overdose deaths in Virginia, beginning in 2013 and rapidly increasing until 2021. In recent years, rates stabilized and then fell precipitously between 2023 and 2024. Multiple factors contribute to the change in illicit fentanyl deaths, including lack of education on the risks of fentanyl, limited availability of appropriate harm reduction strategies, and the COVID-19 pandemic. Data indicates that males, Black or African American individuals, and individuals between the ages of 35 and 44 experienced the highest rates of overdose deaths from fentanyl.

Virginia is successfully implementing evidence-based strategies to address illicit fentanyl use

Staff identified 53 state-funded or state-administered strategies across 18 agencies that address surveillance, prevention, intervention, treatment and recovery efforts. Stakeholders expressed concerns about the continuity of focus on preventing overdoses, the likelihood of sustained state funding, and the lack of information on the effectiveness of efforts that were rapidly implemented. Designating a lead agency in the Commonwealth for comprehensive opioid response may assist with sustainability.

Virginia can take additional steps to enhance ongoing efforts

Virginia programs, legislation, and funding have increased the availability of opioid antagonists. VDH requires continued state funding to distribute naloxone for free or at cost to eligible organizations. Costs to patients for opioid antagonists are also a barrier. The state has made efforts to increase access to medications for opioid use disorder, but counseling corequirements may prevent providers from initiating treatment. The expansion of peer recovery services is limited by misinformed hiring practices for positions that benefit from lived experience.

Gaps exist in efforts to address illicit fentanyl use for certain high-needs populations

Pregnant and parenting women who use fentanyl face unique barriers and need specialized supports. Funding to establish Project LINK sites could expand access to services for this population. The need for substance use services is significantly higher in incarcerated populations than in the general population. Recruiting and retaining health care staff to serve the incarcerated population is difficult, but workforce incentive programs may help. In addition, state investments in treatment and transition services for incarcerated individuals need additional flexibility to encourage expansion.

POLICY OPTIONS IN BRIEF

Option: Designate VDH as the lead agency for comprehensive opioid response in the Commonwealth. (Option 1, page 24)

Option: Appropriate funds to optimally fund VDH’s opioid antagonist distribution program. (Option 2, page 27)

Option: Direct VDH to develop a methodology for estimating future costs of the opioid antagonist distribution program. (Option 3, page 28)

Option: Remove requirement for VDH to purchase eight milligram naloxone nasal spray. (Option 4, page 29)

Option: Require health insurers to cover prescription and over-thecounter opioid antagonists at no cost to patients. (Option 5, page 30)

Option: Amend regulations to clarify initiation of medications for opioid use disorder when psychosocial counseling is refused or unavailable. (Option 6, page 33)

Option: Direct VDH and VADOC to develop guidelines for hiring peer recovery specialists with lived experience. (Option 7, page 36)

Option: Appropriate $1.5M to establish three additional Project LINK programs at CSBs to treat pregnant women who use substances. (Option 8, page 39)

Option: Direct VDH to develop and implement a plan to expand workforce incentive programs to medical staff in local and regional jails. (Option 9, page 42)

Option: Appropriate funds to expand the Jail Mental Health Pilot Program to additional sites. (Option 10, page 43)

Option: Sunset the model addiction recovery program and appropriate funds to expand the Virginia Opioid Use Reduction and Jail-Based Substance Use Disorder Treatment and Transition Program to additional sites. (Option 11, page 45)