Heroin and Opioids Update - A Community Public Health and Safety Crisis: January 2019

1. A Community Public Health and Safety Crisis
Fairfax County, Virginia
Updated January 2019

2. What’s going on?
An epidemic of addiction to heroin and other opioids has
gripped the nation. Overdose deaths are skyrocketing.
 It’s happening throughout Virginia.
 It’s happening here.
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3. Crisis in Virginia –2017
 1,445 Virginians died from an opioid overdose, including
from prescription opioids, heroin, and fentanyl.
 Virginia emergency departments reported 10,164 visits
for opioid and heroin overdose treatment.
 Emergency medical services workers reported 4,533 uses
of naloxone, an overdose-reversal drug.
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(Source: www.vdh.virginia.gov/data/opioid-overdose)

4. Does it really happen here in Fairfax,
with people I know? My loved ones?
 Unfortunately, yes.
 Between 2015-2017, there were 259 opioid deaths in
Fairfax County; more than motor vehicle deaths and gun
deaths. Motor vehicle accident and gun deaths have not
changed over the past decade but opioid deaths rose
substantially over the past three years.
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Source: Virginia Dept. of Health, Office of the Chief Medical Examiner

5. Yes, it’s really happening here.
 Painkillers are the third most commonly used substance, after alcohol
and marijuana, among youth in Fairfax County. Approximately four
percent of 8th, 10th and 12 graders – that’s one in every 22 children –
reported non-medical use of painkillers. (Source: Fairfax County Youth Survey)
 The proportion of opioid use and overdoses that occur in school aged
children and young adults is higher in Fairfax County than elsewhere
in the state.(Source: Virginia Department of Health)
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6. Yes, it’s really happening here.
• There is no “typical” user of opioids. (Source: Virginia Department of Health)
• Overdoses and deaths occur in all age groups, are equally
common among men and women and occur in all areas of the
county. (Source: Virginia Department of Health)
• Overdoses are more often fatal in Fairfax than in the rest of
the state. We believe this is because of more common use of
fentanyl and carfentanil. These drugs are often mixed in with
other drugs, including heroin, cocaine, and marijuana. Often,
users are unaware that they have been mixed in. There is no
sure way to know what is in your non-prescription drugs.
(Source: Virginia Fusion Center; local police agency reports)
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7. What are opioids?
 Opioids act on the brain and produce a euphoric effect.
 Often prescribed to relieve pain. Morphine, oxycodone,
hydrocodone, tramadol, methadone and fentanyl are all
opioids.
 The illegal drug, heroin, is also an opioid.
 Highly addictive, even lethal, if used improperly.
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8. Fentanyl
 Fentanyl is used for pain management
for Stage 4 cancer patients.
 Ten times more potent than heroin.
 Lethal dose of pure fentanyl is about the size of a few
grains of salt.
 From 2014 to 2015, fentanyl encounters more than
doubled in the U.S. (from 5,343 to 13,882).
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9. Carfentanil
 Carfentanil (an opioid tranquilizer used on large animals)
has appeared in illegal drug markets in the U.S. and is
extremely dangerous for humans.
 10,000 times more potent than morphine;
100 times more potent than fentanyl.
 Depresses the central nervous system and ability to
breathe.
 Tiny particles (through nose, mouth, injection) can create life-
threatening effects within minutes of exposure.
 Carfentanil has been identified in overdose deaths in Fairfax County.
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10. What is addiction?
• A chronic disease; can lead to death if not treated.
• Brain chemistry is altered.
• Individual is unable to abstain from the drug; loses ability
to control behavior.
• Emotional responses become dysfunctional; judgment
becomes impaired.
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11. Behavioral warning signs
• Spends a lot of time alone.
• Loss of interest in favorite
activities.
• Eats a lot more or a lot less than
usual.
• Emotionally erratic: quickly
changes between feeling bad and
good.
• Seems tired, sad or nervous,
cranky – or unusually energetic.
• Talks fast, says things that don't
make sense.
• Sleeps at strange hours.
• Misses important appointments.
• Neglects personal hygiene.
• Has problems at work or school.
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12. Risk factors for addiction
 Genetic – Person with family member who has addiction is at greater
risk.
 Environmental – Parents not involved with children, peer use, social
settings.
 Early use – More likely to develop addiction if use starts when
young.
 Smoking or injecting – More addictive because drug passes directly
into bloodstream and brain without being filtered through liver and
other organs.
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13. Physical signs of opioid use
• Pupils of eyes are small, pinpoints.
• Decreased respiration rate.
• Sleepy or non-responsive.
• No appetite.
• Agitated.
• Intense flu-like symptoms: nausea, vomiting, sweating, shaking of
hands, feet, or head.
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14. Behavioral signs of opioid use
• Change in attitude/personality
• Avoiding contact with family
• Change in friends, new
hangouts
• Change in activities, hobbies,
sports
• Drop in grades or work
performance
• Isolation and secretive
behavior
• Moodiness, irritability,
nervousness, giddiness
• Stealing or borrowing money;
financial issues
• Wearing long-sleeved shirts
out of season
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15. Warning signs of drug use
• Missing medications
• Burnt or missing spoons or bottle caps
• Syringes
• Small bags with powder residue
• Missing shoe laces or belts
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16. If someone overdoses…what to do
 If you can’t get a response or you hear a deep snoring sound, don’t
assume the person is asleep; this can be a sign of an overdose.
 Call 911 immediately. Stay with the person.
 Not all fatal overdoses happen quickly; sometimes it can take
hours. Action taken during those critical hours can save a life.
 If naloxone is available and you’ve been trained to use it, do so.
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17. What can I do to help?
 Learn the symptoms of drug addiction.
 Speak of addiction as any other disease. Shame and stigma often
prevent people from seeking help.
 Know where to get assistance and treatment for substance
 Many are fearful of withdrawal. Treatment can include withdrawal
management.
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18. What can I do to help?
 Clean out your medicine cabinet; dispose of
unused, leftover prescriptions safely.
 Consider locking up your prescription opioids
and other medications to keep them out of the
hands of people who may misuse them
 Learn how to dispense naloxone, which reverses
effects of opioid/heroin overdoses. To find a
class, go to www.fairfaxcounty.gov and search
for “revive.”
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19. What is Fairfax County doing to help?
 The Board of Supervisors convened an Opioid Task Force to address
opioid misuse and disorders in our communities. The group is
implementing a comprehensive series of strategies to address the issue.
The Fairfax County Opioid Task Force Plan can be viewed online.
 The Fairfax Falls Church Community Services Board has expanded
medication-assisted treatment (MAT) and has reduced the wait for
residential treatment by 50 percent. MAT combines behavioral therapy
and medications to treat substance use disorders. Medication can
reduce cravings and withdrawal effects.
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20. What is Fairfax County doing to help?
 Fairfax County is re-establishing an anti-drug Community Coalition to
implement awareness campaigns, advocate for policy and coordinate
environmental drug prevention strategies.
 Fairfax County Public Schools is piloting a Substance Abuse Prevention
Program in seven schools. The pilot provides resources and support for
students who are identified as at risk for early substance use.
 The Fairfax County Police Department started an Overdose
Investigation unit responsible for identifying and arresting dealers
involved in the distribution of drugs that resulted in overdose deaths.
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21. What is Fairfax County doing to help?
 REVIVE! training has expanded to include additional trainings across the
county; over 2,000 people have been trained so far. Training is also being
provided to individuals incarcerated in the Adult Detention Center to help
reduce overdose deaths after release when risk is much higher.
 A new outreach program targeting various populations and groups at high
risk of overdose messaging to wider audiences is being rolled out.
 Drug take-back boxes are now located at twenty locations in Fairfax County,
including all eight Fairfax County Police Department police stations. Unused
or unneeded medications can be dropped at any of these sites for safe,
convenient and responsible disposal.
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22. Help is here, 24/7.
If emergency is immediately life-threatening, call 911.
CSB Emergency Services at Merrifield Center – Available 24/7
8221 Willow Oaks Corporate Drive, Fairfax
You can come in to the Merrifield Center directly or call first.
703-573-5679 TTY 711
Fairfax Detoxification Center – Available 24/7
703-502-7000 TTY 703-322-9080
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23. Think you may need help?
 Take a free online, confidential screening, anytime 24/7:
http://screening.mentalhealthscreening.org/northern-virginia
 Come in person to the Merrifield Center during business hours and talk
with our entry and referral staff, Monday through Friday, 9 a.m. to 5
p.m. Youth walk-in evaluations are offered during these times and also
until 7 p.m. on Tuesdays.
 Or call us at 703-383-8500 TTY 711.
 Fairfax Detoxification Center is available 24/7 at 703-502-7000,
TTY 703-322-9080.
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