Crystal Songer remembers her first prescription for opioids.
“I was prescribed it around 15 or 16... Me and my dad were playing, preparing for a softball game in the backyard. And I broke this bone right here under my eye,” she says.
Songer says she got a prescription for Oxycontin from a health care professional, who was already treating her for other issues. Songer describes herself as the child of two parents with addiction problems, and she says she was instantly drawn to the feeling she got from the prescription painkiller. She says, “it was like a warm, fuzzy blanket.”
Songer goes on to describe a life that revolved around getting continuous prescriptions for Oxycontin. She recalls following medical advice during her first pregnancies, taking methadone or other drugs considered safe for an expectant mother. She shares that one of her children was born with drug dependency issues and that another child died of SIDS.
Songer says she moved far away from her home in Franklin County, Virginia, finding that opioids were easy to obtain elsewhere. At a pharmacy in Nebraska, she says she was able to get opioid medication without presenting medical records and with very few questions asked. She says it was too easy for people to become addicted and to stay addicted to opioids.
Eventually, Songer and a younger sister each inherited money from a relative, which she says brought her back to Virginia, where she was able to purchase a home. But she says she continued to abuse opioids through many traumas in her life, including the disappearance and presumed death of her sister more than a decade ago. Songer suspects the loss of her sister is related to drugs as well.
By the time Songer hit bottom, she says, she had lost her home and was living in an encampment along the river. She describes bathing in the river and relying on a local food bank for whatever they might offer her. She says her husband was taken away to jail at the same time.
“I was scared I was going to...overdose. And nobody was going to know where I was,” she says. …"When I found out that I was going to have another baby, I just decided this is it. You can't keep doing this. You can't keep living this way. You have lost so much money and so many people. If you don't change now, you'll probably die.”
Songer says she asked a friend to drop her off at a rehabilitation clinic. But after waiting for what she describes as a long time without anyone helping her, she says she left and found her way to Piedmont Community Services, which she believes saved her life.
Monica Flora is the Treatment and Recovery Coordinator for the Piedmont Community Services Board in Rocky Mount, Virginia. She oversees programming for those in recovery throughout the city of Martinsville, Henry County and surrounding areas, all hard-hit by opioid addiction.
“The first intervention that is needed is to help someone get through the withdrawal period,” Flora says. “So we try to introduce individuals to suboxone as quickly as possible. Because at that point, they feel absolutely miserable. You know, it's like the flu on steroids. They have diarrhea, they're throwing up. They're aching. Their bones sometimes feel like they're shattering. They feel terrible.”
Flora says that while methadone has been a helpful replacement for some individuals trying to wean themselves off opioids, Suboxone has proven much more effective. Suboxone has approval from the Food and Drug Administration as a prescription medication for people suffering from opioid abuse disorder. It contains Buprenorphine and Naloxone, and it decreases the pain of withdrawal by dulling the urge to take opioids.
“If someone can get suboxone, in about a half an hour or 45 minutes, they already start to feel better,” she says.
Martinsville saw the second highest opioid prescription rate per capita in the entire country between 2006 and 2012. Only Norton, Virginia, a few hours west, had more pills distributed per capita over that period.
“I don't think that the community was prepared. And I don't know how you would prepare for so many people to be ill,” Flora says. In the wake of that, she says the suffering has been widespread. “We're losing a lot of people. In 2020, we lost 56 people in the Martinsville, Henry County area. And those are neighbors, those are our loved ones.”
Community efforts in the schools have sought to mitigate some of the pain of children who’ve lost loved ones or who have had changes in guardianship because of adults becoming addicted and unable to care for them. Flora says, “Because there are so many people that are in active use right now, the children need some extra care and attention making sure that they are getting their needs met.”
Regarding the assistance adults need, she says, “We also have folks that live in some tent communities where they've lost housing, they've lost their jobs. And so they don't have any resources. So they live in the tents. And so we're trying to help folks that don't have shelter, don't have food, don't have clothing.”
Piedmont Community Services Board, like other Community Services Boards in the commonwealth, is a nonprofit that provides mental and emotional interventions, primarily for low-income clients. Piedmont has established programs to remind clients of their inherent value as human beings, including Grace House, which opened in December 2021 to provide housing and support programs for pregnant women and postpartum mothers facing drug addiction challenges in the Rocky Mount area.
Flora says she wants to be an ambassador of hope for people, and she’s driven by experiences in her own family as well as what she’s seen in Southwest Virginia communities.
“For many years, active use was full of shame and not wanting to ask for help. And the more that we learn that this is... a disease — it's a disease of choices — the more I want folks to know that they can get help,” she says.
Songer is at Piedmont to offer help now as well. Not only has she become a certified peer recovery counselor, but she also serves on a community task force with other counselors, faith leaders and law enforcement personnel — people who might have arrested her in the past. She’s on call for emergency room visits, and she sits with people in the hospital or in the PCSB offices when those neighbors are trying to get clean.
“I know how bad they feel when they're waiting to talk to somebody. And if I can get them out of withdrawal,” she says. “I'm changing lives every time I go into that ER and share my story. Or I'm sitting in that next room sharing my story. And somebody says, you know, I was gonna use the other day, but I thought about you. Wow, that touches me.”
In nearby Martinsville, having peer counselors in the emergency room is one of four strategies selected by community members as a priority for combating drug abuse. Small groups of stakeholders in the community worked in partnership with Engaging Martinsville, a research initiative funded through Americorps and led by scientists from Virgnia Commonwealth University and Virginia Tech, to select those strategies.
The community partners also identified establishing drug treatment courts, which channel offenders to counseling and classes rather than to jail. They were successful at opening a drug court in January of this year. Martinsville also elected to put resources into prevention programs in the schools and towards educating the general public about what resources are available to them to become or to remain healthy and substance-free.
Carlin Rafie, one of the Virginia Tech researchers, says Martinsville has taken the bull by the horns and that the resilience she’s seen in this city is remarkable but not uncommon.
“I think this is happening in communities all over Virginia. There are many coalitions that have come together,” she says. “There's a lot happening to address the issue, which gives me hope and is what we need to do in order to turn this around.”
Three hours west of Martinsville, in another Southwest Virginia town, Stacy Hicks is turning her life around using a dust cloth and some sturdy trash bags. The Russell County woman says she’s thankful for the opportunity to clean the courthouse and pick up litter along the roads. Two years ago, Hicks was facing a hefty jail sentence for low-level distribution of methamphetamine.
“When I got in trouble with the law, I was worried about how much time I would get and if my family would be mad at me,” she says. Hicks served several weeks in jail but then earned relative freedom through the Russell Community Work Program.
Once skeptical of the program, Russell’s Commonwealth’s Attorney Zach Stoots says that as a remedy for drug abuse, low-level drug crimes and other minor offenses, it’s the best thing happening in his county.
“It allows non-violent offenders to spend their incarceration on a work crew out working in the community instead of being incarcerated,” he says. “It saves the county a ton of money on housing inmates and saves the county on work. They work in county jobs at times, like the animal shelter or at the trash sites, ...paint buildings. One year, we saved a million dollars in work costs.”
Stoots says the program benefits the county and those who are assigned to it, who gain structure in their lives, sometimes for the first time.
“Every day, they get up and go to work. They know they could be drug tested that day. It also addresses the stigma that's out there for opioid use. People who are in everyday jobs in Russell County, who were employees of the government get to work beside offenders and realize that they're humans just like them,” he says.
Program Coordinator Missy Carter has been central to Russell’s Community Work Program since it started in 2016. She says at the outset, "...it was hard to get people to buy into it, because people want you to be hard on crime. And all I could say about that is they need to be in the work program one day because there's nothing easy about it. Some of them still live at home in their bad situation. I don't know how they do it going right back out to that.... But they stay sober. They do everything that we expect of them. And they don't have an issue with it. They're thankful to be home.”
Carter also oversees participants in Russell’s drug court, which emphasizes treatment. She says that, over time, it’s become clear to her that for every case of abuse, there are mental health issues at the root. Now, she says, they encourage treatment for everyone. Carter says that at least once a week, the workday concludes with a van taking workers to the local Community Services Board for counseling.
Now Russell County is sharing lessons learned with other localities.
“I think in late 2017 we met with Wise County and helped them... gave them all the things that we had stumbled upon. And they started a program which has done great, and since then, we've helped about seven other counties. Most recently, Washington County just started a program... got their first people sentenced last month. So, it's pretty exciting,” Carter says.
Wise County has pressed forward aggressively with its program, Wise Works, which has tallied a savings of $3 million since it began in 2018. In Russell, Stacy Hicks says that every county should have a similar program.
“It really helps people....The program has changed my life, because my family's proud of me. I'm proud of myself. I've been clean 17 months. I have a better relationship with my daughters... My days are good because I'm around positive, clean people... And I get to go home with my kids,” she says.
One recurring theme shared by virtually every professional interviewed for this report is that it’s vital to remove the stigma of drug abuse, clinically known as substance abuse disorder. With stigma comes secrecy, which ostensibly protects people struggling with substance abuse from some degree of public shaming but also prevents them from getting the help needed to end addiction and start recovery. Rafie says that if individuals in the community are hiding and ill, then the community cannot be healthy and whole. Flora says everyone is better served by “not asking what is wrong with people but by asking what happened to people” that prompted them to misuse drugs.
Asking the right questions about a statewide — and national — public health crisis becomes more urgent as untreated drug abuse leads to more overdoses each year. Virginia’s Department of Health says opioid overdose became the leading cause of unnatural death in the commonwealth in 2013. In 2020, the first year of the COVID-19 pandemic, four Virginians died from an opioid overdose every day. Opioid use has become even more problematic because of drugs being laced with the synthetic Fentanyl, which is lethal at smaller doses. And some people have transitioned from prescription opioids to heroin or amphetamines.
In 2021, Virginia established an Opioid Abatement Authority, which is headed by state Sen. Todd Pillion (R-Washington) with legal oversight from the Office of the Attorney General. The Abatement Authority will dispense to localities hundreds of millions of dollars that Virginia is now beginning to receive from lawsuits against drug companies for the ways they manufactured, promoted or distributed opioids. So far, Virginia’s portion of a $26 billion dollar payout from Johnson & Johnson is $530 million. Attorney General Jason Miyares said during a March press event in Southwest Virginia that the money will go to localities so each can apply financial resources to its priorities.
While much of Virginia’s efforts are related to treatment and legal responses, researchers at Virginia Tech are looking for a biomedical solution. Mike Zhang is among those testing a vaccine to prevent opioid addiction. He says the technology being tested is similar to what’s worked to subdue nicotine cravings.
“Right now, we are working on vaccine against the oxycodone. We hope we can extend that to the vaccine against the fentanyl. That's the most overused drug on the market right now,” Zhang says. “This approach can help the people that want to stop using... opioids. That will help them to become sober.”
And while overdose deaths have climbed, prompting some communities to declare or restate their status as places with public health crises, chemical interventions have been saving lives as well. National statistics reveal tens of thousands of lives saved from overdose by the prescription drug Naloxone, sometimes referred to by the brand name Narcan. In Virginia communities where large numbers of first responders and family members have been trained in how to use Naloxone, there have been dramatic drops in overdose deaths. That’s according to a VCU analysis of REVIVE, the opioid overdose and Naloxone education program of the Virginia Department of Behavioral Health and Development Services. In the study, prepared for the Virginia Association of Chiefs of Police, the rate of overdose deaths statewide in Virginia, though still increasing, has increased at a slower rate since the introduction of Naloxone in 2017. Another often-cited aid in the fight is a State Health Commission standing order issued in 2018 to make the Naloxone more widely available and easier for anyone to obtain.
With innovations from science, law enforcement and the treatment communities, as well as monetary infusions from government and legal settlements, there’s evidence throughout Virginia that communities are working diligently and collaboratively to recover from a devastating epidemic of opioid abuse. Updated data covering 2006 to 2014 shows Martinsville has dropped from the number two locality for opioid prescriptions per capita to number three.
One Martinsville pharmacist was convicted of writing prescriptions for more than half a million opioid pills in two years; they’re now serving a 40-year prison sentence. Prosecutors described Joel Smithers’ pharmacy as a kind of interstate drug operation. Also in jail is general practitioner Steven Collins, who Crystal Songer says prescribed her first dose of oxycodone when she was a teenager. Collins pleaded guilty in 2015 to child pornography charges as well as prescribing opioids outside his designated practice area.
Songer, whose peer recovery work in Rocky Mount includes training family members in proper use of Naloxone, says recovery is not easy but that is well worth it.
“I would be lying if I didn't tell you.... I didn't have triggers, or if I didn't think about using, but I know that that's not an option for me anymore,” she says. “I have an amazing life, I have a home, I have two vehicles, three beautiful kids that live in the home with me. And a relationship with my oldest that I'm trying to gain back one day....I feel like I'm giving back and all the bad that I put out there in the world will eventually be erased.”
Correction: A previous version on this article stated that Songer received her first opioid prescription from a chiropractor, but chiropractors can't prescribe medicine. We have updated the article and apologize for the error.
