Virginia’s late-2016 declaration of the opioid crisis as a public health emergency marked a shift from treating overdose as a scattered series of individual emergencies to naming it as a statewide public-health crisis. State Health Commissioner Marissa J. Levine cited three Virginians dying each day from drug overdoses and more than two dozen overdose cases a day in emergency departments. She also issued a standing order allowing any resident to purchase naloxone, an opioid antagonist that can reverse an overdose.

The Crisis Behind the Declaration

The declaration followed years in which opioid exposure and the conditions shaping people’s health had converged. The introduction of OxyContin in 1996 coincided with a medical movement to treat pain as the fifth vital sign. New standards for pain assessment, patient-satisfaction measures, and pressure on hospitals to improve their ratings helped encourage liberal pain treatment. Purdue Pharma promoted the drug for a broad range of conditions while presenting addiction as rare, extending opioid prescribing far beyond end-of-life care.

The book also locates the epidemic in communities where work and economic security had weakened. In Martinsville and Henry County, unemployment rose above 20 percent, food-stamp claims more than tripled, and disability rates increased by 60.4 percent. Researcher Shannon Monnat described economic collapse as kindling and opiates as the spark: declining work opportunities and rising disability formed part of the crisis’s structural setting, not merely its backdrop.

Uneven Access to Care

Virginia entered the emergency without the treatment infrastructure available in some states. Its legislature had repeatedly rejected Medicaid expansion after the Affordable Care Act, foregoing federal funds and coverage for 400,000 low-income residents. In states that expanded Medicaid, the program helped pay for treatment, counseling, and addiction medications; Virginia’s decision left many families and advocates frustrated as local treatment options remained scarce.

The obstacles were concrete at the point of care. A private facility in the Roanoke area charged about $20,000 for a 28-day stay, accepted insurance and cash, and did not permit maintenance medication. Tess Henry’s experience showed a different but related strain: her family arranged a $20,000 treatment stay at the Life Center of Galax, with insurance covering most of the bill and her father paying a $6,500 deductible from her college savings. Later, buprenorphine helped her feel normal, but visits to her addiction doctor were cash-only, and follow-up appointments could cost $90 to $100 each, as many as four times a month. The declaration’s emergency order addressed overdose reversal, while these cases made plain how many steps and expenses still separated a person from ongoing treatment.

Naloxone and the Wider Response

The standing order made naloxone available for purchase by any Virginia resident without requiring an individual prescription. Its immediate significance was practical: it broadened access to a medication capable of reversing overdose at a time when emergency departments and families were confronting frequent crises. The measure belonged to a wider public-health approach that included harm reduction. In Vancouver, supervised injection sites, clean-syringe exchange, and naloxone distribution were used to reduce the harms of drug use; Seattle approved a supervised-injection program in 2017, despite the continuing federal prohibition.

The book presents the Virginia order alongside, rather than as a substitute for, treatment and recovery support. In 2017, Dr. Hughes Melton helped broaden access to medication-assisted treatment by working with state Medicaid officials on reimbursement for medication, counseling, and care coordination. At the same time, a Roanoke community services board added medication-assisted treatment for 21 patients, conditional on counseling, while Carilion still had a three-week wait for outpatient care. These developments show the distance between a statewide emergency measure and the slower work of building available, sustained care.

Significance

The declaration converted a rising death toll into an explicit public-health responsibility and gave residents a broader route to obtain naloxone. Yet the surrounding evidence resists treating that action as a complete response. Overdose reversal could create a chance to survive, but insurance gaps, fees, waiting lists, limited local facilities, and disagreement over medication-assisted treatment continued to shape whether that chance led to treatment. The emergency order was therefore both a concrete intervention and a measure of the larger system’s unfinished task: connecting survival to care that people could actually reach and continue.