The nerve center of the Richmond Ambulance Authority is relatively quiet, punctuated by the calm voice of a dispatcher talking someone through an emergency call. It seems slow now, but as one of the paramedics says, “It’s Friday night in Richmond.”
In this headquarters on Hermitage Road, the authority’s chief operating officer, Rob Lawrence, focuses on a set of screens. They display a map with eight years of data that comes fairly close to predicting the future.
“It’s a life-saving computer game,” Lawrence says.
The maps show when and from where the authority is most likely to get calls, and how far its ambulances are from hot spots of activity. Paramedics post up in those zones, marked by a deep purple on the maps, and wait for bad things to happen.
Their vigilance means they arrive at 90 percent of calls in less than nine minutes — a crucial time period for one of their most frequent life-threatening emergencies, opiate overdoses. To combat them, paramedics come armed with the drug naloxone.
In the last 12 months, the authority has administered 398 doses of naloxone, a number that’s has gone up steadily since 2010, when it was used 260 times.
“We’ve had five overdose calls today alone,” Lawrence says.
The eight years of data on these maps shows an increasing problem in Richmond with such drug use as heroin and prescription painkillers. And it follows trends statewide. Virginia recorded nearly 1,000 fatal overdoses in 2014, about 80 percent of them from prescription painkillers and heroin.
It’s a complex problem, and one that Attorney General Mark Herring says he’s made a priority since taking office in 2014.
“I spoke with so many people who have lost loved ones to either heroin or prescription drug overdose,” Herring says, “which just tears your heart out.”
Herring is at the ambulance authority to follow paramedics into the field. It’s an effort to understand what the front lines of the problem look like, and he’s brought a reporter and photographer from Style along.
Last year the General Assembly passed bipartisan legislation to allow police officers to carry naloxone and expand its availability at pharmacies.
But Richmond police don’t need to, Lawrence says, because the response time of the Richmond Ambulance Authority makes it redundant. In more rural parts of the state, Herring says, law enforcement officers have used it a lot.
At pharmacies, Herring says, “If someone, say, a family member, knows they’ve got someone in their household who is a user, they can get a standing order with a pharmacy to be able to have it.”
After he was elected, Herring says, he spent much of the year talking to law enforcement officers across the state about priorities. Opioid addition and overdoses came up first 75 percent of the time.
“We looked at the data and it supported what we were hearing anecdotally, that the spike in heroin and prescription drug [use] started a few years earlier, back in 2011, the overdose deaths were going up,” Herring says. “This is not an urban problem or a suburban problem or rural problem. It’s happening all over that state.”
Herring and Lawrence cite a few factors underlying the issue. In the early 2000s, prescription painkillers touted as nonaddictive became more widely available. And the use of such painkillers by patients recovering from surgery can lead to addiction.
Another problem comes from mixing painkillers like fentanyl with heroin for a more powerful effect. Users may not know exactly what they’re taking.
An opiate antagonist, naloxone works by blocking receptors in your brain that otherwise would absorb the opiate into the tissue. It varies in its effectiveness, depending on the person’s tolerance. It’s administered first via a nasal spray, and sometimes also by intravenous drip or direct injection.
The ambulance authority reports that the average age of patients to whom they administered naloxone was 34 in the past year.
“One of our concerns is that we’re now starting to see frequent users,” Lawrence says. “We’re now starting to see patients we are administering naloxone to more than once in our patient contact time.”
Herring says he knows the availability of naloxone isn’t the only solution. He touts a number of prevention programs, education programs and law-enforcement awareness priorities.
The General Assembly also passed a Good Samaritan reporting law, which has seen results in other states. “The reporting law is to encourage anyone in the presence of someone having an overdose to call 9-1-1, to stay and offer assistance,” Herring says. “Before that, unfortunately what we were seeing is that a lot of people were reluctant to call 9-1-1 for fear they might get in trouble.”
Last week, Herring joined 35 other attorneys general in an antitrust suit against the makers of Suboxone, a prescription drug used to treat opioid addiction by easing the cravings of addiction. The makers are accused of altering the drug slightly to maintain monopoly profits and keep less expensive generic alternatives from the market.
President Barack Obama declared last week Prescription Opioid and Heroin Epidemic Awareness week — within what’s already National Recovery Month — and asked Congress to pass a $1.1 billion plan to expand access to treatment.
Last week also marked the 25th anniversary of the Richmond Ambulance Authority, where paramedics are stationed across the city to serve as the last defense to a spike in overdoses.
But on this Friday night in Richmond, things are quiet.