Western Albemarle Rescue Squad (WARS) Chief Kostas Alibertis is raising the alarm about a strong upswing in opioid overdoses in the Crozet area. “We’ve seen a dramatic, notable increase in the use and abuse of drugs in recent months, and it is not marijuana,” he said. “Overdoses from primarily opioids are happening here in our Crozet growth area at an increasing rate.”
Alibertis, who’s served with the squad for almost 40 years, said WARS had 2,100 calls in 2022 (an average of almost six per day), an increase of 5-10% from the year before. That rate of increase is continuing into this year, and overdoses are a bigger part of the growth than other types of emergencies. “It’s hard to pull exact statistics because of the way we code emergency calls in our database,” he said. “For instance, if you overdose and you’re not breathing, your call is dispatched as a cardiac arrest, not as an overdose. So, it’s difficult to give precise numbers, but I can say that in all of 2019 we had a handful of overdose calls, and now we’re seeing multiple each month. We run these calls, we feel the jump.”
The Virginia Department of Health (VDH) collects data from hospitals that report on multiple causes of emergency department (ED) visits and deaths, so overdose cases are easier to identify. The VDH data shows a sharp uptick, as statewide deaths from opioid overdoses increased from 1,059 in 2018 to 2,223 in 2021, a 110% rise. During the same period, Virginia ED visits for opioids increased by 44%. In Albemarle County, opioid-related ED visits rose from 118 in 2020 to 184 in 2022, and the data from early 2023 extrapolates to an even higher total (240) for this year.
Alibertis described a few different types of overdose victims the squad encounters. “There’s the person who intentionally tries to harm themselves, perhaps in a call for help; there’s the person who’s experimenting with drugs and it gets out of hand; and there’s the chronic user,” he said. He has particularly noticed a higher level of “acuity”—a measure of the degree of sickness of the victim—in overdose calls lately. “We’ve had cases recently where we were called to the same location within a few days of each other related to an overdose. These are the kinds of things we haven’t seen before.”
Over the last 12 months, opioid overdose hospital ED visits in Virginia split about 60/40 between males and females, with 55% white and 35% Black patients. While victims aged 25 to 44 made up the largest block of ED visits, 45 to 64-year-olds were close behind. “In broad terms for what we see, some people are probably more recreational users, where others are doing it more for psychological reasons, like coping with stress or loneliness,” said Alibertis.
“We see people who have opioids because it’s a prescription and they overdo it, and others who buy it from dealers,” he said. “There is more of a methamphetamine problem in the Shenandoah Valley, but here we’re pretty affluent and there is ready access to opioids. The pandemic hit and everybody was isolated, they were stuck inside and lost some coping and social skills. Now we’re at the point where people either want to fit in [to the social scene], or they want to escape.”
An overdose can present itself to rescuers in multiple ways—from just not feeling well, to having a psychological emergency, to being in a car wreck, to having a heart attack—and squad members have to tease out the root causes by asking questions. Alibertis said most people will admit their drug use to rescuers. “We tell them that if we treat you and you hide something from us, we could accidentally do harm. We always share with folks that this [interaction] is private and confidential, but we need to know what you took so we don’t make you worse.”
Overdoses can vary widely in how long they take to be fatal. “You can take an overdose of acetaminophen, which can cause liver failure and eventual death if not treated,” said Alibertis. “You can take an overdose of heroin and die in the next five minutes. So it all depends on the drug, how much was taken, whether it was mixed with other drugs or alcohol. Opioids are depressants and so is alcohol, so if you mix them, they can depress your respiratory function, and you just stop breathing.”
The rescue squad brings about 95% of the people it treats to the hospital Emergency Department, but occasionally some refuse. “Sometimes somebody has not overdosed to the point of being impaired and they still retain their right to refuse. There’s a population of people who are used to getting high and don’t want to go to the hospital, but someone else had called us because they were passed out. In the last six months we’ve seen a dramatic increase in calls that were dispatched as cardiac arrests but were caused by overdosing. In most of those cases, we were able to reverse things, but not all of them.”
The squad is trained in the use of Naloxone (sold as Narcan)—a medication that can reverse an overdose from opioids—and in July it will be available over-the-counter, though Alibertis is not sure that means a reduction in calls. “The thing about treatments like Narcan is that the reversal agent usually lasts a shorter period of time than the insulting agent,” he said. “So Narcan might make you wake up and feel better, but then the Narcan wears off and the drug that you have in your system reintroduces itself.”
While all overdose cases are dispiriting to witness, Alibertis said that some of the most disturbing involve parents of small children. “That’s depressing to me because that person is responsible for a life that can’t yet be responsible for itself,” he said. In many cases there are spillover effects of drug overdoses such as broken families and increased crime. “When you’re addicted to drugs and don’t have money, that can lead to other types of criminal activity.” Law enforcement organizations report that crimes related to opioid addiction can range from petty theft to labor and sex trafficking to murder.
Overdose calls can differ in other ways from emergencies involving car accidents or falls, because they may expose the rescue crew to significantly more danger. “People can get very angry—it’s the attitude of, you just spent your last paycheck on getting high and we took that away,” said Alibertis. “Folks are under the influence, and they lack good judgment. The golden rule is, you cannot have a rational conversation with an irrational individual. They can lash out, they could have a weapon, could be combative, and whenever you enter a situation where someone has lost rationality, you’re at risk.”
In scenarios where the squad has reason to suspect danger on a call, their protocol is to wait for the police to arrive at the scene and go in first. The Albemarle County Police Department has begun carrying Narcan as well, which helps overdose victims. “The police can sometimes get to an emergency scene before we can, just based on where they are when the call comes in, and they can administer Narcan,” said Alibertis. “It’s great—the sooner the better in these situations.”
Overdose calls often result from situations where people have opted to put themselves into a hazardous situation intentionally, as opposed to an accidental injury or hazard. When asked if overdoses are more frustrating to squad members than other kinds of calls, Alibertis demurred. “It’s still an emergency in the truest sense,” he said. “An overdose can kill you, and the most important thing to us is that people call 911. We want them to call us because there’s a chance that our intervention will make a difference in their life. We have over a hundred members [volunteering at the Rescue Squad] and we don’t know when or how we’re going to make that impact, but we know it happens.”
Beyond alerting the community that opioid abuse is on the rise here, Alibertis wants citizens to pay attention to those around them who may be susceptible to drug overdose. “Usually, people are using drugs to fill a void or a gap, to either distract themselves from reality or to find pleasure that they’re not finding in their everyday lives,” he said. “If somebody sees that, and does something, they might be able to fill that that gap. Once a person becomes addicted, then it’s harder, but you never know what intervention can turn it around.”
Alibertis encourages anyone interested in the work that WARS does to volunteer. “We would love to see more community involvement in the Rescue Squad,” he said. “UVA’s hospital and its student population are a great resource, but we’d love more local people to get involved. An EMT class takes just a semester to do, an ambulance driving class is 16 hours.” Created in 1978, the all-volunteer squad could always use more hands. “We have a concurrency rate of 20%, which means that out of every fifth call that goes out, we’ll get a second call before that crew frees up,” said Alibertis.
“When people get involved, it really ties us to the community, and it gives us the ability to surge,” he said. “Surge means that if people are members of the rescue squad and something really bad happens—a plane flies into the side of a mountain, a bus drives into a tractor trailer, a train hits a trash truck—people can come out and help. When you run EMS calls, you help your neighbor and you become vested in your community” he said, “and one of the things Crozet has always been about is everybody helping their neighbor. That’s what we want.”