Cynthia Haley, a peer recovery specialist, works with the HOPE Initiative in Roanoke to offer treatment and resources to people with substance use disorder.
In the last year, Roanoke has seen a steep decrease in overdoses - a phenomenon that local experts feel can be attributed to the individuals and organizations devoted to harm reduction work in the community.
Recent data shows that nationwide, overdose deaths decreased by nearly 27% from 2023 to 2024. Virginia saw the same trend, with drug overdose deaths dropping by more than 43% in 2024, as compared to 2023, according to data from the Virginia Department of Health. VDH data from 2024 is preliminary and subject to change.
From January to April in 2024, there were 232 reported overdose cases in Roanoke, according to Roanoke Fire-EMS. In that same time period in 2025, there were 162 reported overdose cases -- a 30% reduction.
Even with this decrease, Roanoke still had one of the highest drug overdose death rates in Virginia last year at 58.6 per 100,000 residents. For comparison, Lynchburg's death rate in 2024 was 14.7 per 100,000 residents. The death rate in Portsmouth, which is similar in size to Roanoke, in 2024 was 44.2 per 100,000 residents.
In a statement to The Roanoke Times, the Roanoke and Alleghany Health Districts staff said that they believe harm reduction services made a major contribution to the decreased number of overdoses, both fatal and non-fatal.
"While these trends are very encouraging, we must remain vigilant. We continue to have alarming rates of overdoses, likely associated with contaminated, unregulated illicit drug supplies," the statement read. "Every single overdose is preventable. We will continue to work closely with community partners to both prevent and respond to substance use disorder."
Danny Clawson, executive director of the Virginia Harm Reduction Coalition, said that when they first saw the data for 2024, it took them a few weeks to believe it. Once they verified that the numbers were real, they were astonished.
"The overdose deaths reduction that we're seeing in 2024 is real," Clawson said. "It's remarkable."
A 'miracle drug'
Clawson, who uses the pronoun they, has a few theories as to what caused this decrease. First is the access to and distribution of naloxone, which has increased significantly over the past few years. Previously, naloxone was only available at places like the coalition. Now, the opioid overdose reversal drug is much more broadly available, and can even be purchased over the counter. Everyone should carry it, because "you don't know when you're going to come across somebody that needs it," Clawson said.
"There's a lot of time and effort and money put into distributing and getting out this miracle drug, and it is working," they said. "So I think that is the biggest factor in reducing overdose deaths."
Roanoke Fire-EMS Lt. Jeff Proulx agrees.
"In the field, we've seen a decrease in reported overdoses, and I personally attribute that to the availability of Narcan to the general public," he said. Narcan is a brand name for a device that delivers naloxone, the opioid-overdose antidote.
In 2024, VHRC distributed 19,656 doses of naloxone, including both nasal and intramuscular forms. Participants self-reported reversing 1,330 overdoses last year, Clawson said. In the majority of those cases, emergency medical services were never called, and thus those cases were never reported to public health institutions, they said.
First responders are aware of that as well. The stigma that surrounds overdoses, paired with the fact that people are often afraid they'll get in trouble if they're found with drugs on them, can deter people from reporting incidents, Proulx said.
"The biggest thing is we want to make sure that we are helping our citizens and visitors of the Roanoke Valley and getting them the assistance they need and deserve, whether that's on their own or through The HOPE Initiative," he said.
HOPE for the future
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The Bradley Free Clinic's HOPE Initiative helps connect individuals with substance use disorder to treatment and resources. Cynthia Haley, in long-term recovery herself, works as a peer recovery specialist through the program. Recently, she was nominated for the Substance Abuse and Addiction Recovery Alliance of Virginia's 2025 Peer of the Year award.
Haley and another peer recovery specialist are part of a ride-along program in which they ride with rescue crews responding to overdose calls in Roanoke and Salem. Once on scene, Haley is able to speak with the person about treatment and resources, give them her card and, if nothing else, just let them know that they're not alone.
Her personal lived experience is vital to how she connects with people in these situations, and it helps her build a relationship with them, she said. She remembers that when she was in their shoes, she would have never spoken to anyone in uniform, even if it was a first responder, out of fear of getting arrested.
"I want them to know too that I was exactly where they were at one point, so there's never any judgement," Haley said. "I just genuinely want to help."
Haley follows up with the people she meets on the job regularly -- not to pressure them into treatment, but just to let them know that she's there for them when they're ready, she said. Since June 2023, the HOPE Initiative has connected with 196 people, with 68 people accepting treatment.
"I think that Roanoke is very progressive in its approach to treating addiction and substance abuse, and I think that they're seeing results from taking an approach that's maybe not necessarily traditional," Haley said.
The significant decrease in overdose deaths is a sign that things are heading in the right direction, but it's also important to maintain the work that's saving lives, Haley said.
"I think it's important not to get complacent just because they are down for now," she said.
'Volatile drug supply,' volatile funding
While the data from 2024 is promising, Clawson said that what VHRC is seeing in real time in 2025 concerns them. The coalition sends off samples from syringes or empty baggies of substances related to an overdose to the University of North Carolina's street drug analysis lab for a comprehensive review. They heard back that a sample they sent off recently was "just pure fentanyl," Clawson said. Nearly 80% of drug overdose deaths involve fentanyl, fentanyl analogs and tramadol, according to the VDH webpage for drug overdose data.
"People are using more, but also it's the volatility in the drug supply that I think is partially to blame," they said.
Clawson heard from colleagues in Kentucky, North Carolina and Tennessee that they were beginning to see nitazene -- a strong synthetic opioid -- show up in the local drug supply. Knowing it would eventually make its way to Virginia and Roanoke, VHRC worked with the health department to get nitazene test strips, which they now offer in addition to test strips for fentanyl, xylazine and benzodiazepines.
Some of the test strips in Roanoke have indicated positive for nitazene, so they've sent samples off to the UNC lab to confirm, Clawson said.
Lately, participants have reported that they're worried about social service cuts and losing access to programs like Medicaid and food assistance, Clawson said. Many participants have reported that, as a result of that anxiety, they're using drugs more often.
"The rapid dismantling of bedrock government institutions that community organizations and millions of people rely on is having a very quick impact," they said. "People are feeling that impact."
The participants aren't the only ones feeling the impact, either. Around 80% of VHRC's funding originates in federal funding, Clawson said. They've already been hit with budget cuts, to which they're working to adjust. VHRC hasn't had to implement layoffs or pay cuts, but other harm reduction organizations haven't been so lucky, Clawson said.
"One of the syringe programs that we're friends with in Kentucky, the whole staff voted to take salary cuts and hourly cuts to keep people on staff," they said.
Going forward, the most important thing is ensuring that this type of public health work continues, Clawson said. They feel that if harm reduction efforts slow or stop, deaths from drug overdose will start to increase again. Advocating to legislators and stakeholders, as well as finding ways to replace the funding that's been cut, is a priority because people's lives depend on it, they said.
"We cannot take our foot off the gas. If we do, we are going to go backwards," Clawson said. "If I was ever certain about anything in my life, I'm certain about that."
Lily Kincaid
(540) 986-5851
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