The Recommendations

We recommend that Virginia state paraphernalia code be revised such that immunity from prosecution for paraphernalia possession is granted upon the disclosure of syringe possession before search, mirroring similar existing laws in Tennessee and North Carolina. 

A major issue that the New River Health District faces in their effort to institute a syringe exchange program within their three eligible localities--Giles County, Pulaski County, and Radford City--involve local government and law enforcement’s reluctance to provide the explicit approval needed to implement a syringe exchange program, due to both stigma and legitimate legal concerns around their resulting inability to enforce the current Virginia state paraphernalia code. 

To promote support for this policy revision, we recommend targeting stigma within law enforcement through mandatory sensitivity training in interactive crisis intervention focused on substance use disorder. In a study by Dr. JD Livingston et al. (2012) this training was shown to have “significantly reduced officers' desire to maintain social distance from people with substance use disorders.” Currently approximately 25% of officers in the NRV receive this training, but we believe all officers should receive this important training.

Based on our research, we believe an employer toolkit should include strong employee assistant programs (EAP) and workplace leadership to keep those in recovery in the workforce. 

About 66% of worksites with 100 or more employees and 90% of Fortune 500 firms have an EAP. Yet out of all US working-aged adults seeking help for substance abuse, only around 7.5% have been a part of an EAP, demonstrating a significant opportunity for improving this mode of reaching those in need of support. EAP services need to be clearly spelled out and employees must be assured they are absolutely confidential and protected under HIPPA.

An example of leadership in the workplace is PeerCare, a substance abuse prevention and early intervention program created by a major interstate transportation company. Employees completed training to learn how to recognize and intervene with a coworker who has a substance abuse problem. The black line in the figure shows as more employees were trained over the years, injury costs were greatly reduced displayed by the dashed line.

Given Virginia Tech’s expertise in health education around substance misuse, it is poised to model a healthy, positive environment for both employees and students in recovery. Some specific steps we identified through our research are to train RAs in naloxone use and to work with university leadership to support a recovery dorm on campus. Risk of overdose on university campuses is common, whether due to a relapse by a student in recovery, a suicide attempt, or an accidental overdose on the part of a student prescribed opiates post-operation. 

Although Naloxone distribution is allowed on campus and it can be accessed through the health department, Virginia Tech should give direct access to students, as well as make it readily available in dorms and to staff. We believe every Resident Advisor should undergo both naloxone and CPR training. This is feasible to implement, because Hokie Wellness already has certified instructors. Policies that normalize naloxone in a university setting work not only to provide needed health care for students but also reduce stigma. 

 Second, we recommend establishing housing specifically for students in recovery. Having a safe space dedicated solely to recovery is vital for any program to be successful and may lead to greater acceptance of recovery housing within the NRV, which is a top priority need based on our interview results.

Returning to the recovery ecosystem model our research has examined the recovery ecosystem of the New River Valley spanning multiple sectors including the individual and interpersonal level, community level, institutional level, and policy level. 

Returning to our main findings from our interviews, stigma is the primary barrier in the NRV for people in recovery that affects many other aspects to recovery, including access to harm reduction services, housing, transportation, and ultimately fulfilling and sustaining work. Our class was inspired by the people we spoke to throughout the semester, and we want to bring attention to the importance of treating interviewees as people and not just data. Increasing awareness efforts to improve understanding of substance misuse as an illness can increase empathy for those impacted by the opioid crisis.