Abstract
Introduction
Greater Hampton Roads is experiencing a changing overdose epidemic that cannot be fully understood through overall death counts alone. Portsmouth recorded an overdose death rate of 95.7 per 100,000 in 2022 more than three times Virginia’s statewide rate of 29 per 100,000. This study examined how overdose mortality changed across drug classes, localities, and demographic groups in Greater Hampton Roads from 2018–2024, with particular attention to fentanyl and emerging polysubstance patterns.
Methods
A retrospective analysis used Virginia Department of Health (VDH) overdose mortality data and the Greater Hampton Roads Community Data Dashboard (2018–2024), stratified by drug class fentanyl and synthetic opioids, cocaine, heroin, prescription opioids, benzodiazepines, and psychostimulants and by locality, sex, and race/ethnicity. Interrupted time-series analysis with segmented regression assessed level and slope changes at two a priori breakpoints: March 2020 (COVID-19 pandemic onset) and Q3 2021 (post-pandemic fentanyl market acceleration). Trend differences by locality, race/ethnicity, and drug class were examined descriptively with frequency counts, crude rates, and percentage change calculations.
Results
Fentanyl accounted for approximately 79% of regional overdose deaths from 2019–2023, highlighting the dominant role of illicit synthetic opioids in the regional epidemic. At the same time, the drug supply and pattern of overdose mortality shifted. Cocaine-involved deaths increased 221% among males aged 55–64 between 2018 and 2023, raising concern about fentanyl contamination of the stimulant supply. In contrast, heroin-involved deaths declined by more than 60% after 2020, consistent with displacement by illicit fentanyl. Segmented analysis identified a significant post-2021 acceleration in stimulant-involved emergency department visits (+24.3%; 95% confidence interval: 17.9–31.1). Racial disparities also persisted: in 2023, overdose mortality among non-Hispanic Black Virginians was nearly twice that of non-Hispanic White Virginians, with particularly pronounced disparities in Norfolk and Portsmouth. Although opioid-related deaths declined substantially by 2024, improvement was geographically uneven.
Conclusion
Greater Hampton Roads is not simply experiencing fewer overdoses; the epidemic is changing. Declining heroin and prescription-opioid mortality is occurring alongside persistent fentanyl involvement and increasing stimulant-related risk. These findings support a geographically targeted, drug-supply-informed approach to prevention and harm reduction. Priorities should include expanding naloxone availability, strengthening fentanyl test-strip access for people who use stimulants, integrating overdose prevention into behavioral health services, and directing resources toward communities experiencing the greatest disparities. A multi-drug, equity-centered public health response is urgently needed, including naloxone saturation across all seven cities, fentanyl test strip expansion targeting stimulant users among others. A declining death count is a floor, not a finish line.