1085: How the U.S. Virgin Islands Is Using Data and Prevention to Fight the Opioid Crisis

JOHN SHEEHAN: 

This is Public Health Review Morning Edition for Thursday, March 12, 2026. I'm John Sheehan for the Association of State and Territorial Health Officials.

Today: how the U.S. Virgin Islands is using data and prevention to fight the opioid crisis. My guest is Justa Encarnacion, ASTHO member and commissioner of health for the U.S. Virgin Islands Department of Health, who joined us from the ASTHO Leadership Forum in Washington, D.C., last week. Justa will share how island jurisdictions are tackling some of the nation's toughest health challenges with collaboration, data, and community-driven prevention. She'll also discuss the Fentanyl Free PR-USVI Initiative, a partnership with Puerto Rico and federal agencies that blends enforcement with public health strategies, including targeted education and naloxone training to detect opioid trends and respond quickly.

So, Justa, what brought you to this year's Leadership Forum?

JUSTA ENCARNACION: 

This is the sixth year that I've actually been here, so historically, I know that it's actually always going to be informative, and just the collaboration, being able to meet other SHOs and territorial officials is something that I embrace. You learn so much from each other, and also you are able to provide feedback, so you're hoping that they're learning from you as well, and because it's important for the island jurisdictions to be able to express how different we are, and also accept some of the similarities from a state-to-state basis, because each state is different, just as each island is.

SHEEHAN: 

Absolutely, and what have you been hearing at the Forum that you can bring back or apply to the Virgin Islands?

ENCARNACION: 

One of the things that we've been speaking about is making sure that we not just speak to our leaders when we speak, we're speaking to the staff, so they know how important it is. We visited the Hill and I was able to visit our Congresswoman, Stacey Plaskett. And I think it's important for the staff to also know what's happening and actually speak 'real talk' with them and give them some of the examples that we've experienced going on the hill and speaking to other ASTHO members as well. Even Governor Albert Bryan Jr. from the U.S. Virgin Islands. Yesterday, I texted him, and I let him know that so many of the same challenges that we're facing, the mainland is facing as well. And so, it's important for us to be able to correlate what's happening, and so, that's one of the things that I'm taking back to make sure that the staff, not just the leaders, but our staff, who are our leaders, can take advantage of the information that we learn.

SHEEHAN: 

A recent initiative in the Virgin Islands has been the Fentanyl Free USVI initiative. Can you tell us about this? What is it, and what's been happening?

ENCARNACION: 

So, it's the Fentanyl Free PR-USVI Initiative, because it comes out of HIDTA, High-Intensity Drug Enforcement Agency, and OAT Puerto Rico. The Secretary of Health in Puerto Rico, Victor Ramos, and myself, we are on the executive board for HIDTA. And so, we look at fentanyl or opioid processes in two different lines. We look at it from a preventive standpoint, and that's where health comes in. With that, we actually have coordinators under our Division of Behavioral Health and Substance Use, but also from the Department of Education, and of course from HIDTA, who is a former chief police officer, but he has adapted the thought process that prevention is really and truly what his goal is. So, it's not just the enforcement; he comes from an enforcement background, but he has actually embraced the prevention portion of it, and they go into schools on an ongoing basis. And they've actually been able to pull information from the youth as to what we can do differently, and it allows us to look to see where fentanyl is being used throughout the territory, and then we can pinpoint where our education is going and what type of education it's being linked to. I'll give you an example. One of the last meetings that we were in, they were able to show us what type of opioids are used in which districts within a territory, and not only the district, but on the island, where in the island we're seeing what level of and what type of opioid that's being used. So, we can actually target the use of that or education based on that, or however we choose to try to combat fentanyl use or opioid use within a jurisdiction or that section, I think that's incredible. Of course, then you have the enforcement portion of it, so VIPD works extremely close to HIDTA and to the Department of Health to ensure that. We all balance it, and we've actually had some fentanyl or opiate overdoses throughout the last several years, and when you look at the list, it's actually impressive in terms of the number of fentanyl or opiate overdoses that we see, but we haven't had the deaths. And one of the reasons why we haven't had the deaths is because one of the team members in the Department of Health, Jacqueline Greenidge-Payne is her name. She's taken the responsibility to work closely with HIDTA, and what she does is that she is doing CPR education and training with the policemen. And we're teaching the ones who did not know CPR, but also the use of naloxone, and given nanoxone packet. So, it's a combination of things that we're doing, so it's not just okay, we're praying to get 'fentanyl zero' within a territory, but the key thing is to save lives.

SHEEHAN: 

And you cited zero deaths, which again is huge, that's amazing.

ENCARNACION: 

We've had a few, but not recently. We've actually had about maybe five opioid-related deaths, but that was, I would say, about maybe three years ago. Most recently, we've had overdoses, but not death-related.

SHEEHAN: 

Gotcha. And, of course, you know, there's the immediate overdose, which is terrible, but there are all are also long-term effects: psychological. Can you talk about how you've approached how you treat the person going forward?

ENCARNACION: 

There's an aim, and I think we're seeing an increase of substance use psychosis throughout the territory. I think nationally, worldwide, if you really want to be honest, we're seeing that worldwide. And that is as a result of the type of opioids, the type of drugs, not just opioids, being used, and the fact that it's even more sensitive because we see substances being added to it. So, it's not just cannabis, we're seeing cannabis, we've seen the implication of artificial additives on that. If you think about what artificial additives have done historically to your body, think about what it does to your mind. And as a result of that, we're actually seeing a lot more, some, like I said, substance use and psychosis. And it takes a long time, if ever, to really figure out exactly if that person is going to be like who that person was before. So, that's why that prevention piece is so critical. So, what we have been doing is overall having campaigns out there, so that individuals can understand what the psychosis is all about and begin to treat them. And we link it with suicide prevention, and then we, if we get funding for one, we make sure that we're also teaching about every aspect of behavioral health within that. And it cannot be where we focus on just one group. For example, the Gen Z population may be one of the populations that we're targeting, but you cannot target one population and feel like you're going to be getting the results that you need. You have to target the population below and the population above, so parents, siblings, supporters have to know exactly what's happening, so that you can actually have a successful prevention or care process.

SHEEHAN: 

And can you talk about some of the challenges that are specific to the islands, just by the nature of the fact that they're islands, and that you know you are somewhat isolated? What kind of challenges does that present as far as surveillance and that data collection we talked about?

ENCARNACION: 

I have to tell you that it's a benefit to be an island person, island woman, but it's also, there are some disadvantages of living on an island. And you basically said it, it's separate geographically, there's a challenge there, and that is good at times, and really sometimes it's actually more of a challenge for us. And so, that alone, in terms of construction, I'll go to construction, one of the things that we're doing within the territory right now is that we are reconstructing our buildings and our health care facilities and our schools, our top priority human services as well. So, FEMA has provided lots of funding for us to do so, but the construction cost is exorbitant at this point in time, partly because of our location. So, what it would cost to build a building in a mainland sometimes costs three times as much to build a building within a territory. So, we suffer from that, and the reason I say suffer, is because the buildings that we're trying to build at this point in time are critical buildings; hospital infrastructure, public health infrastructure, human services, which focuses on the elderly and the pediatric population, or clinics outside of hospital. And so, you see, there's so many. It creates barriers for us, and then, of course, the timeline for billing is so much longer because we have to wait until those equipment supplies are actually brought into the territory. So, I think that's one of the challenges we have. One of the other challenges that we speak about, and we've been speaking about, because we're here, I'm here, along with the Pacific Island, and we suffer from the same challenge of Medicaid caps. And I'm sure that you've heard that before many times as well. And we've discussed that when we [went to] Congress, and I said we're on the Hill, but we actually are pleading to be able to have our cap increased even more, or at least taken off, and that goes also for Puerto Rico. And the reason why that is so important is because we want to try to balance the use of Medicaid funding with preventative care versus cure. And right now, Medicaid was initially health insurance that focused on cure. But if you look at the prevention portion of it, you actually are projected [that] you'll be spending a lot more money if you start now focusing on the prevention piece, [...] and time after time, you'll actually see the benefits of decreased chronic disease, decreased use of substances. Like we're speaking [about], and looking at how the federal partners will actually be happier and how we're spending and funding. I'm a big believer in being good stewards for whatever the money is; local money, federal money. You take care of what you have, so that you can actually be invited to [be awarded] even more money.

SHEEHAN: 

I imagine that, you know, in addition to those challenges you just mentioned geographically, is there a component to that isolation that also leads to closer community ties and better participation within the community towards that public health goal?

ENCARNACION: 

Of course, I have to tell you that one of the things that we speak about, like after hurricanes, that's when families actually get together, because we can't leave the island, and if you do it, it has to be over time. But that's the time when we know there's no access to wi-fi, there's no access to TV. And so, we sit in groups, and we talk, and everything is manual, and nothing is electronic. And so, there's that benefit, there's a closeness. I have just [been] going on the Hill yesterday and speaking to our Congresswoman Stacey Plaskett. Unlike the many states where you have congressperson, but you're a state of how many millions of individuals, whereas we have 100,000 or thereabouts individuals, and it's maybe three or four is four islands, basically. And we're all in one location at many times, as we know each other. So, it's like speaking to someone that you've known for several years, and that could be good and could be bad, but most [of the] time it actually benefits us because you formed that relationship.

SHEEHAN: 

Justa Encarnacion is an ASTHO member and commissioner of health for the U.S. Virgin Islands Department of Health.

Last week, ASTHO's Jen Layden, senior vice president for population health and innovation, joined the Washington University School of Public Health's  "Talking Public Health" seminar series to discuss public health practice: building partnerships to protect our communities. The series features leading public health voices shaping the field. Access a recording of the seminar through the link in our show notes.

America's food policies may be entering a new era. That's the topic of a new article in The Economist, featuring ASTHO staffer Andy Baker-White. Across the country, state legislatures are advancing a wave of new food regulations inspired by the Make America Healthy Again movement. From bans on certain food dyes in school meals to leading labeling requirements for additives, lawmakers in dozens of states are reshaping how food is regulated and what ends up on the plate. Find a link to the article in the show notes.

This has been Public Health Review Morning Edition. I'm John Sheehan for the Association of State and Territorial Health Officials.