When a suspected opioid overdose case in southwest Virginia raised alarms about a potentially dangerous substance spreading across state lines, the Tennessee and Virginia Overdose Response Strategy (ORS) teams enabled rapid cross-state coordination that strengthened partnerships and sparked efforts to improve overdose response processes. In September 2025, emergency department staff at a community hospital in southwest Virginia discovered a small package containing a yellow powdery substance during treatment for a suspected opioid overdose. This substance closely resembled material connected to recent overdose spikes in West Virginia and Kentucky. Concerned the same substance could be circulating in Virginia, the hospital’s director of security reached out to Tennessee task force partners who contacted the TN Public Health Analyst (PHA). The TN PHA connected the hospital security with the Appalachia HIDTA team, who then also connected with Washington/Baltimore HIDTA and the Virginia Drug Intelligence Officer (DIO). This rapid cross-state chain of communication occurred in less than 30 minutes.

While the substance was not ultimately recovered for testing, the incident led to a new direct connection between the hospital and the Virginia DIO, highlighted areas to expand hospital and law enforcement communication protocols and initiated planning conversations around evidence-handling and information-sharing. This event demonstrated the value of the ORS network in enabling rapid cross-state coordination during an emerging threat, with the established task forces and the I-81 Work Group providing streamlined communication and response.