The opioid and addiction crisis has become a defining characteristic of

21st century America, profoundly affecting the Commonwealth of Virginia in

terms of lives lost, families devastated, communities compromised, and

economic and opportunity costs at multiple levels. This scenario originated

with a rapid increase in opioid prescriptions issued to patients by health care

providers for various pain diagnoses during the 1990s and into the early

2000s. Despite early warnings that the new opioid formulations were far

more addictive than indicated by faulty research trials and marketing claims,

treating pain as the “fifth vital sign” became a widespread practice as a

rationale for prescribing opioids for a broader array of health conditions. As

federal and state policies sought to curtail the increasingly deadly flow of

prescription opioids, some people suffering from opioid addiction turned to

heroin as a substitute, resulting in additional waves of overdose deaths in the

early 2010s and persisting into the current decade. Even as state government

agencies and local grassroots organizations have implemented prevention

and harm reduction approaches and policies over the past twenty years, the

proliferation of illicit and powerful synthetic opioids, including fentanyl and

carfentanil, has resulted in increased opioid and other substance use

disorder (SUD) acuity, as well as persistently high overdose rates.

In response to this ongoing challenge, state legislative and administrative

leadership are increasingly making and supporting proposals to transform

our healthcare systems and communities into recovery-oriented ecosystems.

These ecosystems can support everyone from individuals in acute crisis from

SUD, to those thriving in long-term recovery. For example, a key bi-partisan

effort from the 2023 Virginia General Assembly Session is a pilot project to

transform Catawba Hospital into a treatment center for both acute mental

illness and SUDs. The transformation would utilize excess capacity at

Catawba Hospital to provide SUD residential treatment and detoxification

beds, along with onsite, step-down services to provide a much-needed bridge

as individuals return to their home communities. As a first step, the General

Assembly is providing $500,000 in funding for the Virginia Department of

Behavioral Health and Developmental Services to explore public-private

partnerships that can bring SUD services to Catawba. In the years to come,

the project will need additional support for capital needs, workforce

development, and shoring up the recovery ecosystem.

This article explores the policy and sociological frameworks that have

brought Virginia’s political and health and human service leadership to this point of

innovation and change. Current shifts in policy and program approaches align with

a healthcare movement to treat SUD as a chronic disease, following a long history

of SUD being treated as a criminal offense and a moral issue. The time is right for

immediate and ongoing commitment to innovative approaches to address the

unprecedented crises of mental health and SUD among our fellow Virginians.