Federal legislation would require states to fund addiction recovery programs

As drug overdose deaths surge in Virginia and across the country,  U.S. Rep. Abigail Spanberger, D-Henrico, has introduced a bipartisan bill that would create permanent federal funding for addiction recovery programs. 

The legislation would require states to spend at least 10 percent of the money they receive from the federal Substance Abuse Prevention and Treatment Block Grant on recovery programs with a record of success and peer support specialist programs to “help Virginians stay sober.”

“By establishing a 10 percent set-aside, this bill would provide much-needed assistance to recovery-focused community centers, homes, schools and ministries that are already doing the hard work of helping those struggling with addiction and assisting them as they navigate towards recovery,” Spanberger said. “We can provide hope, end the stigma and make peer recovery services accessible — but we need to demonstrate the federal willpower necessary to sustain recovery programs for the long haul.”

In the most recent fiscal year, Congress provided $1.8 billion for the program, Spanberger’s office said. Virginia’s allotment was $41 million. For next, the House of Representatives has proposed boosting the total appropriation to $2.8 billion.  The block grant accounts for approximately 15 percent of total state substance abuse agency funding.

This legislation comes as VDH data shows a  41.9 percent increase in overdose deaths in Virginia, from 1,627 in 2019 to 2,308 in 2020. However, Virginia Commonwealth University medical professionals say state leaders must look beyond legislation to reach a concrete, long-term solution to the opioid epidemic.

“One overdose death is a big deal, but all the other morbidity and mortality that can come from substance use — in addition to that overdose death — is not being captured by that data,” said Dr. Caitlin Martin, director of OB-GYN addiction services at the OB MOTIVATE Clinic, a program that treats women with substance abuse issues. Martin is also an assistant professor in the Department of Obstetrics and Gynecology at the VCU School of Medicine. “So for every overdose death that is identified, you think of all the other individuals and families that are being affected by addiction that fortunately are not represented in that overdose death,” she said.

While some substance abuse experts suspect the spike in overdose deaths can be attributed to the COVID-19 pandemic and the isolation that came with it, Martin and Dr. Brandon Wills, another VCU physician, said that there are multiple competing factors that are responsible for the surge.

“I don’t know if anyone knows the answers exactly, but it’s a combination of pandemic-related issues related to the stressors that have gone along with it, like mental health, financial pressures, isolation, access to services when everything was shut down,” said Wills, a leader for the Virtual Bridge Clinic in the Emergency Department, an associate professor in the VCU Department of Emergency Medicine and an associate medical director of the Virginia Poison Center. 

Martin emphasized the importance of addressing the recent spike and overall substance abuse epidemic holistically, noting that the community-oriented destigmitization of addiction would have a tangible, positive long-term impact on the commonwealth and the country. According to Martin, that can only be achieved by treating addiction as a legitimate medical disorder rather than something criminal or simply self-inflicted harm.    

“We need to make sure we understand that ODs are happening in the context of a larger big problem that is the disease of addiction, and we aren’t tackling it appropriately in this country on multiple levels,” said Martin. “That goes from recognizing that addiction is a chronic medical disorder. It has a neurobiological basis that we’ve known for decades, and yet we continue to say that it’s a moral failing, that people are choosing addiction.” 

Wills cited the increased role fentanyl — a cheaper,  extremely potent opiate that is often mixed into heroin — is playing in overdose deaths. “I don’t know how much this is discussed, but the rise of fentanyl in the heroin supply … that’s a big part of the surge in overdoses we’re seeing. These largely are unintentional overdoses, these aren’t patients that want to end up in the emergency department. And the vast majority of them don’t want to die when they’re using, but there’s ultra potent fentanyl that’s so prevalent in the heroin supply that it’s the more prevalent ingredient rather than traditional heroin.”

While both doctors acknowledged that cultural acceptance and sensitivity to addiction would be beneficial, each emphasized that goes hand-in-hand with legislative solutions.  Increased health care access, racial equity and education would all indirectly lead to positive results in culling the overdose spike in Virginia.

“Systemic issues, lack of access, those things were happening before, they aren’t new” said Martin. “COVID was definitely new, I’ll give you that, but other than that none of these things are different. Stigma discrimination against individuals with addiction? It was there before. The opioid crisis? It was there before. People want to pinpoint one thing, but it’s not as simple as ‘this caused that,’ it’s a contextual problem. That’s why people need to realize there’s not one solution for this, it’ll take grassroots level efforts as well as top-down level efforts. We all need to play a part.”