The commonwealth can become a national model for what sustained recovery can look like when policy, funding and community are aligned to build what comes next, writes guest columnist Sarah King.
Southwest Virginia has become euphemistic for America’s opioid crisis, the backdrop of Netflix documentaries and the setting of stories like “Demon Copperhead.” For more than a decade, the region has carried some of the highest overdose rates in the commonwealth, with the fewest treatment resources to meet that need — roughly 19 treatment beds per 100,000 residents in Virginia, compared to nearly 100 in neighboring West Virginia.
That imbalance is starting to shift.
Dickenson County’s new Wildwood Recovery Center will soon add 112 treatment beds in a region that has long faced severe shortages. At the same time, Virginia is set to receive more than $1 billion in opioid settlement funding over the coming years, with more than $100 million already awarded through the Opioid Abatement Authority to localities and state agencies.
This is a rare alignment of urgency, resources and political will. It is also a test: whether Virginia will stop at saving lives in the short term, or build a system that makes recovery last.
Nearly seven years ago, I was the person others might have counted out. Addiction nearly claimed my life, and recovery did not happen because of a single intervention. It happened because I found something much harder to build and far easier to overlook: an access to a continuum of support comprising treatment, community, accountability, housing and, eventually, purpose.
In other words, recovery is not a single turning point after someone “hits bottom.” It is a long process made possible by what researchers call recovery capital – the personal, social and community resources that allow someone to rebuild and sustain their life. And that is where Virginia’s approach is still falling short.
Even as overdose deaths begin to decline in the commonwealth, too many Virginians leave treatment without the supports necessary to sustain recovery.
In Southwest Virginia, workforce participation hovers roughly 30 percentage points below the statewide average, while geography, workforce shortages and limited infrastructure compound the challenge. Individuals stabilize in treatment, often across state lines, only to return to the same conditions that made recovery difficult in the first place. Too often, the consequences are fatal.
For context, more than 2,400 individuals died of overdoses – an average of seven Virginians each day – in 2023, according to the most recent data from the VDH. That is not just a service gap. It is a systems design problem, and at the center of it is a surprisingly technical, but deeply consequential issue: licensure.
Virginia’s current behavioral health licensing structure generally requires providers to obtain separate licenses for each level of care. For organizations trying to build a full continuum – from residential treatment to outpatient services and recovery housing – that means navigating multiple applications, duplicative requirements and sequential delays.
In some cases, those delays are not about safety or quality, but process. Providers describe waiting weeks for approval over minor errors that could be resolved in minutes, only to restart the process and wait again. Meanwhile, facilities sit idle, staff remain on payroll and communities wait for services to open.
For large systems, that is inefficient. For small, rural and nonprofit providers, it is often a barrier to entry altogether. The result is a system organized around administrative categories instead of the lived reality of recovery, where timing can mean the difference between life and death.
There is a better way. Virginia should move toward bundled, entity-level licensure with standardized service endorsements, allowing qualified providers to operate multiple levels of care under one regulatory framework rather than starting from scratch each time they expand.
Importantly, this reform is within reach.
Because licensure is governed by regulation, the Department of Behavioral Health and Developmental Services can modernize the framework through rulemaking, with direction and support from the General Assembly and coordination with the Department of Medical Assistance Services. Opioid settlement funds can support implementation, including technical assistance for providers and equitable rollout in high-need regions.
Other states offer a clear proof point. Kentucky has spent decades building integrated recovery-to-work systems that connect treatment, housing, employment and long-term support. The results are striking: completion rates approaching 80%, sustained recovery rates near 75% at 18 months and more than $2 in public savings for every dollar invested.
Virginia already has elements of this model at the community level, including The Healing Place in Richmond, which pairs no-cost residential treatment with peer support, transitional housing and workforce pathways.
And yet, at the national level, policymakers are increasingly looking overseas for solutions. NPR recently highlighted interest from federal leadership in an Italian recovery model built around free treatment and integrated, step-down services. The irony is that similar models already exist here – in Richmond, across Appalachia and in communities nationwide that have built recovery ecosystems from the ground up.
Licensure reform is the most immediate lever to make that possible at scale. It should be paired with practical supports, such as a state-backed licensure navigator to help providers move through the system, much like economic development projects are guided from concept to completion.
Done right, these changes would do more than streamline bureaucracy. They would make it possible for more providers to enter the market, for more services to be delivered locally and for more Virginians to move from treatment into stable, productive lives.
In communities that have borne both economic decline and the highest burden of addiction, that matters far beyond health outcomes. Expanding recovery infrastructure means expanding workforce participation, stabilizing families and strengthening local economies.
Virginia has made real progress in reducing overdose deaths and expanding access to treatment. But stopping overdoses is only the first step. Without structural reform, we risk building a system that saves lives in the moment without giving people a real chance to rebuild them.
Policy cannot create recovery on its own. But it can create the conditions in which recovery is far more likely to endure — and far more widely accessible, regardless of geography. Virginia has already invested in responding to addiction. Now it can become a national model for what sustained recovery can look like when policy, funding and community are aligned to build what comes next.
This commentary is based on a year-long policy analysis conducted in partnership with the Virginia Joint Legislative Audit and Review Commission.