The Joint Commission on Health Care is seeking public comments on the policy options included in Commission staff’s report on the fentanyl crisis in Virginia, which was presented at the Commission’s September 17 meeting. Comments are due by close of business on Friday, October 3 and may be submitted via email to jchcpubliccomments@jchc.virginia.gov or via U.S. Mail to 411 E. Franklin Street, Suite 505, Richmond, VA 23219.
Legislation enacted in 2024 directed staff to analyze fentanyl prevalence and fentanyl overdoses in the Commonwealth, determine which prevention, intervention, and treatment strategies implemented in Virginia are succeeding, and develop recommendations to reduce the prevalence of fentanyl and the number of fentanyl overdoses in the Commonwealth. Staff found that fentanyl overdose deaths dropped significantly in the last two years after a sharp increase during the COVID-19 pandemic, appearing to return to pre-pandemic levels; however, overdose death rates remain higher than levels in 2016 (the year when Virginia first declared opioid addiction to be a public health emergency). More than 50 state-funded or state-administered strategies are in use across 18 agencies, including data collection, educational outreach focusing on youth, harm reduction programs, and treatment programs. Staff identified some opportunities to enhance current efforts by reducing barriers, such as the availability and cost of opioid antagonists like naloxone. Staff also identified pregnant and parenting women and incarcerated individuals as high-need populations and made several recommendations for ways to enhance services to individuals in these circumstances.
Policy options proposed by staff are detailed below. Staff’s presentation is available at this link, and the complete report is available at this link. Commission members will consider public comment and vote on policy options at the next meeting, which is scheduled for October 22.
- Designate the Virginia Department of Health (VDH) as the lead agency for opioid response in the Commonwealth and require state agencies to work with VDH on a statewide strategic plan for opioid response. This recommendation responds to concerns voiced by stakeholders about limited coordination in the Commonwealth’s opioid response.
- Appropriate funding each year to VDH from the state’s opioid settlement funds or state General Funds to maintain the state’s opioid antagonist distribution program. Direct VDH to develop a methodology to estimate annual program costs and provide these estimates to the Commission and the money committees each year.
- Eliminate the current requirement that VDH dedicate $1 million of its naloxone distribution funding to the purchase of a certain formulation of naloxone nasal spray. Although this funding had been requested by certain communities, staff noted that recent studies indicated that this formulation did not show additional benefits relative to the standard option, and removing the set-aside would allow program funding to be used more flexibly.
- Require certain coverage of opioid antagonists by health insurers.
- Clarify regulatory requirements regarding counseling for patients receiving medications for opioid use disorder. Current regulations require practitioners who offer medication-assisted treatment to provide counseling or refer patients to mental health service providers, and have been interpreted by some providers to mean that patients are required to participate in counseling to receive these medications.
- Require VDH and the Virginia Department of Corrections to develop agency guidelines for hiring peer recovery specialists with previous criminal convictions that would clarify requirements for employment in specific programs.
- Provide additional start-up funding for Project Link programs, which are currently offered at 14 of the state’s 40 Community Services Boards and provide specialized services to pregnant and parenting women.
- Direct the development of a plan to expand workforce incentive programs to health care providers in local and regional jails. This recommendation is intended to support the provision of mental health services in these facilities by addressing workforce shortages.
- Expand funding for the Jail Mental Health pilot program to allow additional jails to benefit (currently funding is restricted to the sites originally selected in FY 2017). Consolidate funding for the model addiction recovery program (which supports programming in local and regional jails) into the Jail-Based Substance Use Disorder Treatment and Transition Program (which was established in 2023 and funded with a one-time appropriation of $2 million in state opioid settlement funding in FY 2024, all of which has been allocated) and provide funding for an additional cohort of jails.
At the September 17 meeting, Commission members also received a presentation on key health metrics in Virginia, including life expectancy, prevalence of chronic conditions, insurance coverage, and medical cost burdens. Staff’s briefing is available at this link and the full report is available at this link.
VACo Contact: Katie Boyle