As authorized in §18.2-254.1 of the Code of Virginia, recovery courts aim to reduce substance use, recidivism, and the burden on the criminal justice system by integrating treatment and judicial supervision. This report provides a comprehensive overview of Virginia’s efforts to expand access to Medication for Opioid Use Disorder (MOUD) within the recovery court system including use of funding appropriated in Item 295 X of the 2025 Appropriations Act for longacting, injectable prescription drug treatment. Since 2015, Virginia has aligned its recovery court policies with federal guidelines and best practices from the National Association of Drug Court Professionals (NADCP), ensuring that participants are not denied access to recovery court services based on their use of FDA-approved medications such as methadone, buprenorphine, or naltrexone. These efforts are further supported by protections under the Americans with Disabilities Act (ADA), which prohibits discrimination against individuals receiving MOUD.

The expansion of Medicaid in 2018 and the implementation of the Addiction and Recovery Treatment Services (ARTS) significantly increased access to treatment services across the Commonwealth. As a result, many recovery court participants can receive MOUD through Medicaid or Medicare, thereby reducing reliance on state-funded support mechanisms such as Item 295 X. In addition, the increase in overdose deaths prompted Virginia to prioritize and make available a wider and more comprehensive array of substance use treatment options and support systems, thus offering diverse pathways to recovery. The expansion of substance use services can be seen in the preliminary data from the Virginia Department of Health, which shows a 43 percent decrease in drug overdose deaths as of June 2025 compared to 2023, suggesting that expanded access to treatment is having a measurable impact.

Between FY 2016 and FY 2025, Virginia piloted and expanded MOUD access in multiple jurisdictions, including Henrico, Norfolk, Charlottesville/Albemarle, and the recovery courts serving Buchanan, Dickenson, Russell, and Tazewell Counties. While these programs initially received state funding to support injectable medications, most courts ultimately reported that participants’ insurance coverage rendered the supplemental funding unnecessary.

Henrico and Norfolk Recovery Courts demonstrated strong collaboration with local behavioral health providers and jail-based programs to streamline insurance enrollment and ensure continuity of care. Both courts reported that all MOUD services provided during the most recent fiscal year were covered by insurance. However, they emphasized the importance of maintaining flexible funding in the event of future changes to Medicaid policy or participant eligibility. Findings from DBHDS indicate that while injectable medications are available and effective, some participants prefer oral formulations due to the psychological association of injections with past substance use. Barriers to utilization of injectable medications include insufficient knowledge, experience, or training regarding injectables and medication-assisted treatment (MAT).

In general, certain recovery ideologies and the logistical and coordination challenges between courts, treatment providers, and pharmacies may contribute to a preference for other treatment modalities.

To further support provider education and participant engagement, DBHDS has partnered with external stakeholders and submitted a technical assistance request to the Opioid Response Network to develop statewide training on injectable MOUD options. This report underscores the Commonwealth’s commitment to evidence-based treatment, interagency collaboration, and continuous improvement in addressing the opioid crisis through its recovery court system.