LETTERS: Henrico, region must act on opioid issue

Dear editor,

In my Henrico based behavioral health practice, I treat patients struggling with both pain and addiction — two conditions that Virginia's healthcare system inadvertently connects.

When Richmond announced its new Office of Opioid and Substance Use Response last month, and reports were released showing the troubling jump from 60 overdose deaths in 2019 to 270 in 2023, I felt both gratitude and concern – gratitude for the city's commitment to addressing this crisis, but concern that we're creating new offices to combat a problem while state Medicaid policy continues to complicate our efforts.

Hope, because we desperately need coordinated action. Frustration, because we're creating new offices to fight a fire while state policy continues pouring gasoline on it.

What concerns me most is Virginia's Medicaid "double fail" policy, which requires patients to try — and fail — on two medications before covering non-opioid alternatives. As a businesswoman who's built a career helping people overcome addiction and behavioral challenges, I see how this red tape gets in the way of good care.

In my practice, I work with individuals whose addiction journeys often began with legitimate prescriptions. They weren't seeking highs; they were seeking relief from real pain. Virginia's policy essentially guarantees that Medicaid patients —disproportionately people of color and low-income families — will be steered toward addictive substances before accessing safer alternatives.

What makes this particularly concerning is that we know better. In 2017 — the same year President Trump declared the opioid crisis a Public Health Emergency —Virginia launched its Addiction and Recovery Treatment Services program, expanding Medicaid coverage for comprehensive addiction treatment. Yet the same system that will pay for expensive inpatient detox and residential treatment doesn't prioritize covering non-opioid pain alternatives upfront, potentially creating the addiction it then works to treat.

As the Henrico Citizen reported in June, the county has broken ground on a 60-bed substance detox and recovery center. With Henrico County beds full, and preliminary data from 2024 showing there were over 1,400 drug overdose deaths among Virginia residents, we must act quickly.

I've learned that real change requires addressing root causes, not just symptoms. Richmond's new opioid office is a symptom-focused response. While I applaud the city's commitment to prevention, treatment, and recovery, we must simultaneously demand that Virginia fix its Medicaid policy.

This hits close to home in our communities. As both a healthcare provider and landlord, I've watched how this backwards approach ripples through families and neighborhoods. I've seen young people with so much potential get derailed, parents lose their kids, and whole households fall apart because someone couldn't get safe pain treatment from the start. The effects spread everywhere — into our neighborhoods, our schools, our whole community.

We should make fixing the "double fail" policy a top priority. We can't coordinate prevention while state policy pushes people toward opioids. Every day we wait means more Virginia residents getting steered toward addiction instead of healing — we're literally creating tomorrow's crisis while trying to fix today's.

Sincerely,
Keisha M. Wright,
CEO and founder, ProActive Behavioral Services