R Street Testimony in Support of VA SB 36, Removing penalties from prenatal use of MOUDs
Testimony from:
Robert Melvin, Northeast Region Director, R Street Institute
In Support of SB 36: “Child abuse or neglect; prenatal use of a controlled substance or drug as prescribed.”
January 23, 2026
Senate Rehabilitation and Social Services Committee
Chairman VanValkenburg and members of the committee,
My name is Robert Melvin, and I am the Northeast region director at the R Street Institute. The R Street Institute is a nonprofit, nonpartisan public policy research organization engaged in policy analysis and outreach promoting free markets, and limited, effective governments in a variety of policy areas, including opioid harm reduction. This is why we have a strong interest in Senate Bill 36.
In a perfect world, no one would engage in substance misuse, but my organization recognizes that this is a noble, but unrealistic expectation. Some people will always engage in harmful behaviors and abstinence-based programs don’t work for everyone.[1] In contrast to abstinence-only strategies, harm reduction is an evidence-based policy approach that seeks to reduce health risks and prevent loss of life associated with certain behaviors, such as drug use, while maintaining access to care and support.[2] A harm reduction framework is especially critical when considering how state law treats pregnant individuals who are managing substance use disorders with medical support.
SB 36 removes ambiguity from state law by making it clear that if a pregnant woman is taking a prescribed medication—like a medication for opioid use disorder (MOUD), such as methadone or buprenorphine, under the care of her physician—is not reason to suspect she will abuse or neglect her child.[3] Medications for opioid use disorder help reduce cravings and withdrawal, block the effects of opioids, and support recovery.[4] These changes to state law would simply codify the existing guidelines from the Virginia Department of Social Services when assessing the validity of child abuse or neglect reports where there are allegations of a substance-exposed infant.[5]
In the Commonwealth of Virginia, state code conflicts with regulatory guidance so it leaves women who are pregnant and in recovery from opioid addiction uncertain if they will be subject to mandatory reporting for child abuse and neglect solely because they continued to take their MOUDs.[6] This issue is driven by uncertainty in state law that essentially treats any woman who is prescribed MOUDs—such as methadone and buprenorphine—during pregnancy as a reason to report her for abuse or neglect.[7]
It’s critical that Virginia clarifies and aligns the Code of Virginia with regulatory guidance. Doing so will promote consistent implementation of child abuse and neglect reporting in cases involving substance-exposed newborns and prevent conflicting guidance from influencing reporting decisions.
Moreover, it will help ensure that the state’s legal code considers best practices in the substance use recovery and medical communities. That is because MOUDs are considered the gold standard of treatment, regardless of whether you are or are not pregnant because of their safety and efficacy.[8] The American Medical Association and American College of Obstetrics and Gynecology broadly support the use of these medications.[9]
Medical experts understand that the use of MOUDs by pregnant mothers in recovery leads to better outcomes for both mother and baby than simply abstaining from opioid use.[10] In fact, prenatal MOUD use has been associated with more child wellness visits post-birth, lower maternal overdose risk, and helps build trust between the mother and medical providers—a critical connection to keeping both the mother and baby healthy.[11] This measure helps reinforce that important medical decisions between doctors and patients should be respected and not undermined.
This isn’t a new concept in Virginia or in many other states. Research has found that at least 25 states have laws that make it clear that prenatal use of MOUDs is not solely a reason to require reporting or apply harsher penalties.[12]
This measure will help reduce maternal overdose risks, improve health outcomes for newborn infants and align Virginia with the best practices supported by the medical community by removing ambiguity in state law. Critically, it will ensure that no woman in addiction recovery faces the prospect of having her child taken from her solely because she was taking a medication as prescribed and under the care of her physician. For these reasons, we urge you to pass SB 36.
Thank you,
Robert Melvin
Northeast Region State Government Affairs Director
R Street Institute
rmelvin@rstreet.org
[1] “Harm Reduction,” R Street Institute. Last accessed January 22, 2026. https://www.rstreet.org/home/our-issues/harm-reduction.
[2] “Harm Reduction,” Substance Abuse and Mental Health Administration, April 24, 2023. https://www.samhsa.gov/find-help/harm-reduction.
[3] Virginia General Assembly, 2026 Legislative Session, Senate Bill 36, Last accessed January 22, 2026: https://lis.virginia.gov/bill-details/20261/SB36
[4] National Institute on Drug Abuse, “Medications for Opioid Use Disorder,” Last accessed January 22, 2026. https://nida.nih.gov/research-topics/medications-opioid-use-disorder#medications
[5] Virginia Department of Planning and Budget, 2026 Legislative Session, Fiscal Impact Statement for Senate Bill 36, Last accessed January 22, 2026. https://lis.blob.core.windows.net/files/1085242.PDF
[6] Hillary Samples, et al., “Buprenorphine After Nonfatal Opioid Overdose: reduced Mortality Risk in Medicare Disability Beneficiciaries,” American Journal of Preventative Medicine, Vol. 6, Issue 1, p19-29, July 2023. https://pubmed.ncbi.nlm.nih.gov/36906496/ U.S Centers for Disease Control and Prevention, “Treatment of Opioid Use Disorder Before, During, and After Pregnancy,” Opioid Use During Pregnancy, May 7, 2025. https://www.cdc.gov/opioid-use-during-pregnancy/treatment/index.html#:~:text=Current%20clinical%20recommendations%20for%20pregnant,chances%20of%20a%20healthy%20pregnancy. Shoshana Walter, “They Followed Doctors’ Orders. Then Their Children Were Taken Away,” New York Times, July 1, 2023. https://www.nytimes.com/2023/06/29/magazine/pregnant-women-medication-suboxonbabies.html
[7] Jessica Shorthall, et al., “Barriers to Addressing Substance Use in Pregnancy: the View from Virginia,” R Street Institute, January 14, 2026. https://www.rstreet.org/events/barriers-to-addressing-substance-use-in-pregnancy-the-view-from-virginia/
[8] U.S. Public Health Service, “Facing Addiction in America: The Surgeon General’s Spotlight on Opioids,” The U.S. Department of Health and Human Services, Washington, DC, September 2018. https://www.hhs.gov/sites/default/files/OC_SpotlightOnOpioids.pdf
[9] American Medical Association, “AMA Report on Overdose Crisis in Pregnant and Postpartum People,” Press Release, February 2024. https://www.ama-assn.org/press-center/ama-press-releases/ama-report-overdose-crisis-pregnant-and-postpartum-people American College of Obstetricians and Gynecologists, “Opioid Use and Opioid Use Disorder in Pregnancy,” Committee Opinion, Committee on Obstetric Practice, August 2017. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/08/opioid-use-and-opioid-use-disorder-in-pregnancy
[10] Mallory Locklear, “Treating opioid disorder without meds more harmful than no treatment at all.” Yale News, December 19, 2023. https://news.yale.edu/2023/12/19/treating-opioid-disorder-without-meds-more-harmful-no-treatment-all
[11] Mir M. Ali, et al., “Medications for Opioid Use Disorder During the Prenatal Period and Infant Outcomes,” Journal of the American Medical Association Pediatrics, Vol 177. No 11, August 28, 2023. https://jamanetwork.com/journals/jamapediatrics/fullarticle/2808881 Elizabeth E. Krans, et al., “Outcomes associated with the use of medications for opioid use disorder during pregnancy,” Society for the Study of Addiction Research Report, May 25, 2021. https://onlinelibrary.wiley.com/doi/abs/10.1111/add.15582
[12] Stacey McKenna and Courtney Joslin, “Prenatal Substance Use Laws Inadvertently Endanger Healthy Families: A Review of Laws Affecting Pregnant Women in Recovery and Their Children,” R Street Institute, May 20, 2025. https://www.rstreet.org/research/prenatal-substance-use-laws-inadvertently-endanger-healthy-families-a-review-of-laws-affecting-pregnant-women-in-recovery-and-their-children/#_edn16