How Virginia’s Recent Opioid Reform Helps Pregnant Mothers

Following your doctor’s advice while pregnant just became less complicated in Virginia. Until recently, expectant mothers receiving medically prescribed treatment for opioid use disorder (OUD) could face the prospect of a child protective services (CPS) investigation solely because they were following their healthcare provider’s treatment plan for dealing with their drug addiction. Thanks to the reforms under House Bill 283, this is no longer the case. Without these protections, mothers could have avoided getting help—derailing recovery, increasing overdose risks, and leading to worse pregnancy and birth outcomes.

Maternal health is about more than expanding access to care. Good health policy also removes unnecessary barriers that discourage women from receiving care, even when we’re dealing with controversial addiction issues. That’s why it’s surprising that, although House Bill 283 was signed into law, it received little attention compared to Virginia’s widely discussed and cleverly named “Momnibus” package, a series of bills focused on improving maternal and infant health outcomes. That name combined “mom” with “omnibus,” which is a legislative term for a larger-than-normal bill.

While the Momnibus rightly focused on expanding and strengthening maternal health, HB 283 filled in another critical piece of that puzzle: women who are pregnant and grappling with OUD already face significant barriers to receiving care. Many fear the stigma and judgment or involvement from CPS, making them hesitant to seek prenatal care or addiction treatment. 

For pregnant women receiving medication for opioid use disorder (MOUD), like methadone or buprenorphine, clear health guidance is critical. They need to be able to talk frankly with their doctors about their situation without triggering a mandatory-reporting call to CPS. That fear is the biggest impediment, which is why Virginia’s approach is so important.

Until recently, statutory ambiguity in Virginia created uncertainty for these pregnant women and for the healthcare providers treating them. That lack of clear direction made it harder to ensure consistent application of child-welfare reporting requirements and left families unsure how medically supervised treatment would be interpreted. The General Assembly addressed this issue by clarifying that a pregnant woman’s use of prescribed MOUD as part of addiction treatment is not by itself considered a reason to suspect abuse or neglect. 

This distinction matters because health-related evidence shows that policies imposing “punitive approaches may be associated with unintended adverse pregnancy outcomes” for mothers and infants—including infant stillbirth and mortality, as well as an increase in the mothers’ overdose risk. Even public-health organizations including the American College of Obstetricians and Gynecologists have identified MOUD as safe and effective treatments for opioid use disorder during pregnancy because it “reduces relapse risk and its associated consequences.”

For expectant mothers with OUD, treatment—not punishment—creates the strongest foundation for healthier outcomes. Women receiving MOUD are more likely to remain connected to their healthcare providers and continue treatment after childbirth. Their infants are also more likely to attend recommended well-child visits, while families experience greater stability and are more likely to stay together. Most important, treatment helps build trust between mothers and their medical providers. That relationship is essential to help families thrive. 

Those outcomes reflect the broader goals Virginia has pursued through its maternal health agenda. Although HB 283 was not included in the Momnibus package, it represents the same underlying principle: improving maternal health requires expanding access to care and removing barriers.

Some critics say this clarification could limit the ability of CPS to intervene when children are at risk. No doubt, in some situations child-welfare intervention is critical. However, HB 283 does not prevent investigations when there are legitimate concerns that a child may face abuse or neglect. It simply establishes in the law that prescribed MOUD, taken while a woman is under the care of her provider, should not be treated as the sole reason for initiating an investigation.

Virginia is not alone in recognizing this challenge. More than half the states do not criminalize MOUD use during pregnancy. As the most recent state to take this approach, the Commonwealth is providing an example that it’s never too late to correct old, misguided policies that wrongly treated pregnant women in addiction recovery treatment as abusive or neglectful. 

Pregnancy is already challenging under the best circumstances. Public policy should not make it harder. Virginia chose to align its law with medical evidence rather than legal ambiguity, giving expectant mothers one less reason to avoid the care they need. That is the kind of maternal health reform worth recognizing and worth emulating.