R Street Letter to VA Governor Abigail Spanberger in Support of VA HB 283, Removing Penalties From Prenatal Use of MOUDs

April 1, 2026

The Honorable Abigail Spanberger
Governor of Virginia
Patrick Henry Building
1111 E. Broad Street
Richmond, VA 23219

Re: R Street Institute’s Support for House Bill 283

Governor Spanberger,

My name is Robert Melvin, and I am the Northeast Region Director at the R Street Institute (RSI), which is a nonprofit, nonpartisan, public policy organization. Our mission is to engage in research and outreach to promote free markets and limited, effective government in many areas, including policies that support behavioral health and allow families to thrive. I am reaching out to your office on my organization’s behalf to express our support for House Bill 283.

In a perfect world, no one would engage in substance abuse, 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 women who are taking medications as part of their treatment for a substance use disorder.

HB 283 removes ambiguity from state law by making it clear that taking a medication for opioid use disorder (MOUD) such as methadone or buprenorphine under the care of a physician during pregnancy is not a sufficient reason to suspect a woman will abuse or neglect her child.[3] In fact, MOUDs help reduce cravings and withdrawal; block the effects of opioids; improve women’s treatment retention and recovery outcomes; and ultimately lead to healthier pregnancies, infants, and families.[4] These changes to state law would simply codify the existing guidelines from the Virginia Department of Social Services regarding allegations of a substance-exposed infant.[5]

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 safety and efficacy of MOUDs.[6] For this reason, the American Medical Association and American College of Obstetrics and Gynecology broadly support the use of these medications.[7]

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.[8] 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.[9] 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.[10]

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 medication for opioid use disorder as prescribed and under the care of her physician. For these reasons, we urge you to sign HB 283 into law.

Thank you,

Robert Melvin
Northeast Region State Government Affairs Director
R Street Institute
rmelvin@rstreet.org 

CC:       Gerica Goodman, Legislative Director, Office of Governor Abigail Spanberger

Rebecca Eichmann, Policy Director, Office of Governor Abigail Spanberger

Grant Neely, Deputy Chief of Staff for Policy and Communications, Office of Governor Abigail Spanberger

[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, House Bill 283, Last accessed February 27, 2026: https://lis.virginia.gov/bill-details/20261/HB283.

[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. 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.

[5] Virginia Department of Planning and Budget, 2026 Legislative Session, Fiscal Impact Statement for House Bill 283, Last accessed February 4, 2026. https://lis.blob.core.windows.net/files/1085242.PDF.

[6] 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

[7] 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

[8] 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

Ibid.

[9] 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.

[10] McKenna and Joslin. 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.