Tazewell County, Virginia, is presented as a rural Virginia setting where opioid treatment was shaped by a sharp tension: drug courts could coordinate treatment and supervision, yet many judges restricted medication-assisted treatment. Judge Jack Hurley pointed to the experience of mothers receiving such treatment as evidence of its benefits, giving the county a concrete place in the book’s discussion of access to care.

Courts and treatment access

The county appears in a wider account of rural Virginia drug courts. Although these courts brought prosecutors, defense attorneys, judges, and mental-health advocates together to address addiction, only a handful of the state’s rural drug-court judges permitted participants to receive medication-assisted treatment. In Tazewell County, the question was not simply whether treatment existed, but whether people under court supervision could use medication as part of it.

The surrounding treatment landscape reflected that conflict. The book describes illegal diversion of Suboxone as a prominent concern in local court dockets and the broader landscape, while a billboard along I-81 advertised a Bristol practice whose brief appointments suggested a rapid route to treatment. That juxtaposition places concern about diversion alongside the practical availability—and uneven oversight—of medication-based care.

Judge Hurley’s evidence

Tazewell County judge Jack Hurley cited thirteen babies born to mothers receiving medication-assisted treatment; none had neonatal abstinence syndrome. His example offered a specific counterpoint to resistance toward treatment medication: in his account, maternal treatment and the feared outcome did not coincide in any of those thirteen cases.

The figure made the policy disagreement tangible. Rather than treating medication only as a source of diversion or a challenge to abstinence-based court practices, Hurley invoked birth outcomes to argue for considering what treatment could achieve. The book records his example within the debate over whether drug-court participants should be allowed to remain on medication.

Significance

Tazewell County’s role is focused but revealing. It anchors a statewide access problem in a rural court setting, where formal coordination among justice and health professionals did not guarantee access to medication-assisted treatment. Hurley’s account of thirteen births, set against the limited number of judges who permitted such treatment, captures the gap between evidence offered in favor of care and the rules governing who could receive it.