Virginia Statewide Standing Order for Naloxone

Virginia’s statewide standing order for naloxone was an emergency measure intended to make an overdose-reversing drug more readily obtainable: in late 2016, the state authorized any resident to buy it under a blanket prescription. Issued as officials reported three overdose deaths a day and more than two dozen overdose cases daily in emergency departments across Virginia, the order addressed one urgent point in a much longer and often obstructed path from crisis to care.

Declaration and Scope

Virginia State Health Commissioner Marissa J. Levine declared the opioid crisis a public health emergency in late 2016. Alongside that declaration, she issued a statewide standing order—a blanket prescription—that allowed any Virginia resident to purchase the opioid antagonist naloxone, sold under the brand name Narcan. The order thus made the drug available through a general authorization rather than limiting access to people with an individual prescription from their own clinician.

The policy responded to an immediate public-health danger. Levine cited three Virginians dying every day from drug overdose, while emergency departments throughout the state were seeing more than two dozen overdose cases each day. The standing order was a direct, practical intervention against fatal overdose: it enabled access to a medication that can reverse an opioid overdose. The account does not claim that the order itself reduced deaths or describe how many people obtained or used the drug.

An Emergency Measure, Not a Treatment System

The order addressed the possibility of survival after overdose, but access to medication for continuing addiction treatment remained a distinct problem. The book describes patients facing long waits, substantial out-of-pocket costs, limited treatment capacity, and provider restrictions. Tess Henry’s buprenorphine medication was largely covered by insurance, for example, but her addiction-doctor visits required cash payments, including an upfront charge and repeated follow-up fees. These barriers belonged to the broader treatment system; the standing order did not remove them.

The contrast matters because an overdose reversal is not the same as a connection to continuing care. In Roanoke, Chris Perkins’s Hope Initiative sought to help people navigate treatment through trained volunteers, while the region still had limited local options for inpatient care and medication-assisted treatment. The statewide order supplied one necessary tool for an emergency, but its scope was narrower than the work of arranging treatment, counseling, and follow-up.

Place in Virginia’s Uneven Safety Net

The order arrived in a state where access to health care and addiction services was uneven. Virginia had repeatedly declined Medicaid expansion after the Affordable Care Act, leaving families and health advocates frustrated by the loss of federal funding and insurance coverage. The book also describes uninsured residents relying on occasional free clinics or mobile medical services rather than regular care. Those conditions help explain why a statewide authorization to obtain an overdose-reversing drug could matter without amounting to a comprehensive response.

In the narrative, the standing order marks a shift toward treating overdose as an urgent public-health problem and making a life-saving intervention more broadly available. Its significance lies both in that expanded access and in the limits made visible around it: survival could be addressed by emergency medication, while sustained recovery still depended on treatment capacity, affordability, insurance, and effective links between crisis services and continuing care.