The opioid crisis has created serious challenges across rural America, and the New River Valley (NRV) is taking a proactive approach with the NRV Recovery Ecosystem. What makes this initiative stand out is its coordinated focus on prevention, treatment, recovery, and harm reduction, all working together to drive meaningful, long-term changes in addressing addiction and improving wellness throughout the region.

Led by the NRV Regional Commission, with Montgomery County as the fiscal agent, the program is a collaborative effort involving Floyd, Giles, Montgomery, and Pulaski counties, as well as the City of Radford. The work is carried out by a diverse network of organizations and individuals, all committed to tackling the root causes of addiction and strengthening the overall well-being of the New River Valley.

Origins and Background

The opioid epidemic has disproportionately affected manual laborers in the NRV, including coal miners and farmworkers, who were aggressively targeted by pharmaceutical companies promoting opioids as pain relief. As of 2022, Virginia experienced 2,490 overdose deaths, approximately 79% involving fentanyl​. The opioid-related death rate in Virginia stood at 24.5 per 100,000 residents, a significant rise over the past decade​.

Top 3 methods of unnatural death in Virginia (Photo: VDH)

In the NRV, the death rate from opioids was more than double the state average. In 2023, local leaders launched the NRV Recovery Ecosystem with $6 million in funding to tackle every aspect of substance use disorder, including prevention, treatment, harm reduction, and long-term recovery.

According to Kevin Byrd, Executive Director of the New River Valley Regional Commission, “This crisis isn’t something any one locality or organization can tackle alone. The strength of the NRV Recovery Ecosystem is our regional collaboration, where every partner brings something vital to the table.”

Key Programs and Initiatives

The NRV Recovery Ecosystem’s holistic approach includes programs in four core areas:

• Prevention: Collaboration with schools, law enforcement, and healthcare providers to raise awareness and reduce stigma. Training sessions for law enforcement and medical providers help tackle stigmatized perspectives within these fields.
• Treatment: Expanding treatment, including increasing capacity at New Life Recovery Center and support of families and outpatient access to care.
• Recovery: Programs like Recovery Court and the Recovery Fitness Program provide ongoing support.
• Harm Reduction: The Rise Above Harm Reduction program offers mobile outreach, Comprehensive Harm Reductions services, medical and behavioral testing and treatment referrals, as well as care management and underlying need assessments and connections. This program focuses on meeting people where they are and building trust through nonjudgmental care.

As of September 16, 2024, key achievements include providing over 1,285 on-demand rides for recovery services, training more than 183 individuals in mental health and trauma care, and distributing over 602 naloxone kits.

New River Valley Regional Commission. “Recovery Ecosystem Digest: September.” NRVRC OAA Monthly Updates, September 16, 2024.

These numbers continue to grow due to the phenomenal work taking place in the region, with partners consistently expanding outreach efforts, enhancing service delivery, and building greater community engagement. The momentum behind these initiatives is driving a sustained impact, so that our community receives the support and care it needs as the ecosystem evolves.

NRVRC Community Health Team supporting the NRV Recovery Ecosystem

The NRVRC supports the administrative, evaluation and reporting elements of the program along with training, education, communication and outreach strategies and performance measures. Technical teams and oversight are supported by a committed core team in collaboration with our service and governmental partners. Their collaboration strengthens every facet of prevention, recovery, and harm reduction in the NRV woven together to support a true ecosystem of recovery.

Economic Impacts and Workforce Rehabilitation

The opioid crisis is both a public health emergency and a critical economic issue for the NRV. Substance use disorders reduce workforce participation and productivity while increasing healthcare costs. The NRV Recovery Ecosystem seeks to rehabilitate the workforce by helping individuals overcome addiction and re-enter the labor market, which is critical for the region’s economic stability.

“Addiction doesn’t just impact individuals. It affects our entire region’s ability to grow and thrive economically,” explains Byrd. “By tackling this issue, we’re not only helping people recover but also making sure our region has a strong, healthy workforce.”

Relevance to the Comprehensive Economic Development Strategy (CEDS)
The NRV Recovery Ecosystem aligns closely with the region’s Comprehensive Economic Development Strategy (CEDS) by addressing critical issues that directly affect the region’s workforce, public health, and overall economic vitality. Substance use disorders, particularly the opioid crisis, have drastically reduced workforce participation and productivity, as noted in the CEDS goals of improving workforce development and supporting economic resilience.

The Recovery Ecosystem not only offers essential health interventions but also contributes to workforce rehabilitation, a key element in the NRV’s broader economic development plans. As highlighted in the CEDS, building a resilient workforce is vital for sustaining long-term economic growth. Specifically:

• Goal 1: Build a Strong, Resilient Economy by Improving Workforce Development
  The Recovery Ecosystem helps individuals overcome addiction, contributing to workforce rehabilitation and addressing labor shortages.
• Goal 3: Support Economic Resilience
  By mitigating the opioid crisis’s impact on workforce participation, the initiative bolsters long-term economic resilience.
• Goal 4: Expand Healthcare and Address Health Disparities
  The Ecosystem improves access to addiction treatment and healthcare services, supporting healthier communities and a stronger workforce.

This initiative further supports CEDS priorities, such as fostering partnerships across sectors. As the NRV continues to develop a healthy, well-trained workforce, the Recovery Ecosystem’s contribution to both the social and economic fabric of the region is invaluable. It underscores the importance of regional collaboration in overcoming the challenges of the opioid crisis while fostering long-term economic stability.

Reflections on Progress: Achievements and Insights

Holly Lesko, Director of Community Health for the New River Valley Regional Commission, reflects on progress made throughout the year, sharing highlights and lessons learned from ongoing efforts to build the NRV Recovery Ecosystem.

Highlights from FY24

• Anti-Stigma Campaign: Launched a multi-platform campaign to reduce stigma around substance use recovery. This included social media posts, blogs, website content, and mailers to engage the community. (Follow us @TogetherNRV)
• Lunch and Learns: Held educational sessions across the region to promote the NRV Recovery Ecosystem, encouraging participation in technical teams and programming.
• Partnership Agreements: Finalized Contracts, Memorandums of Agreements (MOAs), and aligned budgets with government and agency partners to solidify collaboration and funding streams.
• Rise Above Program: Launched the Rise Above mobile harm reduction outreach initiative, operated by the New River Health District (NRHD), to provide critical support in the region.
• Hiring and Staffing: Expanded capacity by hiring new staff and contract employees across partner organizations, ensuring there were enough hands on deck to meet the demands of the work.
• Transportation Solutions: Purchased a handicapped-accessible van and implemented new dispatching software to improve coordination of on-demand ride services, operated by NRVCS, for individuals in recovery.
• Advocacy for Recovery Court: Led testimony and advocacy efforts in Richmond, successfully promoting a name change from Drug Court to Recovery Court, marking a shift in focus towards long-term recovery.
• Trauma-Informed Care (TIC) and ACEs Training: Promoted and delivered Trauma-Informed Care and Adverse Childhood Experiences Train the Trainer events to increase regional capacity in these essential recovery and prevention skills.

Lessons Learned from FY24

• Contracts and MOAs take considerable time to develop and execute, highlighting the need for strong leadership and coordination.
• A strong fiscal agent, like Montgomery County, is crucial for managing the complexities of a regional effort.
• System change work often requires patience, as sometimes going slow allows for faster progress later on.
• Involving more people and organizations can be beneficial, but having a structured process and meaningful work for all participants is key. When more are ready to join, ensure the space is made available.
• Flexibility is essential in responding to varying levels of readiness across different fronts. Equity does not always mean equality in action.

Regional Collaboration and Funding

The NRV Recovery Ecosystem thrives on collaboration, involving five local governments and eleven regional agencies. The project has received $4.4 million from the Virginia Opioid Abatement Authority and over $1.5 million from local jurisdictions. This collaborative funding supports prevention, treatment, harm reduction, and stigma-reduction efforts across the region (Roanoke Times). Montgomery County acts as the fiscal agent, ensuring funds are distributed effectively.

To fund stigma reduction and all other facets of the initiative, the project has been allocated almost $6 million within the first two years of the regional project, which began in 2023. The Recovery Ecosystem has received approximately $4.4 million of this from the Opioid Abatement Authority. The local governments receive direct allocations from both the OAA and direct settlements. Between the five jurisdictions, they received over $3 million to spend on opioid abatement activities and committed almost $1.5 million to the regional project.

Future Goals and Vision

The NRV Recovery Ecosystem has set several long-term goals, including:

• Expanding treatment capacity, such as increasing the number of beds at New Life from 10 to 17 (Roanoke Times).
• Enhancing public education to reduce stigma around addiction.
• Securing additional funding for sustainability beyond the current three-year funding window.
• Addressing critical issues like transportation and housing for individuals in recovery.

Conclusion

As Holly Lesko emphasizes, “The work we are doing now is laying the foundation for a healthier, more resilient NRV in the years to come.” By linking services and guiding investment among governmental and agency partners, Lesko notes, “The NRV Recovery Ecosystem is built upon shared commitment and investment in the overall success of the work.”

However, sustainability remains a key challenge. Lesko highlights that “Sustainability is a double-edged sword for this innovative funding effort. It’s critical that work continues beyond OAA funding availability.” She stresses the importance of using current resources wisely: “It is also imperative that service agencies and governmental partners utilize these resources to try new and innovative approaches to address this insidious disease in individuals and communities.”

Lesko also emphasizes the power of bold action and collaboration: “This shared commitment to think and act boldly can build on economies of scale and programming where appropriate. It also builds impetus for shared investment in the long-term success and obligation to the needs of the communities served. We are in this together.”

In conclusion, the New River Valley Recovery Ecosystem is a testament to how regional collaboration can address complex public health crises like the opioid epidemic. Through its integrated approach to prevention, treatment, harm reduction, and recovery, the initiative is making significant strides in saving lives and revitalizing the local economy. As other regions consider adopting similar models, the NRV Recovery Ecosystem stands as a powerful example of partnership, innovation, and resilience.