The Economic Case for Scaling Up the Opioid Care That Saved Thousands of Virginians’ Lives in a Year

People with unhealthy opioid use and their families often face enormous financial stress: from lost productivity and increased health care costs to caregiving for impacted family members and the long-term impact of being incarcerated – to name a few.

The communities around them also experience ripple effects. With fewer healthy people available to participate in the workforce and potentially needing more care:

• Every Virginian pays higher health care premiums.
• Businesses lose out on workers’ potential productivity and pay higher health care costs.
• Governments collect less tax revenue.
• Taxpayer-funded programs face increased costs related to health care, Child Welfare Services and K–12 education, and criminal justice.

Of course, not every impact can be monetized or even measured. In economic terms, though, with better outcomes, for all of the annual cost of $2.6 billion lost to the opioid crisis in a single year:

• Of every dollar of cost, about 43 cents of every dollar falls directly on families and businesses.
• About 57 cents falls on public budgets, which all Virginians help fund through taxes. That includes people who use opioids and their families, who share in both costs.

Better outcomes would ease this strain for everyone.

While the majority of people in active use have jobs, many struggle with daily living.20 They also face a higher risk of opioid-related jail time and overdose.22 People who died due to opioid overdose in 2024 lost a lifetime of earnings – a number that collectively makes up 27% of our total cost estimate.

It is impossible to fully measure the human and social costs of failing to care for people with opioid (and other substance) use and their families. These include far-reaching impacts, such as:

• the many lives lost. In Virginia, those who have died have included everyone from babies to individuals in their eighties. The Faces of Fentanyl memorializes some of the lives lost and lists their “forever ages”
• diminished quality of life for people with substance use, their loved ones, and communities22
• intergenerational trauma for affected children and their families23
• the diversion of resources otherwise spent on other social and community investments

Healing is beginning to happen in our communities, and it’s becoming more visible in some places. The City of Richmond, for example, became the nation’s first Inclusive Recovery City.24 Even so, we need to acknowledge grief.

As Maia Szalavitz writes, “Treating people with dignity itself empowers change. Those who feel respected are more likely to respect themselves. Humane treatment can spur self-care rather than self-destruction.”25

Honoring each other’s dignity includes recognizing our full range of human experiences – from our resilience to our deep sadness for those we’ve lost.

While our data model focuses on the cost of inaction, the truth is that a broad coalition of both grassroots and government organizations succeeded in saving many lives from overdose in 2024. Their work deserves recognition and much more support.

For example, VDH is proud to partner with community groups such as Health Brigade to provide comprehensive harm reduction (CHR) sites throughout Virginia. In 2024, the CHR sites achieved the following outcomes:26

• 31,641 CHR visits were attended by 5,800 clients
• 95.8% received CHR counseling
• Life-saving Naloxone kits were given to 4,379 clients
• 2,855 overdose reversals were reported by 1,776 clients

Harm reduction is just one of nine core evidence-based strategies promoted by Virginia Opioid Abatement Authority, the agency that oversees the spending of money awarded from the opioid settlements.27

Scaling up long-term investments in these strategies would enable us to save thousands of lives. It would also make recovery a likelier possibility for many more people with unhealthy opioid use and their families. In turn, these better outcomes would improve the economic wellbeing of businesses and taxpayers in every single community in Virginia. As we’ll discuss, the health gains of an inclusive recovery community offer enormous economic potential.

We know that with evidence-based care, people with unhealthy opioid use could more easily realize their full potential. Their families and friends could enjoy more years with their loved ones. Additionally, employers in their communities would have greater access to years of talent from a healthy workforce. (While they come from all walks of life, people especially at risk for harmful opioid use include those with physically-demanding jobs.28)

Not everyone realizes, though, that:

• Improving opioid use outcomes would also heal our economy in ways that many Virginians desperately need.
• Relevant research-backed interventions are not only cost-effective, but many are also cost-saving over time.29

Between 2023 and 2024, we found that a modest increase in funding for lifesaving opioid care was associated with at least $16 in economic benefit for every $1 spent. Communities may need different intervention strategies depending on their needs. Though financial impacts should never be the only consideration, they can be a helpful perspective to consider, especially with limited funds. Some cost-saving strategies include: