Key Findings from Virginia’s 2024 Opioid Economic Data

Anyone can begin using substances in ways that harm our health – especially if we are experiencing pain, isolation, or we feel our life lacks meaning and purpose.2 Simply put, though: not having enough money makes it much harder to stay safe and recover if we experience unhealthy substance use.

Opioid-related health crises often deplete the resources of the people and their families impacted by them – adding to any financial stress that they are facing.

• When many people across a community experience unhealthy opioid use and the health risks it brings, community resources are stretched, as well.
• Rising financial insecurity can also directly hurt people’s health by driving up emotional stress, which can show up as physical pain, too.3,4,5

The resources available to us while we are using can powerfully affect our likelihood of accessing care and connecting to the supports we need to stay alive and live well.6

Of course, helping more Virginians survive opioid overdoses and stay safe from infectious diseases matters at a human level that cannot be calculated. At the same time, protecting our health also protects impacted communities’ financial resources in ways that can save more lives and promote more healing.

In 2024, Virginia added an estimated $65 million to $95 million in funding for opioid care across public funding streams, about 2% to 4% of the $2.6 billion in opioid-related costs Virginians faced that year. Our updated data and methods indicate this added investment was linked to an estimated $1.3 billion in lower costs for families, employers, and public budgets, though other factors also contributed.

Recovery capital is the concept of the support available to us to help us recover, coined by addiction researchers William Cloud and Robert Granfield. It includes:

• Social capital: relationships that support belonging, resilience, and pathways to opportunities such as a new job
• Human capital: knowledge, skills, educational credentials, health, mental health
• Physical capital: money, health insurance, or other tangible assets that can be converted into money
• Cultural capital: values, belief systems, and ways of making meaning in the world 13

Recovery can take many forms, and it may or may not require professional treatment or membership in a peer support group.14 Whatever the pathway someone chooses, recovery capital fundamentally makes staying well more likely: both how much is available to us, and how high-quality it is.13 At a community level, this could look like our collective access to all of these resources: housing, employment, and access to care, among other assets.14

Communities facing hardship also hold deep strengths, from mutual aid to faith communities to neighbors who show up for one another. Even so, not everyone has the same access to recovery capital.

Better access to income, housing, health coverage, and opportunity can often translate into supports that help people recover. People with less access to these supports, including historically marginalized groups, have far fewer assets for staying well and reducing or stopping use.15

And yet for people with less socioeconomic privilege, mobilizing family and community resources may be all the more vital. Researchers Rudolf and Bernice Moos found that treatment focused only on the individual helps people less when their family and community supports are limited.16

Notably, another research team found that “compared to those with alcohol and cannabis problems, those with opioid or other drug use problems (e.g., stimulants) had substantially lower recovery capital in the early years.”17

Our data showed a similar pattern: most of the places with the highest opioid costs per resident already faced economic strain. These communities typically face lower median household incomes and higher poverty rates than Virginia as a whole.

Across every community, though, in the words of addiction researcher William White: “Increases in recovery capital can spark turning points that ... trigger recovery initiation, elevate coping abilities, and enhance quality of life in long-term recovery.”13

Tragically, in 2024, we lost more than one thousand Virginians to opioid overdose deaths. Each one of the people we lost had a story that mattered. Many more people live with long-term health effects of substance use, even after they stop using.

At the same time, far fewer Virginians lost their lives to opioids, with the state’s overdose death rate dropping by 43%. Early data suggest that in 2025, outcomes continued to improve, with fatal overdoses decreasing another 23%. While fatal overdoses are just one measure of how communities are doing, they matter a lot.18

One major driver of better survival rates: overdose-reversal medication naloxone reached far more people across the state. Compared to previous years, the state’s overall budget for overdose-reversal medicine naloxone approximately tripled in 2024 – helping the medicine to reach more Virginians at risk of overdose.19

Perhaps most strikingly, the ratio of lives lost to lives saved dramatically improved for drug overdose deaths overall: for every person who died from a drug overdose in 2024, nearly two lives were saved – double the rate in 2023. 20, 21 We also lost fewer people in situations where emergency care may have been available.22

Another driver: funding for opioid care overall also temporarily rose, in the form of:

• state and local taxpayer dollars
• federal State Opioid Response grants
• opioid settlement funds reaching Virginia communities, with the second year of the state agency’s full funding allocations.

With this additional funding, compassionate care helped thousands of people to minimize their risk of opioid-related health problems. We welcome the following outcomes:

• a 24% decrease in estimated prevalence of unhealthy opioid use from 2023 (about 100K people engaged in unhealthy opioid use, down from about 130K)
• a 16% decrease in drug overdose emergency department (ED) visits.23

These improved outcomes in the state as a whole dramatically decreased the harm that communities experienced. With better health, communities experienced less of the complex grief and trauma connected with widespread overdose deaths.24 Many communities experienced less financial stress. In our data model, this looked like:

• higher total earnings from a healthier workforce more able to support themselves and their families
• lower health care impact related to opioid-related health crises and preventable illnesses
• lower economic impact related to supporting children affected by opioid use.

Lives saved matter far beyond any dollar figure. Still, because communities and policymakers weigh costs too, we can also look at our updated estimates through an economic lens: the $1.3 billion drop in costs equals roughly $14 to $20 for every $1 of additional funding for expanded opioid care (about $16 at the midpoint of our estimated range). That figure reflects the total decline in costs, and other factors, such as changes in the drug supply, also contributed.

Lower opioid-related expenses in most places likely helped protect community recovery capital overall. Research shows that “higher levels of recovery capital prospectively predict sustained recovery, higher quality of life, and lower stress one year later.”25

Note: Trends in substance use are complex. Opioid overdose deaths likely fell for a number of reasons: naloxone reached more people, fentanyl became less potent, and many people switched from injecting opioids to smoking them. Additionally, some researchers believe that the tragedies of earlier years may play a role, too: many of the community members at highest risk have already been lost.26, 27 It is a sobering reminder of how many people we have lost, and that families and communities continue to carry that grief.

There is no question: Virginians still need support in surviving unhealthy opioid use and recovering. Healing from the immense harm of the overdose epidemic will likely take generations.

With that said, improvements in outcomes are benefiting communities in meaningful, tangible ways.

• With more people surviving, more families kept a loved one, and more families have the stability they need to heal.
• Costs to families and businesses were an estimated $688 million lower, a 37.8% drop since 2023, helping more people stay well, continue working, and avoid medical bills they would have paid out of pocket.
• Costs to public budgets were an estimated $646 million lower, easing pressure on publicly funded health care, Child Welfare Services, and K-12 schools so these programs can better support children and families.

Even with the increase in funding for opioid care, not everyone benefited equally.

Communities saw unfair and preventable differences in opioid outcomes. Places with higher rates of opioid overdose deaths, unhealthy use, and preventable infectious diseases felt not only grief, but also more economic stress in the form of:

• higher expenses across health care, support for affected children, and the criminal legal system, and
• lower earnings, sometimes for decades into the future.

Note: Because rural areas have small populations, a small change in the number of people can shift a rate a lot. These figures are best read as a sign that neighbors there need support, not as a judgment of any community.

Health Impacts by Place

The majority of Virginia cities and counties saw a decrease in opioid overdose deaths, unhealthy use, and preventable infectious diseases. However,

• 28% of localities saw an increase in unhealthy use. In a handful of western and eastern rural areas, rates more than doubled.
• Another 15% of localities saw an increase in opioid overdose deaths, particularly in rural eastern and western parts of the state, as well as Manassas City.

Even with these increases, though, as in 2023, the highest rates of opioid overdose deaths remained in central Virginia metro areas and in largely rural southwest Virginia.

The highest numbers of people also lost their lives in metro areas of central and northern Virginia. Because central Virginia metro areas had both high overdose rates and large populations, they accounted for a higher total number of lives lost.

Health Impacts by Race and Ethnicity

Racial and ethnic inequities persisted, despite narrowing, and improving across all groups.

Fewer health crises from opioids meant greater financial stability for most families. However, earnings lost to opioid-related incarceration actually rose across Virginia, putting the heaviest strain on communities that had fewer economic opportunities already.

With fewer opioid-related health crises and preventable complications, the vast majority of communities (84%) saw lower overall health care costs.

For impact directly related to opioid use, these included spending:

• 36% less on emergency department visits
• 20% less on hospitalizations
• 27% less on ambulance and emergency-response naloxone.

Communities in Shenandoah Valley, Hampton Roads, and Eastern Virginia saw some of the biggest decreases in opioid-related health care expenses. Even with these significant decreases, central Virginia metro areas were among those with the highest health care cost per resident, together with rural southwestern communities.

At the same time, about 8% of localities experienced an increase in opioid-related health care costs, especially rural communities in the southwest.

Some localities actually saw a decrease in expenses directly related to opioid use, but an increase in secondary disease-related costs – which made up 75% of all health care costs.

Nearly 100K Virginians used opioids in ways that harmed their health, raising their risk of HIV and other diseases. Better access to care kept people safer, and was also linked $298M in savings for affected people and their communities.

Some people who use opioids face a higher risk of infection from preventable diseases such as HIV, hepatitis B and C, tuberculosis, and neonatal abstinence syndrome. They may face these risks due to difficulty reaching sterile supplies or testing, barriers to health care, or having a suppressed immune system.

We can protect our communities by preventing infection among those at risk and connecting impacted people with care and support. This set of health services designed to protect community health is called comprehensive harm reduction. It is intended for those who are unable to, or not ready to stop using drugs.

Across the state, expanded harm reduction services were linked to a 33.5% drop in costs tied to preventable health complications. Most importantly, this means fewer neighbors faced severe, avoidable health struggles—protecting human life, reducing emotional strain, and easing financial stress for families who often lack access to timely medical care.

While several central Virginia metro areas saw remarkable progress—saving more than the state average—they and rural southwestern communities still carry the heaviest health expenses due to long-standing gaps in local healthcare infrastructure.

In 9% of communities, primarily in rural western and eastern Virginia, costs related to secondary diseases actually increased. This finding potentially indicates that problems related to opioid-related health complications intensified – or possibly that with more testing, more people are aware they have an opioid-related disease, potentially opening a pathway for them to be referred to needed care. Whatever the case, further increases in harm reduction services may especially benefit rural areas.

As more people survived and fewer faced challenges with opioid use, Virginia’s opioid-related health care costs fell by nearly a third. However, communities with the lowest insurance coverage saw notably less financial relief.

Possible reasons for the disparity between communities include:

• Having health insurance makes access to opioid care easier, including medication for opioid use disorder (MOUD), the best treatment available. One national study found MOUD linked to 76% fewer overdoses at three months of treatment, compared to people who were given other treatments.34
• 79% of Medicaid enrollees in Virginia, with OUD, for example, receive MOUD.35 As of the most recent reporting (from 2020), this included about 29,800 Virginians.36 Without medical coverage, they may face major barriers to accessing this treatment.

Manassas Park City, Essex County, and Floyd County, for example, saw increases – not decreases – in health care expenses, and also had lower rates of insured residents.

Wider access to evidence-based care is associated with better outcomes, and that eases stress on families and public budgets alike.

Even with fewer opioid-related deaths and less unhealthy use, the youngest group of Virginians did not see the same progress:

• In 2024, 420 infants under one year old were hospitalized with a treatable condition called neonatal abstinence syndrome (NAS). This represented a 10% increase from 2023 after several years of decline.37
• Babies born to parents enrolled in Medicaid and in rural areas were likeliest to be affected, as Medicaid covers a large share of births, and rural areas lack access to both perinatal care and substance use care.37

This outcome indicates greater need for:

• treatment and supports during pregnancy and postpartum38
• expanded services for neonatal abstinence syndrome.39

Pregnant people and new parents, along with their babies, need more care and support across our communities, and especially in correctional facilities, where the number of incarcerated pregnant people in Virginia increased as of 2024.40

As these needs have grown, funding directed to them remains limited. Only 2% of Virginia’s opioid settlement funds have gone to helping pregnant people and babies exposed to substances before birth, about twice the 1% national average, though still a small share.41

Helping affected babies to thrive gives them a brighter future ahead. It would also ease financial stress on their families and communities, as part of the overall $592.1 million in annual cost for preventable opioid-related health complications in Virginia in 2024. (While our cost data model does not break out NAS costs specifically, care for babies with NAS is part of our indirect costs.)

Our special brief on "Healthier Moms, Healthier Babies" outlines a better approach, which we shared with legislators and community partners in September 2026.

Even with the concerning trend for babies, fewer children needed Child Welfare Services and school-based support in 2024, which suggests more families stayed stable.

Most parents who are struggling with substance use, or who are incarcerated, want to keep their families together, and may need extra support to do so.42 Sometimes, though, they are referred to Child Welfare Services – an outcome that many families fear because they worry about being separated from their children. In some cases, children are placed in foster care.43

Fewer children were referred to Child Welfare Services in 2024, and associated estimated costs fell across the state by 25%.

In most places, estimated K-12 school costs for supporting students affected by opioid use (whether their own or a loved one's use) also fell by 26%.

While such improvements are a welcome change, affected children may need support in healing for decades to come. Many have already grown up in a household affected by substance use, and in some cases, the complex grief of losing a parent to overdose or losing time with a parent to incarceration, or in some families, both experiences.

Virginia's southwest has experienced some of the highest drug-related arrest rates, creating disproportionate economic impact felt by local families and communities.

In 2024, estimated earnings lost to incarceration rose 11.4%, to $81.8 million, and public spending on arrests, courts, and incarceration was an estimated $175 million.

These statistics represent a complex reality: Virginia has one of the highest incarceration rates per capita in the world (as of the latest available comparison data, from 2022).44 It has also become a “de facto point of care” for many people with substance use and mental health conditions who are unable to access care elsewhere prior to incarceration.45

Within that system, huge gaps in care remain. Nationally, as many as 85% of people who are incarcerated have a substance use disorder (SUD).46

• Only 17% of Virginia’s Medicaid enrollees who leave prison are diagnosed upon leaving.47
• Compared to other Virginians newly enrolled in Medicaid, those who were formerly incarcerated are six times more likely to receive an opioid use disorder diagnosis. They also face four times the risk of opioid overdose. And only 25% of Medicaid enrollees leaving prison who need treatment receive it.47

At the same time, some correctional facilities have begun offering evidence-based care, blending medication for opioid use disorder with counseling and peer recovery specialist support services.

Research suggests that treatment and diversion are associated with better outcomes and lower costs than incarceration for people with substance use disorders.48,49 Yet at the same time, within Virginia’s current approach to criminalizing substance use, we can recognize and appreciate the positive steps that some facilities are taking to improve community outcomes.