Virginia Opioid Costs Fell $1.3 Billion in 2024 as Overdose Deaths Dropped 37 Percent

Virginia's opioid-related costs fell by an estimated $1.3 billion in 2024 — the same year the state's overdose death count fell by more than a third.

The estimate comes from the Virginia Opioid Cost Data Tool, run jointly by the VCU Center on Society and Health and the Virginia Department of Health. The site was refreshed with 2024 data on Oct. 21 and VCU announced the findings on Oct. 26.

The headline number is a ratio. Virginia added an estimated $65 million to $95 million in public funding for opioid care in 2024, about 2% to 4% of the $2.6 billion residents still carried. The researchers link that added investment to roughly $14 to $20 in avoided costs for every dollar — about $16 at the midpoint of their range.

They are careful about the verb: the funding was "linked to" the lower costs, not proven to cause them, and other factors, including changes in the drug supply, also contributed.

What the state's own numbers show

The death figures are published separately, by the health department, and are unambiguous. In 2024 there were 1,548 drug overdose deaths among Virginia residents, a 37% decrease from 2023, against a peak of 2,622 deaths in 2021. Almost seven in ten of the 2024 deaths involved fentanyl, fentanyl analogs or tramadol.

The cost tool reports the same year differently, as a 43% drop — because it measures the state's overdose death rate, not its death count. A rate can fall faster than a count when the population in the denominator is growing; both are correct for what they measure. Anyone comparing headlines this week should check which number is quoted.

Early data for 2025 points the same way: death certificate data as of July 2026 show 1,197 overdose deaths, a further 23% decrease, though the health department marks those figures preliminary. Emergency departments recorded 16,416 overdose visits in 2025, down 10% from 2024, which itself was down 16% from 2023.

Where the $1.3 billion came from

The tool divides Virginia's remaining $2.6 billion in 2024 costs into four sectors and reports the change from 2023.

• Lost earnings: $1.26 billion (48% of the total, about $144 per resident). This fell by $812 million. More people survived and stayed well enough to work, and the model counts both wages lost to overdose deaths and wages lost to non-fatal health crises.
• Health care: $791 million (30%, about $91 per resident). This fell by $369 million, most of it — $298 million — from fewer preventable opioid-related conditions: HIV, hepatitis B and C, neonatal abstinence syndrome and tuberculosis. Hospitalizations, emergency visits and naloxone accounted for about $71 million.
• Child welfare and K-12 services: $421 million (16%, about $48 per resident). This fell by $115 million.
• Criminal legal system: $175 million (7%, about $20 per resident).

Two measures moved the wrong way. Earnings lost to opioid-related incarceration rose 11.4%, from $73.4 million to $81.8 million, and the increase was 34.3% in the poorest quarter of localities — roughly three times the statewide rate.

Two official Virginia figures that don't match

The health department's own overdose data page still states that "in 2023, opioid misuse cost Virginia $5.2 billion in lost labor, healthcare costs, and other expenses." The VCU and VDH tool puts the 2024 total at $2.6 billion.

Those two numbers are not a $2.6 billion improvement; subtracting one from the other produces nonsense. They come from different models, and the tool's own methods changed: the 2024 update began using real-world employment rates for lost earnings, and the researchers recalculated 2023 the same way so the years could be compared. Their instruction is explicit — compare 2023 and 2024 only using the figures currently on the site.

That is the honest reading of this week's news: a large, well-documented improvement, measured by a model that just changed its own yardstick and says so on the page.

The gaps that did not close

Statewide averages hide the geography, and the tool publishes city- and county-level estimates for that reason.

Opioid overdose death rates remain highest in Central Virginia metropolitan areas and in rural Southwest Virginia. Those same areas carry the highest economic impact per resident.

Black Virginians saw the largest decline in overdose deaths in 2024, at 47% — and still had an overdose death rate nearly twice that of white Virginians. In the communities most affected by deaths among Black residents, the average per-resident economic impact was nearly double the state average.

Infants are the group moving in the wrong direction. In 2024, 420 Virginia infants under one year old were hospitalized with neonatal abstinence syndrome, a 10% increase after several years of decline. Parents enrolled in Medicaid and parents in rural areas were most affected. The researchers estimate that family-oriented recovery approaches could save about $588 million.

The insurance gap shows up in the costs too: health-related costs did not fall as much in communities with the lowest rates of health insurance.

Incarceration is where the economics and the care gap reinforce each other: as many as 85% of incarcerated people nationally have a substance use disorder. Among Virginians newly enrolled in Medicaid, people who were formerly incarcerated are six times more likely to receive an opioid use disorder diagnosis and face four times the risk of overdose — and only 25% of Medicaid enrollees leaving prison who need treatment receive it.

Where the research has already moved money

This is not academic in Virginia: the university says the collaboration has helped guide more than $160 million in grant awards from the Virginia Opioid Abatement Authority, which distributes the state's opioid settlement share.

The authority's grant-making scaled up alongside it: from roughly $10 million to $14 million in planning grants in fiscal 2023 to more than $35 million in approved local, regional and state agency awards in fiscal 2024, according to the tool's funding analysis.

The research also shaped who gets targeted funding. In early 2025 the authority opened Operation STOP! — Specifically Targeted Overdose Prevention — for cities and counties that saw a disproportionate rise in overdose deaths among Black residents. Eligibility required a 100% or higher increase in Black opioid overdose deaths per 100,000 residents between 2019 and 2023, and at least 20 opioid overdose fatalities in that window, with awards of up to $500,000 each.

The underlying trend the program answers is in the authority's own guidance: state health department data given to the authority showed a 59% increase in opioid overdose deaths per 100,000 people statewide from 2019 to 2023. Over the same period the rate rose 11% for white Virginians and 41% for Black Virginians.

Since February 2026 the authority has also published public dashboards, called SUDA, covering drug supply indicators, treatment access, naloxone use at EMS incidents and settlement grants — county-level data anyone can read without a request.

What's next

Two things will decide whether 2024 was a turning point or a good year.

The first is whether the decline holds. Provisional 2025 figures say it has, so far, with a further 23% drop in deaths and 10% fewer overdose emergency visits.

The second is funding. The researchers warn that systemic threats — including potential reductions in Medicaid access — could compromise the gains. That warning lands on a specific mechanism: Medicaid pays for a large share of Virginia's opioid use disorder treatment, and the tool's own reentry analysis shows how thin coverage already is where overdose risk is highest.

The tool's practical value is local: it publishes city and county estimates, so a family or a county supervisor can see what the epidemic costs their own community rather than the state as a whole. Our guide to reading your county's overdose data explains how to use datasets like this one without over-reading them.

Where to get help now

Virginia funds treatment through locally run Community Services Boards, the entry point for publicly funded substance use care statewide. The health department publishes a map of comprehensive harm reduction services, including naloxone access; our guide to getting naloxone covers pharmacies, standing orders and free community programs, and after an overdose covers the first 72 hours after a reversal.

If cost is the obstacle, Medicaid coverage for addiction treatment explains what Virginia's program pays for. If someone is coming home from jail or prison, reentry and treatment covers how to connect them to care in the first days, when tolerance is lowest and risk is highest.

The SAMHSA National Helpline is free, confidential and available 24 hours a day at 1-800-662-4357, with treatment options at FindTreatment.gov. The 988 Suicide and Crisis Lifeline handles mental health and substance-related crises by call or text, and can also connect callers to grief support after a loss.

In an emergency, call 911. Virginia's Safe Harbor law provides affirmative defense protections for people who call 911 or seek medical help during an overdose.