Virginia Opioid Costs Fell $1.3 Billion as Overdose Deaths Dropped 43%

Virginia's preventable overdose deaths fell 43 percent in 2024, and the state's estimated opioid-related costs fell by $1.3 billion in the same year — roughly 14 to 20 times what Virginia added in public spending on opioid care, according to data released Oct. 26 by Virginia Commonwealth University. The figures come from the 2024 update to the Virginia Opioid Cost Data Tool, a joint project of the VCU Center on Society and Health and the Virginia Department of Health.

The tool estimates what the crisis costs communities in lost earnings, medical care and public services at the city and county level. VCU describes it as the only platform in the country offering that localized, multi-sector view. The 2024 numbers are the first to show the cost side moving in the same direction as the death rate.

Where the $1.3 billion came from

Most of the decline came from earnings that were not lost. VCU attributes $812 million to preserved earnings, as people who stayed in or returned to work kept income that the crisis had been draining from households and local economies. Another $369 million came from reduced health care costs, which the university ties to fewer emergency interventions and lower rates of co-occurring conditions such as HIV, hepatitis B and C and tuberculosis. Reductions in child welfare and specialized K-12 support services accounted for $115 million.

Two measures moved the other way. Earnings lost to incarceration rose by $8.4 million, and estimated public spending on opioid-related arrests and incarceration rose by $9.3 million — a reminder that the criminal legal system absorbed part of the crisis even as treatment expanded.

A tool built to steer settlement money

The cost tool is not a standalone academic exercise. VCU says the collaboration has helped guide more than $160 million in grant awards from the Virginia Opioid Abatement Authority, the body that distributes the state's share of opioid litigation settlements. Because the platform estimates costs per resident at the locality level, it gives the authority a way to rank applications by measured burden rather than by the volume of requests.

"Protecting people's health also protects their communities' financial resources, and that can support more healing," said Derek Chapman, director of the VCU Center on Society and Health and a professor at VCU's School of Public Health. He said the data should "spark conversations about what is happening on the ground and why, especially between decision-makers and recovery community leaders with lived experience."

Lauren Yerkes, epidemiology program manager at the Virginia Department of Health, said the partnership gave the state a more complete picture of both the human and the economic cost. "Communities across the commonwealth can use this thoughtful analysis to direct resources toward overdose prevention and substance use treatment — and ultimately save the lives of Virginians," she said.

The map is still uneven

Statewide averages hide where the crisis remains concentrated. Overdose death rates are highest in Central Virginia's metro areas and in rural Southwest Virginia, the same places that carry the highest economic impact per resident.

Black Virginians saw the largest single-year decline in overdose deaths, 47 percent, but their death rate remained nearly twice that of white residents. In communities where overdose deaths among Black residents are concentrated, the average economic impact per resident was close to double the state average. Access to medication-assisted treatment and to outpatient care is uneven along the same lines.

Two other gaps stand out in the data. Health care costs did not fall as much in communities with the lowest insurance rates, and earnings lost to incarceration were three times the state average in the poorest quarter of Virginia communities — the cost of the crisis increasingly landing on the places least able to absorb it.

Infant withdrawal hospitalizations rose 10 percent

One indicator moved decisively in the wrong direction. In 2024, 420 infants were hospitalized with neonatal abstinence syndrome, a 10 percent increase over the previous reporting period, with Medicaid-enrolled families and rural families most affected. VCU estimates that evidence-based, family-oriented recovery approaches could save families, employers and public budgets an estimated $588 million.

The finding sits awkwardly beside the overall decline, and it points to a group that treatment expansion has reached least well: pregnant and postpartum patients, who often face fragmented care and, in some states, the threat of criminal charges. Virginia's residential treatment capacity for parents and children remains limited.

Operation STOP! and the Medicaid warning

The Opioid Abatement Authority has launched a targeted initiative, Operation STOP!, aimed at cities and counties with disproportionate overdose rates among Black residents — an attempt to route money by the disparity the data now makes visible.

The researchers also flagged a risk to the progress itself. Reductions in Medicaid access, they warned, could reverse the gains and keep Virginians from receiving care. That concern is not abstract in a state where the cost decline tracks closely with the expansion of coverage-backed treatment: the savings exist because people were enrolled, dosed and monitored. Virginia's numbers are, in effect, an estimate of what sustained funding buys — and of what stands to be lost if the funding contracts.