Research-Backed Opioid Care Saves Lives. How Scaling Up Care Could Also Save $5.2B
This project is a collaboration between VCU’s Center on Society and Health and the Virginia Department of Health.
Opioid Epidemic Costs by Sector for Virginia in 2023
Research-backed opioid care is saving thousands of Virginians’ lives. We know that a better future is possible – but only if we invest in approaches that help everyone.
Our tool explores the status quo, asking the question, “How can we afford not to improve our opioid response?”
Opioid Epidemic Costs by Sector for Virginia in 2023
$5.2B Spread Across Four Sectors
Lost Labor $0
Lost labor represents workplace productivity lost due to fatal opioid overdoses, non-fatal opioid use, and opioid-related incarceration, combined with collective average lifetime earnings of the people with these experiences in 2023. This prediction was based on Virginia residents of similar ages in a given locality.
Health Care $0
Health care costs directly related to opioid use included responses to overdoses, hospital stays, and emergency department visits. The majority of health care costs, though, were from care for opioid-related conditions such as neonatal abstinence symptoms in babies, hepatitis B, hepatitis C, HIV, and tuberculosis.
Child-Related $0
Child-related spending includes help for opioid-impacted families through the state’s Child Services, which may support children whose parents are unable to safely care for them, and K-12 schools, which offer trauma-informed counseling, academic support, and other services.
Criminal Justice $0
Criminal justice-related costs represent spending related to opioid-related arrests and incarcerations, as well as the need for the courts and police protection that accompany them.
Lost Labor - $3.41B
Health Care - $1.07B
Child-Related - $564M
Criminal Justice - $129M
In 2023, nearly 137K Virginians used opioids in unhealthy ways, with 2,082 losing their lives. But there’s hope.
Evidence-based opioid care can save lives. Over time, every $1 invested also creates at least $7 in economic benefit for our communities. Our study asks, “How can we afford not to improve our opioid response?”
Where We Live Matters
Anyone can begin using opioids and other substances in ways that harm their health. At the same time, our social determinants of health can influence our ability to stay safe while using, reduce harmful use, and potentially recover.1 We can improve opioid use outcomes in every community by investing in evidence-based opioid care.2 Which places might need the most investment? Mapping the epidemic’s latest economic costs shows the potential need for better care resources within each locality.
This annual cost varies across localities due to differences in population size, fatalities, and rates of unhealthy opioid use (UOU).
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All-Sector Costs for Virginia
- The total annual cost across all sectors in Virginia is $5.2B. Higher total costs are seen in metro areas where there are higher counts of people with UOU and opioid fatalities.
- With Virginia's population of 8.73M, the annual all-sector cost divides into $593 per person. Higher per-person costs are seen in places with higher rates of UOU and opioid fatalities – where the epidemic’s effects are spread across fewer people.
Though we can’t monetize or measure every positive impact, our data show that better opioid outcomes would generate all-sector savings for:
- people with unhealthy opioid use and their families
- employers in the communities around them
- anyone with health insurance premiums
- hospitals, publicly-funded health programs, and private insurers
- child welfare services and K-12 school systems
- law enforcement, corrections agencies, and courts
- taxpayers
Even though our estimated total of costs incurred in 2023 is enormous, it is actually conservative. Read our methods for details on economic costs missing from our data model.
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Community Context
People of all backgrounds can use opioids and other substances in unhealthy ways. At the same time, through the lens of public health, we can look at how who we are and where we live influence our quality of life and chances of survival if we develop unhealthy opioid use.
The resources available to us while we are in active use (i.e., our recovery capital) can powerfully affect our likelihood of accessing care and connecting to the supports we need to stay alive and live well.13 Notably, “compared to those with alcohol and cannabis problems, those with opioid or other drug use problems (e.g., stimulants) begin their recovery journey at a substantial disadvantage in terms of recovery capital.”14
In areas with higher poverty and lower income, people have less access to resources that support better opioid outcomes. Put simply, not having enough money can make harm reduction and recovery harder. In poorer communities, many people, including those with unhealthy opioid use, may:
- be less able to afford basic expenses, such as safe, stable housing and healthy food
- be less likely to have health insurance, job security, and paid sick leave needed to access care
- have less access to transportation
- be likelier to become involved with the criminal justice system
Our key insights report also shows that:
- The highest lost labor costs per person were all found in places with high poverty rates.
- Places with the highest opioid costs per person also have a lower median household income than Virginia as a whole.
To better support everyone’s needs, it’s also important to understand who is likeliest to be affected by poverty on their path to recovery. Research shows that:
- Women and certain racialized groups (such as mixed-race and Indigenous people) appear to face ongoing stressors, especially early in recovery – indicating a greater need for support.17
- Notably, they also have disproportionately higher rates of poverty.18
While financial resources are only one part of recovery capital, they may help us realize where more investment is needed. We look forward to further exploring community access to other types of recovery capital in the future.
Households Pay Over Half of the Cost
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 $5.2 billion lost to the opioid crisis in a single year:
- families and businesses could have saved 53 cents of each dollar
- taxpayers could have saved 47 cents for each dollar
Virginia families and businesses would benefit the most from better outcomes
Opioid Epidemic Costs by Payer for Virginia In 2023
46.7% / $2.35B
Payor Breakdown by Locality
Locality | Families / Businesses | Federal Gov't | State / Local Gov't |
|---|
Costs to Families Directly Affected
While the majority of people in active use have jobs, many struggle with daily living.17 They also face a higher risk of opioid-related jail time and overdose.19 People who died due to opioid overdose in 2023 lost a lifetime of earnings – a number that collectively makes up 46% of our total cost estimate.
Lost Labor Per Affected Household
Opioid-affected families often face staggering health care costs, which are included in our model but not broken down by payer.
In our methods, we detail economic costs not included in our model, including impacts on caregivers.
Unaccounted Human & Social Costs
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 communities19
- intergenerational trauma for affected children and their families20
- 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.21 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.”22
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.
“We can estimate a single year’s costs across sectors. For labor, we project lost earnings over a lifetime for people who have died. However, these data offer only a narrow snapshot of the harm caused by overdose crisis. That’s why we must work with communities to understand and support their needs for survival, healing, and connectedness.”
Lifesaving Strategies Need More Support
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 2023. Their work deserves recognition and much more support.
For example, VDH partners with community groups such as Health Brigade to provide comprehensive harm reduction (CHR) sites throughout Virginia. In 2023, the CHR sites achieved the following outcomes23:
- 24,160 CHR visits were attended by 5,753 clients
- 90.6% received CHR counseling
- Life-saving Naloxone kits were given to 3,608 clients
- 2,235 overdose reversals were reported by 1,600 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.24
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.
Economic Return on Investment
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.25)
Not everyone realizes, though, that:
- Improving opioid use outcomes would also boost 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.26
Communities may need different intervention strategies depending on their needs. The evidence is clear, though: investments in opioid care are cost-effective, and in many cases, cost-saving. While financial impacts should never be the only consideration, they can be a helpful perspective to consider, especially with limited funds.
Many investments in evidence-based opioid care not only save lives – they also save money.
$1 spent on substance use prevention
would result in up to
in economic benefit
$1 spent on syringe services programs
would result in
in economic benefit
$1 spent on overdose prevention centers
would result in up to
in economic benefit
$1 spent on substance use treatment programs
would result in
in economic benefit
*Economic benefit ranges from increased earnings to costs avoided on health care, morbidity, and crime – or it may combine several of these categories. See specific studies for more detail on these conservative estimates.
There are many reasons that we underinvest in evidence-based responses to substance use. However, our data model shows that cost-saving cannot be cited as a reason to deny our communities the care they need to survive opioid (and other substance) use and live well. In fact, we lose economic value when we allow preventable deaths to continue.
In 2023, 70% of drug overdoses were preventable in Virginia – with many involving opioids.27
By the numbers:
- Saving 1,458 of the lives lost to opioids could have saved us $1.7 billion in lost labor costs alone, as the impacted people could have ultimately reentered the workforce (among many other benefits to our society).
- Similarly, with better prenatal opioid care for pregnant people, improved care for opioid-exposed newborns, and more care available to people in active use, we could have saved $817 million in costs for treating opioid-related conditions.
- By preventing more parents from becoming incarcerated, unwell, or dying due to opioid-related causes, we could have saved more than $393 million per year in spending on state-run child welfare services.
These are just a few of the categories of costs we explore.
Whether you identify through the lens of a person in active use or recovery, their family and friends, a business, a health care provider, a taxpayer, someone who pays for health care premiums – or all of the above – everyone experiences the downstream effects of the overdose epidemic. Improving our opioid outcomes would benefit every Virginian.
To quote Richmond’s Inclusive Recovery City declaration, “Sustained recovery takes root in the community.”28 An inclusive recovery community can also enhance everyone’s quality of life. The enormous economic potential is yet another reason to work toward a better future.
Need help finding opioid care?
If you think someone is overdosing: Call 911 immediately. Learn about the signs of overdose. Virginia law provides anyone who calls 911 or otherwise alerts the authorities in the case of an overdose a "safe harbor" affirmative defense.
If someone you know needs help staying safe in active use and connecting to care: Find harm reduction services near you on VDH’s comprehensive harm reduction (CHR) center map.
If you are looking for evidence-based opioid care options for yourself or someone you care about: Explore your local options through Virginia’s publicly-funded, localized Community Services Boards.