Understanding the Costs of the
Opioid Epidemic

In 2021, the opioid epidemic had a significant economic impact on Virginia. It is estimated that the total cost of this problem reached $5 billion in 2021 alone. This financial burden has hurt everyone, including workers, families, businesses, and government agencies. It includes both money that was spent directly because of the epidemic and money that will be lost in the future.

Where the Money Went

Many of these costs are shouldered by Virginia's families and businesses. They lose out on money that won't be earned in the future due to people being affected by opioids. Federal, state, and local government agencies also pay a share of the costs. They provide health care and other services for people suffering from the opioid crisis. Additionally, government agencies miss out on money that would have come from taxes in the future. So, the costs of the opioid epidemic are spread across different parts of the community.

“Costs by Sector” and “Costs by Payer”

Looking at "Costs by Sector" and "Costs by Payer" helps us see the economic impact of the opioid crisis in Virginia. "Costs by Sector" shows how much is spent on lost labor, healthcare, crime-related costs and other services. (The category “Crime/Other” refers to criminal justice and other services, including help for children and families.) "Costs by Payer" shows who covers these costs, including households, state and local governments, and the federal government. These analyses help us see where the money goes and who pays for the cost.

Opioid Costs in Virginia, 2021:

By Sector and by Payer

By Sector, Lost Labor: $3,296,384,172. The cost of lost labor was calculated by counting opioid-related deaths, non-fatal cases of opioid use disorder, and incarcerations due to opioids. Next, we predicted the average earnings of these individuals combined. This prediction was based on Virginia residents of similar ages holding a high school diploma.

By Sector, Health Care: $1,067,069,073. The health care total combines direct and indirect health care cost in each locality. Direct costs represent emergency and inpatient visits for opioid overdose, and other opioid-related visits. Indirect costs represent treatment for opioid-related conditions, such as HIV and Neonatal Abstinence Syndrome.

By Sector, Crime/Other: $657,339,741. The crime/other figure estimates government expenditures for public services needed to respond to the opioid epidemic, mainly criminal justice costs, child and family assistance costs, and education costs. In this calculation, we include the economic burden on households, local, state and federal government.

By Payer, Household: $2,680,336,256. The largest portion of the economic burden is held by households and the private sector. Costs include lost wages and increased private healthcare costs.

By Payer, State/Local Gov't: $1,645,108,288. The share of the economic burden held by state and local governments include loss of future tax revenue, contributions to Medicaid and other opioid-related healthcare costs, and necessary expenditures required from the criminal justice system, child and family services, and K-12 education.

By Payer, Federal Gov't: $695,348,443. The share of the economic burden held by the federal government includes loss of income tax revenue, public health insurance costs (such as Medicaid) and costs in K-12 education.

Mapping the Economic Burden of the Opioid Epidemic

The impact of the opioid epidemic varies among Virginia localities. The map below displays each locality’s cost per person (total costs divided by the total population) for each sector.

Scroll over the map below to explore how the opioid crisis impacted counties and independent cities in Virginia. Select the tabs at the top of the map to change which sector or payer is being shown on the map.

By Locality (County or Independent City)
State of Virginia
Sources: View all data sources in "Estimating the Costs of the Opioid Epidemic: Methods," VCU Center on Society & Health, 2023.


Virginia is a state located in the southeastern region of the United States, with a population of 8.5 million residents.

Virginia's public health services are organized into health districts, with each district responsible for providing essential health programs and services to its residents.

The opioid cost per person in Virginia is $588. The total cost of opioids in the state of Virginia is $5,020,792,988.

Costs By Community: Per Person vs. Total

To grasp the opioid epidemic’s reach, it's helpful to investigate both the total cost and cost per person. The total cost presents a bigger picture view of the expenses. Cost per person reveals how the opioid epidemic affects people individually. Using both measures helps us fully understand how the epidemic affects different localities.

The Connection Between Poverty and Opioid Use

Studies have shown a strong link between how much money a person has and their well-being. They find socioeconomic status matters more than lifestyle factors in predicting health.

Why? Being jobless, having less income and lower education, and living in poor housing can all cause stress. Such situations also isolate people from the support they need. When people lack the support they need, they are more likely to experience mental health problems. To cope, they may use substances such as opioids.

We use two ways to understand the economic conditions of localities in Virginia: Poverty Rate and Median Household Income.

Poverty Rate by Locality, Compared to State Poverty Average, 2021

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Source: 2021 American Community Survey (ACS) 5-Year Estimates.

How We Measure Poverty Rates

To calculate the poverty rate of a county, we count how many people in each county have an income below a certain amount of money each year. Then we divide that number by the total population of the county. This helps us compare the number of people in poverty to the total population. It's important to note that counties with more people may not always have the highest poverty rates. A county needs a large number of people below the poverty threshold compared to its total population to have a high poverty rate.

Median Household Income by Locality, Compared to State Median Income, 2021

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Source: 2021 American Community Survey (ACS) 5-Year Estimates.

How We Measure Median Household Income

To find the median household income of a county, we arrange all the household incomes from lowest to highest. Then, we look for the income value that falls exactly in the middle of the list. This value shows the median household income for that county. The median value helps us get an idea of how much people earn in that area, considering everyone, and also helps avoid the impact of extremely high or low incomes.

The Human Cost

The largest part of these labor losses comes from people dying due to opioid overdoses, estimated at $1.9 billion. When we calculate the economic costs of losing lives, it's crucial to remember that these estimates don't include the true value of the lives we've lost, which is immeasurable.

The Losses We Cannot Measure

There are harmful effects of the opioid epidemic that can't be reduced to a dollar amount. These include the emotional impact, reduced quality of life, and other negative effects on communities. So, the numbers mentioned in this study, while important, don't capture the complete impact of the opioid crisis in Virginia.

The Virginia Department of Health (VDH) is dedicated to ending the opioid epidemic, which takes thousands of lives every year.

VDH's Opioid-Reduction Efforts

VDH has several programs to cut down on opioid use and overdoses, such as:

  • Teaming up with emergency departments to connect those who've had an overdose with peer support and treatment programs.
  • Sharing the Centers for Disease Control and Prevention's “It Only Takes a Little to Lose A Lot” media campaign all across Virginia.
  • Gaining a better understanding of the groups affected by opioid use through data and surveillance.
  • Providing educational opportunities for healthcare providers through an online education platform.

Downloadable Publications and Data