For years, Virginia’s opioid crisis was often framed as a rural, white problem centered in the state’s Southwest.
But new data shows that large cities and Black communities have been hit increasingly hard, including several in Hampton Roads.
The analysis from Virginia Commonwealth University and the Virginia Department of Health looked at opioid-related harm - a measure capturing the economic toll of the opioid crisis, including lost labor from premature deaths, health care spending and criminal justice costs.
In Western Virginia’s Bath County, the cost totaled $1,600 per person, the highest tallied in a rural community. In Tazewell County, a rural Southwest Virginia community long associated with the early waves of the opioid epidemic, the cost was $1,500 per resident.
But opioid impact costs were higher in many urban areas. In Portsmouth, the cost reached $1,800 per person in the same period, while several central Virginia cities, including Richmond, saw per-resident costs exceeding $2,000.
“Multiple cities in the Hampton Roads area were among the highest costs because of their large size and the influx increase in rates around those areas,” said Derek Chapman, the director of VCU’s Center for Society and Health.
Chapman said the opioid crisis has followed the highways. Early waves of addiction spread along the Interstate 81 corridor in Southwest Virginia, much like cocaine once moved down Interstate 95 from northern cities.
As fentanyl flooded the drug supply, it traveled those same routes into urban areas, where overdose deaths surged — driving the bulk of opioid-related costs through premature deaths and decades of lost income.
“The biggest driver of the overall cost is lost labor,” Chapman said. “When someone dies in their 20s, their family can lose 50 or 60 years of income, along with all the economic ripple effects that come with it.”
According to the analysis, non-Hispanic Black Virginians were dying from opioid overdoses at nearly twice the rate of non-Hispanic white Virginians in 2023, which Chapman said marked a sharp shift from earlier years of the epidemic.
At the same time, the data shows signs of progress.
Between 2023 and 2024, opioid-related deaths in Virginia fell by nearly 48%, a decline Chapman attributes to expanded prevention and harm-reduction efforts such as wider access to naloxone and treatment for opioid use disorder.
That progress is visible in Hampton Roads, but uneven.
Tes La Dieu, population health manager and public information officer for the Hampton and Peninsula health districts, said overdose deaths in the region have declined.
But substance use is often intertwined with broader health inequities in neighborhoods grappling with housing instability and food insecurity, La Dieu said.
“In communities that are struggling with something like food insecurity or housing instability, we see those social determinants of health impact health outcomes and quality of life across the board,” La Dieu said. “Those factors can compound substance use and increase health disparities.”
To address that, the health district has leaned into harm reduction and community-based support.
La Dieu said they have programs like Project LEAD to provide drug-checking supplies and help residents meet basic needs like food, housing and employment.
Chapman pointed to several statewide efforts that have expanded access to care.
Chesapeake Regional Medical Center recently added 20 psychiatric inpatient beds for patients needing medically assisted treatment, detox services and care for co-occurring conditions.
The state’s Opioid Abatement Authority Toolkit offers guidance on how counties can use opioid settlement funds. It includes Virginia-specific resources, example programs and tools to support prevention, treatment, harm reduction and recovery.
In Newport News, the South Eastern Family Project has reopened its newly renovated residential treatment center for women with substance use disorders, including services for pregnant and postpartum patients.
Chapman said the payoff is measurable – the study shows opioid care could prevent nearly 70% of overdose deaths and save communities about $5.2 billion.
