This report summarizes information from the four executive branch agencies that provide substance use disorder treatment and recovery services: The Department of Behavioral Health and Developmental Services (DBHDS), the Department of Juvenile Justice (DJJ), the Department of Corrections (DOC) and the Department of Medical Assistance Services (DMAS). These agencies share the common goals of increasing the health and wellness of Virginia’s individuals, families, and communities, increasing access to substance use disorder treatment and recovery services, and reducing the impact of those with a substance use disorder and involvement in the criminal justice system. All agencies included in this report are invested in providing evidence-based treatment and recovery services within the specific constraints each has on its ability to provide these services. In this report, the following information is detailed concerning each of these four agencies’ substance use disorder treatment programs:

1. Amount of funding spent for the program in FY 2025;

2. Unduplicated number of individuals who received services in FY 2025;

3. Extent to which program objectives have been accomplished as reflected by an evaluation of outcome measures;

4. Identifying the most effective substance use disorder treatment;

5. How effectiveness could be improved;

6. An estimate of the cost effectiveness of these programs; and

7. Funding recommendations based on these analyses.

As used in this document, treatment means those services directed toward individuals with identified substance use disorders and does not include prevention services.

Treatment Programs for FY 2025

This report provides focused data on specific outcomes. Every fatal drug overdose represents many affected individuals, and every individual who commits a crime associated with substance use disorder represents many others who are also involved.(*1) Many of these individuals are struggling with functional impairment due to their substance use disorder and this is reflected in decreased workforce participation,(*2) negative impact on the economy,(*3) the potential for dissemination of blood borne diseases,(*4) and recidivism.

The inclusion of methamphetamine treatment in monies allocated for 2020 allowed for much needed expansion of services. It should be noted that earmarking funds to ameliorate the impact specific drugs have on health outcomes may fail to acknowledge that substance use, or substance use disorder (SUD) is not limited to a specific drug. SUD is a non-substance specific recognized and diagnosable disorder. Lack of flexibility to utilize funding when addressing misuse of ALL drugs may indirectly result in increased use of others.

While fatal overdoses due to opioids and methamphetamines decreased from 2022 to 2023, they increased for cocaine.(*5) Deaths from all three types of drugs exhibited a sharp decline from 2023 to 2024. In fact, the number of fatal overdoses from all drugs decreased by 33.5 percent and by 43.6 percent for fentanyl during this same time period. However, the rate of decline appears decreasing, and we may be reaching a plateau based on Q1 2025 data. Cocaine and fentanyl are the most common combination of substances causing fatal overdoses, accounting for 28.9 percent of all overdose deaths.

Further, it appears that deaths attributable to benzodiazepines and prescription opioids (excluding fentanyl) are increasing in 2025.(*6) These data illustrate that the number of overdose deaths from different substances can trend independently of one another. This clearly indicates that a reactive or drug specific approach to substance use funding may result in duplicated services, and poorer outcomes.
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(*1) Virginia Department of Health: Office of the Chief Medical Examiner. (2025). Fatal Drug Overdose Quarterly Report. Retrieved from https://www.vdh.virginia.gov/medical-examiner/forensic-epidemiology/
(*2) Over the last 15 years, LFP fell more in counties where more opioids were prescribed." Alan B. Krueger; BPEA Article; Brookings Institute; Thursday, September 7, 2017; “Where have all the workers gone? An inquiry into the decline of the U.S. labor force participation rate"; https://www.brookings.edu/articles/where-have-all-the-workersgone-an-inquiry-into-the-decline-of-the-u-s-labor-force-participation-rate/
(*3) Midgette, Gregory, Steven Davenport, Jonathan P. Caulkins, and Beau Kilmer, What America's Users Spend on Illegal Drugs, 2006–2016. Santa Monica, CA: RAND Corporation, 2019. https://www.rand.org/pubs/research_reports/RR3140.html. Also available in print form.
(*4) County-Level Vulnerability Assessment for Rapid Dissemination of HIV or HCV Infections Among Persons Who Inject Drugs, United States; Buchanan et. al. MJAIDS Journal of Acquired Immune Deficiency Syndromes: November 1, 2016 - Volume 73 - Issue 3 - p 323–331 doi: 10.1097/QAI.0000000000001098 Epidemiology and Prevention
(*5) Virginia Department of Health: Office of the Chief Medical Examiner. (2025). Fatal Drug Overdose Quarterly Report. Retrieved from https://www.vdh.virginia.gov/medical-examiner/forensic-epidemiology/
(*6) Virginia Department of Health: Office of the Chief Medical Examiner. (2025). Fatal Drug Overdose Quarterly Report. Retrieved from https://www.vdh.virginia.gov/medical-exam`iner/forensic-epidemiology/