The cost, by county.
Every county in Tennessee is paying for the substance use crisis. This is what the cost looks like at the local level for all 95 counties, in two different framings, with sources. Use the toggle below to switch between an annual death-cohort view and the cumulative lifetime burden of currently active cases. Click any county for the full breakdown.
Death-Cohort Loss
Tennessee, 2023
OUD Case (Avalere)
All Reporting
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What these figures do not include
The numbers on this page count drug overdose deaths only. They do not include alcohol-induced deaths (approximately 2,000 to 2,500 per year in Tennessee, tracked separately by TDH and CDC), the non-fatal cost of alcohol use disorder, or the non-fatal cost of stimulant use disorder. They also exclude alcohol-related emergency visits, methamphetamine-driven foster placements, and the labor-market impact of untreated addiction. The full economic burden of substance use disorder in Tennessee is meaningfully larger than what is shown here.
| County ↕ | Deaths (2023) ↕ |
Rate per 100K ↕ |
Per resident ↓ |
Family of four ↕ |
Total economic loss ↕ |
|---|
What treatment actually buys.
Federal research consistently finds that every dollar invested in evidence-based addiction treatment avoids $4 in healthcare costs and $7 in criminal justice costs, a $11-to-$1 return. Try a number below.
In dollars. Example: $50,000,000 = $50 million.
1 to 20 years. Compounding is not modeled in v1.
$4 per $1 invested $1.0B
$7 per $1 invested $1.75B
Source: U.S. Department of Health and Human Services, NIDA, and SAMHSA peer-reviewed research on the return on investment of evidence-based SUD treatment. Figures are illustrative; actual returns vary by program type, retention, and population served.
Work with me
Need this analysis for your county?
Tennessee counties are routinely underestimating the true cost of substance use disorder. I build short, defensible fiscal impact briefs that commissioners, grant writers, and opioid task force chairs can actually use to justify funding decisions.
Melissa Kilpatrick, LADAC II, QCS. Tennessee-based addiction policy consultant, clinical supervisor, and the person who built this tool.
Methodology & sources.
Every figure on this page is sourced. The cost methodology is adapted from Brewer & Freeman (2018), Indiana Business Review. Death data is from the Tennessee Department of Health 2023 and 2024 Fatal Drug Overdose Reports. Use the year toggle at the top of the page to switch between the 2023 baseline and the most recent 2024 data.
What is and is not counted on this page
Counted. All drug overdose deaths in Tennessee in 2023 and 2024, as reported by the Tennessee Department of Health. This includes opioid overdoses, stimulant overdoses (cocaine and methamphetamine), and polysubstance overdoses. Use the year toggle to switch between the two reporting years.
Not counted. Alcohol-induced deaths (chronic alcohol abuse, alcoholic liver disease, alcohol poisoning), which TDH and CDC track separately and which run approximately 2,000 to 2,500 per year in Tennessee. Non-fatal alcohol use disorder costs (emergency department visits, chronic medical care, lost productivity from the population currently living with AUD). Non-fatal stimulant use disorder costs (foster placements, criminal justice costs, ED visits). The full economic burden of substance use disorder in Tennessee is meaningfully larger than what is shown here.
Sources for figures excluded above: CDC WONDER alcohol-induced mortality data; NIAAA economic burden of alcohol misuse (~$249B nationally per year); TDH Hospital Discharge Data System; SAMHSA NSDUH.
How the two views differ
Annual death-cohort loss. Multiplies the selected year's fatal overdoses (2023 or 2024) by $1.6M in projected lifetime productivity per death. Answers, "what did one year of deaths cost in lifetime impact?" This is the framing used in the Op Ed.
Cumulative OUD burden. Allocates the total estimated lifetime cost of currently active TN OUD cases ($105B, derived from Avalere $808K per case × ~130,000 SAMHSA-estimated cases) to counties using the Brewer-Freeman 80/20 severity-and-population formula. Answers, "what is the total lifetime burden of the people currently living with OUD in this county?"
Both are valid. Both are sourced. They answer different questions, which is why the per-resident figures differ by roughly 19x. Always label which view you are citing.
Cost-per-death anchor ($1.6M)
Average age of decedent in TN is approximately 42. With 23 years of remaining productivity at the Tennessee average wage (~$56,000 per year), discounted at a 0.85 present value factor, the lifetime productivity loss per fatal overdose comes to approximately $1.6 million in lost earnings and forgone tax revenue. This is consistent with CDC and Council of Economic Advisers ranges on overdose-cost-per-life.
Sensitivity range: The $1.6M figure is a single-point estimate. Reasonable variation in assumptions about wage trajectory (whether the decedent's earnings rise above or below the TN average over time), discount rate (anywhere from 3 to 7 percent annually), and remaining work years (depending on actual age at death) places the per-death estimate in the range of approximately $1.2M to $1.9M. For county-commissioner and grant-application use, the $1.6M anchor is appropriate. For academic or peer-reviewed work, the full range should be cited.
Brewer-Freeman allocation formula (cumulative view)
Allocation_county = 0.2 × Population_share + 0.8 × Severity_share, where Severity_share is the county's proportionate share of statewide fatal overdose deaths in 2023. This 80/20 weighting is the methodology applied to Indiana's opioid crisis in Brewer & Freeman (2018), Indiana Business Review.
Indiana-to-Tennessee validation caveat: The Brewer-Freeman 80/20 formula was developed for Indiana, whose county structure varies less dramatically in rurality, healthcare access, and population density than Tennessee's does. Applying the same severity-weighting to Tennessee counties is a reasonable starting point but has not been independently validated against TN-specific cost data. For any single-county citation in the cumulative view, this should be read as an order-of-magnitude estimate, not a precise allocation. Independent academic validation of the formula's TN applicability is a Phase 1 milestone for this tool.
Sensitivity testing across alternate weightings
The 80/20 Brewer-Freeman weighting is one defensible choice. Reasonable researchers could argue for 50/50, 70/30, or pure population or pure severity. To test how much the answer depends on the assumption, the cumulative allocation has been recalculated for every Tennessee county at six different weightings, from 100/0 (pure population) to 0/100 (pure severity).
What the testing shows:
• The top-ranked counties by per-capita burden (Roane, Hancock, Cocke, Claiborne, Anderson, Morgan, Knox) stay near the top across every weighting tested. Roane stays in the top 13 in every scenario. Knox stays in the top 7. These rankings are robust.
• Roughly 41 of 95 counties have a per-capita range narrower than 30 percent of the 80/20 estimate. These are high-confidence allocations.
• Roughly 22 counties have ranges greater than 70 percent. These are typically smaller, lower-death counties whose allocation depends meaningfully on whether the formula weights population or severity. Treat single-county figures for these as order-of-magnitude estimates.
Implication for use: For policy or advocacy citation of the top-burdened counties, the cumulative figures hold up well to alternate weightings. For citation of specific mid-rank or low-rank counties, the prudent move is to cite the range, not the single point.
The full county-by-county sensitivity table is not published here for proprietary reasons. It is part of the consulting engagement deliverable and is shared with paying clients evaluating a specific county.
$11-per-$1 ROI calculation
Federal research, including the National Institute on Drug Abuse and SAMHSA published findings, consistently shows that every dollar invested in evidence-based addiction treatment avoids approximately $4 in healthcare costs and $7 in criminal justice costs over time. The calculator applies this ratio to user-specified annual investment.
Requesting the underlying dataset
The county-by-county figures rendered on this page are available as an assembled dataset on request. The dataset is shared as part of consulting engagements and on a case-by-case basis for academic or grant-writing use.
Contact: melissa@melissakilpatrick.com
Substance breakdown sources (2023 and 2024)
County-level substance breakdown is now available for both 2023 and 2024 toggle views. The data sources and categories differ slightly between years.
2023 substance breakdown is sourced from the TDH 2023 Tennessee Drug Overdose Death Report (March 1, 2025 release). Categories: All opioids, Fentanyl, Pain relievers, Heroin, and Any stimulant (which combines cocaine and non-cocaine stimulants).
2024 substance breakdown is sourced from the TDH 2024 Fatal Drug Overdose Report. Categories: All opioids, Fentanyl, Pain relievers, Stimulants (non-cocaine), and Cocaine. Heroin is folded into All opioids in the 2024 categorization.
Year-over-year category note: When comparing 2023 to 2024, use these mappings: 2023 "All opioids" maps to 2024 "All opioids"; 2023 "Fentanyl" to 2024 "Fentanyl"; 2023 "Pain relievers" to 2024 "Pain relievers"; 2023 "Any stimulant" to 2024 "Stimulants (non-cocaine) + Cocaine combined" for apples-to-apples stimulant trend.
What this tool cannot do for your county
The public tool gives you the cost picture for any Tennessee county. It does not give you:
• A targeted action plan for the specific funding decisions your county is making
• A breakdown of which interventions are likely to move which line items
• A multi-year fiscal trajectory under different policy scenarios
• Direct comparison against grant funder priorities (OAC, SAMHSA SOR, TennCare 1915i, federal block grants)
Those are the deliverables of a consulting engagement. Tier 1 single-county fiscal impact briefs start at $500. Multi-county comparisons and grant application support are also available. Contact: melissa@melissakilpatrick.com
Limitations
1. County-level ER and hospital discharge data was not available; deaths used as the sole severity proxy in cumulative allocation.
2. OUD case count is a state-level estimate; county-level prevalence data is unavailable.
3. The TDH report counts Tennessee residents only. Non-residents who fatally overdose in Tennessee are not included, an undercount in border counties.
4. Cost categories exclude pain-and-suffering, foster care placement, NAS, and family productivity losses. The figures here are conservative.
Data sources
TDH 2023 Drug Overdose Deaths Report. Tennessee Department of Health, Office of Informatics and Analytics, March 2025.
TDH 2024 Fatal Drug Overdose Report. Tennessee Department of Health, Office of Informatics and Analytics, 2026.
Avalere Health (2025). "The Cost of Addiction: OUD in the US."
U.S. Census Bureau ACS. county population estimates.
Bureau of Labor Statistics. county unemployment rates.
SAMHSA NSDUH. state OUD prevalence estimates.
Brewer & Freeman (2018). Indiana Business Review, allocation methodology.
This tool gives you the numbers. For county-specific recommendations, a defensible brief for your commission, or a comparative analysis across a region, see the work with me section above or email melissa@melissakilpatrick.com.