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Fairfax County, Virginia Invests Opioid Settlement Dollars in Youth Treatment

By Hannah Fitzmaurice

Background

Fairfax County, VA has made a concerted effort since 2017 to address the local impacts of the opioid epidemic.*

In 2023, County leaders formed the Opioid Settlement Executive Committee (OSEC) to guide the County’s use of settlement funds and make recommendations to the local elected officials. The OSEC, comprised of a subset of leaders involved in the County’s opioid response, created a process for County agencies to request opioid settlement funds, and partnerships with external organizations were encouraged. Through that initial process, eight projects were proposed, and all were fully funded. Several of these projects are youth-focused, as the county experienced a sharp uptick in opioid overdoses among youth from 2022-2023.

Investing in Residential Youth Treatment

Given the recent increases in youth overdoses, improving access to youth substance use treatment services in Northern Virgina was identified as a top priority by both leaders of the County’s opioid response workgroups and community members. One key gap in services identified was the lack of a regional residential treatment facility specifically geared towards youth with substance use disorders. To address this issue, Fairfax County partnered with several neighboring jurisdictions to apply for funding from the VA Opioid Abatement Authority (OAA) to open a residential youth treatment facility.

Notably, the initial application to the VA OAA was endorsed with over 20 letters of support from Northern Virginia community members, including emergency department physicians, public school superintendents, public safety partners, judges, private behavioral health providers, and more. The project was initially awarded funding by the VA OAA in 2023 and, after some challenges finding a qualified vendor to provide services, a contract was awarded in April 2025 for a 16-bed residential substance use treatment facility which opened in March 2026. The facility is the first of its kind in Virginia and plans to add withdrawal management and crisis stabilization services in the future.

In addition to funding from the VA OAA, this facility is supported by a braided approach that leverages local matching funds from the five participating Northern Virginia jurisdictions (with some utilizing their direct shares of opioid settlement funds for their matches) and Medicaid reimbursement for services, which will support the Center’s long-term financial sustainability once settlement funds are expended.

Investing in Youth Outpatient Treatment

To complement its investment in the youth residential treatment facility, Fairfax County has also used opioid settlement dollars to expand access to community-based youth treatment services. In FY24-25, Fairfax allocated $1.2 million of its opioid settlement funds to the Youth Medication Assisted Treatment (MAT) Expansion (YMAT-E) program; FY26-FY27 and subsequent year funding is using a combination of OAA noncompetitive funds and local opioid settlement dollars. The YMAT-E program provides comprehensive clinical services including medication for opioid use disorder (MOUD), counseling, and peer support services. From the start of YMAT-E in July 2024 through June 2025, the program has served 76 youth, and funds for this initiative are also being used to expand eligibility for these services to transitional age youth.

Ellen Volo, Fairfax County’s Opioid Response Manager, noted that fatal and non-fatal opioid overdoses among youth in Fairfax County have decreased substantially from the peaks seen in 2022 and 2023. These investments in youth treatment provide a strong foundation to sustain these reductions and drive further improvements.

Alignment with the Principles

  • Principle 1 (Spend the Money to Save Lives): Settlement dollars are being spent to address youth substance use and to help to prevent fatalities among this population.
  • Principle 2 (Use Evidence to Guide Spending): The effectiveness of MOUD in the general population is well established. While there is less research on using MOUD to specifically treat youth and adolescent substance use, both the Society for Adolescent Health and Medicine and the American Academy of Pediatrics recommend increasing access to MOUD for adolescents and cite supporting evidence for this population in their position statements. These recommendations also call for incorporating these medications as part of comprehensive, integrated treatment approaches that include nonpharmacologic interventions such as counseling, which the YMAT-E program aligns with.
  • Principle 5 (Develop a Fair and Transparent Process for Deciding Where to Spend the Funding): A key component of this principle is to determine areas of need where funding can make the biggest difference. These investments in youth treatment were informed by increases in youth opioid overdoses in 2022-2023, as well as the lack of a residential facility in the area. The letters of support from community members obtained by the County for the residential youth treatment facility also align with Principle 5’s emphasis on engaging groups that touch different parts of the opioid epidemic.

Next Steps in Fairfax County: Fairfax County is also advancing several other opioid settlement initiatives in FY27. This includes a competitive procurement process for external organizations to access opioid settlement funds for allowable abatement services, programs, and/or activities that align with the County’s opioid response plan and focus on demographic groups with disparities in overdose outcomes. To learn more about this and other programs the county is funding, you can visit the county website, linked here.

Footnote

* Fairfax has a number of entities that have collaborated in order to achieve the shared goal of advancing the County’s opioid response strategy, including the Opioid and Substance Use (OSU) Task Force (comprised of a wide range of partners, including representatives from the criminal justice system, Fairfax County Public Schools and Health and Fairfax Human Services), the Opioid Steering Committee (comprised of County agency leaders), and the Fairfax Prevention Coalition (the OSU task force’s community engagement arm).

Hannah Fitzmaurice is an intern at the National Association of Counties. Drawing from both professional and lived experience, Hannah is committed to advancing equitable, evidence-based programs and policies that strengthen systems of care and improve outcomes for individuals, families, and communities affected by substance use and addiction.