Statewide, fentanyl is the drug most often behind overdose deaths. In Lee County, it is methamphetamine.
Of the 23 drug overdose deaths that happened in the county from 2023 through 2025, 15 involved meth. That is about 65%, by The Lee Daily Register’s count from the state medical examiner’s locality tables. Seven involved fentanyl, about 30%. Across Virginia over the same three years, the shares were nearly reversed: about 22% of overdose deaths involved meth and 67% involved fentanyl. A death can involve more than one drug, so the shares overlap.
Fewer deaths, still a higher rate
The number of Lee County residents who died of an overdose has fallen for two years in a row. The Virginia Department of Health’s death certificate data, which the department asks the media to use, counts 11 resident deaths in 2023, 8 in 2024 and 6 in 2025. The 2025 figure is preliminary.
The decline tracks the state’s. Virginia recorded 1,197 resident overdose deaths in 2025, down 23% from 2024 and less than half the 2,622 of the 2021 peak, according to the department. Lee County’s six deaths work out to 25.8 per 100,000 residents, compared with 13.9 statewide, so the county’s rate is still nearly double Virginia’s. With counts this small, one death moves the county’s rate by about four points.
| Year | Lee County resident deaths | Lee rate per 100,000 | Virginia rate per 100,000 |
|---|---|---|---|
| 2023 | 11 | 47.3 | 28.7 |
| 2024 | 8 | 34.4 | 18.0 |
| 2025 (preliminary) | 6 | 25.8 | 13.9 |
Why meth stands out
The medical examiner’s tables count deaths by where the overdose happened, not where the person lived, and they are the only state source that shows Lee County deaths by drug every year. They list meth in 9 of the county’s 11 deaths in 2023, and in 3 of 6 in both 2024 and 2025. Fentanyl appears in 4, 2 and 1.
The health department’s resident data point the same way. Lee County residents died of overdoses involving psychostimulants, the category that includes meth, at a rate of 38.7 per 100,000 in 2023 and 25.8 in 2024. The state rates were 6.5 and 4.5, so Lee County’s was about six times higher in both years. The department suppressed the county’s 2025 figure because the count was below five.
The pattern is regional. Lee, Wise, Scott and Dickenson counties and the City of Norton had 94 overdose deaths from 2023 through 2025. Meth was involved in 69 of them, about 73%, by our count from the medical examiner’s tables. Fentanyl was involved in 43, about 46%.
More overdose ER visits this year
Emergency room numbers are moving the other way. Lee County residents made 48 overdose visits to Virginia emergency departments from January through September 2026, according to the department’s emergency department data, extracted October 10. That is already close to the 52 visits for all of 2025. If visits continue at the same average pace, the year would end near 64, about 23% more than last year.
The latest quarter, July through September, had 17 visits, and the department’s quarterly file marks both the count and the rate for Lee County as an increase. Statewide, the quarter’s count was marked stable.
The department measures these visits per 10,000 emergency room visits of any kind. On that scale, Lee County’s 2026 rate so far is 50.5, above the state’s 40.0. In 2025, the county was below the state, at 38.9 against 41.6. For opioid overdose visits alone, the county’s 2026 rate is 30.5, about 1.7 times the state’s 17.9.
What the numbers leave out
The two death counts do not match. The health department counted eight Lee County residents who died of overdoses in 2024, and the medical examiner counted six overdose deaths that happened in the county that year. The files do not explain the difference. One possible reason is that the resident count includes people who died somewhere else, such as a hospital in another county or state.
The emergency room data include only Virginia hospitals, so residents treated in Tennessee or Kentucky are not counted. No reliable death count for 2026 is available yet. The department suppressed the county’s partial 2026 figure, and the medical examiner’s most recent report, covering January through March, lists one death that occurred in Lee County. The medical examiner’s next quarterly report was due in October and had not been posted as of November 5.
The state’s overdose need score, which combines 12 measures from deaths to poverty, rated Lee County as having “higher” need every year from 2021 through 2024. Earlier this fall, The Lee Daily Register reported on how the county is spending its opioid settlement money.
