In Virginia, the leading cause of unnatural death is drug overdoses, and has been since 2013. Opioids – specifically fentanyl – have been the driving force behind the large increases. In 2021, fentanyl contributed to 76.4% of all Virginia overdose deaths. The total number of fatal fentanyl overdoses increased 22.8% from 2020 to 2021. It was estimated that in 2021, 98% of fatal fentanyl overdoses in Virginia were caused by the illicit, rather than prescription, version of the drug.