Exclusive: Opioid use disorder costs almost $700K per case

Axios

20-05-2025

Opioid abuse is as much an economic problem as a public health one, according to a comprehensive analysis provided first to Axios that concludes it costs an average of nearly $700,000 to treat each affected person.
Why it matters: The cost burden falls unevenly, with states in a belt stretching through Appalachia to New England typically having bigger caseloads and a higher cost per case.
Opioid use disorder cost the U.S. an estimated $4 trillion last year, per the analysis from Avalere, which used 2017 figures to project 2024 net costs.
"While this is a cost to government, it's also a cost to private businesses, and the huge cost, of course, is to the individuals who have OUD," said Margaret Scott, a principal at Avalere and author of the report.
By the numbers: The projected cost of opioid use disorder in 2024 ranged from $419,527 per case in Idaho to more than $2.4 million in D.C. That covers lost productivity, health insurance costs, property lost to crime and other variables.
The cost per case totaled more than $1 million in West Virginia, Rhode Island, Ohio and Maryland.
Some of the regional variation in costs is from lost tax revenue, which varies by state. The local availability of treatment for opioid use disorder may also drive the cost, Scott said.
State of play: Opioid use disorder — defined as frequent opioid use and unsuccessful efforts to quit — is estimated to affect more than 6 million people in the United States.
The cumulative economic burden on patients, including years of life lost and reduced quality of life, exceeded $3 trillion in 2024, Avalere estimated.
Private businesses absorbed more than $467 billion in costs from lost productivity and health insurance costs while the federal government bore about $118 billion in Medicare and other federal insurance costs, lost taxes and criminal justice expenses.
It cost state and local governments more than $94 billion, with about $42 billion of that going toward criminal justice costs.
The Trump administration in March released its own analysis that estimated illicit opioids cost the U.S. about $2.7 trillion in 2023.
Where it stands: Treatment can defray the costs by more than 40% in some instances, the analysis found.
Behavioral therapy alongside long-acting injectable buprenorphine — a treatment that reduces the risk of future overdoses — generated an estimated $295,000 savings per case, the biggest cost-saver of the options Avalere analyzed.
Therapy plus methadone and therapy plus buprenorphine administered through mucous membranes like the mouth each save about $271,000. Behavioral therapy alone saves a project $144,000 per case.
The treatment savings estimates assume that patients fully adhere to the regimen for a year.
Yes, but: Federal data from 2022 showed that only one-quarter of adults who needed medication treatment for OUD actually got it.
Less than half of adults who received any OUD care that year got medication treatment.
However, buprenorphine distribution increased significantly between 2019 and 2022 as policy changes during the COVID-19 pandemic allowed people to start treatment via telehealth.
Between the lines: Overdose deaths in the U.S. fell to the lowest level since 2019 last year, partly due to expanded availability of the overdose reversal drug naloxone. An estimated 80,391 people died from drug overdoses in 2024, down nearly 27% from the previous year, per Centers for Disease Control and Prevention data.
But some addiction experts say cuts to federal grant funding and other program changes led by Health and Human Services Secretary Robert F. Kennedy Jr. could hurt addiction recovery programs.