OBJECTIVES: Opioid dependence imposes substantial harm, not only to individuals suffering from this chronic relapsing disease, but also to public health and safety. This comes with significant socioeconomic costs. Quantifying these costs is necessary for policy and decision makers weighing interventions to reduce opioid dependence. The purpose of this study was to develop an economic model to estimate the wider socioeconomic costs per problematic drug user (PDU) on and off treatment in Germany.

METHODS: A costing model was developed to calculate the wider socioeconomic costs of PDUs on and off treatment. Model inputs included dependency prevalence, PDU demographic data, and frequency and cost estimates of opioid dependence-related events. Data unavailable in Germany were imputed first from EU markets and then non-EU markets. Costs were stratified according to the payer liable and the sector in which costs were incurred.

RESULTS: The annual cost per PDU on and off treatment in Germany was estimated to be €80,001 and €177,602, respectively. The 81,300 PDUs on treatment cost an estimated €6.5 billion, and the 79,212 PDUs off treatment €14.1 billion. The government bore the largest portion of on-treatment costs (45%), and for PDUs off treatment, family and community bore the majority (43%). Loss of income accounted for 36% and 34% of on and off treatment costs respectively, wider social network for 24% and 31%, healthcare 22% and 13%, criminal justice 15% and 19%, and social care 3% and 3%.

CONCLUSIONS: The model quantifies savings associated with getting PDUs on treatment and maintains previous findings that doing so reduces costs to society and heavily reduces financial burden on families and communities. Substantially larger savings occur outside healthcare – a sector that faces heavy treatment costs, and thus has a monetary counterincentive to implementation. Therefore, wide-perspective policy is necessary to launch and sustain interventions that increase treatment retention and access.