OBJECTIVES: World’s 80% of opioid supply is consumed by the United States (US). Consequently, the abuse of opioids poses a significant challenge to the nation which declared it as an epidemic in 2013, and a national public health emergency in 2017. This systematic review evaluates the economic burden of prescription opioid abuse in the US after 2017.

METHODS: A systematic review adhering to PRISMA guidelines was conducted in Embase^® and MEDLINE^® to identify literature published from 1-January-2018 to 30-November-2023. Publications reporting cost and healthcare resource utilization (HCRU) associated with abuse of prescription opioids were included.

RESULTS: A total of 5,354 records were retrieved. After deduplication, 4,655 abstracts were reviewed, followed by full-text screening of 728 publications. Finally, 14 unique publications were included with most of them (n=10) published in 2019 and 2020. Seven publications reported both HCRU and cost outcomes. Most of the publications (n=9) reported the direct cost of opioid prescription abuse. Patel et al. (2021) reported total, direct, and indirect costs of pediatric prescription opioid poisonings as US$230.8 million, US$21.1 million, and US$209.7 million, respectively. White et al. (2020) reported significant work loss associated with prescription opioid use disorder (OUD), with indirect mean cost estimates of US$8,193 per employee (OUD) versus US$5,438 per employee (no OUD) (p<0.001). Sears et al. (2020) reported that the state-level average annual prescription opioid overdose hospitalization rates ranged from 0.3 to 1.2 per 100,000 employed workers. Schepis et al. (2019) reported high rates of emergency department visits (42.7%) in older adults due to prescription opioid misuse.

CONCLUSIONS: The evidence indicates that the prescription opioid abuse still contributes to significant economic and HCRU burden in the US. This calls for more effective measures in controlling the epidemic. Further, there were lack of publications investigating the indirect costs of prescription opioid abuse which warrants further research.