OBJECTIVES: To examine the economic burden and health care utilization for patients diagnosed with opioid abuse in the U.S. veteran population. METHODS: Patients diagnosed with opioid abuse (International Classification of Diseases, 9^th Revision, Clinical Diagnosis codes 965.0x and 965.8x) were identified using the Veterans Health Administration (VHA) Medical SAS Datasets from October 1, 2007 through September 30, 2012. The first diagnosis date was designated as the index date. A comparison cohort was created including patients without opioid abuse using 1:1 propensity score matching to control for age, region, gender, index year and baseline Charlson Comorbidity Index score. The index date was chosen randomly for the comparison cohort to minimize selection bias. Patients in both cohorts were required to be at least age 18 years and have continuous medical and pharmacy benefits 1 year pre- and 1 year post-index date. Study outcomes including health care costs and utilizations were compared between the disease and comparison cohorts based on the matched sample. RESULTS: After 1:1 matching, 1,652 patients were included in each cohort, and the baseline characteristics were well-balanced. More patients with opioid abuse had inpatient stays (92.37% vs. 5.08%, p<0.0001) and emergency room (ER) (73.85% vs. 11.38%, p<0.0001), physician office (96.91% vs. 71.91%, p<0.0001), outpatient (97.46% vs. 72.82%, p<0.0001) and pharmacy visits (89.83% vs. 75.00%, p<0.0001). Higher all-cause health care costs were also observed for patients with opioid abuse, including inpatient ($29,203 vs. $1,394, p<0.0001), ER ($1,155 vs. $112, p<0.0001), outpatient ($9,193 vs. $2,665, p<0.0001), pharmacy ($1,516 vs. $696, p<0.0001) and total costs ($39,913 vs. $4,757, p<0.0001) than for study subjects without opioid abuse. CONCLUSIONS: During a period of 12 months, VHA patients diagnosed with opioid abuse reported higher health care utilization and costs than their matched controls.