OBJECTIVES: Opioid abuse is a significant public health problem in the United States, with opioid-related overdoses accounting for over 16,500 deaths per year. In addition, opioid abuse imposes a significant economic burden due to increased health care utilization and costs. This study calculates updated, payer-specific, excess medical costs of diagnosed opioid abuse among commercially-insured, Medicaid, and Medicare patients with recent prescription opioid (RxO) use. METHODS: Using de-identified Truven MarketScan medical and pharmacy claims data for commercially-insured, Medicaid, and Medicare patients, we examined the excess costs of diagnosed opioid abuse among patients with at least one pharmacy claim for an RxO, 2009-2011. Diagnosed abusers were identified using ICD-9 diagnosis codes for opioid abuse/dependence and were matched to non-abusers using propensity score methods. Medical costs were calculated over a 12-month period around the index date, which was the date of the first abuse diagnosis for abusers and the date of a random medical claim for non-abusers. Costs reflected payments by insurers as well as out-of-pocket patient costs, measured in 2011USD. The excess costs of diagnosed opioid abuse were calculated as the difference in costs between abusers and non-abusers following matching and included inpatient, emergency room (ER), and outpatient services. RESULTS: A total of 2510 commercially-insured, 536 Medicaid, and 268 Medicare patients with diagnosed opioid abuse were matched to non-abusers. The annual per patient excess medical costs associated with diagnosed opioid abuse were $9,456 (p<0.001) for commercially-insured patients, $11,501 (p<0.001) for Medicaid patients, and $10,046 (p<0.001) for Medicare patients. Inpatient costs accounted for 63.0%-78.6% of total excess medical costs, and ER costs accounted for 5.6%-12.6% of total excess medical costs. CONCLUSIONS: The excess medical costs of opioid abuse are substantial and reveal a consistent pattern across payers. These estimates are comparable to prior research, suggesting opioid abuse continues to impose significant economic burden.