OBJECTIVES:  Opioid use disorder (OUD) is a chronic disorder with multi-faceted and negative medical, psychological and social consequences affecting a variety of health-related quality of life (HRQL) domains. Utility values (UVs) provide informative, relative estimates of HRQL across patients suffering from various chronic disorders. The HRQL of patients with OUD is low relative to the general population and to patients with other chronic diseases. We aimed to identify published UVs for OUD and to discuss evidence gaps. METHODS:  A systematic review of published studies that measured utility in an OUD population was conducted by searching global electronic databases, health technology assessment websites, conference proceedings and reference lists. Literature searches were unrestricted by country or year. Data quality was appraised using published checklists. RESULTS:  We identified 1,524 relevant publications. Only seven original studies reporting utilities (UVs: 0.53-0.86) were suitable for data extraction, while six of these only considered one treatment. Three studies examined comorbidities (one each for HIV co-infected patients [UVs: 0.62-0.67], patients with psychiatric disorders [UVs: 0.53-0.69] and HCV co-infected patients [UVs: 0.71-0.75]). EQ-5D and SF-36 were the most commonly used instruments to measure UVs. Long-term data were available in four studies, where only one reported utilities for continuously abstinent patients (UVs: 0.84). A parallel systematic literature review identified seven further economic models alongside clinical trials collecting HRQL data (UVs: 0.38-0.87). CONCLUSIONS:  We observed a lack of studies setting out comparative UVs and a wide range of utility values (0.38-0.87). Furthermore, publications inconsistently reported all HRQL domains and often ignored psychological implications and related co-morbidities, which are considered significant within this patient population. Given the importance of HRQL in healthcare decision making, more widespread and consistent use of utility instruments for the treatment of OUD is needed to allow for treatment comparisons.