OBJECTIVES: To determine healthcare costs among immediate release (IR) hydrocodone patients diagnosed with opioid abuse compared to those without such diagnosis in the United States (US).  METHODS: Retrospective analysis using claims from the Truven MarketScan® commercial, Medicare supplemental, and Medicaid databases was performed.  Patients prescribed IR hydrocodone during the 6-month baseline period (7/2011-12/2011), and with continuous enrollment during baseline and the 12-month follow-up period (2012), were selected. IR hydrocodone patients with an ICD-9-CM diagnosis for opioid abuse or dependence (abuse) were identified in the follow-up period. Descriptive analyses were employed to compare demographic and clinical characteristics between diagnosed opioid abusers and non-abusers. Total healthcare costs (standardized to 2013 US dollars) for abusers vs. non-abusers during the follow-up were estimated by plan type. Propensity score matching was used to estimate incremental costs in the follow-up. RESULTS: A total of 1,743,933 commercial, 277,096 Medicare, and 157,992 Medicaid IR hydrocodone patients were selected. Prevalence of diagnosed opioid abuse for these samples in follow-up was 0.9%, 0.5%, and 3.2% for commercial, Medicare, and Medicaid, respectively. Among commercial patients, unmatched data at baseline showed that abusers had on average higher co-morbidity burden (0.96 vs. 0.67), and higher pill count (60.8 vs. 20.5 pills/month) and days’ supply (67.4 vs. 24.1 days) for IR hydrocodone, compared to non-abusers.  After matching there were no differences in co-morbidity burden (.96 vs. .99) and pill count (60.8 vs. 60.5) but days’ supply remained significantly different (67.4 vs. 63.4).  In the matched subset, incremental costs were significantly higher among abusers ($14,720, $6,589, and $14,786 for commercial, Medicare, and Medicaid patients, respectively) as compared with non-abusers.  CONCLUSIONS: IR hydrocodone patients with diagnosed opioid abuse have higher healthcare costs when compared to matched non-abusers, suggesting significant negative economic impact of opioid abuse in the US. Similar trends were observed regardless of plan type.