The DOI matches its Crossref record; 33 of the 38 references it cites were found in a registry or an index; 11 of the 22 sources its claims cite were checked for support.
The economic burden of opioid use disorder and fatal opioid overdose in the United States, 2017
Open accessAbstract
Background The United States (U.S.) is experiencing an ongoing opioid crisis. Economic burden estimates that describe the impact of the crisis are needed when considering federal and state resources devoted to addressing overdoses. In this study, we estimate the societal costs for opioid use disorder and fatal overdose from all opioids in 2017. Methods We estimated costs of fatal overdose from all opioids and opioid use disorder based on the incidence of overdose deaths and the prevalence of past-year opioid use disorder for 2017. Incidence of fatal opioid overdose was obtained from the National Vital Statistics System; prevalence of past-year opioid use disorder was estimated from the National Survey of Drug Use and Health. Costs were estimated for health care, criminal justice and lost productivity. Costs for the reduced quality of life for opioid use disorder and life lost due to fatal opioid overdose were valued using U.S. Department of Health and Human Services guidelines for valuing reductions in morbidity and mortality. Results Costs for opioid use disorder and fatal opioid overdose in 2017 were estimated to be $1.02 trillion. The majority of the economic burden is due to reduced quality of life from opioid use disorder and the value of life lost due to fatal opioid overdose. Conclusions These estimates can assist decision makers in understanding the magnitude of opioid use disorder and fatal overdose. Knowing the magnitude and distribution of the economic burden can inform public policy, clinical practice, research, and prevention and response activities.
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Claims the paper makes
19 Own result · 13 Own method · 6 Own interpretation · 5 Supported · 5 Sources not found · 3 Partly supported · 2 Supported so far · 1 Couldn’t confirm · 1 No full text of the sources · 1 Not checked yet · accuracy not yet measured
Every source the paper cites for this claim was checked and supports it.
In the paper
“However, the population requiring treatment has been estimated to be much larger than the current treatment capacity (Jones et al., 2015).”
§ The Economic Burden of Opioid Use Disorder and Fatal Opioid Overdose in the United States, 2017 > Discussion
What the sources say
- Supportedcites Jones et al., 2015 sourceExperimental — accuracy not yet measured
The Discussion reports that, in the United States in 2012, treatment need exceeded even maximum potential opioid agonist medication-assisted treatment capacity by nearly 1 million people. This directly supports the citing sentence’s comparison, though the paper measures capacity specifically for this form of treatment. (LLM, conf=0.93)
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“Naloxone distribution programs have been shown to reduce opioid mortality rates (Walley et al., 2013).”
§ The Economic Burden of Opioid Use Disorder and Fatal Opioid Overdose in the United States, 2017 > Discussion
What the sources say
- Supportedcites Walley et al., 2013 source
The Discussion (‘What this study adds’) states that opioid overdose death rates were lower in communities where overdose education and naloxone distribution was implemented than in communities where it was not. The paper describes this as observational evidence, rather than proof from a randomized trial. (LLM, conf=0.92)
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“This is a change from previously published estimates, where a large share of costs was attributable to opioid use disorder (Birnbaum et al., 2011; Florence et al., 2016; Rice et al., 2014).”
§ The Economic Burden of Opioid Use Disorder and Fatal Opioid Overdose in the United States, 2017 > Discussion
What the sources say
- Not checked — no full text of the sourcecites Birnbaum et al., 2011 source
- Supportedcites Florence et al., 2016 source
The Results section reports that almost two-thirds of the estimated $78.5 billion in prescription-opioid-related costs were for health care, substance abuse treatment, and lost productivity in nonfatal cases. The paper estimates those nonfatal costs using the prevalence of opioid abuse and dependence, supporting the claim that a large share was attributable to OUD. (LLM, conf=0.91)
- Not checked — no full text of the sourcecites Rice et al., 2014 source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“These HRQOL weights are based on a survey of 1,178 participants from the US population to assess the reduction in quality of life based on whether or not a person with opioid use disorder was currently using opioids either by injection or prescription opioid misuse”
§ The Economic Burden of Opioid Use Disorder and Fatal Opioid Overdose in the United States, 2017 > Methods > Valuation of Lost Quality of Life and Life Lost
What the sources say
- Partly supportedcites Wittenberg et al., 2016 sourceExperimental — accuracy not yet measured
The Results report 1,178 respondents in the individual-focused survey, which assessed opioid-misuse health states. But the survey had 2,054 respondents overall, and the Methods (Study design) say responses from the 876-person spouse-spillover version also supplemented the individual utility data. Thus 1,178 is not the full survey sample underlying the weights. Page numbers are unavailable in our copy. (LLM, conf=0.88)
plainn = 1,178- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Using and alternative source of health care cost data has the smallest impact on the estimates (from $1,020.7 billion to $1,020.9 billion).”
§ The Economic Burden of Opioid Use Disorder and Fatal Opioid Overdose in the United States, 2017 > Results
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Costs for opioid use disorder and fatal opioid overdose in 2017 were estimated to be $1.02 trillion.”
- Also stated in: § Results · hedged
“The overall economic burden totaled approximately $1,020.7 billion (95% PI $967.2 to $1,075.7 billion) in 2017.”
§ The Economic Burden of Opioid Use Disorder and Fatal Opioid Overdose in the United States, 2017 > Abstract > Results:
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Rests on an assumption: The sum of health care, criminal justice, lost productivity, and HRQOL/VSL valuations captures the total societal economic burden of OUD and fatal opioid overdose.
- Also stated in: § Results · hedged
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Slightly more than one-half of the cost is associated with fatal overdoses.”
§ The Economic Burden of Opioid Use Disorder and Fatal Opioid Overdose in the United States, 2017 > Discussion
plaincorrelational- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Lost productivity, for individuals with opioid use disorder ($23.5 billion) and fatal opioid overdose ($68.7 billion), together accounts for over $92 billion.”
§ The Economic Burden of Opioid Use Disorder and Fatal Opioid Overdose in the United States, 2017 > Results
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Lost productivity, for individuals with opioid use disorder ($23.5 billion) and fatal opioid overdose ($68.7 billion), together accounts for over $92 billion.”
§ The Economic Burden of Opioid Use Disorder and Fatal Opioid Overdose in the United States, 2017 > Results
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“By far the largest components of the overall economic burden, however, are the value of reduced quality of life from opioid use disorder ($390.0 billion) and life lost to opioid overdose ($480.7 billion).”
§ The Economic Burden of Opioid Use Disorder and Fatal Opioid Overdose in the United States, 2017 > Results
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Rests on an assumption: The general-purpose VSL and VSLY values from HHS guidelines reflect the U.S. population's willingness to pay to prevent opioid overdose deaths and morbidity.
- It may state two separate claims as one. 16
- Probably not a substantial claim. 15
- The quote only partly states this claim. 1
Every source the paper cites for this claim was checked and supports it.
In the paper
“Mandatory provider review of prescription drug monitoring programs before prescribing opioids and laws that govern the ownership and operation of pain clinics have been shown to reduce the amount of opioids prescribed and prescription overdose death rates (Dowell et al., 2016).”
§ The Economic Burden of Opioid Use Disorder and Fatal Opioid Overdose in the United States, 2017 > Discussion
What the sources say
- Supportedcites Dowell et al., 2016 source
The Abstract reports that combined implementation of mandatory PDMP review and pain clinic laws reduced opioid amounts prescribed by 8 percent and prescription opioid overdose death rates by 12 percent. The Study Data and Methods section describes pain clinic laws as governing clinic ownership and operation. The Discussion cautions that the study could not determine which policy drove the observed changes; the citing sentence attributes the result to the policies together. (LLM, conf=0.93)
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“We also only value lost HRQL for individuals with opioid use disorder. There is likely a substantial reduction in quality of life for friends and family members who care for loved with use disorder, and lose loved ones to overdose (Wittenberg et al., 2016).”
§ The Economic Burden of Opioid Use Disorder and Fatal Opioid Overdose in the United States, 2017 > Discussion
What the sources say
- Partly supportedcites Wittenberg et al., 2016 sourceExperimental — accuracy not yet measured
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“The original source study used a matched case-control design to estimate the impact of opioid use disorder diagnoses on health care spending.”
§ The Economic Burden of Opioid Use Disorder and Fatal Opioid Overdose in the United States, 2017 > Methods > Health Care Costs
What the sources say
- Supportedcites Florence et al., 2016 source
The Methods > Health Care Costs section explicitly says the study used a matched case-control design to estimate the impact of opioid abuse diagnoses on health care spending. It also describes comparing costs for patients diagnosed with abuse or dependence against matched comparison patients. (LLM, conf=0.94)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Supported
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“Finally, previous research has shown that both fatal opioid overdose (Ruhm, 2017) and opioid use disorder (Barocas et al., 2018) is likely undercounted in the data sources we used.”
§ The Economic Burden of Opioid Use Disorder and Fatal Opioid Overdose in the United States, 2017 > Methods > Sensitivity Analysis
What the sources say
- Not checked — no full text of the sourcecites Ruhm, 2017 source
- Supportedcites Barocas et al., 2018 source
Barocas et al. is cited for the OUD portion of the sentence, not the fatal-overdose portion. The Discussion reports that fewer than 50% of people with OUD were known to the health care system and that estimates based only on known cases were nearly half the capture–recapture estimates. Page numbers are not supplied in our copy. (LLM, conf=0.93)
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Opioid use disorder can be undercounted because the NSDUH surveys the noninstitutionalized population, which will exclude incarcerated persons. The homeless population will also likely be missed by household-based surveys.”
§ The Economic Burden of Opioid Use Disorder and Fatal Opioid Overdose in the United States, 2017 > Methods > Sensitivity Analysis
What the sources say
- Partly supportedcites Barocas et al., 2018 sourceExperimental — accuracy not yet measured
The Discussion (page unavailable) says survey-based approaches can underreport OUD and reports prevalence estimates higher than national estimates. It does not say that NSDUH excludes incarcerated people or that household surveys likely miss homeless people; searches for those survey-population claims found no supporting passage. (LLM, conf=0.83)
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
The cited sources that could be checked couldn’t confirm or dispute this claim.
In the paper
“Both of these populations have been shown to have high rates of substance use disorder (Barocas et al., 2018).”
§ The Economic Burden of Opioid Use Disorder and Fatal Opioid Overdose in the United States, 2017 > Methods > Sensitivity Analysis
What the sources say
- Could not verifycites Barocas et al., 2018 sourceExperimental — accuracy not yet measured
The Methods describe identifying opioid use disorder in linked Massachusetts databases, and the Discussion reports prevalence by county and age group. Neither section reports substance use disorder rates specifically among incarcerated or homeless people; searches for “incarcerated” and “homeless” found no relevant passage. (LLM, conf=0.76)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Could not verify
Every source the paper cites for this claim was checked and supports it.
In the paper
“Matching controlled for basic demographic variables, health status was matched based on the Charlson comorbidity index and health care costs prior to use disorder diagnosis, and regression models controlled for skewness in the expenditure data.”
§ The Economic Burden of Opioid Use Disorder and Fatal Opioid Overdose in the United States, 2017 > Methods > Health Care Costs
What the sources say
- Supportedcites Florence et al., 2016 source
The Methods > Health Care Costs section says propensity-score matching included age, sex, baseline health care costs, and the Charlson comorbidity index. It also says nonlinear regression models accounted for skewed health care expenditure data. The preceding Methods passage identifies the matching baseline as the six months before the diagnosis index date; page numbers are not available in our copy. (LLM, conf=0.94)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
- Supported
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Slightly less than half of these costs were attributable to opioid use disorder ($471.0 billion (95% PI $417.8 to $525.7billion)).”
§ The Economic Burden of Opioid Use Disorder and Fatal Opioid Overdose in the United States, 2017 > Results
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Rests on an assumption: The sum of health care, criminal justice, lost productivity, and HRQOL/VSL valuations captures the total societal economic burden of OUD and fatal opioid overdose.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Our results are most sensitive to the choice of values for the VSL and VSLY. At the low estimate of a VSL/VSLY from the HHS guidelines, the overall economic burden is $556.0 billion, and at the high value of the VSL/VSLY, the overall burden is over $1,480.4 billion.”
§ The Economic Burden of Opioid Use Disorder and Fatal Opioid Overdose in the United States, 2017 > Results
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Rests on an assumption: The general-purpose VSL and VSLY values from HHS guidelines reflect the U.S. population's willingness to pay to prevent opioid overdose deaths and morbidity.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“These costs are also only estimated for diagnosed cases of opioid use disorder in persons age 12+, so we do not estimate costs to other persons, such as in the case of neonatal abstinence syndrome.”
§ The Economic Burden of Opioid Use Disorder and Fatal Opioid Overdose in the United States, 2017 > Discussion
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Criminal justice costs were apportioned from government budget data and may not reflect the costs of all criminal justice activity related to opioids.”
§ The Economic Burden of Opioid Use Disorder and Fatal Opioid Overdose in the United States, 2017 > Discussion
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Medication-assisted treatment for opioid use disorder has been shown to reduce the rate of opioid misuse among patients with opioid use disorder and the rate of fatal opioid overdose (Mattick et al., 2009, 2014; Schwartz et al., 2013).”
§ The Economic Burden of Opioid Use Disorder and Fatal Opioid Overdose in the United States, 2017 > Discussion
What the sources say
- Not matchedcites Mattick et al., 2009, 2014
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not checked — no full text of the sourcecites Schwartz et al., 2013 source
boosteddirect- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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It may state two separate claims as one.
- Not matched
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Health care costs were estimated with a convenience sample of health insurers and public insurance beneficiaries and may not be representative of the U.S. population.”
§ The Economic Burden of Opioid Use Disorder and Fatal Opioid Overdose in the United States, 2017 > Discussion
hedged- Asserted: passes — The authors put it forward as true.
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- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We then conducted a simulation with 10,000 replications and report a 95% prediction interval [PI] that is at the 2.5% and 97.5% cutoffs of the distribution of estimates in the simulation.”
§ The Economic Burden of Opioid Use Disorder and Fatal Opioid Overdose in the United States, 2017 > Methods > Sensitivity Analysis
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Calculation of the economic burden in this study uses data from a variety of sources, so it is not possible to directly estimate a traditional confidence interval for the estimates.”
§ The Economic Burden of Opioid Use Disorder and Fatal Opioid Overdose in the United States, 2017 > Methods > Sensitivity Analysis
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“This is a broader range of outcomes, and a more comprehensive estimate, than the most recent studies (Davenport et al., 2019).”
§ The Economic Burden of Opioid Use Disorder and Fatal Opioid Overdose in the United States, 2017 > Discussion
What the sources say
- Not matchedcites Davenport et al., 2019
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Not matched
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Many of the cost estimation methods used methods from a previous study, so the limitations of that study are also present in these results.”
§ The Economic Burden of Opioid Use Disorder and Fatal Opioid Overdose in the United States, 2017 > Discussion
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The resulting cost estimate is the increase in annual health care costs associated with opioid use disorder.”
§ The Economic Burden of Opioid Use Disorder and Fatal Opioid Overdose in the United States, 2017 > Methods > Health Care Costs
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“This includes all opioid-related overdose deaths regardless of intent (intentional, unintentional, homicide, or undetermined).”
§ The Economic Burden of Opioid Use Disorder and Fatal Opioid Overdose in the United States, 2017 > Methods > Overview
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
In the paper
“However, the guidelines provide consensus estimates of a VSL, discounted to present value at a rate of 3%.”
§ The Economic Burden of Opioid Use Disorder and Fatal Opioid Overdose in the United States, 2017 > Methods > Valuation of Lost Quality of Life and Life Lost
What the sources say
- Not matchedcites Office of the Assistant Secretary for Planning and Evaluation, 2016
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
- Not matched
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Survey weights were used to estimate nationally representative population totals for cases of opioid use disorder.”
§ The Economic Burden of Opioid Use Disorder and Fatal Opioid Overdose in the United States, 2017 > Methods > Overview
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
In the paper
“The NSDUH is a nationally representative sample of the U.S. civilian noninstitutionalized population ages 12 and older.”
§ The Economic Burden of Opioid Use Disorder and Fatal Opioid Overdose in the United States, 2017 > Methods > Overview
What the sources say
- Not matchedcites Center for Behavioral Health Statistics and Quality, 2018
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
- Not matched
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Despite these limitations, these estimates provide an up-to-date understanding of the overall economic impact of the crisis.”
§ The Economic Burden of Opioid Use Disorder and Fatal Opioid Overdose in the United States, 2017 > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We use these alternative measures as a sensitivity analysis, and not as our primary results, because both instruments lacks specificity to the condition being studied, and the populations studied were limited to subsets of the population of persons with opioid use disorder (e.g. only those who use heroin).”
§ The Economic Burden of Opioid Use Disorder and Fatal Opioid Overdose in the United States, 2017 > Methods > Sensitivity Analysis
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“The guidelines recommend using measures of lost quality of life and the VSL that are specific to the outcome being analyzed, when feasible. The rationale for this is that the preferences of the U.S. population for reducing the risk of morbidity and mortality may differ by the cause and population affected.”
§ The Economic Burden of Opioid Use Disorder and Fatal Opioid Overdose in the United States, 2017 > Methods > Valuation of Lost Quality of Life and Life Lost
What the sources say
- Not matchedcites Office of the Assistant Secretary for Planning and Evaluation, 2016
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plainconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Not matched
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“A primary limitation of our methodology is that we only measure the cost of opioid use disorder in a single year.”
§ The Economic Burden of Opioid Use Disorder and Fatal Opioid Overdose in the United States, 2017 > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one. The quote only partly states this claim.
In the paper
“The survey collects detailed information on substance use, including a questionnaire that identifies opioid use disorder (opioid abuse or dependence) based on questions similar to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) (American Psychiatric Association, 1994).”
§ The Economic Burden of Opioid Use Disorder and Fatal Opioid Overdose in the United States, 2017 > Methods > Overview
What the sources say
- Not matchedcites American Psychiatric Association, 1994
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Not matched
The paper relies on this without support.
The general-purpose VSL and VSLY values from HHS guidelines reflect the U.S. population's willingness to pay to prevent opioid overdose deaths and morbidity.
“We did not have a VSL value specific to the willingness to pay to prevent an opioid overdose death and instead used a general-purpose set of values based on results from studies that examined the value of risk reduction over a diverse set of risks.”
The paper relies on this without support.
The sum of health care, criminal justice, lost productivity, and HRQOL/VSL valuations captures the total societal economic burden of OUD and fatal opioid overdose.
“Our total valuation of economic burden of opioid use disorder and fatal overdose is therefore the sum of the HRQOL/VSL valuation, health care and substance use disorder treatment cost, criminal justice and lost productivity.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Cost per case of opioid use disorder ($221,219) was derived by dividing the total U.S. cost of opioid use disorder ($470,975 million) during 2017 by the number of opioid use disorder cases the same year (2.129 million) (3).”
From State-Level Economic Costs of Opioid Use Disorder and Fatal Opioid Overdose — United States, 2017 (2021) · cites this paper as [3]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“Cost per case of fatal opioid overdose ($11.548 million) was derived by dividing the total cost of fatal opioid overdose ($549,691 million) by the number of fatal opioid overdose cases (47,600) (3).”
From State-Level Economic Costs of Opioid Use Disorder and Fatal Opioid Overdose — United States, 2017 (2021) · cites this paper as [3]
The cited source says what the claim attributes to it.
In the citing paper
“The economic cost of the U.S. opioid epidemic in 2017 was estimated at $1,021 billion, including cost of opioid use disorder estimated at $471 billion and cost of fatal opioid overdose estimated at $550 billion (3).”
From State-Level Economic Costs of Opioid Use Disorder and Fatal Opioid Overdose — United States, 2017 (2021) · cites this paper as [3]
Citations
Cites
Diagnostic and Statistical Manual of Mental Disorders
Williams, J. B. W., & First, M. B. (2013) · Oxford University Press eBooks · doi:10.1093/acrefore/9780199975839.013.104 · Cited by 109,845
Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence
Mattick, R. P., Breen, C. L., Kimber, J., & Davoli, M. (2014) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd002207.pub4 · Cited by 2,312
Web-based Injury Statistics Query and Reporting System (WISQARS)
:unav (2009) · Harvard Dataverse · doi:10.7910/dvn/n8emxe · Cited by 1,803
Drug and Opioid-Involved Overdose Deaths — United States, 2013–2017
Scholl, L., Seth, P., Kariisa, M., Wilson, N. O., & Baldwin, G. T. (2018) · MMWR Morbidity and Mortality Weekly Report · doi:10.15585/mmwr.mm675152e1 · Cited by 1,754
Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence
Mattick, R. P., Breen, C., Kimber, J., & Davoli, M. (2009) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd002209.pub2 · Cited by 1,654
The economic burden of prescription opioid overdose, abuse and dependence in the United States, 2013
Florence, C. S., Zhou, C., Luo, F., & Xu, L. (2016) · Medical Care · doi:10.1097/mlr.0000000000000625 · Cited by 1,152
Self-citationDiagnostic and Statistical Manual of Mental Disorders
Preedy, V., & Watson, R. (2010) · Springer eBooks · doi:10.1007/978-0-387-78665-0_5485 · Cited by 1,146
Walley, A. Y., Xuan, Z., Hackman, H. H., Quinn, E., Doe-Simkins, M., Sorensen-Alawad, A., Ruiz, S., & Ozonoff, A. (2013) · BMJ · doi:10.1136/bmj.f174 · Cited by 999 · cited 1×
“Naloxone distribution programs have been shown to reduce opioid mortality rates (Walley et al., 2013).”
BackgroundNational and state treatment need and capacity for opioid agonist medication-assisted treatment
Jones, C. M., Campopiano, M., Baldwin, G., & McCance-Katz, E. (2015) · American Journal of Public Health · doi:10.2105/ajph.2015.302664 · Cited by 668 · cited 1×
“However, the population requiring treatment has been estimated to be much larger than the current treatment capacity (Jones et al., 2015).”
BackgroundSocietal costs of prescription opioid abuse, dependence, and misuse in the United States
Birnbaum, H. G., White, A. G., Schiller, M., Waldman, T., Cleveland, J. M., & Roland, C. L. (2011) · Pain Medicine · doi:10.1111/j.1526-4637.2011.01075.x · Cited by 644 · cited 2×
“This is a change from previously published estimates, where a large share of costs was attributable to opioid use disorder (Birnbaum et al., 2011; Florence et al., 2016; Rice et al., 2014).”
Background
Cited by
Sorted by citations
Nandi, A., Counts, N., Chen, S., Seligman, B., Tortorice, D., Vigo, D., & Bloom, D. E. (2022) · eClinicalMedicine · doi:10.1016/j.eclinm.2022.101580 · Cited by 402
State-Level Economic Costs of Opioid Use Disorder and Fatal Opioid Overdose — United States, 2017
Luo, F., Li, M., & Florence, C. (2021) · MMWR Morbidity and Mortality Weekly Report · doi:10.15585/mmwr.mm7015a1 · Cited by 166
Self-citationAssociation of Intraoperative Opioid Administration With Postoperative Pain and Opioid Use
Mercado, L. A. S. C., Liu, R., Bharadwaj, K. M., Johnson, J. J., Gutiérrez, R., Das, P., Balanza, G. A., Deng, H., Pandit, A., Stone, T. A. D., et al. (2023) · JAMA Surgery · doi:10.1001/jamasurg.2023.2009 · Cited by 154
Treatment of overdose in the synthetic opioid era
Skolnick, P. (2021) · Pharmacology & Therapeutics · doi:10.1016/j.pharmthera.2021.108019 · Cited by 123
“Florence, Luo, and Rice (2021) have modelled the economic burden of opioid use disorder and fatal opioid overdose, estimated at $1.02 trillion in 2017.”
BackgroundInfluentialThe Opioid Epidemic: a Crisis Disproportionately Impacting Black Americans and Urban Communities
Gondré‐Lewis, M. C., Abijo, T., & Gondré-Lewis, T. A. (2022) · Journal of Racial and Ethnic Health Disparities · doi:10.1007/s40615-022-01384-6 · Cited by 122
“0 trillion per year in 2017, to cover the cost of healthcare, lost productivity, addiction treatment, and criminal justice involvement [36].”
BackgroundOpioid Crisis Effects On Municipal Finance
Cornaggia, K. R., Hund, J. E., Nguyen, G., & Ye, Z. (2019) · Review of Financial Studies · doi:10.1093/rfs/hhab066 · Cited by 98
Endogenous opioid systems alterations in pain and opioid use disorder
Higginbotham, J. A., Markovic, T., Massaly, N., & Morón, J. A. (2022) · Frontiers in Systems Neuroscience · doi:10.3389/fnsys.2022.1014768 · Cited by 94
Economic Studies on the Opioid Crisis: A Review
Maclean, J. C., Mallatt, J., Ruhm, C. J., & Simon, K. I. (2020) · National Bureau of Economic Research · doi:10.3386/w28067 · Cited by 86
“…other costs, yields much higher estimates of $504 billion in 2015 from the Council of Economic Advisers (White House Council of Economic Advisers, 2017), $179 billion in 2018 from the Society of Actuaries (Davenport et al., 2019) and, most recently, over $1 trillion in 2017 (Florence et al., 2020).”
BackgroundQeadan, F., McCunn, A., & Tingey, B. (2025) · Addiction · doi:10.1111/add.16679 · Cited by 90
“Opioid use and OUD have been associated with many adverse health outcomes and result severe economic burden [6, 7].”
Old Drugs and New Challenges: A Narrative Review of Nitazenes
Pergolizzi Jr, J., Raffa, R., LeQuang, J. A. K., Breve, F., & Varrassi, G. (2023) · Cureus · doi:10.7759/cureus.40736 · Cited by 81
Modulation of 5-HT release by dynorphin mediates social deficits during opioid withdrawal
Pomrenze, M. B., Pinto, D. F. C., Neumann, P. A., Llorach, P., Tucciarone, J., Morishita, W., Eshel, N., Heifets, B. D., & Malenka, R. C. (2022) · Neuron · doi:10.1016/j.neuron.2022.09.024 · Cited by 79
Opioids and Public Health: The Prescription Opioid Ecosystem and Need for Improved Management
Kharasch, E. D., Clark, J. D., & Adams, J. M. (2021) · Anesthesiology · doi:10.1097/aln.0000000000004065 · Cited by 74
New Synthetic Opioids: Clinical Considerations and Dangers
Edinoff, A. N., Martinez Garza, D., Vining, S. P., Vasterling, M. E., Jackson, E. D., Murnane, K. S., Kaye, A. M., Fair, R. N., Torres, Y. J. L., Badr, A. E., et al. (2023) · Pain and Therapy · doi:10.1007/s40122-023-00481-6 · Cited by 61
Spatial-temporal trends in the risk of illicit drug toxicity death in British Columbia
Hu, K., Klinkenberg, B., Gan, W., et al. (2022) · BMC Public Health · doi:10.1186/s12889-022-14586-8 · Cited by 47
Johnson, M., Albizri, A., Harfouche, A., & Tutun, S. (2021) · Industrial Management & Data Systems · doi:10.1108/imds-04-2021-0248 · Cited by 51
County-level predictors of US drug overdose mortality: A systematic review
Cano, M. N., Oh, S., Osborn, P. R., Olowolaju, S. A., Sanchez, A., Kim, Y., & Moreno, A. C. (2022) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2022.109714 · Cited by 39
Rewarding recovery: the time is now for contingency management for opioid use disorder
Proctor, S. L. (2022) · Annals of Medicine · doi:10.1080/07853890.2022.2068805 · Cited by 39
Bedene, A., Dahan, A., Rosendaal, F. R., & van Dorp, E. L. A. (2022) · Expert Review of Clinical Pharmacology · doi:10.1080/17512433.2022.2114898 · Cited by 38
“epidemic in the US was estimated to be about one trillion US dollars in 2017 alone [59].”
BackgroundNanoparticle delivery systems for substance use disorder
Kasina, V., Mownn, R. J., Bahal, R., & Sartor, G. C. (2022) · Neuropsychopharmacology · doi:10.1038/s41386-022-01311-7 · Cited by 39
“INTRODUCTION Substance use disorder (SUD) is a devastating brain disease that inflicts enormous emotional and economic cost to the individual, families, and society [1, 2].”
BackgroundZhao, L., Li, Z., Jin, B., Hou, N., & Yang, H. (2024) · BMC Anesthesiology · doi:10.1186/s12871-024-02429-5 · Cited by 37
“Opioids, as potent analgesics, are primarily employed for perioperative pain management due to their efficacy in suppressing the stress response and providing organ-protective effects, especially in instances of moderate to severe pain [6].”
BackgroundJudd, H., Meier, C. L., Yaugher, A. C., Campbell, E. R., & Atisme, K. (2021) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-021-00606-y · Cited by 36
“In addition to claiming thousands of lives each year, the economic burden of OUD and fatal opioid overdose (accounting for health care and treatment, criminal justice, lost productivity, and value of life lost costs) surpasses one billion dollars annually in the USA alone (Florence et al., 2021).”
BackgroundDavis, A., Stringer, K. L., Drainoni, M., Oser, C. B., Knudsen, H. K., Aldrich, A. M., Surratt, H. L., Walker, D. M., Gilbert, L., Downey, D. L., et al. (2023) · International Journal of Drug Policy · doi:10.1016/j.drugpo.2023.104241 · Cited by 30
Long-term Outcomes of Persistent Postoperative Opioid Use
Aalberg, J. J., Kimball, M. D., McIntire, T. R., & McCullen, G. M. (2022) · Annals of Surgery · doi:10.1097/sla.0000000000005372 · Cited by 36
Metabolic characterization of the new benzimidazole synthetic opioids - nitazenes
Jadhav, G. R., & Fasinu, P. S. (2024) · Frontiers in Pharmacology · doi:10.3389/fphar.2024.1434573 · Cited by 29
Electrodermal activity in pain assessment and its clinical applications
Kong, Y., & Chon, K. H. (2024) · Applied Physics Reviews · doi:10.1063/5.0200395 · Cited by 31
Pridgen, B. E., Bontemps, A. P., Lloyd, A. R., Wagner, W. P., Kay, E. S., Eaton, E., & Cropsey, K. L. (2025) · Harm Reduction Journal · doi:10.1186/s12954-025-01238-4 · Cited by 30
“A recent analysis utilizing methods by a 2017 CDC study [17] estimated a total economic cost of the opioid epidemic at $2.7 trillion in 2023, with $1.1 trillion (41”
InfluentialDissemination of Contingency Management for the Treatment of Opioid Use Disorder
DeFulio, A. (2023) · Perspectives on Behavior Science · doi:10.1007/s40614-022-00328-z · Cited by 28
Cannabinoids in Chronic Pain Management: A Review of the History, Efficacy, Applications, and Risks
Johnson, B. W., Strand, N. H., Raynak, J., Jara, C., Habtegiorgis, K., Hand, B. A., Hong, S., & Maloney, J. A. (2025) · Biomedicines · doi:10.3390/biomedicines13030530 · Cited by 31
“…an estimated staggering annual cost of over USD 1 trillion in the United States, including the costs from healthcare expenses, loss of productivity, criminal justice, social welfare interventions, reduced quality of life for opioid use disorder, and life lost due to fatal opioid overdose [6].”
ElSherief, M., Sumner, S. A., Jones, C. M., Law, R., Kacha-Ochana, A., Schieber, L. Z., Cordier, L., Holton, K., & Choudhury, M. D. (2021) · Journal of Medical Internet Research · doi:10.2196/30753 · Cited by 28
“In the United States, opioid overdose continues to be a leading cause of death [1].”
BackgroundKelley, A. T., Incze, M. A., Baylis, J. D., Calder, S. G., Weiner, S. J., Zickmund, S. L., Jones, A. L., Vanneman, M. E., Conroy, M. B., Gordon, A. J., et al. (2022) · Substance Abuse · doi:10.1080/08897077.2022.2095082 · Cited by 29
Barreveld, A. M., Mendelson, A. M., Deiling, B. L., Armstrong, C. A., Viscusi, E. R., & Kohan, L. R. (2023) · Anesthesia & Analgesia · doi:10.1213/ane.0000000000006280 · Cited by 25
Medical Cannabis Patients Report Improvements in Health Functioning and Reductions in Opiate Use
Pritchett, C. E., Flynn, H. A., Wang, Y., & Polston, J. E. (2022) · Substance Use & Misuse · doi:10.1080/10826084.2022.2107673 · Cited by 25
“Given the great individual and societal costs associated with the opioid crisis (Florence et al., 2021; National Institute on Drug Abuse, n.d.), the public health implications of these findings are important to consider.”
BackgroundTauscher, J. S., DePue, M. K., Swank, J. M., & Salloum, R. G. (2023) · Journal of Substance Use and Addiction Treatment · doi:10.1016/j.josat.2022.208938 · Cited by 24
Maimaiti, A., & Yan, B. (2025) · Advanced Functional Materials · doi:10.1002/adfm.202425919 · Cited by 22
Baxley, C., Borsari, B. E., Reavis, J. V., Manuel, J. K., Herbst, E. D., Becker, W. C., Pennington, D., Batki, S. L., & Seal, K. H. (2022) · Addictive Behaviors · doi:10.1016/j.addbeh.2022.107589 · Cited by 22
Kitchen, S. A., McCormack, D., Werb, D., Caudarella, A., Martins, D., Matheson, F. I., & Gomes, T. (2021) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2021.108830 · Cited by 24
Edwards, G. G., Ochoa, A. M., Castillo, E. G., Goodman‐Meza, D., Kalofonos, I., Landovitz, R. J., Leibowitz, A. A., Pulsipher, C., Sayed, E. E., SHOPTAW, S. J., et al. (2022) · AIDS and Behavior · doi:10.1007/s10461-022-03817-z · Cited by 21
Kelley, A. T., Wilcox, J., Baylis, J. D., Crossnohere, N. L., Magel, J. S., Jones, A. L., Gordon, A. J., & Bridges, J. F. P. (2022) · Journal of General Internal Medicine · doi:10.1007/s11606-022-07975-7 · Cited by 21
“The human and economic costs associated with opioids and OUD are significant: more than 75,000 overdose deaths were attributed to opioids in the US in 2021,(2) and the annual US economic burden of OUD has been estimated at more than $1 trillion.(3) Further, individuals with OUD experience reduced quality of life and f…”
BackgroundLuminescence-based detection and identification of illicit drugs
Chen, M., Burn, P. L., & Shaw, P. E. (2023) · Physical Chemistry Chemical Physics · doi:10.1039/d3cp00524k · Cited by 21
Does drug decriminalization increase unintentional drug overdose deaths?
Spencer, N. (2023) · Journal of Health Economics · doi:10.1016/j.jhealeco.2023.102798 · Cited by 20
From Pharmacology to Physiology: Endocrine Functions of μ-Opioid Receptor Networks
Jaschke, N., Pählig, S., Pan, Y., Hofbauer, L. C., Göbel, A., & Rachner, T. D. (2021) · Trends in Endocrinology and Metabolism · doi:10.1016/j.tem.2021.02.004 · Cited by 23
Hypoxia driven opioid targeted automated device for overdose rescue
Imtiaz, M. S., Bandoian, C. V., & Santoro, T. J. (2021) · Scientific Reports · doi:10.1038/s41598-021-04094-x · Cited by 24
Oviedo‐Joekes, E., Dobischok, S., Carvajal, J., Macdonald, S., McDermid, C., Klakowicz, P., Harrison, S., Lajeunesse, J., Chow, N., Brown, M., et al. (2023) · BMC Health Services Research · doi:10.1186/s12913-023-09558-6 · Cited by 20
Claustral neurons projecting to frontal cortex restrict opioid consumption
Terem, A., Fatal, Y., Peretz‐Rivlin, N., Turm, H., Koren, S. S., Kitsberg, D., Ashwal-Fluss, R., Mukherjee, D., Habib, N., & Citri, A. (2023) · Current Biology · doi:10.1016/j.cub.2023.05.065 · Cited by 20
Sex differences in comorbid pain and opioid use disorder: A scoping review
DeVito, E. E., Ameral, V., & Sofuoglu, M. (2024) · British Journal of Clinical Pharmacology · doi:10.1111/bcp.16218 · Cited by 19
Thein, K. Z. K., Herberholz, C., Sandar, W. P., & Yadanar (2021) · PLoS ONE · doi:10.1371/journal.pone.0258183 · Cited by 19
Wen, H., Wei, X., Ge, S.-Q., Zeng, J.-C., Luo, W., Chen, R., Dong, Y., Xiao, S., Lai, Y., & Lu, L.-M. (2021) · Frontiers in Public Health · doi:10.3389/fpubh.2021.689753 · Cited by 16
“02 trillion was spent on opioid use disorders and fatal opioid overdoses in 2017 (4).”
BackgroundMerkel, R., Moreno, A., Zhang, Y., Herman, R. J., Nathan, J. B., Zeb, S., Rahematpura, S., Stecyk, K. S., Milliken, B. T., Hayes, M. R., et al. (2021) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2021.10.026 · Cited by 17
Gerlach, E. B., Plantz, M. A., Swiatek, P. R., Wu, S. A., Arpey, N. C., Fei‐Zhang, D. J., Divi, S. N., Hsu, W. K., & Patel, A. A. (2022) · Global Spine Journal · doi:10.1177/21925682221104731 · Cited by 18
Gottlieb, D. J., Shiner, B. R., Hoyt, J. E., Riblet, N. B. V., Peltzman, T., Teja, N., & Watts, B. V. (2022) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.13477 · Cited by 23
“Opioid use disorder (OUD) is a public health crisis associated with high mortality and societal costs.(1,2) Opioid agonist treatments (OAT) including methadone and buprenorphine have demonstrated effectiveness in the reduction of withdrawal symptoms, illicit opioid use, and risk of death.”
BackgroundThe opioid industry document archive: New directions in research on corporate political strategy
MacKenzie, R., Hawkins, B., Klein, D. E., et al. (2023) · International Journal of Drug Policy · doi:10.1016/j.drugpo.2023.103997 · Cited by 18
McAlearney, A. S., Walker, D. M., Shiu‐Yee, K., Crable, E. L., Auritt, V., Barkowski, L. K., Batty, E. J., Dasgupta, A., Goddard‐Eckrich, D., Knudsen, H. K., et al. (2023) · International Journal of Qualitative Methods · doi:10.1177/16094069231165933 · Cited by 19
“The opioid epidemic remains a serious and growing public health problem, contributing to signi fi cant mortality and morbidity (Centers for Disease Control and Prevention, 2021), and imposing an economic burden of greater than $1 trillion (Florence et al., 2021).”
BackgroundAllen, M. I., Duke, A. N., Nader, S. H., Adler-Neal, A. L., Sai, K. K. S., Reboussin, B. A., Gage, H. D., Voll, R. J., Mintz, A., Goodman, M. M., et al. (2023) · Neuropsychopharmacology · doi:10.1038/s41386-023-01622-3 · Cited by 18
Targeting Opioid Receptors in Addiction and Drug Withdrawal: Where Are We Going?
Tabanelli, R., Brogi, S., & Calderone, V. (2023) · International Journal of Molecular Sciences · doi:10.3390/ijms241310888 · Cited by 20
Kuhn, B. N., Cannella, N., Chitre, A. S., Nguyen, K., Cohen, K. A., Chen, D., Peng, B. F., Ziegler, K. S., Lin, B., Johnson, B. B., et al. (2025) · Molecular Psychiatry · doi:10.1038/s41380-025-02922-4 · Cited by 17
Impact of preoperative opioid use disorder on outcomes following lumbar-spine surgery
Lui, B., Weinberg, R. Y., Milewski, A., Ma, X., Bustillo, M. A., Mack, P. F., & White, R. S. (2021) · Clinical Neurology and Neurosurgery · doi:10.1016/j.clineuro.2021.106865 · Cited by 19
Prolonged Opioid Use After Lumbar Fusion Surgery: A Meta-Analysis of Prevalence and Risk Factors
Kuo, C. C., Soliman, M. A. R., Iskander, J., Rho, K., Khan, A., Jowdy, P. K., Pollina, J., & Mullin, J. P. (2022) · World Neurosurgery · doi:10.1016/j.wneu.2022.09.058 · Cited by 21
Chin, E. M., Kitase, Y., Madurai, N. K., Robinson, S., & Jantzie, L. L. (2023) · Frontiers in Pediatrics · doi:10.3389/fped.2023.1139378 · Cited by 18
Maya, S., Kahn, J. G., Lin, T. K., Jacobs, L. M., Schmidt, L. A., Burrough, W., Ghasemzadeh, R., Mousli, L. M., Allan, M., Donovan, M., et al. (2022) · PLoS ONE · doi:10.1371/journal.pone.0271523 · Cited by 15
Primary care providers’ influence on opioid use and its adverse consequences
Eichmeyer, S., & Zhang, J. (2022) · Journal of Public Economics · doi:10.1016/j.jpubeco.2022.104784 · Cited by 17
Craft, W. H., Shin, H., Tegge, A. N., Keith, D. R., Athamneh, L. N., Stein, J. S., Ferreira, M. A. R., Chilcoat, H. D., Moigne, A. L., DeVeaugh‐Geiss, A., et al. (2022) · Addiction · doi:10.1111/add.16115 · Cited by 17
Shakya, S., & Ruseski, J. E. (2023) · Contemporary Economic Policy · doi:10.1111/coep.12607 · Cited by 15
Stokes, E. K., Pickens, C. M. G., Wilt, G. E., Liu, S., & David, F. (2023) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2023.109889 · Cited by 17
Falconnier, C., Caparros-Roissard, A., Decraene, C., & Lutz, P.-É. (2023) · Molecular Psychiatry · doi:10.1038/s41380-023-02238-1 · Cited by 19
“US[2], and increasing use and harm in Europe[3].”
BackgroundChen, M., Burn, P. L., & Shaw, P. E. (2023) · ACS Sensors · doi:10.1021/acssensors.3c01566 · Cited by 16
Acharya, A., Izquierdo, A. M., Gonçalves, S. F., Bates, R. A., Taxman, F. S., Slawski, M., Rangwala, H., & Sikdar, S. (2022) · PLoS ONE · doi:10.1371/journal.pone.0269509 · Cited by 16
Bilden, R. C., Roberts, M. S., Stein, B. D., et al. (2024) · Substance Use & Addiction Journal · doi:10.1177/29767342241303583 · Cited by 15
Velez, F. F., Luderer, H. F., Gerwien, R. W., Parcher, B., Mezzio, D. J., & Malone, D. C. (2021) · Postgraduate Medicine · doi:10.1080/00325481.2021.1884471 · Cited by 15
“, generating an estimated $40-70 USDB in direct medical costs annually [9,10] from just two million Americans affected by the disorder [11].”
BackgroundLethal Unemployment Bonuses? Substitution and Income Effects on Substance Abuse, 2020-21
Mulligan, C. B. (2022) · National Bureau of Economic Research · doi:10.3386/w29719 · Cited by 14
Exogenous Opioids and the Human Endocrine System: An Endocrine Society Scientific Statement
Karavitaki, N., Bettinger, J. J., Biermasz, N., Christ-Crain, M., Gadelha, M. R., Inder, W. J., Tsourdi, E., Wakeman, S. E., & Zatelli, M. (2024) · Endocrine Reviews · doi:10.1210/endrev/bnae023 · Cited by 14
Breaking bad: how can supply chain management better address illegal supply chains?
Pullman, M., McCarthy, L., & Mena, C. (2023) · International Journal of Operations & Production Management · doi:10.1108/ijopm-02-2023-0079 · Cited by 14
Costa, G. P. A., Nunes, J. C., Heringer, D. L., Anand, A., & Aquino, J. P. D. (2024) · The American Journal of Drug and Alcohol Abuse · doi:10.1080/00952990.2023.2287406 · Cited by 14
“In the U.S., the economic costs related to the opioid crisis amount to over 1.02 trillion dollars annually (3); yet high rates of morbidity and mortality rates persist (4,5), with more than 120 drug overdose deaths every day (6).”
BackgroundInfluentialShafer, S. L., Teichman, S. L., Gottlieb, I. J., Singla, N., Minkowitz, H. S., Leiman, D. G., Vaughn, B. J., & Donovan, J. F. (2024) · Anesthesiology · doi:10.1097/aln.0000000000005027 · Cited by 14
Webber, H. E., Badawi, J. C., Schmitz, J. M., Yoon, J. H., Calvillo, D. J., Becker, C. I., & Lane, S. D. (2024) · Journal of Sleep Research · doi:10.1111/jsr.14330 · Cited by 16
“While the opioid number was more surprising given the attention to the opioid epidemic and the burden on society (Florence et al., 2021), that section also excluded more studies for comorbid conditions.”
Social determinants of opioid use behaviors among adults in the United States
Nicholson, H. L. (2022) · Journal of Substance Use · doi:10.1080/14659891.2022.2050317 · Cited by 13
“Indeed, expenditures for opioid-related problems (e.g., opioid use disorder and overdose) have reached nearly $1 trillion (Florence et al., 2021).”
BackgroundManza, P., Kroll, D. S., McPherson, K. L., Johnson, A., Dennis, E., Hu, L., Tai, B., & Volkow, N. D. (2022) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2022.109575 · Cited by 14
Recent Rates of Substance Use Among Adolescents and Young Adults with Type 1 Diabetes in the USA
Sannegowda, R., Villalba, K., Suk, R., Gurnurkar, S., & Wasserman, R. M. (2023) · Current Diabetes Reports · doi:10.1007/s11892-022-01496-7 · Cited by 14
Knudsen, H. K., Freeman, P. R., Oyler, D. R., Oser, C. B., & WALSH, S. L. (2023) · Addiction Science & Clinical Practice · doi:10.1186/s13722-023-00426-6 · Cited by 13
“Costs of the opioid epidemic likely exceed $1 trillion due to a combination of premature mortality, lost productivity, healthcare to treat opioid use disorder (OUD) and its medical consequences, and criminal justice expenditures [2].”
BackgroundKetamine in treating opioid use disorder and opioid withdrawal: a scoping review
Shen, M. R., Campbell, D. E., Kopczynski, A., Maddams, S., Rosenblum, N., Nigam, K. B., & Suzuki, J. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1552084 · Cited by 14
Predictors of US states’ adoption of naloxone access laws, 2001–2017
Bohler, R. M., Hodgkin, D., Kreiner, P. W., & Green, T. C. (2021) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2021.108772 · Cited by 15
Comprehensive Workplace Policies and Practices Regarding Employee Opioid Use
Cooper, R., & Bixler, E. A. (2021) · NEW SOLUTIONS A Journal of Environmental and Occupational Health Policy · doi:10.1177/10482911211037905 · Cited by 13
Importing the Opioid Crisis? International Trade and Fentanyl Overdoses
Moore, T., Olney, W. W., & Hansen, B. (2023) · National Bureau of Economic Research · doi:10.3386/w31885 · Cited by 13
Mammoliti, E., Nielsen, S., & Roxburgh, A. (2026) · Drug and Alcohol Review · doi:10.1111/dar.14079 · Cited by 14
Soares, J. A. G., Sutley-Koury, S. N., Pomrenze, M. B., & Tucciarone, J. (2025) · Frontiers in Neuroanatomy · doi:10.3389/fnana.2024.1521016 · Cited by 14
“The relevance of OUD extends beyond the personal struggles of those affected as it poses significant public health and societal challenges, including increased rates of overdose, reduced quality of life, and strain on healthcare resources (Florence et al., 2021; Murphy, 2020).”
Gabriel, R. A., Simpson, S., Zhong, W., Burton, B. N., Mehdipour, S., & Said, E. T. (2023) · JMIR Perioperative Medicine · doi:10.2196/40455 · Cited by 12
Li, Z., Liu, J., Dong, F., Chang, N., Huang, R., Xia, M., Patterson, T. A., & Hong, H. (2023) · International Journal of Molecular Sciences · doi:10.3390/ijms24087042 · Cited by 14
“0 billion) have accounted for over 85% of the total economic burden [2].”
BackgroundGarcia, C. C., Bounthavong, M., Gordon, A. J., Gustavson, A. M., Kenny, M. E., Miller, W., Esmaeili, A., Ackland, P. E., Clothier, B. A., Bangerter, A. K., et al. (2023) · Implementation Science Communications · doi:10.1186/s43058-023-00482-8 · Cited by 12
ElSherief, M., Sumner, S. A., Krishnasamy, V. P., Jones, C. M., Law, R., Kacha-Ochana, A., Schieber, L. Z., & Choudhury, M. D. (2023) · JMIR Formative Research · doi:10.2196/44726 · Cited by 11
“Beyond lives lost, the economic costs of both fatal opioid overdose and opioid use disorder (OUD) are estimated to be greater than 1 trillion US dollars per year [2,3].”
BackgroundO’Shay, S., Pasman, E., Hicks, D. L., Brown, S., Aguis, E., & Resko, S. M. (2023) · Journal of Family Communication · doi:10.1080/15267431.2023.2186882 · Cited by 12
“…of neonatal abstinence syndrome (Hirai et al., 2021), infectious disease outbreaks (Centers for Disease Control and Prevention, 2021), foster care entry (Bullinger & Ward, 2021), crime and violence (Morgan & Truman, 2020), and lost productivity (Florence et al., 2021) associated with opioid misuse.”
BackgroundGreenwald, M. K., Wiest, K. L., Haight, B. R., Laffont, C. M., & Zhao, Y. (2023) · Harm Reduction Journal · doi:10.1186/s12954-023-00906-7 · Cited by 11
“Examples of personal harms include death from overdose (from opioid use alone or polysubstance use) [1, 4, 5], medical and psychiatric comorbidities (e.g., human immunodeficiency virus (HIV), hepatitis C virus (HCV), cardiopulmonary disease, depression, and anxiety) [6– 11], problems with…”
BackgroundWalter, D. L., Bian, Y., Hu, H., Hamid, F. A. A. A., Rostamizadeh, K., Vigliaturo, J. R., DeHority, R., Ehrich, M. F., Runyon, S. P., Pravetoni, M., et al. (2024) · Biomaterials · doi:10.1016/j.biomaterials.2024.122758 · Cited by 12
Opioid use and patient outcomes in an Australian hip and knee arthroplasty cohort
Huang, P., Brownrigg, J. R. W., Roe, J. P., et al. (2022) · ANZ Journal of Surgery · doi:10.1111/ans.17969 · Cited by 11
Do Opioid Prescriptions Lead to Fatal Car Crashes?
Betz, M., & Jones, L. E. (2021) · American Journal of Health Economics · doi:10.1086/718511 · Cited by 11
Cortade, D. L., & Wang, S. X. (2022) · Analytical and Bioanalytical Chemistry · doi:10.1007/s00216-022-04274-2 · Cited by 10
“In 2017, it was estimated that the total economic cost of opioid abuse disorder was $471 billion dollars in the USA, with an additional economic impact of $550 billion from fatal opioid overdose [3].”
BackgroundMachine Learning Algorithms Predict Long-Term Postoperative Opioid Misuse: A Systematic Review
Emam, O. S., Eldaly, A. S., Ávila, F. R., Torres‐Guzman, R. A., Maita, K. C., Garcia, J. P., Brown, S. A., Haider, C. R., & Forte, A. J. (2023) · The American Surgeon · doi:10.1177/00031348231198112 · Cited by 10
A Guide to Expanding the Use of Buprenorphine Beyond Standard Initiations for Opioid Use Disorder
Miller, J. C., Brooks, M. A., Wurzel, K. E., Cox, E. J., & Wurzel, J. F. (2023) · Drugs in R&D · doi:10.1007/s40268-023-00443-5 · Cited by 11
“The cost of the opioid epidemic in the US in 2017 was estimated at US$1 trillion, with an average per-case cost of US$221,219 [51, 52].”
BackgroundFrontline Perspectives on Buprenorphine for the Management of Chronic Pain
Adler, J. A., Mallick‐Searle, T., Garofoli, M., & Zimmerman, A. (2024) · Journal of Multidisciplinary Healthcare · doi:10.2147/jmdh.s449748 · Cited by 10
Rawal, S., Welsh, J. W., Yarbrough, C. R., Abraham, A. J., Crawford, N. D., Khail, J. W., Chinchilla, A., Caballero, J., Zapata, L. V., & Young, H. N. (2024) · Journal of the American Pharmacists Association · doi:10.1016/j.japh.2024.102319 · Cited by 11
A descriptive analysis of drivers under the influence of opioids in Kentucky
Dickson, M. F., Kissel, M., Shore, S., & Webster, J. M. (2022) · Accident Analysis & Prevention · doi:10.1016/j.aap.2022.106837 · Cited by 10
Sleep is increased by liraglutide, a glucagon-like peptide-1 receptor agonist, in rats
Fang, J., Miller, P., & Grigson, P. S. (2022) · Brain Research Bulletin · doi:10.1016/j.brainresbull.2022.11.012 · Cited by 10
Metadata
- Authors
- Florence, C., Luo, F., & Rice, K.
- Affiliations
- Centers for Disease Control and Prevention (US)
- Corresponding author
- Florence, Curtis
- Venue
- Drug and Alcohol Dependence
- Publisher
- Elsevier BV
- Published
- 2021-01
- Volume
- 218
- Pages
- 108350
- ISSN
- 0376-8716 (ISSN-L)
- PMC
- PMC8091480
- OpenAlex
- W3095492073
- Cited by
- 511
- References
- 38
- Citations by year
- 2026: 69 · 2025: 122 · 2024: 103 · 2023: 110 · 2022: 68 · 2021: 36
- FWCI
- 40.44
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Drug and Alcohol Dependence (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (CC999999)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Keywords
- opioid use disorder, economic burden, social costs, health care costs, criminal justice costs, productivity loss, quality of life, opioid epidemic, public policy
- MeSH terms
- Opioid Epidemic, Opiate Overdose, Analgesics, Opioid, Criminal Law, Delivery of Health Care, Humans, Opioid-Related Disorders, Quality of Life, United States, Prevalence, Cost of Illness, Drug Overdose
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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