Opioid abuse places a large burden on the U.S. society. Two similarly designed studies recently identified the economic and health impact of opioid abuse in patients with private or Medicaid insurance. The prevalence of opioid abuse was estimated to be over 10 times higher in Medicaid beneficiaries than private insurance populations, 87 versus 8 per 10,000, respectively. Opioid abusers incurred annual medical costs that were $14,054 to $6650 higher than nonabusers in patients with private insurance or Medicaid beneficiaries, respectively (P < .01 for both). Annual costs were similar for abusers with private insurance ($15,884) or Medicaid beneficiaries ($13,658). Costs for nonabuser Medicaid beneficiaries were $7008 versus $1830 for those with private insurance, which likely reflects the lower health status of the overall Medicaid population. In both studies, the prevalence of comorbidities associated with substance abuse or chronic pain were significantly higher in abusers than nonabusers. These studies confirm that opioid abuse is associated with comorbidities that increase direct medical costs for patients with private insurance and for Medicaid beneficiaries, increasing the societal burden of opioid abuse.