IORTI · Independent research

Why nobody agrees what the opioid crisis costs

Published estimates run from $78.5 billion to $4 trillion — a fifty-fold spread for the same country. Almost none of that gap is disagreement about the epidemic. It comes down to three choices, and on this page you make them yourself.

Set the controls to any published study's choices and the total reproduces that study's headline. That is how you can tell this explanation is the real one rather than a guess.

Choice one

Whose deaths do you count?

Only deaths involving an opioid, or every drug overdose death? And in which year — the epidemic peaked in 2022 and has fallen sharply since.

Choice two

What is one death worth?

The earnings that person would have produced, or what a population would pay to avoid one additional death? These differ by about nine times. This is the biggest lever by far.

Choice three

Do you count people who are still alive?

Health care, lost work and reduced quality of life for people living with addiction. Including it can more than double the total, and the case counts themselves are contested.

Whose deaths are counted

What one death is worth

Costs for people living with addiction

—

Where your total sits against the four published estimates. The spacing is logarithmic — each equal step is a tenfold increase — because a linear axis would put the first two studies on top of each other.

The second control is the one that matters. Valuing a death by the earnings that person would have produced gives roughly $1.3–1.5 million. Valuing it by what a population would pay to avoid one additional death — the standard used in federal regulatory analysis — gives $10–13 million. Same deaths, same year, nearly nine times the number. Neither is wrong. They answer different questions, and estimates using one are routinely compared with estimates using the other as though they measured the same thing.

The published estimates, and what each one chose

Click any row to load that study's settings into the controls above. Hover for the arithmetic.

Three things this makes visible

Sources. Death counts: CDC Vital Statistics Rapid Release, provisional drug overdose death counts, twelve months ending December, retrieved 28 July 2026. Valuation figures and case counts are as used by each named study. Opioid use disorder prevalence is from NSDUH.

Studies cited: Florence, Zhou, Luo & Xu, Medical Care (2016); Society of Actuaries / Milliman (2019); Florence, Luo & Rice, Drug and Alcohol Dependence (2021) and the companion CDC MMWR 70(15); White House Council of Economic Advisers (2025).