Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Social costs of untreated opioid dependence


Using cost-of-illness methodology applied to a comprehensive survey of 114 daily opiate users not currently in or seeking treatment for their addiction, we estimated the 1996 social costs of untreated opioid dependence in Toronto (Ontario, Canada). The survey collected data on social and demographic characteristics, drug use history, physical and mental health status, the use of health care and substance treatment services, drug use modality and sex-related risks of infectious diseases, sources of income, as well as criminality and involvement with the law enforcement system. The annual social cost generated by this sample, calculated at Canadian $5.086 million, is explained mostly by crime victimization (44.6%) and law enforcement (42.4%), followed by productivity losses (7.0%) and the utilization of health care (6.1%). Applying the $13,100 cost to the estimated 8,000 to 13,000 users and 2.456 million residents living in Toronto yields a range of social cost between $43 and $69 per capita.

This is a preview of subscription content, log in to check access.


  1. 1.

    Fischer B, Rehm J. The case for a heroin substitution treatment trial in Canada.Can J Public Health. 1997;88:367–370.

  2. 2.

    Kendall P, Fischer B, Rehm J, Room R. Charting WHO goals for the year 2000: are we on track? Keynote address delivered at: 37th ICAA Congress; August 26, 1995; San Diego, CA.

  3. 3.

    Rehm J, Fischer B. Measuring harm: implications for alcohol epidemiology. In: Plant M, Single E, Stockwell T ed.Alcohol: Minimising the Harm? What Works? London: Free Association Books; 1997:248–261.

  4. 4.

    Hodgson TA, Meiners MR. Cost-of-illness methodology: a guide to current practices and procedures.Milbank Memorial Fund Q/Health Soc. 1982;60:429–462.

  5. 5.

    Single E, Robson L, Xie X, Rehm J. The economic costs of alcohol, tobacco and illicit drugs in Canada, 1992.Addiction. 1998;93:983–998.

  6. 6.

    Xie X, Rehm J, Single E, Robson L, Paul J. The economic costs of illicit drug use in Ontario, 1992.Health Econ [letter]. 1998;7:81–85.

  7. 7.

    Van Truong M, Williams B, Timoshenko G.Ontario Profile: Alcohol and Other Drugs, 1998. Toronto: Addiction Research Foundation; 1998.

  8. 8.

    Millar JS. A time for everything: changing attitudes and approaches to reducing substance abuse.Can Med Assoc J [editorial]. 1998;159:485–487.

  9. 9.

    Research Group on Drug Use.Drug Use in Toronto. Toronto, ON, Canada: Drug Prevention Centre, City of Toronto Department of Public Health Services; 1998.

  10. 10.

    O'Flaherty B.Making Room: The Economics of Homelessness. Cambridge, MA: Harvard University Press; 1996.

  11. 11.

    Single E, Easton B, Collins D, Harwood H, Lapsley H, Maynard A, eds.International Guidelines for Estimating the Costs of Substance Abuse, Ottawa, ON, Canada: Canadian Centre on Substance Abuse; 1996.

  12. 12.

    Canadian Coordinating Office for Health Technology Assessment.A Guidance Document for the Costing Process. Version 1.0. Ottawa, ON, Canada: Canadian Coordinating Office for Health Technology Assessment; 1996.

  13. 13.

    Coleman C, Moynihan J.Understanding Crime Data: Haunted by the Dark Figure. Philadelphia, PA: Open University Press; 1992.

  14. 14.

    Brantingham P, Easton ST.The Crime Bill: Who Pays and How Much? Victoria, BC, Canada: The Fraser Institute Critical Issues Bulletin; 1996.

  15. 15.

    Cohen MA. Alcohol, drugs and crime: is “crime” really one-third of the problem? [commentary].Addiction. 1999;94:644–647.

  16. 16.

    Harwood HJ, Fountain D, Livermore G.The Economic Costs of Alcohol and Drug Abuse in the United States, 1992. Rockville, MD: US Department of Health and Human Services, National Institutes of Health; 1998.

  17. 17.

    Deschenes EP, Anglin MD, Speckart G. Narcotics addiction: related criminal careers, social and economic costs.J Drug Issues. 1991;21:383–411.

  18. 18.

    Becker GS. Crime and punishment: an economic approach.J Political Econ. 1968;82: 169–217.

  19. 19.

    Rajkumar AS, French MT. Drug abuse, crime costs, and the economic benefits of treatment.J Quant Criminol. 1997;13:291–323.

  20. 20.

    Brochu S. Estimating the costs of drug-related crime. Available at:http://www.ccsa.ca/brochu.htm. Accessed May 5, 1998.

  21. 21.

    Cohen MA. A note on the cost of crime to victims.Urban Stud. 1990;27:139–146.

  22. 22.

    Gillespie RW. Heroin addiction, crime and economic cost: a critical analysis.J Criminal Justice. 1978;6:305–313.

  23. 23.

    Harwood HJ. Societal costs of heroin addiction. In: National Institutes of Health.NIH Consensus Development Conference on Effective Medical Treatment of Heroin Addiction, Bethesda, Maryland, November 17–19, 1997. Washington, DC: National Institutes of Health; 1998;53–56.

  24. 24.

    Frei A, Greiner AR, Mehnert A, Dinkel R. Socioeconomic evaluation of heroin maintenance treatment. In: Gutzwiller F, Steffen T, eds.Cost Benefit Analysis of Heroin Maintenance Treatment. Basel, Switzerland: Karger Verlag; 2000;37–130.

  25. 25.

    Healey A, Knapp M, Astin J, Gossop M, Marsden J, Stewart D, et al. Economic burden of drug dependency: social costs incurred by drug users at intake to the National Treatment Outcome Research Study.Br J Psychiatry. 1998;173:160–165.

  26. 26.

    Harwood HJ, Fountain D, Fountain G. Economic cost of alcohol and drug abuse in the United States, 1992 [report].Addiction. 1999;94:631–635.

  27. 27.

    Reuter P. Are calculations of the economic costs of drug abuse either possible or useful? [commentary].Addiction. 1999;94:635–638.

  28. 28.

    Kleiman MAR. “Economic cost” measurements, damage minimization and drug abuse control policy [commentary].Addiction. 1999;94:638–641.

  29. 29.

    Kopp P. Economic costs calculations and drug policy evaluation [commentary].Addiction. 1999;94:641–644.

  30. 30.

    Goeree R, O'Brien BJ, Blackhouse G, Agro K, Goering P.. The valuation of productivity costs due to premature mortality: a comparison of the human-captial and friction-cost methods for schizophrenia.Can J Psychiatry. 1999;44:455–463.

  31. 31.

    Fischer B, Medved W, Gliksman L, Rehm J. Illicit opiates in Toronto: a profile of current users.Addiction Res. 1999;7:377–415.

  32. 32.

    Dunn J, Ferri C. Epidemiological methods for research with drug misusers: review of methods for studying prevalence and morbidity.Rev Saude Publica. 1999;33:206–215.

  33. 33.

    Spreen M, Zwaagstra R. Personal network sampling, out degree analysis and multilevel analysis: introducing the network concept on studies of hidden population.Int Sociol. 1994;9:475–491.

  34. 34.

    Watters J, Biernacki P. Targeted sampling: options for the study of hidden populations.Soc Probl. 1989;36:416–430.

  35. 35.

    Howell DC,Statistical Methods for Psychology. 3rd ed. Boston, MA: PWS-Kent; 1992.

  36. 36.

    Bolton S.Pharmaceutical Statistics: Practical and Clinical Applications. 2nd ed. New York, NY: Marcel Dekker; 1990.

  37. 37.

    Altman DG, Gore SS, Gardner MJ, Pocock SJ. Statistical guidelines for contributors to medical journals. In: Altman DG, Machin D, Bryant TN, Gardner MJ, eds.Statistics with Confidence. 2nd ed. London: BMJ Books; 2000:171–201.

  38. 38.

    Jacobs P, Bachynsky J.An Alberta Standard Cost List for Health Economics Evaluations. Edmonton, AB, Canada: Institute of Pharmaco-Economics; 1997. Working Paper 97–5.

  39. 39.

    Jacobs P, Shanahan M, Roos NP, Farnworth M.Cost List for Manitoba Health Services. Winnipeg, MB, Canada: Manitoba Centre for Health Policy and Evaluation; 1999.

  40. 40.

    Wall R, DeCoster C, Roos N.Estimating per Diem Costs for Manitoba Hospitals: a First Step. Winnipeg, MB, Canada: Manitoba Centre for Health Policy and Evaluation; 1994.

  41. 41.

    Pope D, Fernandes CMB, Bouthillette F, Etherington J. Frequent users of the emergency department: a program to improve care and reduce visits.Can Med Assoc J. 2000;162: 1017–1020.

  42. 42.

    Stewart J, Rehm J, Fischer B, et al.The Social Costs of Untreated Opiate Use. Toronto, ON, Canada: Addiction Research Foundation; 1997 Research. Documents Series 137.

  43. 43.

    Nestman LJ.Management Control and Funding Systems: for Canadian Health Service Eexecutives. Ottawa, ON, Canada: Canadian College of Health Service Executives; 1989.

  44. 44.

    Krahn MD, Berka C, Langlois P, Detsky AS. Direct and indirect costs of asthma in Canada, 1990.Can Med Assoc J. 1996;154:821–831.

  45. 45.

    Rush B, Kim C, Schmidt G.A Manual for Cost Analysis of Substance Abuse Treatment. London, ON, Canada: Addiction Research Foundation; 1998.

  46. 46.

    Ontario Ministry of Health.Schedule of Benefits: Physician Services Under the Health Insurance Act. Toronto, ON, Canada: Ontario Ministry of Health Physician Services Branch; 1992.

  47. 47.

    Ontario Ministry of Health.Ontario Drug Benefit Formulary/Comparative Drug Index. Toronto, ON, Canada: Ontario Ministry of Health Drug Branch; 1996.

  48. 48.

    Cooper JR, Czechowicz DJ, Petersen RC, Molinari SP. Prescription drug diversion control and medical practice.JAMA. 1992;268:1306–1310.

  49. 49.

    Sajan A, Corneil T, Grzybowski S. The street value of prescription drugs.Can Med Assoc J. 1998;159:139–142.

  50. 50.

    Goldman B. The news on the street: prescription drugs on the black market.Can Med Assoc J [editorial]. 1998;159:149–150.

  51. 51.

    Johnson BD, Goldstein PJ, Preble E et al.Taking Care of Business: The Economics of Crime by Heroin Abusers. Lexington, MA: Lexington Books; 1985.

  52. 52.

    Fernandez H.Heroin. Center City, MN: Hazelden; 1998.

  53. 53.

    Wolff L, Reingold B.Drug Use and Crime. Ottawa, ON, Canada: Canadian Centre for Justice Statistics; 1994 Statistics Canada, Juristat, Catalogue 85–102, Vol. 14, No. 6.

  54. 54.

    Platt JJ.Heroin Addiction: Theory, Research, and Treatment. Volume 2: The Addict, the Treatment Process, and Social Control. Malabar, FL: Krieger; 1995.

  55. 55.

    Bell J, Mattick R, Hay A, Chan J, Hall W. Methadone maintenance and drug-related crime.J Subst Abuse. 1997;9:15–25.

  56. 56.

    Ball JC, Ross A:The Effectiveness of Methadone Maintenance Treatment: Patients, Programs, Services, and Outcome. New York, NY: Springer Verlag; 1991.

  57. 57.

    Grimes C.Adult Criminal Court Statistics, 1995–1996 Ottawa, ON, Canada: Canadian Centre for Justice Statistics; 1997. Statistics Canada, Juristat, Catalogue 85-002-XPE, Vol. 17, No. 6.

  58. 58.

    Swol K.Crime and Police Resources in Canadian Municipalities, 1996. Ottawa, ON, Canada: Canadian Centre for Justice Statistics; 1997. Statistics Canada Catalogue 85-223-XPE.

  59. 59.

    Foran T.Government Spending on Adult Correctional Services. Ottawa, ON, Canada: Canadian Centre for Justice Statistics; 1996. Statistics Canada, Juristat, Catalogue 85-002, Vol. 16, No. 3.

  60. 60.

    Reed M, Morrison D.Adult Correctional Services Statistics, 1995–96. Ottawa, ON, Canada: Canadian Centre for Justice; 1997. Statistics Canada, Juristat, Catalogue 85-002, Vol. 17, No. 4.

  61. 61.

    Wright C.Risk of Personal and Household Victimization: Canada, 1993. Ottawa, ON, Canada: Canadian Centre for Justice Statistics; 1995. Statistics Canada, Juristat, Catalogue 85-002, Vol. 15, No. 2.

  62. 62.

    Criminal Injuries Compensation Board.Twenty-fourth Annual Report. Toronto, ON, Canada: Criminal Injuries Compensation Board: 1996.

  63. 63.

    McElrath K, Chitwood DD, Comerford M. Crime victimization among injection drug users.J Drug Issues. 1997;27:771–783.

  64. 64.

    Himelfarb A. Cost of crime to victims: preliminary findings of the Canadian urban victimization survey.Impact. 1984;2:36–49.

  65. 65.

    Hanvelt RA, Ruedy NS, Hogg RS, et al. Indirect costs of HIV/AIDS mortality in Canada.AIDS. 1994;8:F7-F11.

  66. 66.

    Rehm J, Ialomiteaunu D, Walsh G, Adlaf E, Single E.The Quantification of Mortality Caused by Illicit Drugs in Canada, 1992. Toronto, ON, Canada: Addiction Research Foundation; 1996.

  67. 67.

    Rettig R, Yarmolinsky A.Federal Regulation of Methadone Treatment. Washington, DC: National Academy Press; 1995.

  68. 68.

    Faupel C, Klockars C. Drugs-crime connections: elaborations from the life histories of hard-core heroin addicts.Soc Probl. 1987;34:54–68.

  69. 69.

    Strathdee SA, Patrick DM, Currie SL, et al. Needle exchange is not enough: lessons from the Vancouver injecting drug use study.AIDS. 1997;11:59–65.

  70. 70.

    Bruneau J, Lamothe F, Franco E, et al. High rates of HIV infection among injection drug users participating in needle exchange programs in Montreal: results of a cohort study.Am J Epidemiol. 1997;146:994–1002.

  71. 71.

    Fischer B. Opiate addiction treatment, research and policy in Canada—past, present and future issues. In: Rehs-Middel M, Haemmig R, Matthias R, Matthias L, eds.Heroin-Assisted Treatment for Dependent Drug Users: State of the Art and New Research Perspectives, Scientific Findings and Political Perspectives. Berne, Switzerland: University of Berne; in press.

  72. 72.

    Kilias M, Rabasa J.Schlussbericht zu den Auswirkungen der Verschreibung von Betaeubungsmitteln auf die Delinquenz von Drogenabhaengigen. Lausanne, Switzerland: Institut de police scientifique et de criminologie; 1997.

  73. 73.

    Kilias M, Rabasa J. Less crime in the cities through heroin prescription? Preliminary results from the evaluation of the Swiss Heroin Prescription projects.Howard J Criminal Justice. 1997;36:424–429.

  74. 74.

    Kilias M, Rabasa J. Auswirkungen der Heroin-Verschreibung auf die Delinquenz von Drogenabhaengiger.Monatsschrift fuer Kriminologie und Strafrechtsreform. 1998;81: 1–16.

  75. 75.

    Kilias M, Rabasa J. Does heroin prescription reduce crime? Results from the evaluation of the Swiss Heroin Prescription projects.Stud Crime Crime Prev. 1998;7:127–133.

  76. 76.

    Drake S. Self-report among injecting drug users: a review.Drug Alcohol Depend. 1998; 51:253–263.

  77. 77.

    Des Jarlais DC. Validity of self-reported data, scientific methods and drug policy [commentary].Drug Alcohol Depend. 1998;51:265–266.

  78. 78.

    Bell J. Self report among injecting drug users [commentary].Drug Alcohol Depend. 1998; 51:267–268.

  79. 79.

    Finch E, Strang J. Reliability and validity of self-report: on the importance of considering context [commentary].Drug Alcohol Depend. 1998;51:269

  80. 80.

    Johnson ME, Fisher DG, Reynolds G. Reliability of drug users' self-report of economic variables.Addict Res. 1999;7:227–238.

  81. 81.

    Chaiken J, Chaiken M.Varieties of Criminal Behavior. Santa Monica, CA: RAND; 1982. Publication R-2814-ICJ.

  82. 82.

    Inciardi JA. Heroin use and street crime.Crime Delinquency. 1979;25:335–346.

  83. 83.

    Inciardi JA.Criminal Justice. Orlando, FL: Academic; 1984.

  84. 84.

    French MT, McGeary KA, Chitwood DD, McCoy CB. Chronic illicit drug use, health services utilization and the cost of medical care.Soc Sci Med. 2000;50:1703–1713.

  85. 85.

    Maynard C, Cox GB, Krupski A, Stark D. Utilization of services by persons discharged from involuntary chemical dependency treatment.J Addict Dis. 2000;19;83–93.

  86. 86.

    Powis B, Strang J, Griffiths P, et al. Self-reported overdose among injecting drug users in London: extent and nature of the problem.Addiction. 1999;94:471–478.

  87. 87.

    Dunlop S, Coyte PC, McIsaac W. Socio-economic status and the utilisation of physicians services: results from the Canadian National Population Health Survey.Soc Sci Med. 2000;51:123–133.

  88. 88.

    Sanchez-Carbonell X, Seus L. Ten-year survival analysis of a cohort of heroin addicts in Catalonia: the EMETYST project [research report].Addiction. 2000;95:941–948.

  89. 89.

    Fischer B, Kendall P, Rehm J, Room R. Charting WHO goals for licit and illicit drugs for the year 2000: are we on track?Public Health. 1997;111:271–277.

  90. 90.

    Giffen J, Endicott S, Lambert S.Panic and Indifference—the Politics of Canada's Drug Laws. Ottawa, ON, Canada: Canadian Centre on Substance Abuse; 1991.

  91. 91.

    Musto DF:The American Disease: Origins of Narcotic Control. New York, NY: Oxford University Press; 1987.

  92. 92.

    National Institute on Drug Abuse.Methadone Maintenance Treatment: Translating Research into Policy. Washington, DC: National Institute on Drug Abuse; 1995.

  93. 93.

    National Institute on Health National Consensus Development Panel on Effective Medical Treatment of Opiate Addiction. Effective medical treatment of opiate addiction.JAMA. 1998;280:1936–1943.

  94. 94.

    Ralston G, Wilson P. Methadone programs: the cost and benefits to society.Pharmaco-Economics. 1997;10:321–326.

  95. 95.

    Brands J, Brands B, Marsh DC. The expansion of methadone prescribing in Ontario, 1996–1997.Addict Res. In press.

  96. 96.

    Drake RE, Mercer-McFadden C, Mueser KT, McHugo GJ, Bond GR. Review of integrated mental health an substance abuse treatment for patients with dual disorders.Schizophr Bull. 1998;24:589–608.

Download references

Author information

Correspondence to Dr. Ronald Wall PhD.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Wall, R., Rehm, J., Fischer, B. et al. Social costs of untreated opioid dependence. J Urban Health 77, 688–722 (2000). https://doi.org/10.1007/BF02344032

Download citation

Key Words

  • Cost of illness
  • Illicit drugs
  • Opioid dependence