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To better understand this relationship, we evaluated the associations between federal poverty level (FPL) with healthcare costs and utilizations among adult opioid users in the United States (US).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>A serial cross-sectional study using pooled data (2008\u20132019) from the Medical Expenditure Panel Survey (MEPS) was used to evaluate the association between FPL with healthcare expenditures among a representative sample of the US adult population with\u2009&gt; =\u20091 opioid prescription. FPL was defined as Poor\/Near Poor-Income, Low-Income, Middle-Income, and High-Income. Healthcare expenditures included costs and resource utilization. Survey weights were applied to generate standard errors for the representative sample of the US population. Generalized linear models were constructed to evaluate the association between FPL and healthcare expenditures adjusting for confounders. FPL groups were stratified by insurance coverage, frequency of opioid prescriptions filled, and pain level to evaluate their impact on healthcare expenditures.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Total weighted sample was 27,289,263 respondents; 21.6% in Poor\/Near Poor-Income, 14.9% in Low-Income, 28.6% in Middle-Income, and 34.9% in High-Income groups. The average annual increase in total healthcare costs for the Poor\/Near Poor-Income group was $451 (95% CI: $142-$761), $275 (95% CI: $48-$502) for the Low-Income group, $640 (95% CI: $447-$834) for the Middle-Income group, and $618 (95% CI: $360-$877) for the High-Income group. Between-group comparisons yielded significant increases in average annual total healthcare costs for Middle- and High-Income groups versus Low-Income group; significant increases in average annual emergency room costs between Middle- versus Low-Income groups, and significant increases in average annual inpatient costs between Middle-Income versus Poor\/Near Poor- and Low-Income groups. Stratified analyses yielded several significant increases in average annual costs and expenditures. However, no differences were reported for respondents who were uninsured across FPL groups.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>Respondents across FPL groups consumed healthcare at various rates, particularly when stratified by insurance coverage, frequency of opioid prescriptions filled, and pain level. FPL plays an important role in healthcare consumption, but further research is needed to understand these mechanisms and their impact on the opioid crisis.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s12939-025-02413-6","type":"journal-article","created":{"date-parts":[[2025,2,24]],"date-time":"2025-02-24T06:23:48Z","timestamp":1740378228000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association of federal poverty level with healthcare expenditures among opioids users in the United States (2008\u20132019): a serial cross-sectional study"],"prefix":"10.1186","volume":"24","author":[{"given":"Mark","family":"Bounthavong","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kangho","family":"Suh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aryana","family":"Sepassi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Britney","family":"Stottlemyer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick","family":"Spoutz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Hart","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meng","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,2,24]]},"reference":[{"key":"2413_CR1","unstructured":"U.S. Department of Health & Human Services. 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