Background: Cost effectiveness, the ratio of relative costs of a program to its desired outcomes, is one of the basic issues in various screening programs performed to detect opium abuse. This study aimed to find the cost-effectiveness of opiates abuse screening through urine analysis. Methods: A total number of 64698 individuals were selected and divided into to five distinct groups based on the reason for which they were tested. Cost-effectiveness of opiates abuse screening in each group was calculated by dividing the total cost, including personnel and overhead costs, to the number of detected cases. Finally, the results were compared. Findings: The total number of positive cases based on rapid screening assay (RSA) and thin layer chromatography (TLC) was 3460 (5.3%). According to incremental cost-effectiveness analysis, screening program of the group referred by the police was the most cost-effective program with the breakeven point at 2%. Conclusion: According to the obtained results, continuation of drug abuse screening programs is recommended. Keywords: Cost effectiveness, Substance abuse, Urine, Opiates.