[Objectives] Crohn’s disease (CD) is a chronic inflammatory bowel disease causing abdominal pain and diarrhea. CD patients often receive prescriptions for opioid analgesics to manage pain and postoperative recovery. This study aims to assess healthcare resource utilization costs in the first year following initiation of opioid use. [Methods] We conducted a retrospective cohort study using the Korea Health Insurance Review and Assessment Service data from 2010 and 2022 covering the entire population in Korea. We identified patients who received the first prescription of CD-related opioid. CD patients were defined as those with at least one CD diagnosis (ICD-10: K50). The index date was defined as the date of the first prescription of opioid (including Codeine, Dihydrocodeine, Hydrocodone, Fentanyl, Morphine, Oxycodone, and Hydromorphone). Costs were calculated as total healthcare costs. [Results] A total of 60,552 patients were included in analysis, of whom 42.4% were female. Dihydrocodeine was the most prescribed first opioid (87.5%). The mean annual total costs were KRW 2,627,194 (SD: KRW 8,944,836). Outpatient costs were KRW 912,425 (95% CI: KRW 881,650-KRW 943,200), while hopitalization costs, excluding ICU, were KRW 5,487,783 (95% CI: KRW 5,311,604-KRW 5,663,962). [Conclusion] This study examined healthcare resource utilization costs during the first year of opioid use in CD patients. We found that CD-related hospitalization costs are high after opioid use, further research is needed to determine total annual economic burden impact.