Background Many injection drug users have elevated STD/HIV risks, such as sexual-trade for drugs, risky condom-less sex, or multiple sex partners. STD diagnosis and screening among opioid users has not been examined. Methods Using 2016 MarketScan commercial claims data, men and women aged 15–24 with opioid prescriptions were identified. We have assessed STD diagnosis and screenings, including chlamydia, gonorrhea, syphilis, and HIV, as well as heroin use using ICD-10 and CPT codes. Women were identified as sexually-active using HEDIS criteria whereas no other criteria used for men. Results We identified 10% (0.4 million) patients aged 15–24 who had opioid use in 2016. Among sexually-active women aged 15–24 years, screening and diagnosis was 48.1% and 2.3% for chlamydia, 56.0% and 4.1% for gonorrhea, 16.6% and 3.8% for syphilis, and 16.0% and 0.3% for HIV among 154,960 women who had opioid use and 51.6% and 2.0% for chlamydia, 55.5% and 4.1% for gonorrhea, 15.1% and 3.8% for syphilis, and 14.7% and 0.4% for HIV among 812,005 women who had no opioid use. Among 332 male and 159 female opioid plus heroin users, screening was 21.2% and 56.6% for chlamydia, 25.9% and 62.3% for gonorrhea, 36.5% and 44.7% for syphilis, and 35.8%, 47.8% for HIV, respectively. Conclusion STD screening among patients with opioids was not significantly different from the enrollees without opioids. STD diagnosis and screening among heroin users are much higher than patients who had not used heroin. Disclosure No significant relationships.