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Secondary analysis of Medical Expenditure Panel Survey from 1996 to 1999.To examine patterns in opioid use in 1996, 1997, 1998, and 1999 among individuals with back pain in the United States and to investigate trends in the use of overall and individual opioid category.To the authors’ best knowledge, no study has examined at a national level the patterns and trends in opioid use among individuals with back pain in the United States.Individuals with back pain were stratified by sociodemographic characteristics and geographic regions. Rates of overall opioid use were compared among different strata by the use of simple and multivariate logistic regression models. To investigate trends in opioid use, use rates of the overall and individual opioid category in each year were calculated and compared.From 1996 to 1999, wide variations in overall opioid use were consistently observed among individuals with different educational levels, family income, and health insurance status. Regional variation in opioid use was also observed for most of the 4 years. After adjustment for covariates, health insurance status and geographic regions were consistent predictors of opioid use from 1997 to 1999. Trend analysis indicated that the rates of overall opioid use increased slightly across the 4-year span. Among individual opioid categories, the use of oxycodone or hydrocodone increased, whereas the use of propoxyphene decreased.The variation in overall opioid use among individuals with back pain with different sociodemographic characteristics and from different geographic regions suggested an opportunity to improve opioid prescribing patterns. The increase in the use of hydrocodone and oxycodone indicated a need to better assess the efficacy and safety associated with these drugs among individuals with back pain.