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Recent literature focused on prescription opioids has neglected sex differences in use. Here, we evaluated the recent literature (since 2015) examining sex differences in prescription opioid use.Between 2015 and 2016, our review found only eight articles addressing sex differences in prescription opioid use mostly opioid misuse in North America among individuals with chronic pain. Risk factors included depression, pain, and polydrug use. In addition to that review, we had the opportunity to further address sex differences in, and risk factors for, prescription opioid use through a community engagement program, HealthStreet. Among the sample (n = 8525, Mage = 43.7 years, 58.6% women), approximately half reported use of prescription opioids. Women were significantly more likely to report lifetime use (54.9 vs. 42.2%; P < 0.0001) and report cancer compared with men, yet, women with cancer had a significantly reduced risk of using opioids compared with men with cancer (odds ratio: 0.46; 95% confidence interval, 0.36–0.59).Only a few recently published studies analyzed sex differences related to prescription opioid use. Findings from the literature and our data suggest women are more likely to use prescription opioids compared with men. There is limited information on sex differences in opioid use risk factors and outcomes and more research in this area is warranted.