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To examine fentanyl utilisation in the Australian community and determine the geographic and socio-demographic factors associated with higher rates of fentanyl utilisation.National sales data (supplied by IMS Health) were used to estimate fentanyl utilisation (in pack sales and milligrams) in Australia during 2013, mapped to Australian Bureau of Statistics (ABS) Statistical Local Areas (SLAs) and Remoteness Areas. Socio-demographic characteristics and total population estimates of SLAs were obtained from the ABS. SLA-level data on sex, age distribution, income, occupations involving physical labour and number of pharmacies, were included in linear regression analyses to examine their association with fentanyl use.An estimated 12.3 kg (or 859,518 packs) of fentanyl was sold across Australia in 2013, equating to an average of 0.55 mg/person over the year. Transdermal patches accounted for the majority (99%; 850,923 packs) of fentanyl sales. South Australia had the highest rate of utilisation per person. Rates of fentanyl utilisation were higher among more remote areas in three jurisdictions. Overall, higher utilisation rates were observed in SLAs that were less populated (β 0.12; p < 0.001) and those with a higher proportion of older people (β 0.12; p < 0.001), low-income households (β 0.12; p < 0.001) and people working in jobs requiring physical labour (β 0.08; p < 0.05).Transdermal fentanyl patches account for the majority of fentanyl utilisation in the Australian community. There is marked variation in fentanyl utilisation across geographic areas, with higher use apparent in areas with a higher proportion of older people and indicators of greater socio-economic disadvantage.This is the first population-based study that details fentanyl utilisation across Australia.Transdermal fentanyl patches account for the majority (99%) of total fentanyl use in the Australian community.Rates of fentanyl utilisation were higher among more remote areas in three jurisdictions.Areas with greater socio-economic disadvantage and older residents were associated with higher rates of fentanyl utilisation.