OBJECTIVES: Opioid use has grown over the last decade and neuropathy and diabetic peripheral neuropathy (DPN) guidelines do not recommend opioids as first line treatment. This study sought to examine the proportion of DPN patients who are prescribed opioids and to determine the proportion of DPN patients who are prescribed opioids as first line treatment. METHODS: A 10% sample of IMS-LifeLink claims data from 1998 through 2008 were used. The study population consisted of patients with ≥1 diagnosis for diabetes and/or ≥1 claim for an antidiabetic prescription. DPN patients were identified with a validated DPN identification algorithm; and the first date of a DPN diagnosis served as the index date. All patients were required to have continuous 12 month pre- and post index date plan enrollment and be >17 years of age. Patients with cancer, non-cancer pain conditions, surgery in the pre- and post- 12 month index period, and with opioid use in the pre-index period were excluded. Descriptive statistics including demographic Charlson-comorbidities, with first line use of DPN related medications were calculated. RESULTS: A total of 984 DPN patients met inclusion exclusion criteria with a mean age of 60.08 years.  37.40% were female and 29.88% used insulin. 428 DPN patients (43.49%) received DPN pharmacologic treatment. Of those with DPN pharmacologic treatments, 91 (21.26%) received opioid as first line treatment. Antidepressants, anticonvulsants and NSAIDs were initially used by 28.97%, 23.60%, and 21.96% respectively. The most commonly used opioids were hydrocodone combinations (8.03%), followed by codeine combinations (2.64%) and oxycodone CR (2.44%).  Factors associated with opioid use will be reported.  CONCLUSIONS: Over 50% of DPN patients remained untreated with pharmacologic therapy after a DPN diagnosis, which may reflect under-treatment. Despite DPN treatment guidelines that do not recommend opioids as first line treatment, opioids were among the most common first line agents used.