OBJECTIVES: We sought to determine the relationship between the choice of the first opioid prescription and the likelihood of continued opioid use at 1 and 3 years. METHODS: We identified cancer-free persons with new opioid use episodes in a nationally representative commercially insured database from 2006-2015. The first opioid prescription was categorized into 5 mutually exclusive types: Long Acting Opioids, Low Potency Opioids, Hydrocodone Short Acting, Oxycodone Short Acting and Other Short Acting. Persons were followed until they discontinued opioids (a gap of at least 180 days without opioid use), lost eligibility, or study end (September 2015). Kaplan Meier survival curves were used to estimate the median days of opioid use and the probability of continuing opioid use at 1 and 3 years for each type first opioid prescription group. RESULTS: A total of 1,316,061 patients, with an average age and duration of enrollment of 44.54 years (±14.56 years) and 2.48 years (±2.04 years) were included. The highest probability of one and three year continued opioid use was found among those initiated on a long-acting opioid (28.08% and 19.26%), followed by patients initiated on a low potency opioid (13.73% and 6.84%). Among patients initiated with low potency opioids, over 60% of the patients who continued opioid use beyond one or three years were still on short acting low potency opioids. The probability of long term use for those starting on hydrocodone, oxycodone or other short acting opioids was similar with three year probabilities of continued use between 2.98% and 2.50%. CONCLUSIONS: When physicians consider long term opioid therapy for pain, they may be selecting low potency opioids such as tramadol or a long acting opioid. Further research evaluating the long term efficacy and safety of low potency opioids must be conducted before physicians use them for chronic pain management.