OBJECTIVES: Tramadol was the most often prescribed opioid in a South African study conducted on 2011 data of a medical insurance scheme database. The primary aim of this study was to analyse the prescribing patterns of opioids dispensed by community pharmacies to determine if opioid prescribing patterns were similar if a different prescriber and dispensing database was used. METHODS: A retrospective, cross-sectional drug utilisation study was conducted on a 2013 pharmacy dispensing database in South Africa. All records for ATC subgroup N02A were extracted and analysed. RESULTS: A total of 212 527 opioids were dispensed to 105 118 patients at a total cost of R30 227 819.83 (average cost of R142.23 per product). Twelve different active ingredients or active ingredient combinations were prescribed. Tramadol, an atypical opioid, in combination with paracetamol accounted for 71.90% of products, followed by tramadol alone (22.74% of products). These two products therefore accounted for 94.64% of all the products dispensed in ATC subgroup N02A. The originator product of the combination of tramadol and paracetamol accounted for 90.08% of products dispensed, with only 2.00% generic prescribing. Oxycodone (N02AA05, 1.99%) and fentanyl (N02AB03, 1.10%) were the only other opioids dispensed that accounted for more than 1% of the total number of opioids dispensed. In the 2013 study, all the prescriptions were dispensed by community pharmacies. In the 2011 study on a medical insurance scheme database, most prescriptions for opioids were issued by private hospitals (62.89%), followed by pharmacies (24.42%) and general medical practices (12.16%). If only pharmacies are considered, 94.54% of prescriptions were for tramadol or the combination of tramadol and paracetamol (67.59% for tramadol in combination with paracetamol, and 26.95% for tramadol alone). CONCLUSIONS: The dispensing patterns of opioids by community pharmacies were nearly identical in the community pharmacy and medical insurance scheme studies, with tramadol clearly dominating opioid prescribing.