OBJECTIVES: COPD contributes significant morbidity and mortality worldwide and is currently the third leading cause of mortality in the United States. Chronic pain prevalence is high among COPD patients leading to a high rate of prescription opioid use. The potential impact of concurrent prescription opioid use on COPD maintenance medication adherence is not well understood. The study objective was to assess the impact of long-term prescription opioid use (≥90 day prescription opioid supply in a one-year period) compared to no prescription opioid use on COPD maintenance medication adherence. METHODS: Patients with COPD diagnosis were identified using ICD9-CM diagnosis codes and COPD maintenance medication prescription claims from the Truven Health MarketScan^® Commercial Claims and Encounters Database from July 1, 2008 to December 31, 2009. COPD patients with prescription opioid claims were matched 1:1 to non-opioid users on baseline characteristics: age (±3 years), sex, severe and moderate COPD exacerbations, oxygen therapy use, short-acting beta-agonist use, COPD maintenance medication adherence, and asthma status. Conditional multiple logistic regression was used to identify the impact of long-term prescription opioid use versus no opioid use on COPD maintenance medication adherence [defined as proportion of days covered (PDC) ≥0.8] in a one-year period. RESULTS: A total of 5,541 matched pairs of prescription opioid versus non-opioid users were identified. Long-term prescription opioid users (n=566) had significantly higher mean Deyo-Charlson comorbidity scores (2.4±1.8 vs 1.7±1.2, p<0.0001), presence of comorbid chronic conditions (86.6% vs 76.3%, p<0.0001) and comorbid pain conditions (93.5% vs 70.7%, p<0.0001). After adjusting for confounders, long-term prescription opioid use was associated with 0.63 times (95% CI 0.46-0.88, p<0.01) lower odds of being adherent to COPD maintenance medications. CONCLUSIONS: Concurrent long-term use of prescription opioids may significantly lower COPD maintenance medication adherence which may translate into suboptimal control of COPD symptoms and requires additional investigation.