The number of the powerful painkillers prescribed by NHS Scotland has more than doubled in 13 years.
Opioids are used to treat chronic pain but can become highly addictive if taken over a prolonged period of time. There were 2.7 million opioids prescribed in 2017-18 in Scotland, at a cost of £31 million, according to official figures.
This is up from 1.3m prescribed in 2004-5, at a cost of £18m.
Opioid prescriptions dipped by less than 0.1% in 2017-18, but overall rose by more than 100% from 2004-5.
England and Wales has experienced a similar increase in opioid prescriptions.
Prof Blair Smith, Scotland’s clinical lead for chronic pain and an advisor to the Scottish Government, said: “Chronic pain is increasing in its prevalence. More people have long-lasting pain than previously for a number of reasons, not least the older we get the more likely we are to have persistent pain, and there is an ageing population.
“There is also an increase in some conditions associated with chronic pain, for example diabetes.
“There is also an association between chronic pain and deprivation. People living in poorer areas are more likely to have chronic pain and be prescribed with opioids.
“At a time of uncertainty and difficulty at a widespread level in deprivation related issues, it is perhaps not surprising that pain and opioids are increasing in their prevalence.”
He added: “Opioids do have a role in managing chronic pain in carefully selected people where there is agreed shared goals and early and frequent reviews of both effectiveness and side effects.
“But we also need to do what we can to reduce unnecessary prescribing for reasons of patient safety and reduce the harm they do.”
David Liddell, chief executive of the Scottish Drugs Forum, said: “Prescribers have to be aware that people who are dependent have a wider range of access to illegal alternatives than previously.
“It’s important to bear in mind that opioid painkillers will only work for a limited period of time – around 12 weeks. People needing longer-term supports will need other medication and support.”
At First Minister’s Questions at Holyrood on Thursday, Labour MSP David Stewart said opiate painkillers “can ruin lives every bit as much as illegal drugs can”.
Nicola Sturgeon said opioid prescribing can be appropriate for short-term pain but doctors should discuss alternatives with patients for longer-term pain.
She said a working group of experts is examining prescribing trends in Scotland.