Researchers examined prescription records for 293 patients in Olmsted County, MN, over a 1-year period to determine the progression to episodic or long-term patterns of opioid prescribing. The patients received a total of 515 new prescriptions for opioid analgesics in 2009. Opioid prescribing was categorized as short-term, episodic, or long-term. Of the patients, 21% progressed to an episodic prescribing pattern, and 6% progressed to a long-term pattern. The most common indication for the first prescription was a painful procedure, such as surgery. Most patients received one prescription, but 16% received two prescriptions, and 16% received three or more. Substance abuse was associated with a long-term prescribing pattern compared with a short-term pattern. Nicotine use and substance abuse were significantly associated with an episodic or long-term prescribing pattern. These findings could help identify at-risk patients and contribute to the development of targeted clinical interventions.