Long-term opioids may benefit chronic pain patients but have also been linked to harmful outcomes. In the UK the predominant source of opioids is primary care prescription. The objective was to examine changes in the incidence, length, and opioid potency of long-term prescribing episodes for musculoskeletal conditions in UK primary care (2002-2013). This was an observational database study (Clinical Practice Research Datalink, 190 practices). Participants (≥18 years) were prescribed an opioid for a musculoskeletal condition (no opioid prescribed in previous 6 months), and issued ≥2 opioid prescriptions within 90 days (long-term episode). Opioids were divided into short and long-acting non-controlled, and controlled drugs. Annual incidence of long-term opioid episodes was determined, and for those still in a long-term episode, the percentage of patients prescribed each type 1-2 years, and >2 year after initiation. Annual denominator population varied from 1.25-1.38m. 76,416 patients started one long-term episode. Annual long-term episode incidence increased (2002-2009) by 38% (42.4 to 58.3 per 10,000 person-years), remaining stable to 2011, then decreasing slightly to 55.8/10,000(2013). Patients prescribed long-acting controlled opioids within the first 90 days of long-term use increased from 2002-2013 (2.3% to 9.9%). In those still in a long-term opioid episode (>2 years), long-acting controlled opioid prescribing increased from 3.5% to 22.6%.This study has uniquely shown an increase in prescribing of long-term opioids to 2009, gradually decreasing from 2011 in the UK. The trend was towards increased prescribing of controlled long-acting opioids and earlier use. Further research into the risks and benefits of opioids is required.This is an open access article distributed under the terms of the Creative Commons Attribution License 4.0 (CC BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.