Prescription opioids are associated with an increased risk of adverse drug events and individual’s underlying mental health conditions may be more likely to be prescribed long-term opioid therapy. This study examined opioid treatment patterns among individuals with schizophrenia, bipolar disorder, or major depressive disorder (MDD) and found that having a diagnosis of bipolar disorder or MDD was associated with increased odds of receiving chronic opioid mediations, whereas a diagnosis of schizophrenia was not.