STUDY DESIGN: Population-based data linkage of state-based opioid dispensing, hospital administrative and death registry data. OBJECTIVE: This study aimed to provide a detailed overview of opioid dispensing in the 2-years following SCI. SETTING: Community. METHODS: Linked data were obtained for adults admitted to Queensland hospitals with a newly diagnosed traumatic or non-traumatic SCI from 1 January 2014-31 December 2017. Community opioid dispensing data was obtained for 3 months pre-SCI and up to two years after their Index Hospital Admission for SCI. Chronic dispensing (≥90 cumulative dispensing days) and high end dose (median daily dose of 50 or more oral morphine equivalents in the last 3 months of dispensing) were calculated from dispensing data. RESULTS: Of the 298 included cases (180 traumatic; 118 non-traumatic), 1 or more opioids were dispensed to 19% of the cohort in the 3 months pre-SCI (40% non-traumatic SCI; 6% traumatic SCI) and to 53% post-SCI (56% non-traumatic SCI; 52% traumatic SCI). Those who were dispensed opioids pre-SCI were 3.7 times more likely to have been dispensed opioids in the observation period (95% confidence interval: 1.90, 7.24, p < 0.001). Thirty percent of the cohort have been dispensed opioids chronically. High opioid end doses were significantly more likely among those with non-traumatic SCI. CONCLUSIONS: Whilst it was positive that many were not dispensed an opioid post-SCI, the high prevalence of high opioid doses and chronic duration is concerning. The reliance on opioids for pain management suggests stronger approaches to coordinated and improved multi-disciplinary long-term pain management is needed.