Objective To examine the proportion of diabetic peripheral neuropathy (DPN) patients receiving pharmacologic DPN treatments and specifically to identify the rates and factors associated with opioid use and first line opioid use. Methods A 10% sample of IMS-LifeLink claims data from 1998 through 2008 was used. The study population consisted of diabetic patients who met DPN criteria using a validated DPN algorithm. Multivariable logistic regression controlling for demographics, comorbidities, and other clinical characteristics was used to identify factors associated with any DPN pharmacologic treatment, any opioid use, and first-line opioid treatment. Sensitivity analyses were conducted to explore variations in exclusion criteria as well as opioid use definitions. Results 666 DPN patients met inclusion criteria and pharmacologic treatment was received by 288 subjects (43.24%) and of those, 154 (53.47%) had DPN related opioid use and 96 (33.33%) received opioid as first line treatment. Persons with diabetic complications were more likely to use opioids (OR=4.53, 95% CI=1.09-18.92). FDA approved DPN agents duloxetine 1.04% (n=3) and pregabalin 5.56% (n=16) had much lower rates of use. DPN related drug use and DPN related opioid usage increased as we used less restrictive samples in sensitivity analyses. Conclusion Opioids were the most frequently prescribed first line agents for DPN. More than 50 % of DPN patients remained untreated with pharmacologic agents one year after a DPN diagnosis.