For the better part of the 21st century, opioid abuse and related consequences have beleaguered the United States. Effectively fighting the crisis may require a better understanding of potential differences among the types of opioids available, since treating them as one homogeneous group may mask emerging trends and conflate more benign ones with those more troubling. The current study used a census tract-level data set with population, concentrated disadvantage, and prescription drug monitoring payment variables to address study goals. Findings show disparate prescribing patterns among the four types of opioids and considerable differences in the community factors that predict their change. Implications for future research and interventions are discussed. (publisher abstract modified)