Background Pharmaceutical opioid consumption has been increasing worldwide, but disparities in access to these medications exist. Few countries of the WHO Eastern Mediterranean Region have well defined pain management policies. Aims This study presents trends in the consumption of pharmaceutical opioids in the 22 countries in the Eastern Mediterranean Region from 2010 to 2019, with comparative intra-and extra-regional analyses; the correlation between pharmaceutical opioid consumption and human development index rankings; and pharmaceutical opioids use in the region. Methods We calculated the defined daily doses for statistical purposes (S-DDD) per million inhabitants per day of pharmaceutical opioids from 2010 to 2019, and used the mixed effects models to assess changes in consumption. We used regression analyses to establish the strength of associations between human development index level and consumption in the region and elsewhere. Results Pharmaceutical opioid use has fluctuated in the region since 2010, with a mean sum of S-DDD of 2547 for 2010– 2019. Consumption is relatively low in the region irrespective of the human development index. The highest-consuming country reported 369 S-DDD in 2019 and the lowest reported 1 S-DDD. The most used pharmaceutical opioids in the region were fentanyl, morphine, pethidine, oxycodone, and codeine. Conclusion Consumption could be considered inadequate in several countries of the region. Supporting these countries to improve collection and reporting of consumption data, and providing humanitarian assistance to enhance access to pain relief, should be a priority for the international community. © Authors 2022; Licensee: World Health Organization.