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Objective To analyze whether outpatient opioid and non-opioid analgesic prescribing after traumatic brain injury (TBI) admission has varied over time among commercially insured patients in the USA.Setting 2016–2022 Merative MarketScan commercial claims.Participants Commercially insured, opioid-naïve adults aged 18–64 hospitalized for TBI and/or long bone fracture (LBF).Design Retrospective observational study.Main measures We identified patients filling an opioid, benzodiazepine, muscle relaxant, gabapentinoid or non-steroidal anti-inflammatory drug within 30 days of discharge by injury type (TBI, LBF, both). We calculated the difference in prescription prevalence from 2016 to 2022 among patients with TBI compared with the difference among patients with LBF to estimate the change in prescribing practices over time and then used modified Poisson regression to adjust for confounders.Results We identified 15,928 patients with TBI only (39.4%), 22,912 patients with LBF (56.6%) and 1,615 patients with both TBI and LBF (4.0%). The proportion of patients filling an opioid was 45.4% after TBI, 75.4% after LBF only and 72.3% after both TBI/LBF. Among all patients, opioid fulfillments were lower in 2022 compared with 2016 (54.6% vs 69.9%; adjusted relative risk (aRR) 0.79 (95% CI 0.77 to 0.82)). Patients with all injury types observed a decrease in opioid prescribing (TBI/LBF: −19.0% (95% CI −27.5% to –10.6%); TBI only: −17.2% (95% CI −20.2% to –14.2%); LBF only: −13.7% (95% CI −15.8% to –11.5%)). Gabapentin use increased from 2016 to 2022 (6.8% vs 19.3%; aRR 2.80 (95% CI 2.52 to 3.11)) whereas muscle relaxant use did not change (14.5% vs 13.5%; aRR 0.93 (95% CI 0.85 to 1.02)).Conclusion Opioids remain a significant component of postdischarge pain management for hospitalized patients with TBI, with and without LBF, although the prevalence of opioid prescription has declined.Level of evidence Level III