Background and Aims: Population-based data on prescribed opioid use among adults with Crohn's disease (CD) remain limited. Methods: This nationwide register-based study included individuals >= 18 years with incident (2008-2019) or prevalent (2008-2021) CD and up to 10 individually matched reference individuals without inflammatory bowel disease. We categorised opioid dispensations as weak (e.g., tramadol) or strong (e.g., oxycodone). We calculated the prevalence of >= 1 dispensation and mean daily doses (MDD) of opioids per 6 month period from 2 years before until 5 years following CD diagnosis (for incident cohort) and annual dispensation and MDD of opioids (for prevalent cohort). Results: Among 10,527 patients with incident CD and 96,123 references, opioid dispensations were two-fold among patients 2 years before diagnosis (26.2% vs. 12.6%) and remained high 13-36 months after diagnosis (26.5% vs. 11.7%). In the prevalent cohort (32,306 patients and 289,516 reference individuals), there was a declining trend in the use of dispensed opioids. During observation, the use of weak opioids decreased substantially among individuals with CD (16.0% vs. 6.0%) and reference individuals (8.0% vs. 3.0%). However, opioid MDD only decreased substantially among those with CD between 2008 and 2021. Conclusion: Adults with incident CD had a two-fold higher use of dispensed opioids than references 2 years before diagnosis, which peaked at three- and four-fold higher use around diagnosis and remained high for 3-5 years. The decreased use of weak opioids might explain the recent decline in opioid consumption among patients with CD.