This commentary relates to an article entitled "Off-Label Prescribing of Medications for Pain: Maintaining Optimal Care at an Intersection of Law, Public Policy, and Ethics," which appears in the same journal issue. Off-label prescribing and off-label marketing of drugs are differentiated. Vulnerability of pain patients with off-label prescribing is noted as is the lack of data on benefits and risks of the practice. The influence of the pharmaceutical industry in off-label prescribing is discussed. A lack of transparency when communicating with patients about off-label drug use is a concern.