Abuse of opioids has had and continues to have a devastating impact on public health and safety in the United States, and the use of opioids has increased dramatically in the last two decades. The purpose of this chapter is to examine the roots of this tragic state of affairs and what may be done about it moving forward. The authors review the medical-legal risks physicians face when prescribing pain relieving medications for their patients. Strategies are offered for staying out of trouble while providing quality pain management for patients.