With the emphasis on pain control (i.e., pain as the fifth vital sign) starting in the late 1990s and the increased prescribing of opioids, the opioid epidemic began. With the expanding misuse of opioids a new emphasis has been given for more responsible management of opioid prescribing by health care providers in all specialties. Since the pain experienced by patients with chronic musculoskeletal pain and acute postoperative pain can be severe, specific attention must be given to these patients who may be at increased risk for opioid abuse. We review the opioid epidemic and the impact of the epidemic on physicians and patients. As a result of this epidemic, several intraoperative techniques have been developed to decrease the need for postoperative pain medication. In addition, we identify several key features of a patient's background and their behavior that can indicate a potential for opioid abuse or misuse. Treatment strategies for providers including opioid prescribing guidelines are also discussed.