The challenge for physicians and public policymakers is how to deter prescription drug abuse while maintaining patient access to appropriate treatment. The physician must be up to date on the proper use of medications and treatments, including pain medications. Physicians have an ethical obligation to manage and relieve pain yet to do so responsibly and in accord with scientific evidence (11). Improvement in function through the short-term use of opioids and related substances to treat acute pain and their use to ease suffering at the end of life are well-accepted medical practices. However, long-term opioid use for chronic pain is controversial because of concerns about addiction, overuse, misuse, and adverse effects. Long-term use can also lead to opioid-induced hyperalgesia, which in turn leads to increased doses of opioids, further escalating sensitivity to pain. Furthermore, evidence for long-term efficacy is lacking (12). Concerns about pain being underdiagnosed and undertreated remain, particularly for ethnic and racial minorities (13). The result is needless suffering for patients, complications that cause further injury or death, and unnecessary treatment costs. Controlled substances include medications to treat not only pain but also sleep disorders, nerve conditions, weight loss, and other conditions. However, prescribing controlled substances, which can be addictive or abused, can subject physicians to substantial regulatory and administrative burdens. Physicians face criminal and civil penalties, including loss of licensure (and consequent inability to practice) for failure to comply with state and federal laws regulating controlled substances. On the other hand, failure to adequately medicate a patient can expose a physician to malpractice charges of negligence. Physicians can also be sued for overmedication that results in addiction or serious adverse effects (14). State medical boards also report addressing complaints for both overtreatment and undertreatment of pain.