It is easy to suggest time-consuming, unreimbursed approaches to improve the safety of opioid prescribing without specifying how they can be incorporated into already overburdened clinical settings. Frankly, we do not know how to increase clinical diligence without additional work, time, or money, although technology can facilitate some of these suggested practice changes. The threat to patient safety is too great to allow current pain management and opioid-prescribing practices to remain as they are. Dunn and colleagues' data show the need to assess the risk for opioid misuse, provide close oversight, dose judiciously, and continually reevaluate the benefit of these potentially risky drugs. Smarter, more responsible practices are the only hope to avoid tragic, avoidable deaths.