Controversies continue to exist regarding safe and appropriate management of people with chronic pain. The "pendulum has swung in the other direction" with respect to the utility, safety, and efficacy of the use of opioids as a key component of chronic pain treatment. It seems to be unclear to many what can rationally be offered to patients whose lives have been derailed by often debilitating chronic pain. This is further complicated by the "opioid epidemic" that has resulted in a dramatic increase in unintended deaths related to opioids, heroin, and now fentanyl. This presentation will detail many of the hurdles that exist in clinical practice trying to compassionately help and support patients while navigating the challenges and pressures of state and national guidelines, educational deficits, ethical dilemmas, and regulatory scrutiny. This discussion will include the fact that in many cases, clinicians have questioned whether or not it is worth the effort to try to conform to all of the constraints involved, especially in the face of decreased available resources and funding. Intended and unintended consequences of this exodus will be addressed, along with possible strategies for preventing it.