Medical practice with respect to the use of opioids for the treatment of pain has been heavily influenced by societal perceptions of problems of addiction and by laws governing the use of opioids. To effectively use opioids for the treatment of chronic pain, physicians must recognize pervasive, but clinically often irrelevant societal and legal influences on prescribing, while at the same time respecting opioid properties which may lead to unwanted consequences in the course of opioid therapy. This paper reviews history and legislation that has shaped medical prescribing of opioids, examines the potential risks and consequences of long-term opioid therapy and assesses three models of long-term opioid therapy.