The expanded use of opioids for chronic pain has created a population of patients prescribed long-term opioid therapy lasting years or decades. Doses are often above the thresholds suggested in the 2016 Centers for Disease Control and Prevention (CDC) guideline (morphine-equivalent dose >50 or >90 mg/d). Long-term opioid therapy is associated with adverse effects, morbidity, and overdose death; some risks are dose-dependent. At the same time, evidence indicates that long-term opioid therapy confers little benefit versus nonopioid therapy, particularly for function. Opioid use disorder (OUD) occurs in a subset of patients, and quality of life may be adversely affected despite perceived pain benefits.