Backgrounds <p>Opioid crisis is surging globally including Pakistan. Opioid stewardship programs can play a fundamental role in avoiding and dealing with this crisis. The objective of this study was to evaluate the awareness of policies and regulations of opioid stewardship practices in hospitals and attitudes of healthcare professionals towards strategies to optimize appropriate opioid use in the hospital setting across the whole country.</p> Methods <p>In this cross-sectional study data was gathered conveniently from 34 government and 25 private hospitals selected across the whole country from February 2023 to September 2023. Data were acquired from various healthcare professionals (doctors, surgeons, pharmacist, nurses etc.) operating in diverse hospital environments. A self-structured questionnaire of 49 items was employed to gather data on healthcare professionals’ understanding of the opioid epidemic, their awareness and adherence to legislation regarding opioid stewardship, and proposed strategies for optimizing opioid usage. Descriptive statistics were employed for nominal and continuous variables utilizing R (version 4.4.2, R Foundation for Statistical Computing, Vienna, Austria).</p> Results <p>Out of 3983&#xa0;approached individuals, 2838 answered the questionnaire (71.2%), with a predominance of males (59.6%) and government employees (55.0%). The majority of the populace was concerned about the situation of opioid crisis, perceiving it as both a national and global issue, with around two-thirds viewing the stewardship program as a solution. Awareness and adherence to opioid regulations were inadequate and only 27.7% were aware of the requirement for patients to sign an agreement for opioid medication, and just 22.2% mindful of access to the drug monitoring program. Likewise, healthcare professionals exhibited inadequate clinical practices, with the greatest rates pertaining to access to treatment recommendations on dose and monitoring for chronic pain (55.5%), whereas 55.3% said that healthcare professionals review the appropriateness of palliative drugs following discharge.</p> Conclusion <p>Healthcare professionals deemed opioid crisis as a threat and despite of its emergence globally and nationally they demonstrated poor adherence to guidelines. This further strengthened by their views about opioids stewardship program as solution to crisis. To contribute to safer consumption practices of opioids in hospitals additional, structured opioid education and formal stewardship practices are required.</p>