Outpatient opioid prescribing for chronic pain remains a critical aspect of clinical practice, requiring careful consideration of efficacy, safety, and regulatory compliance. This chapter provides a review of principles guiding opioid use in the outpatient setting, emphasizing patient selection, risk stratification, and monitoring strategies. It outlines the importance of a structured clinical evaluation, including assessment of pain characteristics, functional impact, and coexisting psychiatric or substance use disorders. Key elements such as opioid agreements, urine drug screening, and prescription drug monitoring programs (PDMPs) are discussed in regard to responsible prescribing. The chapter also reviews opioid titration strategies and management of common challenges such as tolerance, hyperalgesia, and breakthrough pain. Additionally, the role of co-prescribing naloxone and integrating non-opioid and non-pharmacologic therapies is discussed. This chapter aims to equip clinicians with the knowledge necessary to provide safe and effective opioid therapy while minimizing the risk of misuse, diversion, and adverse outcomes.