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* Abbreviations: EMR — : electronic medical record QI — : quality improvement Since the early 1990s, the United States has been fighting the epidemic of opioid addiction. Increases in the prescription of over-the-counter opioid pain medications were correlated with a notable rise in overdose deaths as early as 1999.1 These trends may have been driven in part by national efforts to improve the assessment and management of pain among patients and the “pain as a fifth vital sign” culture.2 In this issue of Pediatrics , Bryl et al3 describe their quality improvement (QI) initiative to decrease prescription of opioid medications at discharge from their urban pediatric emergency department. Evaluation of data showing that nearly half of the opioid-related deaths among patients 0 to 21 years in the San Diego area involved patients seen at their institution prompted a call to action. As the largest pediatric provider in that region, achieving a decrease in the group’s prescription of opioid medications could have a significant impact on this population. The team used rigorous QI methods to guide their initiative. These included developing a specific … Address correspondence to Jacqueline B. Corboy, MD, MS, Division of Emergency Medicine, Ann & Robert H Lurie Children’s Hospital of Chicago, 225 East Chicago Ave, Box 62, Chicago, IL 60611-2991. E-mail: jcorboy{at}luriechildrens.org