This presentation will review the scope and history of the chronic pain and opioid epidemic in the US.  It will then discuss how chronic pain and opioid use is being dealt with in community settings, with a focus on primary care physicians.  The presentation then discusses the application Lipsky's theory of street level bureaucracy to explaining physician and patient behavior related to chronic pain and opioids.  Implications for standard laboratory testing for opioid use and its application to the community is discussed.