Pain is the most common reason for medical care in the United States (Vukmir, 2004), with 32.8% of the U.S. population experiencing persistent or chronic pain symptoms. Undertreatment of pain is pervasive, as Congress declared 2001 to 2010 "the decade of pain control in research" and pharmaceutical companies responded with more effective medications to fight pain. However, nonmedical use and abuse of prescription pain medication has risen at an alarming rate in the United States within the past 5 years, especially among adolescents. The number of those abusing prescription drugs exceeds even combined numbers of those abusing cocaine, heroin, inhalants, and hallucinogens. This article examines the intersection of policies addressing nonmedical use and abuse of prescription pain medications and effects of enforcement strategies and policy direction on pain patients. Alternative policy direction and enforcement strategies are discussed.