The opioid epidemic is has not ended. Sadly, we all know the statistics: of the 106,000 overdose deaths in the United States, 80,411 involved opioids (up from 47,600 in 2019). Even though these numbers are intimidating, culture change can be even more daunting. While some states have been successful in dramatically decreasing opioid prescribing and improving access to treatment for opioid use disorder, some have honestly lagged. During this session, we will discuss the legislative, administrative, financial, and work-force based challenges that an under-resourced state like Arkansas (currently ranked 49th in opioid prescribing) have encountered. We will discuss the many successes (and unfortunate failures) in our state. Lastly, we will provide pearls from our experience that could be applicable to any upstream or downstream initiative to improve pain care in the United States.