Introduction: The rate of prescription opioids for adolescent patients is increasing. Initial exposure to opioids is most commonly from prescriptions and the increasing rate of opioid misuse is linked to prescription exposure. There are limited recommendations on indications for opioid use among adolescents. Conclusion: Pain type is not associated with an increased odds sustained opioid use, but quantity of take-home prescription is. Given opioid misuse is linked to prescription exposure, limiting the amount of opioids available at home may help. There is a role for better physician patient communication surrounding opioid prescriptions and tailoring discussion and follow-up appointments around known risk factors.