This article outlines a public health-oriented framework to opioid stewardship in primary care, emphasizing safe prescribing, risk assessment, and treatment of opioid use disorder. It reviews evidence-based practices for managing chronic pain, mitigating overdose risk, and initiating buprenorphine in primary care. The article highlights the importance of individualized, patient-centered care, addresses barriers such as stigma and regulatory fear, and underscores the value of collaborative care models—including pharmacists, behavioral health, and peer support—to reduce opioid-related harms and improve outcomes.