The opioid epidemic has drawn increasing attention as opioid prescribing rates and opioid related deaths continue to rise. Opioid prescribing by health care providers has quadrupled over the past 18 years and is directly proportionate to opioid-related overdoses. Primary care providers initiate chronic opioid pain management and frequently fail due to the multifaceted nature of chronic pain. A rural North Dakota health care system implemented strategies to improve chronic opioid pain management. Strategies were based on the 2016 Centers for Disease Control and Prevention Guideline for Prescribing Opioids for Chronic Pain. Interventions were directed at improving opioid prescribing practices for chronic non-cancer pain management of primary care providers and reducing risks of long term opioid use. Providing clinicians with education and a quick-reference sheet on current evidence-based recommendations and accepted best practices developed their knowledge to complete remaining interventions. Chart audits identified patients on chronic opioid therapy, patients with a signed pain contract, and those with daily opioid doses meeting or exceeding recommended upper daily morphine milligram equivalence. Provider notification of identified patients allowed for further recommended interventions. Chart flagging allowed providers to easily identify patients currently on a pain contract, patients eligible for a pain contract, and patients receiving the upper daily morphine milligram equivalence limits. Evaluation was performed four months after initiation of the project. Results showed the education provided increased clinicians’ knowledge and comfort in the evidence-based guidelines for managing chronic pain with opioids. Recommended monitoring strategies were improved after providers received education. Evaluation found the prescription drug monitoring program review and documentation had improved from 0 to 18. Annual urine drug screens increased from 9 to 15. Eighty-five percent of pain contract eligible patients were enrolled in a pain contract. Evaluation of patients prescribed daily morphine milligram equivalence ≥ 50 and ≥ 90 that had appropriate recommended interventions were 57% and 50% respectively. Forty-five pain management patients were identified at the time of evaluation and flagged in the electronic health record. Overall, each intervention implemented showed improvement upon comparison of pre-implementation and post-implementation data.