This study reports the results of a researcher-administered survey with 115 patients receiving chronic opioid therapy (>90 days) to obtain information regarding how chronic opioid therapy was started. Chronic opioids were started after surgery (27.0%, 95% confidence interval [Cl], 18.5-35.5) or for the treatment of acute injury-related pain (27.0%, 95% CI, 18.5-35.5). Many who initiated opioid therapy after surgery reported postoperative complications (61.3%, 95% CI, 50.8-71.8) and many with injury-related pain reported follow-up corrective surgery (58.1%, 95% CI, 47.5-68.7), which led to the continuation of opioids. A large percentage of patients had concurrent depression (43.5%, 95% CI, 34.0-53.0) and anxiety (23.5%, 95% CI, 15.3-31.7). Many participants had a medical history of aberrant drug-related behavior (32.5%, 95% CI, 23.5-41.5) and self-reported history of addiction (21.7%, 95% CI, 13.7-29.7). Almost one-quarter reported taking opioids for a different indication than that for which opioids were started (95% CI, 26.6-45.0). Patients receiving long-term opioid therapy often transitioned to chronic use after starting opioids for the short-term treatment of postoperative or injury-related pain. It is not evident if a clear decision to continue opioids on a chronic basis was made. This survey provides insight as to how chronic opioid therapy is started, and may suggest opportunities for improved patient selection for opioid therapy. Perspective: This article explores the reasons why patients using chronic opioid therapy (>90 days) initiated opioid medications. The results of this study may help clinicians better select patients for chronic opioid therapy. (C) 2017 by the American Pain Society