Substance use disorder (SUD) is a multifactorial issue that leads to over 67,000 overdose deaths annually, with the most recent data identifying 98,000 deaths in 2020 according to the Center for Disease Control (CDC). In 2018, Staten Island, with a population of approximately 500,000, was identified as the epicenter of the opioid epidemic in New York City. One specific area of concern during an analysis of potential causes was that the number of opioid prescriptions per capita, dosing, and duration on Staten Island far exceeded city and state norms. A committee of prescribers was formed to create safe prescribing guidelines. The recommendations included prescribing standards, education on non-opioid alternatives, safe disposal, and screening for substance misuse. Community-wide attention was brought to the topic via media campaigns, patient literature, and the involvement of multiple community stakeholders. After the education of over 500 prescribers, the postintervention period resulted in significant and sustained reductions in all indicators. The greatest improvements were in total prescriptions filled, which were reduced by over 12,000 prescriptions or 31% (p-value <.00001), and in recipients of opioid prescriptions, which reduced by over 1,700 individuals or 22% (p-value <.00001). Continuing education, recruitment of new practitioners, and on-line education was instituted to ensure sustainability.