Opioid analgesics are commonly used medications for the treatment of acute and chronic pain syndromes associated with multiple disease states. However, their use is often limited by adverse effects. Opioid-induced pruritus (OIP) is one of the most common adverse effects, affecting patients on oral and neuraxial opioids. Although not life-threatening, pruritus is an unpleasant side effect potentially contributing to patient discomfort, decreased quality of life, and noncompliance. The occurrence of pruritus varies with the type of opioid, dose, and method of administration. Pharmacists can make interventions that will optimize control of, or reduce the incidence of, OIP. An understanding of the receptors, mechanisms, incidence, and pharmacological therapies available to manage OIP is required knowledge for practitioners caring for patients who use opioids.