The discussion and deliberation about the value proposition of opioid analgesics in long term pain management, along with state and federal regulatory guidelines/recommendations, have redefined the term “opioid risk.” The informed consent process used to involve identifying, communicating, and ensuring that the patient understands the risks and benefits. That was all part of autonomous shared decision-making and incorporating any modality into a comprehensive pain treatment plan. However, when opioid analgesics are determined to be an appropriate component of pain treatment, these familiar processes need to be modified. Patient level risk of adverse effects and development of unhealthy use continue to be of paramount importance. This presentation will identify and explore how we use “new math” to perform an opioid risk/benefit analysis that incorporates not only patient level risk, but also considers household, community, and societal risk as part of our informed consent process to better facilitate understanding, communication, trust, safety, and regulatory adherence.