Opioid Stewardship programs, endorsed by authoritative bodies such as The Joint Commission, National Institute of Health, National Quality Forum, and the American Hospital Association, represent a critical response to the opioid crisis gripping the United States. Despite the provision of toolkits and guidelines, these initiatives exhibit a predominant emphasis on reducing morphine milligram equivalents (MMEs). However, this singular focus fails to adequately address the evolving landscape of opioid-related deaths, which persistently escalate due to the influx of illicit fentanyl and its analogues.This presentation aims to scrutinize prevailing recommendations, pinpoint their limitations, and propose alternative strategies for opioid stewardship that prioritize patient-centric approaches and quality metrics. Rather than solely fixating on MME reduction, a more comprehensive framework should be adopted. This includes integrating measures that address the multifaceted aspects of opioid misuse and overdose, such as enhancing prescriber education, fostering safer prescribing practices, implementing robust screening and intervention protocols, and expanding access to evidence-based treatments for opioid use disorder (OUD).