Opioid-induced nausea and vomiting is a distressing symptom affecting the quality of life of patients and complicating the management of their pain. With initiation of opioid therapy, nausea with or without vomiting is not uncommon. While some patients may experience this side effect only transiently, for others it may be persistent. This presentation will explore the risk factors predictive of opioid-induced nausea in patients with chronic cancer and noncancer pain. The audience will be introduced to the 4 interrelated neural pathways that mediate nausea and vomiting, and also where anti-emetic therapies act in these pathways, particularly as it relates to opioid-induced nausea and vomiting. Although not completely known, the suspected 3 part pathogenesis of opioid-induced nausea and vomiting will be explored. Finally, this presentation will address strategies for managing opioid-induced nausea such as anti-emetic use, opioid rotation/reduction, and changing the route of administration. With greater recognition and understanding, we can tame the opioid-induced spew!