Bob Dylan’s 1965 song, Highway 61 Revisited, provides us with an interesting way to examine the challenges the Main Street Practitioner faces today and beyond in pain management and medication assisted treatment (MAT). How does one demonstrate individualized patient care and “authorized” medical treatment when prescribing controlled substances? Does a patient’s use of marijuana impact a DEA registrant’s ability to demonstrate “authorized” opioid prescribing? You may be thinking, “What do I do with patients who require care that might be perceived as being on the fence dividing authorized (valid) prescribing from unauthorized (invalid/illegal) prescribing? Where do I turn for answers?” The Main Street Practitioner knows he/she should not wholly ignore the drama resulting from stakeholder activities on different sides of the marijuana, MAT, and opioid debates. This lecture is for those seeking an improved understanding of—and roadmap for—addressing challenges today and beyond. Key takeaways include ideas for proactively demonstrating compliance with applicable licensing board rules and controlled substances laws, while also genuinely caring for and treating patients who face their own complex issues in our rapidly changing society. Additional Reading List