The problem addressed by this phenomenological qualitative study examined the decision-making elements of pharmacists when presented an opioid prescription. Pharmacists are in a precarious situation amid an assumed honest prescribing doctor and an authentic patient in need of medical relief. With the epidemic increase in opioid drug misuse and related deaths, a pharmacist’s decision to dispense or to deny an opioid prescription can be risky to the patient’s well-being. The purpose of this lived experience study was to detect and explain the rationale used by pharmacists when presented an opioid prescription to better understand the virtuous decision making process. The study used four overarching research questions: (1) How do pharmacists decide to fill an opioid prescription when she or he suspects a patient’s drug abuse or a patent’s diversion behavior? (2) How does a pharmacist use her or his ethical judgment when presented with opioid prescription refills for a patient with an unknown opioid addiction? (3) What impact, if any, had the prescribed opioid epidemic had on pharmacists’ decisions to fill or to deny opioid prescriptions? (4) How do pharmacists uphold the Oath of the Pharmacist with the ongoing opioid epidemic? Guided by the research questions, interviews were conducted to ascertain the foundational elements of decisioned opioid prescriptions from community based pharmacists. The theoretical framework that supported this study was based on ethical and process decision making theories. Purposeful and snowball sampling were used to identify and select participants who were actively employed pharmacists at either an independent or retail chain pharmacy. Data collection was completed through semi-structured telephone interviews. The interviews were transcribed and analyzed using NVivo 12 Plus qualitative data analysis software. The study research contributed to the prevailing research into pharmacy practices while expanding the ethical decision making theory to druggists. The research findings provided insight into a dominant theme that pharmacists’ underlying opioid decision factor was the patient’s health. Subordinate to the dominant theme was: (1) patient behaviors; (2) professional integrity; (3) knowledge of the patient; (4) knowledge of the doctor; (5) knowledge of the community; (6) opioid crisis awareness; and (7) legislative changes.