OBJECTIVES: The number of patients on opiates for chronic non-malignant pain continues to grow. With an emphasis on treating pain, opiate medication is being used more often. Following patients in a Primary care clinic has become more difficult because of the increased time required to manage and assess medication effects and the large number of unscheduled walk-in visits. Our objectives were to reduce unscheduled walk-in visits, reduce substance abuse, and diversion. METHODS: We established a multidisciplianry opiate renewal clinic that meets once a week and sees between 20 - 50 patients in a group education setting. A thirty minute educational presentation is made each session; all patients undergo urine drug testing and blood work. Patients who are negative for prescribed medication receive a one week renewal and return date to rule out diversion. Patients who have street drugs present are referred for Substance abuse counseling and given a one week renewal. Patients who are impaired do not receive medication and appropriate referral is made. Patients who are compliant may receive a one month renewal and face-to-face vists every two months. RESULTS: Unscheduled walk-in visits decreased by 76%. Referrals for substance abuse treatment increased by 100%. It was previously difficult to diagnose substance abuse without drug testing. Approximately 32% of patients had positive urine for marijuana, cocaine or both. CONCLUSIONS: An Opiate renewal clinic for patients with chronic non-maligant pain and substance abuse can be a cost effective approach to management.