We live in one world, which is divided by two opioid crises: Much of the world suffers not from abuse of opioids, but absence of them. Withholding evidence-based analgesia to children with serious illness is not only unethical, but causes immediate and long-term harm. Opioids are associated with many side effects and are potentially lethal - but, no other analgesics equal in potency and effect have been discovered or developed to reduce pain and suffering. The potential risks in the safety of analgesics is real, but very manageable and cannot justify denying administration of opioids to patients with severe tissue injury and/or serious illness.