In recent years, the precipitous rise in opioid overdose fatalities in the United States has led to the widely held view that the problem has reached the level of a crisis or epidemic. However, the opioid problem has been simmering for many years, and state policymakers have been working to address this issue long before it prompted widespread public recognition. Looking back at the early opioid-related policy efforts in several states—when options were more resource-constrained—reveals valuable reflection points for lawmakers continuing to address the problem. This brief summarizes common insights and experiences of state policymakers working to address opioid issues, collected in 2015 from the first seven states to participate in the National Governors Association’s Prescription Drug Abuse Reduction Policy Academy. This brief is intended to provide a retrospective on states’ efforts to curb opioid misuse from 2012 through 2015.