There is no financial information to disclose. An opioid epidemic is currently affecting millions of Americans. Overdose deaths involving prescription opioids were 5 times higher in 2016 than 1999,1 and sales of these prescription drugs have quadrupled.3 From 1999 to 2016, more than 200,000 people have died in the U.S. from overdoses related to prescription opioids.1,2 Prescribing habits vary widely between residents in training programs. We hypothesized that the implementation of an evidence-based narcotic prescription protocol4 would decrease overprescription of narcotics in a surgical training program. An evidence-based narcotic prescription protocol was developed and instituted in the plastic surgery training program at the Medical University of South Carolina for 1 year. Three patient groups identified based on patient history of narcotic use, surgical procedure, and a combination of narcotic, NSAID, and adjuncts were recommended for each group. Using a national prescription monitoring program (PMP), we compared the prescription habits of residents and interns for the 5.5 months following implementation of the protocol to the 4 months prior to implementation. T-tests, ANOVA tests, and linear regressions were used as appropriate. All narcotic prescriptions were converted to oral morphine equivalents (OME) for standardization. 975 narcotic prescriptions were written by the residents and interns during the study period. Prior to development of the protocol, the mean morphine equivalents per prescription by residents varied significantly (ANOVA test, P ≤ 0001). Four of the 5 residents had a significant reduction in their mean morphine equivalents prescribed postimplementation (range: –64 to –17 OME/prescription, P < .01). The mean OME per prescription for the residents was reduced from 287.4 to 184.6 (P < .001). The mean OME per prescription by the interns was also reduced from 441.9 to 319 (P < .001). •An evidence-based narcotic prescription protocol significantly reduced the mean OME per prescription among trainees in a surgical residency program.•Junior trainees still tended to prescribe more OME per prescription than senior trainees.•More emphasis should be placed on discussing pain management in residency training programs.•Further research should be undertaken to identify effective methods of training residents to avoid overprescription of narcotic pain medication.•Partnering with national or state-sponsored prescription monitoring programs is an ideal way to monitor the success or failure of narcotic prescription protocols and identify areas for improvement.•Other training programs should implement similar protocols and share their results to further develop effective methods of curbing narcotic pain medication overprescription.