There is an increasing risk of opioid-related abuse, misuse, and diversion due to the rising usage of opioids in low- and middle-income countries (LMICs). As essential members of healthcare teams, pharmacists play a crucial role in opioid stewardship in LMICs and are in charge of prescribing and overseeing the use of opioids. This article outlines suitable tactics for encouraging responsible opioid use and discusses the potential and varied roles that pharmacists may play in opioid stewardship in environments with limited resources. Opioid stewardship entails giving evidence-based pain treatment, prescription, and management techniques top priority. It includes actions like implementing safe disposal through drug take-back programs, promoting non-opioid pain management, addressing the stigma associated with opioid addiction, tapering the dosage of opioids, educating patients and caregivers, setting up drug information centers, offering rehabilitative services, integrating collaboration with communities and experts, and incorporating prescription drug monitoring programs for appropriate prescriptions of opioids. The vulnerability to opioid addiction, misuse, and diversion in LMICs is exacerbated by the combined challenges of limited access to healthcare resources and services and low literacy levels. To ensure safe and efficient opioid use and reduce the risks of overdose and addiction, early diagnosis, evaluation, and implementation of treatments to optimize opioid usage are essential. One of the most important ways to close the current gaps in opioid stewardship in LMICs is for pharmacists to be involved in encouraging safe and efficient opioid use via monitoring, education, cooperation, and policy lobbying.