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Opioid use disorder has drastically increased in recent years within adult populations. Limited understanding exists regarding how people enter medication-assisted treatment (MAT) for opioid use disorder—particularly those who initiate opioid use to treat a painful condition.This research examines the process involved when adults first initiate the use of opioid medicines to treat pain through enrollment in an outpatient MAT program.Grounded theory methodology guided the study. Data analysis included interpretation of interview transcripts from 10 adults who were enrolled in a single outpatient MAT program in the Pacific Northwest. Inclusion criteria were adults in MAT reporting that their initial use of opioids was to treat their pain. Corbin and Strauss’ approach to theory development was followed.A newly developed theory titled Living With Persistent Pain: From Opioid Initiation to Substance Use Treatment was supported by three predominant categories emerging from the data: “addiction pathway,” “becoming normal,” and “relationship spectrum.” The core category “living with pain” was described as a complex and tumultuous process spanning the emergence of pain, to the initial use of opioid medicines, through opioid addiction and MAT. A notable aspect of this process was the turning point to enter MAT, which was both helped and hindered by significant relationships.The decision to enter MAT for opioid addiction was key to helping participants gain a sense of normalcy. Insights gained from participants’ experiences—particularly in relationships with healthcare providers—can be used to guide treatment approaches.