Mounting evidence suggests patients diagnosed with cancer may be at increased risk for opioid misuse and diversion. Substance use disorders (SUDs), involving prescription medications and/or illegal substances, may significantly compromise the ability of healthcare professionals to deliver high-quality cancer care. A substance use screening pilot was conducted in ambulatory oncology clinics at a large cancer hospital in the midwestern United States. In this article, the authors present results from this quality improvement project. Future directions involve innovative methods to deliver addiction-specific knowledge to oncology healthcare providers and should focus on discussing screening results, as well as providing tailored recommendations using shared decision-making with patients and caregivers.