Treating patients with restless legs syndrome (RLS) may pose a significant challenge to the clinician if those with intractable disease worsen with chronic treatment. Opioids are established as effective treatment for refractory RLS; however, some patients may be reluctant to try opioids because of the risk of dependency. Understanding the physician's duty to the patient through the framework of a shared decision-making model allows the neurologist to propose opioid therapy despite possible initial reluctance by the patient when the neurologist believes that this therapy is the most medically reasonable approach to optimizing the patient's well-being.