Background: Limited access to opioids in the Middle East results in pain undertreatment, particularly in palliative care. However, increased opioid supply, as seen in the U.S., can lead to a crisis. This review examines the opioid crisis in the Middle East, focusing on Israel and Saudi Arabia, to inform nursing practice and policy. Methods: A review was conducted using Web of Science, PubMed, ScienceDirect, and Google Scholar with the keywords “opioid crisis” and “Middle East.” Findings: The opioid crisis in the Middle East differs from the U.S., with tramadol being the primary drug of concern. Israel has seen a significant rise in opioid use, especially fentanyl and oxycodone, indicating a potential crisis. In contrast, Saudi Arabia shows lower opioid misuse but has issues with overprescription and poor dispensing practices. Discussion: The opioid crisis in the Middle East varies by country and requires tailored policy interventions. Nurses play a critical role in preventing opioid misuse through education and monitoring of patients prescribed opioids. Conclusions: Policy recommendations include mandatory pre-prescribing education by nurses. Future research should focus on nationwide surveys to provide a representative picture of the current state of the opioid crises in various countries in the Middle East.