Covid-19 has overshadowed another severe health crisis, which has also been called an epidemic, though not of infectious origin: the misuse of opioid drugs that has generated an enormous morbidity and mortality, particularly in North America, but threatening to increasingly affect Europe as well. In this crisis, misuse, overuse and underuse of opioid medication converge to form an intricate public health problem. This article reflects on some salient ethical implications of the opioid crisis from the lens of a clinical ethicist, exemplified by real case vignettes of clinical ethics consultation (CEC) in a Swiss university hospital. In the ethical analysis, potential responses to this crisis will be presented on three levels: the micro-level of individual clinical ethics, the meso-level of organizational ethics in healthcare institutions, and the macro-level of public health ethics. The important role of clinical ethicists will become evident, particularly for the first two levels.