I understand the issue from the medical side and from the patient side functioning from both most of my life. I am a chronic pain sufferer. As long as its chronic I can manage without opioids or narcotics of any kind but if an acute issue rises then it can be more than one can stand. Communication and transparency is the key. If the patient is not following the strict guidelines set forth for them then the MD must protect their license and cut them off but recommend the see someone because that patient if a long term user/abuser then it can be dangerous not to titrate in a protected monitored environment. In the end responsibility lies with the patient. Not prescribing is silly. Responsible prescribing is smart along with referrals to PM and R doctors.