Hypothetical case: You've got a 50-ish patient, chronic back and neck pain, axial neck, axial and radicular back. He's tried a lot of conservative treatment including multiple meds, PT, HEP, a couple LESI's and a L4-5 laminectomy 3 years ago. He's tried and failed several NSAID's, tramadol, gabapentin and pregabalin, amitrptyline, venlafaxine - all the usual suspects, none with significant improvement in either pain or functioning. He's been on hydrocodone 10/325 mg QID for the past 2 years, it "takes the edge off" and keeps him working as a machinist. No Hx substance abuse, no opioid issues in the past as far as you can tell from the records available. He is a smoker, infrequent alcohol use. After a review of recent MRI and Hx/PE, you discuss/offer him interventional procedures such as TFESI, FJI/RFA, maybe even SCS. He politely declines them all, saying injections haven't helped him in the past, some have made him worse and he doesn't want more surgery. Further PT unlikely to help, plus his schedule really doesn't allow for it. He's got about 10 years to retirement. Fill in the rest of the history with your experiences with this patient - we've all seen him. If you had been treating him for a few months, would you continue to prescribe the opioid? If this was your first visit with him, would you take over precribing? Would the referral source matter? Would his insurance matter (e.g. BCBS vs WC vs Medicaid)? What this gets down to is, would you be willing to prescribe opioids to this guy for the next 20 - 30 years or so, given that he appears to be a straight shooter, appears low risk for abuse, but you're not likely to do any other procedures on him?