Often, the prescriber determines to stop therapy even when the patient wants to continue. The discussion with the patient about the indication to discontinue is key to successful communication.
The prescriber should explain the rationale for stopping the therapy. If there is a clear indication for stopping, such as illegal activity or harm outweighing benefit, then the discussion is focused on how to help the patient without using opioid medications. If the indication for stopping therapy is less clear it may be an opportunity to reevaluate the entire pain treatment program and patient goals.
Sometimes the prescriber sees signs of a use disorder. These are some of the most difficult conversations to have with a patient. The prescriber should reference observed behaviors and objective data (e.g. urine drug screen, PDMP, pill counts) when discussing with the patient. Patients often deny or disagree in the moment but may reconsider the conversation at a later time. The key at this point is to maintain the therapeutic relationship with the patient.