Table 1.

Summary of themes and sub-themes

Theme	Sub-theme	Example
(1) Difficult conversations
	(a) Patient objections and complaints	“they beg, they plead, they think if they talk to you enough you’ll change your mind… they go to the patient advocate and complain.”
	(b) Clinician ambivalence	“…it’s very hard to apply the new feelings on this to people who have been managing a different way for a very long time and I worry that it’s a little unfair to patients to all of a sudden…”
(2) Clinician strategies: verbal heuristics for difficult interactions
	(a) Safety heuristic	“Okay, it’s clear to us that you are not following through with the guidelines of the contract. And if that’s the case then… I do not feel comfortable prescribing for you anymore because you are using in a way that’s unsafe.”
	(b) Setting expectations heuristic	“I establish ground rules with them and now I am even saying no early refills even for legitimate reasons…”
	(c) Following orders heuristic	“I try to act as if this is just some kind of big cog in the government wheel and there’s nothing I can do.”
	(d) Standardization heuristic	“I make it a point to say that I do this for everybody so I that do not forget to do it on anybody…I do it for all my patients who are on prescription opioids whether they are 29 or 85…”