In the wake of the opioid overdose epidemic providers often find themselves at the crossroads between declining to prescribe controlled substances as a matter of course, and starting or continuing medications as clinically indicated. Many times, providers find themselves in clinical situations where their clinical judgment is at odds with what the patient wants (and sometimes demands). This session focuses on how to have these conversations with patients using patient centered and trauma-informed communication tools. The use of these forms of communication, including a conversational roadmap, can improve the patient experience, attenuate shame and lessen the emotional burden on providers.