A 45-year old male presents to the clinic with a history of…

A 45-year old male presents to the clinic with a history of chronic low back pain after a motor vehicle accident that caused burst fractures at T12 and L1 resulting in 3 surgeries over the last 5 years.  He is taking meloxicam 15mg daily and acetaminophen 1gm tid.  He has a history of depression and is on disability. He has been to Pain Management and told “they can’t do anything for me.”  He admits he is smoking marijuana but has not pursued a medical marijuana card because he cannot afford it.  He is asking for “a small amount of oxy.”  He rates the pain as least 5/10, 10/10 when he is bringing in firewood.  He lives alone.   The NP is aware there are limited options for pain management for his condition and will perform a risk assessment using