Hey Scott, You are absulutely right. His prescribing practices don't really make sense. Normally docs will follow the principles of their specialty, Use the guidelines of their specialty orginizations and try to follow manufacturer recomendations. By following a set standard it actually protects the doc from investigation.
Flying alone with your own theories puts him at more risk of investigation than following the principles of the AAPM or even the prescribing guidelines from a manufacturer of a particular medication.
His lone wolf aproach will make him stand out and alone and doesn't give him any back up from orginazations that he may be part of or the principles of treatment he should subscribe too. It is hard to change a docs views on opiates and I'm sure he belives he is helping but with improper dosing and setting you up to go through withdrawal ever night pretty much negates any good he may think he's doing.
Lay them out and have a back up in palace, as in an apt already made with another PM doc should he decide or your decide it's time to part ways. His method may work for some people. Ceratian conditions don't cause pain around the clock every day, some conditons kind of move from flair up to remission to flair up again. Fibro for example. A patient may have days where they function quite well, those days may last weeks or may be short lived. His method of prescibing may suite this type of patient, where they have days where minmal meds are needed and this allows them to set meds aside for when round the clock meds are needed. But your not in that population of people that probably could get buy with PRN dosing.
Maybe it's just comunication and he thinks you have days that your med needs are minimal and this allows you to save for when your med needs are higher. With constant intractable pain, you really don't have that oportunity to save meds for the bad nights.
He may believe his prescribing leaving gaps will somehow hinder dependence because the treatment isn't continuous, if that's his idea, again, he's standing alone in a ield with a big red X begging to be investigated because he isn't following anyones principles of pain management but his own.
I know a few people like that in the real world, they aren't docs, but there are folks that you just can't tell them a thing, they think they are right in everything they do and say, and arguing your position or an acurate theory is just met with his own beliefs whether they are right or wrong, he stands strongly by his own decisons.
For an example, I was at a friends house who had injured his back recently, he was prescribed Norco, another guy we knew showed up and started to tell us everythng he knew about narcan, you couldn't tell him he was talking about a different med entirely, he thought he was right, climbed up on his soap box and just spewed garbage out about his knowledge of Narcan. Not that he's ever taken opiates long term or ever needed to use Narcan or knew anyone that did. But there was no changing his mind that we were not talking about the same thing. So, me and my injured bud just let him ramble on till he felt he had convinced us that he was more knowledgable about this med than we were.
I don't mind letting someone think they know more about something than me, I just sit back and smile and let someone ramble about things totally unrelated because there is no point in wasting your breath trying to tell someone like that, that they are wrong. Just as your docs idea that SA meds last 6 hours is wrong, but is it possible to convince him otherwise?
Just because some of his patients are satisfied with the amount of short acting meds, you can't slam every square patient into a round whole and insist they respond the way his other patients respond.
So work on your back up plan and have that in place when you go and lay the cards on the table, explain how the SA medds work, wait 45 minutes, cram activity into 3 hours and then lay down until it's time to take another SA med and give it time to work so you can start the darn cycle all over.
Even if he switched you to 4 30 mg Roxicodone a day, Unless you break them in half and dose every 3-4 hours, you would run into the same problem. I don't know why docs think a larger dose lasts longer than a smaller dose, It just raises your serum level for the exact same amount of time.
Good luck and let us know how things turn out.
Was that quote from the AAPM's use of opiates statement, I'll take a look for it and if that wasn't it I'll post it for you.
Take care, Shore
Re: shore
on your Dr. for not listening, I mean really listening and helping you appropriately. I hope things work out for ya, I really do...it's just not right when people are denied proper care, especially for chronic pain. It irks me to no end....take care and please let us know how it goes k? Thanks, Surg Disaster 
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