you have an issue with #2.
if i were you, i would do gradual weans over time. you need to tell him that his level of medication is unsustainable, and while each wean will cause some discomfort, things settle down, with time you will get him down - not to zero, but to a level that is reasonable, safe, and will not send flags to DEA/State DOH. and hopefully butrans. remind him that you two are in this together, but he is free to go see someone else to take over his pills. this is what you have to do.
you do not have to do this in 1 week or month or even a year. there is no set time frame. document a slow wean, from 150 mg oxy down to, say 60 mg. for example, i took over a patient on 300 mg morphine ER and 180 oxy, after fusion L1-S1 with stim that was replaced. over 3 months, we weaned off morphine, took a few month break and the next year we weaned from 180 oxy down to his current 60 mg daily.
unfortunately, you do have a diagnosis now - opioid dependence.
