Recent shifts in opioid prescribing practices, although well-intentioned and necessary at times, have also led to decreased access and adverse outcomes for some stable, opioid-treated patients experiencing chronic pain. TOWard SafER Opioid Prescribing (TOWER) is a provider-facing intervention designed to support HIV primary care providers’ adherence to CDC Opioid Prescribing Guidelines. TOWER includes three components: prescription opioid management training including patient-recommended communication strategies; access to patient-reported risk-benefit data via an app; and a medical encounter note template. This study describes qualitative findings of a randomized trial examining outcomes among TOWER-trained providers vs. usual care. Review of visit content demonstrated greater guidelines alignment among intervention provider encounters: topic areas with greatest discrepancies included discussions of treatment goals and progress assessment, opioid medication adherence review, and evaluation (and discussion) of harms/risk factors.