Hillbilly heroin

I've kinda changed my mind -- kinda -- about opioid prescribing. I used to lean toward emphasizing that doctors are often too reluctant to prescribe opioid analgesics, that they can be a tremendous boon to people in chronic pain, and that a) short term use for pain relief seldom leads to addiction and b) if people who need them basically forever technically become addicted, who cares? Biologically, maintenance on a steady level of opioids can have some side effects, such as constipation, but people can function perfectly well and in fact better than they would in chronic pain.

But, as CDC reports here, we have a large and growing problem with prescription opioid abuse and the ultimate manifestation, that we can't look away from, is death by overdose. It turns out that by 2008, death from prescription drug overdose rivaled death from motor vehicle crashes, the leading cause of unintentional injury death (36,450 vs. 39,973). Since motor vehicle deaths are declining (due to socialist fascist nanny state regulations such as air bags, antilock brakes, etc.), and prescription opioid ODs are increasing, those lines will probably cross soon if they haven't already. (By the way, it's non-Hispanic whites who are at by far the highest risk. African Americans and Hispanics have much lower rates of death from misuse of opioid pain relievers. They're much more likely to end up in jail for drug offenses, but they commit them less often. This is another national scandal.)

However, I've only kinda changed my mind. As the linked report also states, it has been found that 3% of physicians account for 64% of opioid prescriptions, and there's plenty of evidence that most of this epidemic is linked to "Pill Mills" -- unscrupulous operations that hand out scrips without appropriate medical indication, evaluation, or follow up. Astonishingly, the governor of Florida, the state with the highest concentration of these operations, long resisted efforts to crack down. It's still likely that many physicians are withholding relief from some people who ought to get it. But we need to stop these criminals.