> My wife, The Doctor, is a board-certified addictionologist, in addition to being an internist, with a subspecialty in prescription drug addiction and signficant experience in running drug and alcohol treatment centers.
> She has informed me that (1) most “enlightened” doctors are liberal with narcotics for those who have not been previously addicted and stingy with those who have been hooked, and (2) these doctors don’t know what the hell they are doing. ...
> What about the danger of getting people re-hooked? If the medication level, no matter how high, is kept below the threshold of euphoria, the chances for re-hooking the patient are low. And if the patient does become hooked, there are programs and facilities that can handle that problem.
> The worst part about asking the patient if he or she has previously been hooked is that patients not in recovery, who are likely to con you out of all the drug they can, are going to lie, while patients in recovery, who will use the pump responsibly, are going to tell the truth. Therefore, those addicts who are most likely to get in trouble with high doses will receive high doses, while the rest are left in significant pain.
> In my own case, I wrote down on my drug history that I had once had a single methadone tablet. This was prescribed by my oncologist while I was recovering from cancer some 20 years ago. I took one tablet and concluded, based on the side effects, that I’d rather die than take another. Nonetheless, one of the seven anesthesiologists that took turns deciding, a couple months ago, how much narcotic the pump would supply me “today,” took this fleeting mention of methodone to indicate that I was a dangerous heroin addict who had been on methadone maintainance. So he did the only thing reasonable. He reduced my pain medication to almost nothing.
This would suggest that even in 1999 the order was still your #1/#2.
The Feds eventually cracked down on this racket, but not before it had spawned a tremendous number of white, middle-class addicts who found themselves turning to the black market in heroin for their fixes. These people, in turn, are running headlong into the insanely punitive legal structures developed to terrorize, brutalize, and demonize black users when crack became a thing in the 80s.
Given a choice between accepting the punishments they were happy to dole out to others or abandoning this particular vector for racism, bigoted white people are deciding they can find other ways to keep the spirit of Jim Crow alive and well. For them, the Drug War has failed not because it failed to get rid of drugs (that was never the point) but because it's no longer as discriminatory as it used to be.
If you look at who supported the drugs policies, blacks supported them almost as much as whites did. Drugs were ravaging neighborhoods, and back then, this is how societies had treated drugs addicts. Russia, China, Singapore, African countries, etc. It wasn't till the Swiss experimented with alternative back in the nineties that others began looking at alternative policies in treating drugs addicts. Then we had a number of countries in Europe begin to try alternative methods to treat their addicts and people began to see these alternatives were more effective than jailing addicts and now we're seeing similar approaches in the US.
When someone comes in for painkillers for hip problems, etc and the time passes where it was either effective or not, but the drugs are still prescribed because the patient claims the issue persists way beyond the normal timeline, it's then time to reevaluate the usefulness of the drug's initial prescription.