In this case it looks like they are incentives for pain pills to be issued on both sides -- money maker for pharma and time saver for doctors (a third side -- convenience and feel good for the patient).
It is not as useful to find so-called bad actors but instead we should evaluate the medical system as a whole and put in safeguards to do less harm. Patients have generally too much influence on doctors for their treatment (otherwise why would direct to consumer marketing exist?), that doctors are not educating patients enough on the risks of narcotics and that pharma has $$ incentive to push medicine. That things like physical therapy and lifestyle changes will better deal with root causes than drugs that only address the symptom (but feel better and are easier to swallow). It's a recipe for a disaster.
I was in a motorcycle accident a few years ago and broke over 10 bones. The worst part of my recovery was kicking my addiction to narcotics. I did not understand what I was getting into and I was never given a path to get off them (not in a coherent way, not until I called to say I was going through withdrawals). This should not be.
On the other hand, the pharmacies might know, but that could be worked around by a motivated pill-obtainer.
The pharma companies, however, definitely know that they sent 780 million painkillers to a state with only 1.8 million men, women, and children.
I am not saying it is their duty to do something about this, but maybe they have some high-level information that others do not.
I really don't see a way this could be fixed without giving every doctor in the US access to some huge database of every prescription of every person in the country -- which I would not be cool with, nor would anyone else, other than maybe law enforcement agencies.
I can't imagine many people that have real pain bad enough to need opioids are going to be selling them to other people.
For people that really need them to manage pain, they can literally be a live saver.
So if you can get enough pills to cover your own pain management (meaning you likely can't work anyway), and you know you can get and sell more pills by going to other doctors, why not?
He said after a while it became a game. User would get a script and come in totally strung out. My buddy would refuse to refill their meds. User would call doctor and yell and them. Doctor would call Pharmacy and yell at my friend, who would then have to tell the Doctor what was going on. Most of the time, he said the Doctors had no idea this person had 15 different scripts for pain killers.
For me, there's still too many loopholes to exploit in the process.
I'm in favor of maximum MD power. I think they should be allowed to prescribe everything from cocaine to bleach, or any other chemical compound, as suits the patient care, if they know what they're doing.
But they should also bear maximum accountability for what they prescribe, including abuse potential.