My partner had a post-cancer DIEP flap reconstruction last month at a top cancer center in NYC, and due to the nature of the surgery, couldn't take NSAIDs, which are typically most effective for her (they have blood thinning side effects and were banned for 2 weeks post-surgery to avoid risk of hematomas). So she was left with taking over the counter Tylenol plus prescription opioids. They prescribed opioids 2 days of pills at a time, which required me to constantly drive to pick up new prescriptions (since obviously she couldn't drive), and it felt like some kind of interrogation each time she'd call up and report her current pain levels. As if they assumed by default she was lying or was a drug addict or something, versus someone recovering from major surgery that doesn't heal in 2 days, and furthermore is not allowed to take anything else that's effective (NSAIDs). Hours spent writhing in pain trying to get some pills prescribed and picked up. It only got resolved once the two-week NSAID ban was up. Then she stopped calling about the opioid-based analgesic and just started taking large ibuprofen doses instead. Problem solved, since you can buy as much ibuprofen as you want. But a pretty shit two weeks up until that point.

As a result, I strongly dislike a number of aspects of the anti-opioid backlash. It made our lives worse and caused us more suffering.

As a kid I had migraines, and quickly developed an immunity to the pain-relieving aspect of paracetemol, they were basically candy by the time I was a teenager. Luckily they disappeared in my late teens, but now I'm in my 40s and I get weird pains they call "cluster headaches" in my face. I did some tests, got an MRI, and they didn't turn up anything, which is pretty much the end of medicine, pain management is all there is for me. In Australia we need a prescription for any opiates, so I have to be treated like a drug addict to get painkillers the rest of the world can buy over the counter, it's a disgrace.

if you have not already done this, you could consult an "migraine center". There is no cure but there are some effective (for some people at least) options for treating cluster headaches, like triptans and lifestyle changes (regularity in sleep patterns, etc.)

I don’t respond much to opiates anyways, but I still find it completely ridiculous.

There's a big distance between "5 days worth of low dose Tramadol" (+ max dose of Paracetamol) and "2 months worth of Oxycodone". It's really not a hard problem to solve for the medical establishment.

The good thing about opioids is that you can dosage them precisely, and that you have plenty of opiates in a ladder of potency. Tramadol (sold as Ultram in the US) is a middle-ground painkiller despite being an opiate. Same as codeine. Slightly above is tapentadol. Curious thing is despite tapentadol has not been found addictive (at least as addictive as other opiates), it's still an opiate, and so the FDA put it in the same bucket as fentanyl and morphine.

Another analgesic is cannabis. Sadly, it has the same problem as opiates: it was deemed too fun or too good, it seems we must endure pain to make the regulators happy. It turns out people hate pain, so they end up taking fentanyl and heroing under a bridge.

The sad thing about all this is that the regulators decided pain is not a bad thing, so you must endure it. But they decided anxiety is a terrible thing, so you can get as much bromazepam as you need. Even when bromazepan and other benzodiazepines create dependence and tolerance (and the withdrawal is terrible), I'm sure you now at least a dozen people taking it cronically (I do). They are as hooked to that thing as it was heroin but, hey, it's legally prescribed, so no problem here: one pill for breakfast, one before bed, and they are 24/7 high while nobody bats an eye.

Docs in the US tend to think they are above being marketed to, but Purdue Pharma knew better, and they paid their drugs reps a ton to go out to "everytown US" and convince doctors that they had made a non-addicting opiate. Enough docs bought it, and here we are.

How did they do? Well, 20 years ago drug reps used to be able to take doctors on trips: to sports games, to see the dog races, to museum trips, the price of a day trip with you and one or two loved ones was to sit through an hour (or two) lecture by a rep that convinced you to to prescribe a drug. Not a bad deal!

There were complex reasons why the opiate crisis started, but the environment was ripe for an upstart company like Purdue to come in, reformulate an old opiate, pretend the addiction problem isn't there, then sell a miracle drug because opiates are extremely effective short term analgesics. Long term, we're still paying for it!

I've looked a lot into the opiate crisis, and it's a pretty bad stain on the US medical institution, particularly our medical science. We fucked up.

> I have a friend in the US who told me they have an app on their phone where they can just tap a button and the next day they can refill their benzo prescription, and it's been like that for years without having seen a doctor again.

Is this the "request a refill" feature that every US pharmacy offers? Granted, benzodiazepines are less restricted than stimulant drugs¹, but a doctor in the US need to at least review a prescription twice a year.

Chronic (daily) of benzodiazepines is bad, and doctors will not² start new patients on this.

There's still a lot of legacy patients who are on chronic benzodiazepine treatments -- doctors should work with them to wean them off, but it's very challenging and disruptive.

Requiring a patient receiving a benzodiazepine at a non-daily level (e.g. for seizures, anxiety, occasional insomnia) to go back to see their doctor when nothing's changed several times a year is just pushing medical costs (money/time) on the disabled.

¹: e.g. Adderall, which can't be refilled

²: Providers are trained not to these days, at least

It's complicated for some people to admit the 'war on drugs' has failed maybe, but that's a different issues all together.

IMHO this is because of alienation, a loss of community, strong personal bonds, lack of goals.

There's a famous experiment that sums it all up perfectly - the one where animals were given an unlimited supply of cocaine and they took it until they basically starved themselves to death. But when they put the animals in a nice stimulating environment with toys and friends to play with they basically ignored the drug supply.

So yes, providing govt run shooting galleries will stop people from dying and you'll make them slightly less miserable but those people will still live lives that you wouldn't want for your children. They have an illness that needs to be cured.

I think you're referring to the Rat Park experiment (https://en.wikipedia.org/wiki/Rat_Park), and (as always) its conclusions are not as solid as the myth implies. That's not to say its results have been disproven, but they haven't been confirmed with other studies either.

Having to do it on the regular would be just cruel.