The DEA could still go after pill mills or over-prescribers without supply limits. The main thing supply limits do is just make it inconvenient for everybody prescribed a particular medication to get it filled.

No, the argument for OxyContin was two-fold and targeted at doctors:

1. “Pain is the fifth vital sign.” You are a Bad Doctor if you do not consider pain.

2. OxyContin is not habit-forming.

1 is a little more complicated. I believe as part of the ACA hospitals were actually evaluated on subjective pain management as reported by patients with financial implications if it seemed pain was not being managed.

Also, a lot of people got started on Oxy after a surgery in which they were given it on their way out. They either started taking it and liked it, or didn’t take it and possibly had it diverted to acquaintances/family. With adderall you have to get it prescribed for ADHD or (more rarely) narcolepsy - of course it could still get diverted, but it’s not something that’s being routinely given to the general population like painkillers.

It's a lot easier to tell a GP you have ADHD than to get a surgery.

Not if you actually need a surgery. If you need a surgery you can generally get one pretty quickly and with little complication. Getting a prescription for Adderall from a responsible doctor when you actually need it can take months and multiple visits to a psychiatrist.

This was 15 years before the ACA

And it's a good one. Opiates have life-changing efficacy, it's the implementation that failed. Doctors weren't clever, if even actively malicious, about duration and tapering.

They're doing the same thing today with benzos, it's just less marked on society.

There's room in between full removal and liberal prescribing.

And it's still the correct argument. One person abusing something isn't a reason to harm another. I really do feel for people that are dealing with opioid addiction issues. It's been something that's hit close to me as well. But the ridiculous levels of interference in proper medical treatment is a strong driver of the very addition problems its attempting to solve.

Getting proper pain management requires going to "pain specialists" which may or may not be pill mills since their entire business is now built on pain management rather than general medical care. Getting your medications is heavily restricted and complicated. You can't fill a script for more than a month. You can't fill more than 2-3 days before the date on the script. You can't stock up for a trip, and you can't even start the process of trying to get it early in a shortage situation. The fear of DEA / government means your normal providers won't touch it, and it means if you're dealing with a bad provider (say you wound up at a pill mill and you're trying to get out) other providers won't want to take you on. It means if you've been mis-managed, rather than trying to help you wean down, you're more likely to have a new provider cut you off cold turkey and then treat you as an addict when your withdrawl symptoms kick in. An uncomfortable number of addicts have the same basic history, of being put on pain meds for some reason or another and being cut off cold turkey by some other provider without consideration for their current dependency levels or their actual pain needs. And that doesn't even begin to get into how impossible it becomes to get proper help if you are an addict.

Addiction is an awful thing, and it's an issue that needs to be dealt with. Dealing with it by making it harder for non-addicts and addicts alike to get the help they need is not the answer.

And I still think it’s a good one. Someone who wants to get a Rx of painkillers specifically to abuse it themselves or sell it to other abusers isn’t what we should really care about too much about outside of getting them into rehab. Someone might be a drug seeker is not a good reason to let someone who isn’t suffer.

Accidentally getting someone who had no intention of abusing it addicted without recognizing it was/is the much bigger issue and availability doesn’t really help that.