Alcohol can be just as addictive as opiates, in fact there are far more alcoholics than opiate addicts, but you probably don’t advocate for the prohibition of alcohol
Nor am I advocating for the prohibition of opioids, only their usage held to the same clinical standard any one of you criticising me would readily acknowledge with antibiotics. Alcohol was once prescribed widely and even now I've used medicinal vodka in the emergency room. Is that alcohol appropriate for infant sleeping tonics? Fuck no. Is it appropriate for a patient with a dislocated or broken arm? Nope. Patient seizing because they're a severe alcoholic and there are clinical indications their body needs it? That's a responsible and informed decision which takes their situation into account beyond their feelings on it. It's based on protocols based on current science. Serious painkillers have their uses and they also have a long list of times when they shouldn't be used. Could be used, patient would be thrilled if they were used, but it's not blood on the patient's hands when the next appointment also wants the same drug and has a negative outcome.
Stingy by what standard though? Indications/contraindications/statistics or the patient's personal goals independent of the reality of their medical situation? I've discharged a lot of patients with narcotic prescriptions and felt totally fine about it. Same risks of addiction, same potential contribution to the opioid epidemic, same self-reported level of pain as the next patient who is denied that drug. They just had the appropriate indications for using those drugs over other drugs. The risks were outweighed by what could be achieved by that drug but not a lesser drug. It's when that isn't met where I have an issue with their usage. Whatever is the most appropriate course of care holds that place for a good reason. Under-utilising them looks and feels bad certainly. Over-utilising them is worse. They're over-utilised where the patient's desires take priority over their clinical state. Necessarily the right level of usage falling below that will fail to meet their desires, even if it's protecting them in ways they don't prioritise or the patient after them who is demographically different but treated under the same protocols.
Nor am I advocating for the prohibition of opioids, only their usage held to the same clinical standard any one of you criticising me would readily acknowledge with antibiotics. Alcohol was once prescribed widely and even now I've used medicinal vodka in the emergency room. Is that alcohol appropriate for infant sleeping tonics? Fuck no. Is it appropriate for a patient with a dislocated or broken arm? Nope. Patient seizing because they're a severe alcoholic and there are clinical indications their body needs it? That's a responsible and informed decision which takes their situation into account beyond their feelings on it. It's based on protocols based on current science. Serious painkillers have their uses and they also have a long list of times when they shouldn't be used. Could be used, patient would be thrilled if they were used, but it's not blood on the patient's hands when the next appointment also wants the same drug and has a negative outcome.
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Stingy by what standard though? Indications/contraindications/statistics or the patient's personal goals independent of the reality of their medical situation? I've discharged a lot of patients with narcotic prescriptions and felt totally fine about it. Same risks of addiction, same potential contribution to the opioid epidemic, same self-reported level of pain as the next patient who is denied that drug. They just had the appropriate indications for using those drugs over other drugs. The risks were outweighed by what could be achieved by that drug but not a lesser drug. It's when that isn't met where I have an issue with their usage. Whatever is the most appropriate course of care holds that place for a good reason. Under-utilising them looks and feels bad certainly. Over-utilising them is worse. They're over-utilised where the patient's desires take priority over their clinical state. Necessarily the right level of usage falling below that will fail to meet their desires, even if it's protecting them in ways they don't prioritise or the patient after them who is demographically different but treated under the same protocols.