This was all occurring around the time that there was a HUGE push against undertreated pain! Pain was declared to be the “5th vital sign” and something that had to be assessed at every patient encounter. Doctors were taken to task (and sued) for being callous about our patients’ suffering: some legit and horrific, lots of it trivial. Regulatory agencies such as the JCAH required hospitals to have an individual pain control plan for every patient, and record of the patient’s pain was adequately controlled, not just while hospitalized, but also after discharge. Drug companies pushed lousy studies on opioids that seemed to indicate that opioids, especially the long-acting ones like oxycontin, MS contin, etc were NOT likely to be addictive in properly selected patients, and they told us that 98+% of the patients out there wouldn’t have addiction problems on these delayed release meds, since they had ‘legitimate pain’ that needed treating. Doctors had parts of their salaries based on ‘satisfaction surveys’ by their patients, and found quickly that prescribing narcotics for any pain complaint resulted in happier patients. Medical students and residents were taught that pain needed to be treated with opioids. It was an INSANE time.
I, as a recovering addict during that era (I got clean in 1990) never bought into all that and didn’t change my practice much. Opioids for significant acute pain, and malignant pain, etc. That pissed off some of my patients but by that time my pay wasn’t based on inmate-satisfaction surveys. I only occasionally was threatened with a shanking over the issue. Lawsuit threats were pretty common over the issue, including some that actually did go to court (I didn’t lose any of them).
Summary: Some docs should have known better, some docs did know better, many spoke out, but we were ignored largely, and our young professionals were schooled to believe they were doing the right thing by providing opioids.
Stupid stupid stupid on so many, many levels.