> "...overprescription of pain killers" Yup, definitely a problem. Not so much in my county that I saw, but definitely a problem. And then the people who have them prescribed to them are selling them to get money because they have none. Another anecdote- I did a brief stint as an in-home healthcare aide in college and the sweet old lady I took care of who was in the 1st stages of dementia sold her painkillers to her neighbor at $3 a pill "Because he says he will get them to people who can't afford to go to the doctor, poor dears." Also, if you're able-bodied and out of work, you're definitely not able to afford to go to the doctor or pay for prescription painkillers.

Yeah, the New Yorker article I linked to mentioned that as well but I didn't quote it:

> And then there are the real-life Walter Whites. I once helped care for a patient with lung cancer who wasn’t taking his narcotics, unbeknownst to his doctors. This patient’s cancer had spread to his bones and other organs, which can be incredibly painful. But he was selling his prescription narcotics to help support his wife and himself. So when given these high-dose narcotics in the hospital, he overdosed—though not fatally, fortunately.

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> "...they would turn to drinking if they wouldn't/couldn't do illegal drugs?" Probably/definitely not. There's one ABC store in my entire county (population 50K now, closer to 25K in 2001) and again, really hard to be anonymous with your drinking when you went to high school with everyone who works at the ABC store and it's where everyone in the entire county goes to get their booze so chances are you'll see your brother in law and your best friend's grandmother and your ex-girlfriend's uncle while you're in there. Drugs can be done in the shadows and hidden way more effectively than booze.

Fair enough, the idea of literally one store for an entire county didn't occur to me honestly.

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> RE: overprescription: I have no idea why this is a thing. Profit margins on painkillers mean salespeople give under the table kickbacks to underpaid rural doctors in return for more prescriptions? Aging population on Medicaid becomes only cash cow for rural doctors after so many people lose their jobs (and health insurance) so they have to start prescribing more pills that they know Medicaid will pay for? Lack of doctor education leads to overprescription because they don't know any better? It's a big unknown, and not addressed in the article at all.

The pain management guidelines for hospitals was set by Big Pharma, basically. Similar tricks are used to encourage doctors to do the same.

https://www.cms.gov/openpayments/

For instance, exists because of these payments. And yes, I'd say its likely a combination of "feel good" marketing [e.g. It is safe, just give it to your patient to help the feel better] and kickbacks.

And yeah, its not addressed in the article at all. Florida [from the CDC article I linked to] ended up passing a bunch of laws which reduced overdose deaths by shutting down "pill mills" and such.

http://www.drugfree.org/join-together/florida-combats-prescr...

> After the state cracked down on pill mills and instituted other changes, the number of prescription drug-related deaths decreased in Florida in 2011. Deaths related to oxycodone decreased more than 17 percent. There are no doctors from Florida on the Drug Enforcement Administration’s (DEA) list of physicians who purchase the most oxycodone, the article notes.

Its not perfect but some combination of improved enforcement and better incentives for doctors is needed. I doubt education is the issue given the fact cash and subverting the bodies that create the standards is what Big Pharma seems to target.