This is definitely a problem. Turns out once you start getting to the "going to destroy your liver / stomach" levels of NSAIDs and Tylenol, there really isn't anything other than opioids for pain management. Unfortunately the war on drugs and America's latent puritan streak means that since some people in some places use opioids to get high, then all uses of opioids should be avoided whenever possible, and when they are used, they should only be used grudgingly and with extreme skepticism of the person receiving them. Surely nothing will be better for the health of an individual than barely managing their condition, constantly forcing them to stop effective treatment to make sure they're not growing tolerant of the medication and treating them as only slightly more trustworthy than a criminal conman.

Sure, opioids are addictive, and you might find yourself in a situation where you're stuck on them for life and that's not great. And ultimately we have to ask "so what?" There are many conditions and medications that are lifelong and we don't treat the patients or their conditions the same way. Imagine telling a person taking SSRIs that they can't have a higher dosage because they're getting "tolerant" of the medication. Imagine telling a diabetes patient that you're not going to give them metformin or insulin because they might be on it for life. There are huge amounts of chronic conditions for which the ongoing treatments suck and have a lot of negative side effects, but living with the condition un-treated is worse than the negative side effects. Chronic pain (and the conditions causing that pain) seem to be the only category that we don't accept the possibility of long term negative consequences as the price of dealing with the chronic condition.

And the hell of it is, I agree with concerns about pill mills. My family that has had to deal with this has had to deal with pill mills too. And it's bad just having higher and higher doses thrown at you. I agree that treatment needs to include more than just escalating opioid doses. But those same family members that were stuck in a pill mill were there for years longer than they needed to be because finding a way out was nearly impossible. If you want to change pain management doctors, 99% of them will not prescribe you opioids on your first visit. But you likely have a contract with your current pain doctor that says you won't go to other doctors for pain medications, so you can't see a different doctor while getting pain management from your current doctor. Then even if you could get them to prescribe your medications, they almost all want to start you from zero again. Imagine you want to change heart doctors but before they will treat you they want you to stop all your heart medications for a few months so that they can "get a baseline" for your condition. That would be an insane thing to ask for any other chronic condition, and yet that's a common thing to be asked of pain patients all the time.

Overall as a society we're terrible at dealing with the concept of a chronic condition. We don't really grok the idea that some folks just won't ever "get better", and our entire system is set up to assume you will. The sad reality is some people are going to be in constant pain for their entire lives, and there's nothing we can do to stop that from being the case. Restricting these people from being able to safely access treatments to manage that pain because they might get addicted is misguided, cruel and missing the forest for the trees.