There are certainly cases where opioids should be prescribed as painkillers. But in the US, when weighing two bad things (pain, and adverse effects of a drug), pain seems to be considered more important than elsewhere, since doctors prescribe more of it.
It must be that elsewhere doctors more frequently say “yes, your condition is painful, but if normal painkillers don’t help, the next alternative is worse than the pain”.
It’s not clear to me why this discrepancy exists. Pharma can’t be the only reason. Maybe the private insurance system is a factor (“I paid a lot for this healthcare now fix my pain or I’ll take my business elsewhere”)?
Anecdotally, I have heard grumblings from nurse friends that a big annoyance is that "patient satisfaction" is now a big portion of performance reviews, since patients' satisfaction can go down for things that make them better.
Keep in mind that not only insurance is a factor, but also the fact that many hospital systems themselves are private and have lots of cost pressures. A fair amount of advertising I've seen is for hospital systems.
Patient satisfaction is part of performance reviews because CMS decided to use it as an input for their hospital ratings that are posted online. They also adjust payments to hospitals based on the results.
Also, most hospitals in the US are nonprofits, though that doesn't free them from cost pressures or the need to advertise.
Or patient satisfaction can go down because they are the face of a system that has many operational 'opportunities' to improve efficacy of care in the inpatient setting. They are grumbling because they have almost zero control over any of it.
This is pure speculation, but I could see several scenarios that might produce the discrepancy:
America's fear of regulation results in more workers being injured and developing chronic pain.
America's broken healthcare system means that people are less likely to have access to alternatives such as physical therapy, meditation, counseling, etc.
America's weak social safety net means that people have to relieve their pain so that they can continue working.
Cultural factors result in people being less accepting of pain as part of their lives.
It really is about companies like Purdue that pushed these drugs and worked to change the protocols around pain management. Even generic manufacturers of cheap generics were making a fortune due to volume.
My mom ran different units in busy NYC hospitals in the 80s. At that time, the protocols for most pain events were Tylenol and/or Motrin. Getting more than 600mg of Motrin was unusual.
When I had back problems in the early 2000s, the protocols were totally different. If you had back pain, once the newer NSAIDS like Vioxx and Celebrex were mostly removed from the market, the substitute was an opioid. In my case, physical therapy, motrin/aleve, etc helped until surgery was required. I know a few people who went to opioid route, and a couple of them have struggled with dependency.
It must be that elsewhere doctors more frequently say “yes, your condition is painful, but if normal painkillers don’t help, the next alternative is worse than the pain”.
It’s not clear to me why this discrepancy exists. Pharma can’t be the only reason. Maybe the private insurance system is a factor (“I paid a lot for this healthcare now fix my pain or I’ll take my business elsewhere”)?