[nsagent]

My mom worked as an ER physician in Pennington Gap, VA during the early years of opioid abuse there (late nineties through through the early oughts) [1]. She would constantly complain about drug seekers there and refused to give out pain meds. According to her, she was the only doctor who would refuse to give out pain meds.

Fast forward to 2022, she needed heart surgery and was in the ICU for three weeks afterward. She never asked for pain meds and regularly refused them when asked. I think she had became so accustomed to denying people pain meds, that she even denied herself, though it was clear she was in pain.

[1]: https://www.nytimes.com/2019/08/18/health/opioids-purdue-pen...

[lukan]

"though it was clear she was in pain"

One can learn how to handle pain yourself. Some people went very far with this.

While younger, I was a bit advanced in those technics - basically it is about accepting the pain and working with it.

In my theory, pain was like a alarm sound - and a painkiller just deactivating the alarm, but therefore maybe stopping a adequate body response.

Nowdays I got a bit softer as currently I am on weak painkillers, but a very low dose compared to the recommendations. And for my (disease related) empty stomach, this is probably way better. Also less extra stress on the liver and kidneys.

But even so, I experienced the feeling, that can put people into the path of addiction. Just one more pill and everything feels fine again. No more struggle, being calm again. But this is dangerous.

[_heimdall]

I'm not sure where I would have learned it in my life, but this is very similar to my experience with pain so far. I'll definitely feel it but I do experience it more like an alarm, and once I recognize what happened the pain signal seems to go away after about 30 seconds.

To this day I'm still surprised by it, and appreciative for whatever it is that allows my body to apparently recognize and then silence the pain signals.

[somenameforme]

If she never explained what was happening there, public ERs cannot refuse service to anybody for any reason. So drug addicts will use ERs as an attempt to score drugs by pretending to have some illness or another. If they fail, they'll just go to another one. And then repeat the circle. Even when the people at the ER know they're faking and they're there solely to try to get drugs, they have to continue trying to treat them in good faith. It's a major source of burn-out for ER workers, because it's just never-ending and a complete waste of resources.

[nradov]

That's not quite accurate. Under EMTALA, ERs are only required to stabilize patients. Once an indigent patient is stabilized and no longer at immediate risk, the hospital is free to discharge them even if they have serious medical conditions.

https://www.acep.org/life-as-a-physician/ethics--legal/emtal...

Some hospitals voluntarily do more than the law requires to treat such patients.

[somenameforme]

There's a much more informative article available here. [1] Stabilization does not have the colloquial meaning. It's defined as, "To provide such medical treatment of the condition as may be necessary to assure, within reasonable medical probability, that no material deterioration of the condition is likely to result from or occur during the transfer of the individual from a facility, or, with respect to an emergency medical condition..."

So somebody with a serious medial condition could be discharged, but only once that condition was treated and unlikely to further deteriorate. And then there's also a bunch of other rules hospitals that accept medicare have to follow for all patients, which are similar in spirit to EMTALA. And then there are going to state rules on top of all of this. Violations are severe with penalties able to be imposed on both the hospital and the doctors/staff involved - up to and including loss of license, and they are not covered by malpractice insurance. And the courts have invariably ruled on the side of patients, so I don't think there's any doctor that's going to be looking to try to short-serve the requirements of the law. Part of the reason you can find a million negative articles about it!

[1] - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1305897/

[n8henrie]

I'd say it's fairly accurate. It's difficult to confidently establish "stable" in a patient with possibly feigned or exaggerated symptoms based on history and exam alone. It is generally agreed that pain management is part of managing an emergency, and so if an emergency has not been confidently excluded, it is usually part of care until a workup is concluded. If one could know from the initial evaluation that an emergency could not possibly be present, one could certainly discharge without additional care, but that can be impossible to know immediately (even with highly trained and calibrated eyeballs).

[_fat_santa]

I remember going to the dentist a number of times a few years back and they always prescribed me something crazy like percs, vicodin, oxy, etc. I never actually got any of the scripts filled because by then I had read too may stories about the opioid crisis and was determined to never venture down that road. I did notice once the opioid crisis really hit the mainstream press, my dentist stopped prescribing those strong painkillers and prescribed prescription grade tylenol or ibuprofen instead. Never filled those prescriptions either because the prescription grade stuff was the same as taking more of the regular OTC medicine.

[nradov]

Back in 2007 an oral surgeon gave me an opioid painkiller prescription after a routine tooth extraction. I never filled it but in retrospect it seems crazy how they were handing out those scripts like nothing.

[cprayingmantis]

It hit this area hard. I’m from neighboring Scott County and I left in 2015 to pursue a job in a larger market. When I brought my family back in 2021 we shocked to see just how much the opioid crisis had hollowed out the community. Whatever big pharma has paid it’s not enough to repair the generations of damage it’s done to the area. I am on the local Board of Supervisors and I’m trying my best (along with the rest of the board) to get everything running back in the right direction.

[hypothesis]

Last I heard, culprits are arguing at SCOTUS that they should get immunity for a fraction of their gains. Also, some payouts will come from selling more of the same, which is nuts. It’s pretty hopeless…