Every patient is different, and that’s why we leave these decisions to doctors who know each patient’s specific situation. Sometimes potential substance use disorder is by far the lesser of 2 evils.

Say patient 1 has a 100% chance of developing substance abuse disorder. Patient 1 has also just been hit by a train. They’re on the verge of death, they’re peeing the hospital bed crying, asking for god to put them out of their misery because of the unthinkable amount of pain they’re in. There’s a real chance that they’ll die soon.

Patient 2 also has a 100% chance of developing substance use disorder. Patient 2 says that they have mild lower back pain after they get home from their office job. They have no other medical problems, and they live a normal, well adjusted life.

Using your reasoning, both patients should be denied painkillers. Do you think that is a sound medical decision?

Every case is different, and every medical decision carries various risks and trade offs. It’s between a patient and their doctor to decide which trade offs are worth it, which aren’t. You’d be crazy to say that the amount of harm done by a touch of back pain is greater than the amount of harm done by a long term opiate addiction, but what about patient 1, who was hit by a train? They may or may not live to see the next month - don’t you think that the trade off for that patient when looking at a potential opiate addiction would be a little bit different than the patient with slight back pain?

Every single medical decision is like that, to varying degrees. Some decisions are easier than others, and some carry with them much less risk of harm, but nothing is free of side effects or risks. Opiates are no different. Leave the doctors to make the decisions that they’ve been trained to make, looking at individual patients and circumstances.