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Notes -
PO->fentanyl pipeline I was getting mostly from personal observations plus common sense, but also backed by this paper. Though that paper isn't only about fentanyl so maybe it's not a strict majority for fentanyl itself.
For healthcare I can imagine a variety of policies including stricter prescription control, but really I'm thinking about something bigger than that.
I suspect that a lot of things we prescribe long-term pain meds for could be treated with combinations of things like rehabilitative therapy, biofeedback therapy, various surgeries, personal trainers to maintain overall health, etc. And a lot of things that do need pain meds could be prevented from turning into a long-term addiction with close monitoring by a doctor or nurse to test whether patients still need the meds and help them taper off slowly while using exercise/rehabilitation to recover promptly.
(obviously not all chronic pain conditions are like that, but I wouldn't be surprised if 60% of long-term opioid cases could be resolved with something in these genres)
The problem is all of that takes expensive one-on-one care and treatment by a variety of professionals, as well as some type of personal relationship with medical providers where they remember your name and your issues and are forming and executing long-term plans to work through them with you, and all of that is both more expensive than pills and not the way the system wants to be designed. The system is very much geared towards insurance only supporting the cheapest treatment in the short-term, which is normally pills, and in having an atomized care model where you get 15 minutes with your doctor and they follow a checklist to prescribe you something and then your relationship with them is over and you have to start from scratch if you want another appointment.
I really think the opioid epidemic in large part stems from opioids maximizing metrics that the modern healthcare and insurance industries judge themselves by - it 'solves' a ton of problems at a fairly low cost with very little physician time spent and no expensive in-care facilities needed. I think we could improve this and a lot of other medical problems if we weren't so focused on those metrics, but that would require really fundamentally changing the way the whole industry works.
Not to mention a tremendous amount of personal discipline, faith, and ability to work through pain for years and years. Trust me, as someone who has done PT and put in over ten thousand hours into stretching/exercise to deal with chronic pain, it is brutally difficult. Easily the most challenging thing I've struggled with in my life.
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