Have you ever sought a particular prescription from a doctor? Many general practitioners in the United States are glorified drug dealers. You will probably get whatever you ask for if you can afford the copay.
"Any drug allergies?"
"Aspirin, Tylenol, Tramadol, etc"
"Oh, so you're allergic to 'all' non-narcotic pain medication? That must be ... inconvenient."
For me: I look at physiological symptoms. You tell me you're in 10/10 pain (the "worst of your life"/"worst you could imagine") and you're in no visible distress with normal vital signs, then I'll factor that into the decision.
That being said, I believe it is unethical, immoral to withhold something that could benefit a patient who is in genuine distress, regardless of anything else. For those patients, we have options, too. Fentanyl, for one, is used a lot pre-hospital as it is both an effective analgesic with a short lifetime in the body.
There used to be (probably still is) doctors in the ED who don't want a patient to come in with pain meds onboard because they want to see a "baseline presentation". Again, I think this falls into the realm of poor provider care. We have diagnostic tools for objective analysis, and having a patient in pain just so we can measure it is inhumane.
Bottom line: if a patient requires pain medication, they will get it from me, subject to analysis of circumstances. In your example above, if it's not "drug seeking" but concerns about side effects, then the patient and I can have a discussion about benefits versus risks (the flip side to that being if a patient has a broken femur, for example, that conversation is likely to be limited to 'give me the damn drug!").
No. There are plenty of other options for treating their pain without using opioids -- first I would educate them about the relative risks and benefits of, say, acetaminophen/APAP. I could use something like intravenous lidocaine or low-dose ketamine, or if it's a traumatic type of pain some kind of regional anesthesia. If it's more neuropathic, you can use tricyclics or drugs that work on GABA pathways. Beyond all that, I try to talk to people about the harms associated with opiates/oids such as hyperalgesia that develops in many long-term users, which is a really significant and underappreciated harm alongside things like addiction and potential respiratory depression.
Even worse, this further kills equality. A worker desiring to boost performance can easily afford top-notch medicines -- speed's only $20 a month for a starting dose at a pharmacy. But the prescription alone can be 10x that, and sometimes may be required every month. Not to mention the cost of a higher-end doctor that will assist customers. Poorer patients are thus denied medicine, creating a negative feedback loop.
this would introduce a myriad of acute public health issues and do great harm to the public good, costing taxpayers billions of dollars for remediation.
Edit: the DHHS's report on prescription medication abuse is good reading in this area: http://www.cdc.gov/drugoverdose/pdf/hhs_prescription_drug_ab...
There are definitely more dangerous drugs than alcohol but legalization of all drugs isn't going to destroy society.
http://www.niaaa.nih.gov/alcohol-health/overview-alcohol-con...
To claim that alcohol isn't regulated on usage or that most alcohol regulations are for taxation purposes only is pretty far off the mark.
The primary rationale for the taxation of alcohol itself is to counterbalance the public health issues that alcohol causes. Public health issues cost money to remediate.
Any chemicals? In any arrangement?
The guys in the park selling opiates at unspecified dosage and purity are available 24/7 and don't even ask questions.