If you can believe it, both are true. It sounds like a contradiction, but it isn't as cut and dry as our brains might like it to be, or like a writer might like it to be.
They are both over and under-prescribed. Pain is both over and undertreated every day in every state in the country. There are pill mills, there are stingy ER's and clinics, it goes both ways. It isn't one or the other.
On one hand, you have doctor shopping.
On the other, you have legitimate chronic pain sufferers turning to the street to make ends meet.
My grandparents bought pills from the black market at black market prices to fill the gap of under treatment. At the same time, people were paying cash-only pain management clinics for prescriptions which they were filling multiple times.
There will always be abusers, lawmakers and activists need to realize that you can't regulate or price someone out of an addiction (or a dependency.)
There is a staggering difference between addiction (which usually involves abuse) and dependency (which usually involves no abuse)
Addiction to prescription opiates leads to one of two roads. The problem road is heroin. For example:
Let's say you get addicted because you abuse the pills prescribed to you after surgery. You continue to maintain your addiction with drugs purchased from the street, then at some point you remember that heroin exists and is dirt cheap compared to the dollar per milligram you were paying for oxycodone. Suddenly, heroin doesn't seem so evil. Now you have a new perspective about heroin, mainly that it's cheaper and more potent than prescription pills.
Dependency, meanwhile, can be maintained under a doctors supervision for years. Pain can be managed with prescription opiates safely and effectively, increasing the quality of life of someone who suffers from pain every single day.
It's a multi-faceted issue with many variables, you can't really reduce it down to one sentence or another. There is no easy solution, either. You can't under-prescribe or prosecute doctors, that just hurts the people suffering the most.
I know what the solution isn't, though: banning fucking kratom. this entire thing is a complete and total structure fire, and the DEA is trying to immediately move to Schedule I a powdered leaf that stops withdrawals for addicts. For the opiate naive, taking powdered kratom leaf results in a light buzz. For an opiate addict, it's no buzz + immediate relief of withdrawal symptoms.
There is always methadone and suboxone, but these drugs are extremely long-acting. Meaning that if and when you come off of them, you will be in withdrawals for weeks or even months. For comparison, short-acting opiates like heroin withdrawals last about a week, maybe two.
Now that you know this, it might not surprise you to hear that methadone patients often switch back to shorter-acting drugs like heroin to attempt to get clean.
Ironic, isn't it?