The book talks about (chronic) Pain Managment before all the (addictive) "wonder" drugs showed up. Apparently there were Pain Clinics (univ of washington model) that had a multi disciplinary approach(not purely drug based) to pain managment that seemed to be working. No life long addiction and ever increasing issues. But that initial one time cost was more than the cost of pills. So Insurance Companies just stopped covering that as an option. Result was those clinics shutdown and the only option most people were given were pills. They get addicted. Pharma companies profit multiply. Wall St is happy. Those who run out of cash for pills turn too and prop up the drug cartels. What is sad is once everyone starts profiting breaking out of the pattern for all parties involved gets harder and harder.