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Reality is that wealthier clients represent a dramatically better risk:reward ratio. They’re usually well-monitored, generally healthy, and strongly incentivized to remain functional. And they won’t draw attention by turning around & selling your script on the street
The situation is bad, and IMO the official recommendations to address the “epidemic” are stupid, but “be a gatekeeper who gives meds for conditions that can only be diagnosed based on self-report and never ever make a mistake” is not a real option
It's tempting to hoist the failed system onto complacent rich people + greedy doctors, but IMO the incentives suggest another story: risk-averse docs giving better-but-riskier treatments to patients who are less likely to be irrecoverably harmed by themhttps://twitter.com/StephenPiment/status/1104178389080977409 …
If Uncle Joe endures intolerable pain & ultimately attempts suicide as a result, he's probably less a legal liability to his doctor than if he's prescribed opioids for long-term pain management & suffers an impairment-related accident or any number of correlated health problems
Celebrity Joe has a driver who ensures he gets around safely, a personal trainer who monitors his physical condition on a near-daily basis, an assistant who checks on him every morning. Celebrity Joe has a *lot* of built-in safeties whether or not he always makes good choices
None of this makes it remotely OK that over the course of many soul-rending months of genuine torture Uncle Joe is driven to take his own life, especially in a world where risky-but-effective interventions exist but were withheld from him. I'm explaining, not justifying
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