Yes of course there are realistic ways to prescribe opioids routine and safely. Purdue did not invent opioids, what they did is patent a particularly strong formulation, and then work to undermine the cultural taboo in medicine around their use. That last thing was their crime.
There isn't, at this time, any other way to treat serious pain (in all cases). Opioid prescriptions will continue to be an unfortunately necessary feature of our medical system until we invent painkillers strong/good enough to replace them. I say this as someone who was personally addicted to opioids in general and Oxycontin in particular and feel very lucky to have only one dead friend as a result.
Opioids can't be banned until we can replace them with something equally generally effective. But what we should do is reinstate the taboo around prescribing them, and probably stop offering take home fentanyl prescriptions at all (it's still useful for anaesthesia, in hospitals). Perhaps more importantly, I think the cat is kind of out of the bag on prescriptions. I haven't been around that world for a long time, but it seems to me like pharmaceuticals aren't the primary entrypoint to opioid addiction anymore - people just start with fentanyl.
Dealing with fentanyl seems to me to be basically impossible. One kilogram of pure fentanyl is ~2,000,000 doses, for someone without a tolerance. This is impossible to interdict at the border. It is also fully synthetic, with no great choke point on synthesis routes. I have heard that there are other, even more dangerous, compounds like https://en.wikipedia.org/wiki/Etonitazene that are also even easier to synthesize. I don't really know if there is a good way out of this other than doing the slightly less impossible thing, which is curing addiction.
There isn't, at this time, any other way to treat serious pain (in all cases). Opioid prescriptions will continue to be an unfortunately necessary feature of our medical system until we invent painkillers strong/good enough to replace them. I say this as someone who was personally addicted to opioids in general and Oxycontin in particular and feel very lucky to have only one dead friend as a result.
Opioids can't be banned until we can replace them with something equally generally effective. But what we should do is reinstate the taboo around prescribing them, and probably stop offering take home fentanyl prescriptions at all (it's still useful for anaesthesia, in hospitals). Perhaps more importantly, I think the cat is kind of out of the bag on prescriptions. I haven't been around that world for a long time, but it seems to me like pharmaceuticals aren't the primary entrypoint to opioid addiction anymore - people just start with fentanyl.
Dealing with fentanyl seems to me to be basically impossible. One kilogram of pure fentanyl is ~2,000,000 doses, for someone without a tolerance. This is impossible to interdict at the border. It is also fully synthetic, with no great choke point on synthesis routes. I have heard that there are other, even more dangerous, compounds like https://en.wikipedia.org/wiki/Etonitazene that are also even easier to synthesize. I don't really know if there is a good way out of this other than doing the slightly less impossible thing, which is curing addiction.