Let me shed a little light on this. I have direct experience.
Many, many countries have EXTREMELY strict laws about dispensing opiates. So strict, the doctors are terrified to dispense them. Take Russia (and all FSU countries, really). I worked with Russian doctors who were issued morphine for emergency. 10mg ampules. The standard dose? 10mg. Because to waste any unused morphine had to be done in front of a police officer. Here in the US, we typically do it with any witness, such as a nurse, doctor, EMT, etc. The only accounting is the patient chart, which are audited by pharmacists. I have personally had to, well, lets just say "use vigorous verbal encouragement" to get a Russian doctor to give a patient having a heart attack morphine. There is an excellent article somewhere on the internet of a guy who basically runs an illegal pharmacy service for cancer and pain patients in Russia, where he obtains the meds by legal and illegal means (often, I believe, mailed to him from donors out of country whose family member has passed on). He is a hero.
My mother in law developed lung cancer in a FSU country. Her last days, she received only IM toradol (a good painkiller, but non narcotic. Think super-ibuprofen). She died in extreme pain. I had taken her to the UAE for treatment at one point, and asked the oncologist, a Finnish gentleman, about the issue of pain medicine for cancer patients. He said it wasn't too bad for him personally, because he had a good relationship with the Ministry of Health. But, still, these are medications that are normally only given in a hospital. Chronic pain sufferers should be aware to NEVER travel to a Muslim country unless they have all the right documentation for their pain medicine. Bringing your oxycontin into UAE or Malaysia without the governments approval (and getting that often requires, -NO SHIT- a letter from the US Secretary of State, as well as a mound of other paperwork) can land you in prison, possibly even a death sentence. A prescription is worthless.
I worked on a ship and we had a sailor break his leg in one of the above mentioned countries. I took him to a hospital to get an x ray and a backslab put on. The doctors refused to give anything because "the pharmacy was closed." I told the doc I had some tylenol with codeine from the ship's supply (all countries allow this, as part of international maritime treaty law. Don't even THINK of taking it off the ship though, and good luck getting it resupplied outside of the US, Europe, Singapore and a few other countries). The local doc just said, "Better that you keep giving him that." I could tell he was relieved. He didn't want to deal with issuing a narcotic script in his draconian medical system. For a badly fractured leg.
TL;dr- In most of the world, the doctors are so afraid of running afoul of the narcotics laws, they refuse to give them out.
Nor is the US without its own issues. There are doctors around who still believe "dont give pain meds for abdominal pain" because it will "mask symptoms". Virtually every hospital is guilty of oligoanalgesia (not enough pain relief). It happens literally everywhere, all the time. Often the fear is suppression of breathing /overdose. So they give orders for small doses every few hours. This happened to me recently, after surgery. I was getting .2mg of dilaudid about every 4 hours. It barely took the edge off. Then my pain went to 10/10. I thought it might be gas (common after laproscopic surgery). The nurse tried simethicone, suppository, but I was in so much pain I couldnt even get out of bed to use the toilet. I finally told her "Look, .2 is not enough. I weigh 120kg. You need to give me 1mg. Call for an order." She did (she was a good nurse). The doctor said she could give .5mg. It helped, but not as much as 1mg would have. Turned out the pain was coming from my drain (next morning they removed the drain, which stopped the pain, but it was an agonizing 12 hours). Note: THIS WAS AT A HOSPITAL RATED NO. 1 IN THE WORLD.
Having worked as a flight medic, I have given literally GALLONS of pain meds over my career. If you want good pain relief, call a paramedic. We aren't worried about ODing the patient, because we literally are sitting right next to them every second, and watching them. We mix up fentanyl drips (the Holy Grail of pain relief) and up the dose until we get the patient comfortable. Yet doctors are worried that nurses, despite all the monitoring equipment available, will OD the patient. I should have been given a PCA pump and placed on a continuous vital sign monitor, but because I have mild sleep apnea, I had to make my nurse keep pestering the doctor for pain orders.
My father was in the hospital for surgery for pancreatic cancer. My mother said he was in intense pain. I got the ICU intensivist on the phone (was out of state). I said, "Look, he's a 300 pound man with diabetic neuropathy. How much pain medication are you giving him?" She said something like 5mg of morphine every few hours. I told her "He takes 30mg of oral morphine a DAY. Think about that. He's obviously got a tolerance. You need to up his dose considerably." She said she hadnt realized that and would do so.
Side note: Every patient in a hospital needs an advocate, even if its only the patient themselves. My son had an appendectomy and was having a lot of post surgical pain. I told the nurse in no uncertain terms I wanted an increase in his morphine order. She was, luckily, an ex-flight nurse, so we were totally on the same page, but she had to fight for it. The doctors were very reluctant. Yes, they have reasons: decreased motility, respiratory depression, etc. But these are ALL treatable. Patients need to be aware it is an ethical violation to withhold sufficient pain medication. If you or a family member are in a hospital, and not getting sufficient pain medicine after reasonable requests, DEMAND to see the hospital's patient advocate or patient rights representative, or someone on the ethics committee.
So dumb. Ease their pain! Like a opiate addiction matters when one is facing serious trauma or death.
Better to die pain free than in pain. Fuck you for looking down on suffering.
this country prescribes enough opiods.
Never ever come to Japan when you suffer from Pain/ chronically Pain, the palliative Treatment here is a catastrophe!
Afaik you get a bit in your last Days only. (Terminal Illness)
The Oncology Units are full of crying Patients!
But there are not many Morphine-Type Abuser here.
I've never understood why the medical field is so worried that someone might die addicted? Is that really more important to them than being able to live with some dignity and joy in your final days?
Interestingly, morphine isn't addictive whilst the patient is suffering from chronic pain. The addiction fear comes from incorrect weaning.
The Oncology Units are full of crying Patients!
That's so disturbing to hear in a first world country in the 21st century :(
EDIT: Looked this up - disturbing stuff:
Thank you for this. I just watched my great aunt die and I'm sure she wasn't getting enough pain meds those last 8 days she was in hospice. It was so hard to watch.
Am I the only one who sees the irony of not being able to get opioids in Afghanistan?
Heres how you fix this, sue