A definition of irresponsible prescribing that applies patient by patient and situation by situation would be so helpful.
I guess it is tempting to think this problem of being "responsible" is easy. It is not. It must be one of the most challenging for practicing physicians. How to be compassionate and still not screw up a perfectly normal person converting them into an addict.
Folks did not come into the office with an "A" on the their forehead if they were addicts or were likely to become addicted. In fact, those addicts spent an enormous amount of time and effort attempting to deceive and defraud well-meaning docs. (I had one guy who we learned presented to my office late on a Friday afternoon with a "fresh" few-day-old surgical wound on the midline of his abdomen with a well-practiced story of travel home, significant pain, etc etc. The thing was his he kept freshening his wound with a razor blade for one doc after another). So ya, docs get gun-shy.
And we do see injured people requiring/requesting/pleading for pain meds. The trick was to convince them that try to take away their pain entirely was practically impossible and attempting to do so has significant risk. A cooperative approach with them doing their part to avoid addiction is important. When I hear folks wanting the docs to "take their pain away" I see huge red flags. That is the whole point of what I have written. Use the meds responsibly, but fear them. They are dangerous and there are untold numbers of good people who have been harmed by well-intended treatments. If the patient takes initiative to protect themselves outcomes will be better and they will be safer.
I did not think that needed explanation, but maybe it does. Machinery is dangerous and anyone using it should be clearly cautioned. Pain Medications are also just as dangerous and more insidious, and patients certainly should be cautioned.
All of these fear mongering CDC and news articles are confusing the situation by mixing long term chronic pain patients and drug seekers. There's no confusion in a situation where a patient sees a doctor long term, but a doctor is still afraid to prescribe medication because addicts have f*cked things all up. For instance, I've seen the same doctor for pain management for well over a decade. He still expresses fear of the ATF and CDC guidelines. Most people do that same mixing of addicts and legitimate patients in severe pain. I have no sympathy for drug seekers for that reason. You're barking up the wrong tree if you expect find any here. I also don't see how a patient that is regularly randomly drug tested could possibly be taking medications or dosages that they shouldn't be without getting caught. Being cautioned is one thing. To caution someone you say "be aware, be careful." Fear mongering is another. Saying"fear this! Be afraid!" Is not cautioning. The only thing to fear is irresponsible use. That isn't the fault of the medication. It's the fault of the person who doesn't have enough willpower not to abuse it to get high and the fact that they're somehow able to get away with it when they shouldn't be.