It's true... in a population of 350MM (the USA), that's over a million people reporting abuse or dependence. Though I'd like to see a further breakdown of what abuse means in this context.

Of course, the question that needs to be asked: how many of those began as legitimate prescriptions and ended in dependence? Certainly not all of them, perhaps even a small fraction. But a well-to-do person become addicted after minor surgery tends to get more attention than poor people substituting fentanyl for heroin.

Finally, there's a cost/benefit analysis. Painkillers have an obvious benefit for people who need them - whether to treat chronic pain or temporarily after surgery. What is the cost to restricting access to those who have a legitimate need for these drugs?

I don't have answers to these questions. I will note that public health policy has a checkered past when it comes to unintended consequences. Our attempts at wide-scale social engineering, particularly that driven by outrage and headlines, rarely work the way we expect.

To whit, I can't help but think that the crackdown on prescription painkillers in our recent past (central registries, jailing physicians, imposing production ceilings on opioid manufacturers) has directly lead to the rise of synthetic alternatives we're seeing today.