The code of conduct changed around 2009 as the author points out. Prior to that time it was a torrent of all kinds of expensive gifts, which were not restricted

The code of conduct changed around 2009 as the author points out. Prior to that time it was a torrent of all kinds of expensive gifts, which were not restricted to opioid prescriptions. The higher the number of “scripts” a physician had, the more extravagant the giveaways. Interestingly, prior to the opioid frenzy, the culture was one of great restraint often leading to under medication of pain and unnecessary suffering for patients. This was superseded by the conviction that pain had to be eliminated if at all possible, it was a physician’s moral imperative to do so. Now in hindsight, it’s clear that Pharma was driving a lot of this ethos.