I disagree. First, following your first link, I found the CDC bullet point that says 53% of drug overdose deaths in the US in 2012 were "related to pharmaceuti

I disagree. First, following your first link, I found the CDC bullet point that says 53% of drug overdose deaths in the US in 2012 were "related to pharmaceuticals". Note that doesn't say "were prescription drug deaths" as you did. "Related" includes those deaths in which someone who had a legal prescription for a drug used something with it that was fatal - a simple example would be alcohol combined with many of the opiate painkillers, but it would also include somebody on the antidepressant drug selegeline who ate a tyramine-rich food like bleu cheese or sausage and died of hypertensive crisis. There are many other examples of deaths "related to pharmaceuticals" that would not involve painkillers, nor other pharmaceuticals used as directed. I recommend you do the analysis needed to see what's actually going on, not merely that which may constitute confirmation bias for your views. Second - of course there are externalities that could well account for the increase in painkiller prescriptions since 1991. Just one example - we have an aging population. When people age, they encounter illnesses that hurt. Osteoarthritis, for example - it is common for those who have it to be unable to do something as simple as remove a twist-off jar lid because of the pain involved. Ditto climbing three or four steps because of pain in their feet and knees. Nevermind diabetic neuropathy, and other such painful, age-related diseases. Have you explored the increase in our aging population and projected the numbers of people who could reasonably be expected to need painkillers to remain functional as they age? What did you find? Further, one reason for the increased level of painkiller prescriptions could well be that analgesia has been underprescribed due to irrational prejudice against it and we're finally realizing it. In the US, opioid pharmaceuticals seem be regarded as "The Great Satan" by some Americans and by American law enforcement. Consequently, pain relief - which should be a straightforward (if complex) medical issue - is demonized, hindered, and encumbered with useless transactional friction. So, yes - it's certain that our aging population has increased the need for painkiller prescriptions since 1991. How much, I don't know. If you look into it quantitatively, please let us know. But from what I've seen in the medical profession, the increase could well be independently explained by the recognition that pain relief is critical to quicker recovery from acute illness and equally critical for prolonged productivity and quality of life, and the shedding of prejudices that have blocked such recognition. I understand YMMV.