I appreciated the concepts of ‘varied vulnerability across patients’ and the ‘road map’ theory of addiction. Although now retired, I follow the trends and have misgivings about new, well-intentioned but misguided approaches utilizing alternatives like ketamine and IV acetominophen in post-op patients to ostensibly avoid later addiction., I agree that pop-up charlatan ‘treatment’ clinics are seemingly next door to every grocery store across America and/or people like Miriam and Sheldon Adelson’s ‘rehab’ clinics cater to moneyed addicts on the West Coast. This makes me recall Robert Downey Jr., saying (after he ultimately detoxed after multiple near death heroin overdoses, that the problem was NEVER ‘getting clean’; but in NOT starting up drug use again! I suspect the answer lies in that realm of ‘not starting again’ but it’s so multi-faceted (and EXPENSIVE) that no single discipline can mount an effective response. I am saddened to hear you both say that we (medical community) caused this problem although I know I had my own role to play in rx-ing opiates at bit freely, when it was not unusual to do so. I also recall an inservice in the late 90s hearing the anesthesiologist advising us to rx fentanyl patches ‘for pain’… Read more »