It’s only very recently that they’ve taken steps in the US to join up prescription history. So if you’re a “legal” abuser and you need more than your doctor will prescribe, you pop down the road to the next, and the next, and the next. Then you realise street heroin is way cheaper and less hassle to get, so you use that instead. If you’re white working class with no job because the local factory closed, it’s a way to comfortably while away the days and not care about how shit life is. Quality is variable though, and super strong stuff like fentanyl mixed in with the other stuff so people who were managing OK end up overdosing accidentally.
Far more care is taken in the UK to manage people on painkillers and avoid that spiral.
Their healthcare system too means if you’re uninsured you can end up with a painful condition that will be managed with opioids rather than having surgery that might fix it. More of the pills around (and the prescription amounts can be hundreds of pills) mean kids can get hold of them to try from their parents/grandparents stash.
The pharma companies aren’t entirely to blame but have been guilty of inaction (and lobbying against action) because they like making the drugs and making money from it. All very sad and lots of factors at play here.
