After Surgery in Germany, I Wanted Vicodin, Not Herbal Tea

Only for prescription drugs ("verschreibungspflichtig"), so no "ask your doctor if XYZ is right for you" bullshit.

Non-prescription drugs ("apothekenpflichtig") are heavily advertised in pharmacies, sometimes on billboards, and on TV. Most TV ads for drugs are running on ARD and ZDF [1] since that's what old people watch.

[1] Though only between 18:00 and 20:00, which is when the public broadcasters are allowed to air ads.

Some might say it's like a tax, it gets deducted from your paycheck, but then that's the same everywhere, including the US. Difference is that it's managed by independent entities and not the government, and they even compete. The private insurances are quite significant in Germany too. You are allowed to leave the government-mandated "Krankenkassen" if you earn over a certain amount of money per year, then you have to get private insurance - which is less expensive if you are young, but unlike the Krankenkasse family members (e.g. non.working spouse, children) are not included and it may become much more expensive when you get older, it's hard to predict because it depends on many factors including if you picked the right insurance company (that didn't lose as much money and now has to raise prices).

I do think a great many people either overprescribe or are overly dependent on painkillers, opioid and otherwise, but there's also many different kinds of pain. I have a fairly high pain tolerance for most things, but certain kinds of acute pain, mouth pain or the warning pain of a migraine immediately disrupt my ability to concentrate usefully, which can be problematic when you need to concentrate to resolve the source of the pain.

There's also a weird thing where a good number of people I've known have regularly taken well in excess of the maximum safe dosage (even for Rx) of painkillers for days or weeks every month, and not think this is something they should bring up with their doctor. If this were "I talked to the doctor and made this choice based on X information," I wouldn't be as surprised, but it just never crossed their minds that it was abnormal to have crippling pain on a recurring basis.

In the US, I recently had two teeth removed that had horrendous infections (the swelling was tremendous); after the surgery, I asked them about painkillers, and they told me I wouldn't need them, just take ibuprofen if the pain gets bad and it'll go away in a day or so. I was skeptical but listened, and much to my surprise, the pain did almost magically vanish after I went to sleep that night.

AIUI the reason they still tried opiate painkillers is that there aren't really many non-opioid alternatives available other than the OTC stuff - and the effectiveness of both types varies wildly by person, but since the distribution is wider for the opioids, on average you're more likely to get pain relief from it. (My brother, for example, gets almost no benefit from any non-IV opioid painkiller, whereas if I take a single hydrocodone I'm both pain-free and borderline asleep.)

It'd be nice if we could find ways of relieving crippling pain without risk of physiological addiction, but so far, I don't think I've seen much compelling research toward that.

There are only three categories: overprescribing, underpresribing, and prescribing the correct amount.

In the case of opioid-based painkillers, overprescribing leads to unnecessary addiction, in turn leading to heroin or fentaynl abuse, breakup of families, overdose, etc.

If you’re underprescribed opioid painkillers, you just feel temporary pain (or not, since non-opioid painkillers exist).

So, they’re not even really close in terms of long term consequences.