text: As a Physician Assistant in the rural areas, I've seen rampant "legal drug dealing" by my peers and many other health care providers. I am describing the routine if not gratuitous prescribing of controlled medications to the demands of "patients". I often ask what is being treated in the patients being given opioids routinely, only to hear "pain" or see a blank face. Pain is not a diagnosis, it is a symptom. The use of opioids to treat "chronic pain" is not the standard of care or recognized as appropriate therapy. I can't cite the specific numbers but there had been a more than massive increase in the prescribing of opioids in this country over the past 20 years. The problem is providers opened the floodgates and now the those downstream are drowning.