“I have a patient with inoperable spinal stenosis who needs to be able to keep chopping wood to heat his home. A one-size-fits-all prescription algorithm just doesn’t fit him. But I have to comply.” Prescription opioids are the real gateway drug — often leading to addiction and heroin abuse. But there are also millions of chronic pain patients who now depend on them. So like everything related pain and its various treatments, the situation is complicated. From the NYT: Patients in pain, and a doctor who must limit drugs.