There&#x27;s certainly a cynicism present in some providers - we&#x27;re definitely not a perfect bunch, and some areas will have more explicit policy on the use of narcotic pain relief.<p>For me: I look at physiological symptoms. You tell me you&#x27;re in 10&#x2F;10 pain (the &quot;worst of your life&quot;&#x2F;&quot;worst you could imagine&quot;) and you&#x27;re in no visible distress with normal vital signs, then I&#x27;ll factor that into the decision.<p>That being said, I believe it is unethical, immoral to withhold something that could benefit a patient who is in genuine distress, regardless of anything else. For those patients, we have options, too. Fentanyl, for one, is used a lot pre-hospital as it is both an effective analgesic with a short lifetime in the body.<p>There used to be (probably still is) doctors in the ED who don&#x27;t want a patient to come in with pain meds onboard because they want to see a &quot;baseline presentation&quot;. Again, I think this falls into the realm of poor provider care. We have diagnostic tools for objective analysis, and having a patient in pain just so we can measure it is inhumane.<p>Bottom line: if a patient requires pain medication, they will get it from me, subject to analysis of circumstances. In your example above, if it&#x27;s not &quot;drug seeking&quot; but concerns about side effects, then the patient and I can have a discussion about benefits versus risks (the flip side to that being if a patient has a broken femur, for example, that conversation is likely to be limited to &#x27;give me the damn drug!&quot;).