For three decades I have been a participant in and an observer of America’s addictions. It’s a time when there have been remarkable changes in physicians’ prescriptive habits. Americans’ addictions have passed from heroin and crack cocaine, to opioids and now, the deadly Fentanyl/Zylazine cocktail. In the 1980s, establishment medicine had little to do with crack cocaine-addicted Americans, who were denizens of the nation’s poor inner cities who died or were incarcerated in droves. They were, to me, the canary in the coal mine of America’s drug-addiction crisis to come.

We physicians managed somatic pain in a clinical, orderly fashion. I was judicious and fair but wary of drug seekers and sundry pretenders — FBI and DEA agents; the government kept us on our toes. Not always being sufficiently cognizant or sympathetic to our patients’ pain, some of our attitudes varied between those who did or didn’t spend time holding patients’ hands.

Our opioid epidemic appeared in the 1990s after certain opioid merchants — the Sacklers and others — saw an opportunity to insert themselves into where doctors had failed to manage pain properly. I remember the seminars run by fluent, convincing folks with two ideas: our pain management was all wrong and inadequate; and giving large amounts of opioids did not risk addiction post operatively. I remember thinking how for so long we had let our patients suffer needlessly. And just as quickly we changed our prescriptive habits; we could justify giving more opioids.

Some of us over-prescribed narcotics. Like Blacks of 1980s, our public suffered its own existential angst and loved the drugs. They became addicted to opioids. They, luckily, were not incarcerated. We empathized with relatives for deaths that visited many hamlets.

We began taking patients’ pain seriously by defining it, describing it and weighing it. We quantified it, like fever, blood pressure and other vital signs. You see, for long we had viewed anyone complaining of pain with suspicion, of malingering or drug seeking. Sadly, too, race played a significant role in the perceived veracity of Black patients’ complaints. Some White physicians believed Blacks didn’t feel pain just as for a long time, babies and children were not supposed to feel pain.

It was also the hospice moment; in 1993, President Clinton’s health care reform included hospice care. Using liberal doses of narcotics is a humane way of relieving pain in people with terminal ailments and cancers. The old Catholic concept of the twins — pain and salvation — walking hand in hand was left behind in the dust.

We should have intuited it, but the first wave of opioid addictions as a result of our increased use of opioids and methadone prescriptions was quite a surprise. The results were the heroin overdoses of 2010 and, later, the overdose deaths of 2013 to the present. Physicians have not played any role in the current overdoses from heroin, cocaine, fentanyl and Xylazine. Today’s supply of these deadly drugs is a massive international enterprise.

Taking opioids for acute disease should not lead to addiction. Addictions occur as an expression of some deep pathology, something drugs cannot cure. I alluded to the crack cocaine and heroin addiction in the minority populations in 1980s. The addiction then was, to me, an expression of a permanent psychic pathology in the population. I would posit that Rockefeller’s drug laws of 1972 with incarceration of over 2 million people could have been much better handled if it had been tempered with psychotherapy.

The state of being in many areas where large numbers of the addicted live is one of desperation. Improving the lot of these people — jobs, education, better health care — in addition to psychotherapy, can go a long way to reducing the numbers of those seeking drugs and dying. But therapy, sadly, costs money.

We obviously have to manage the ordinary pain of being alive — the broken toe, the painful dead gallbladder and angina pectoris. Whatever state agencies say, doctors have to manage these patients. We luckily are in a good place today with pain management. We have come a long way; we now have a new pain-management medical specialty. Patients with chronic pain are seen by “pain specialists.

In the end, a good doctor’s duty is to relieve pain and to do no harm. This is accomplished in narrow, two person spaces, where governments, corporations or society should never be allowed in. They are called doctor-patient relationships.

Pius Kamau, M.D., a retired general surgeon, is president of the Aurora-based Africa America Higher Education Partnerships (AAHEP); co-founder of the Africa Enterprise Group and an activist for minority students’ STEM education. He is a National Public Radio commentator, Huffington Post blogger, and past columnist for Denver dailies. He has authored a memoir and a novel recounting Kenya’s bloody colonial history.