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The following discussion roams through numerous facets of opioid prescribing for pain, without clear focus and without any particular connection to dextromoramide specifically. It might be better placed in an article about opioid prescribing generally. If for some reason we put it back in this article, it would be better somewhere other than the intro paragraph. In any case it needs editing to tighten up the tone, copyediting for mechanics/punctuation, citations for disputable statements and value judgements, and correction of frankly false claims like "practitioners, not government regulators, have sole legal responsibility for pain treatment." eritain (talk) 18:17, 4 December 2020 (UTC)[reply]
Usually, it is marketed solely in the Netherlands, while in the UK diamorphine or morphine are preferred; in the US, hydrocodone and oxycodone are sometimes used; and in the Scandinavian countries, medicines like ketobemidone are available to doctors in such dire cases. Both the US and to a lesser extent, the EU have faced a problem with opioid abusers creating a stigma or difficulty around prescribing in palliative care and when very strong opioids are indeed indicated. The legal and moral responsibility remains with the prescriber, clinician and to some extent the pharmacist, rather than purely regulatory or government authorities to solely dictate the way in which severe pain and suffering are approached. Some barriers to entry may be required, simply to protect patients or addicts from escalating their usage to an uncontrollable or severely toxic level, this threatening both their life and quality of life, however this does not preclude sparing and even liberal use of palliative medications when they are indicated, to end or lessen severe pain and suffering, including the worst aspect of terminal disease in the physiological sense, as well as in the literal sense - in reference to pain receptors in the central and peripheral nervous system responding to real stimuli. In the case of purely psychological or psychosomatic pain, a better approach can include low dose methylphenidate, hydrocodone, or a typical serotonergic antidepressant. However it cannot be denied that in very severe treatment resistant depression that has not responded to any of the typical, atypical, or even off label agents available, then an opioid can be trialled with care. [citation needed]
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