Is it training?

Yes. As you may or may not remember, the Sackler family spent billions on and made hundreds of billions off of getting the American south addicted to opiates over the 1990s and early 2000s. Every single doctor and hospital involved was sued by their former patients. There are still billboards up in some southern states advertising law firms that specialize in suing doctors over developed addictions.

So any doctor that graduated in the last 16 years has had one specific thing drilled into their head: Do. Not. Treat. Pain.

Because you will be sued if your patient is an addict or becomes an addict.

Is it the fact that becoming a doctor in the U.S. requires the kind of upper middle class upbringing that doesn’t tend to help people develop empathy?

This has always affected doctors in the US, but the medical profession is a calling regardless. If you want money there are so many better pathways, leaving exactly three reasons people become doctors:

1. They want control over life and death

2. They want the prestige of the title for themselves or their family

3: They have an uncontrollable natural urge to try to help others.

So 2/3rds of doctors are not going to fight their training and just try to prescribe pain meds as little as possible.

Of the remain 1/3rd of doctors or so, the ones that genuinely love helping others and want to deliver the best possible care, one bad experience with addicts can permanently change their attitude, and they may get hundreds of experiences per shift if they happen to do their residency in an ER inside any American city.

On top of all of this is the inherent gender and racial biases in medicine, and American medicine in general. Women’s pain is taken less seriously. It was in medical textbooks world wide until the 2020s that black people felt less pain and were genetically more prone to addiction. There was a literal course in every MA, RN, LVN, MD, etc course about “how different races feel and express pain.”

So if you want pain relief, you better have both the vital stats showing you are experiencing pain (which is awful for chronic pain sufferers who no longer have high BP/High pulse from their pain), and you better be a white man with a conservative lifestyle/look (because we know the gays are more likely to pop pills[This is literally in medical textbooks]), you better get lucky that you have a doctor willing to prescribe pain management, and even if you qualify at that point you better not ever ask for pain meds, period, regardless of your situation. As it only takes one single nurse or doctor to put drug seeking behavior on your chart to ruin your chances at ever receiving pain management ever again.