In his Dec. 1 Outlook essay, “Our dangerous fear of pain,” James D. Hudson compared living with chronic pain to living by the noisy El tracks in Chicago — an annoyance but something you can adapt to. But what happens to those people over time? Eventually, they may suffer hearing loss or develop other problems likely to become more difficult to treat the longer they live there. Similarly, the longer people are not offered effective relief from incessant pain, the more likely it is that their pain will increase, they will develop other kinds of related ailments, and they may over time suffer from psychological trauma and depression.

The only concrete alternative to pain medication that Dr. Hudson offered was physical therapy, which has never helped my long-term pain from interstitial cystitis (IC). Moreover, many urologists, physical therapists and pain specialists refuse to treat IC patients, or they charge exorbitant upfront consultation fees not covered by insurance. Doctors and health professionals must take the time and effort to closely monitor and consult with those who need and deserve pain meds, as well as encourage the use of underfunded, under-researched alternatives, including medical marijuana, hypnosis, acupuncture, herbal supplements and meditation.

Margaret Blair, Rockville

James D. Hudson wrote that doctors must disabuse themselves of the desire to provide their patients a pain-free existence and that patients need to learn to accept and live with pain. He recalled the rule he learned as a third-year medical student on a general surgery rotation to withhold pain medication until after the consulting surgeon examined the patient with an acute abdomen, using the location and character of the pain to make a diagnosis. Dr. Hudson might have had a general surgery rotation, but I am a general surgeon. In 35 years, that diagnostic rule has not changed. But Dr. Hudson did not say once surgeons complete the exam, we treat the patient’s pain. A major part of our mission is to relieve human suffering.

Now, with the return of opiophobia reminiscent of the mid-20th century, doctors are pressured by law enforcement and regulators to curtail the treatment of pain. It has reached the point at which pain patients are organizing in protest and the Centers for Disease Control and Prevention announced that its 2016 guidelines for prescribing pain medications were misinterpreted and misapplied. While Dr. Hudson and others address the overdose crisis by telling patients to concede that “life isn’t ‘pain free,’ ” nobody wants to address the giant elephant in the room: The overwhelming majority of opioid-related deaths are from heroin and illicit fentanyl, obtained by nonmedical users in the dangerous black market made possible by drug prohibition.

Jeffrey A. Singer, Washington

The writer is a senior fellow at the Cato Institute.

I do not have any sympathy for Morgan Godvin’s position that laws that “sweep up” addicts are unfair [“My friend overdosed. I was arrested.,” Outlook, Dec. 1].

Homicide is defined as when one person kills another. If someone kills another person as a result of the drugs the first sold the second, and the law holds the seller accountable, I say “good.”

I recognize addiction is a disease, and people suffering addiction should receive treatment. An addiction, however, does not give someone a free pass for bad behavior. I have friends and family who are addicts, and I have known many people who have died of this horrible disease. I don’t hear any arguments that people who drive under the influence should not be held accountable for their actions. Why should it be different if your actions result in another’s death?

I do agree with the writer that addiction is a public-health crisis and requires a public-health response. Let’s not mix that up with also being legally responsible for drug-related bad behavior.

Jay Gallamore, Lusby

Despite the protests of Arthur Sackler’s wife, her late husband was not necessarily an innocent in the OxyContin scandal. The Dec. 1 Business article “A fight to protect one Sackler from opioid crisis” contained the comment, “His seminal contribution was bringing the full power of advertising and promotion to pharmaceutical marketing.” Aggressive advertising and promotion contributed to OxyContin becoming a societal crisis.

Shahram Ahari explained in his Dec. 1 Outlook essay, “How drug reps push doctors to overprescribe,” how pharmaceutical sales representatives seriously distort health-care practices in the United States and contribute to higher drug prices. That article ended with the comment, “In the case of opioids, this delusion [that physicians and drug reps are acting without bias] has exacted a terrible human cost.”

Sackler may deserve some responsibility for the OxyContin scandal.

Carl E. Nash, Washington