For decades, I treated patients with chronic pain. One truth became evident early: most older adults prescribed narcotics use them responsibly. My clinical acumen, shaped over more than forty years, intuitively knew this to be true. Still, I understood that intuition and opinion alone are insufficient. Compassion in medicine must be paired with objectivity.

Now the data confirms what practice long suggested. A national survey of adults aged 50 and older reported that 8.9 percent of those 50 to ∂64 misused prescription opioids, but misuse dropped sharply to just 3.2 percent among those 65 and older. That means 96.8 percent of seniors do not misuse their medication, yet current prescribing culture often treats every older patient as if they are potential abusers.

This is not how compassion works. It is not ethical to let nearly all patients suffer because a small minority might misuse. Abusers are quickly identified: their stories collapse under gentle but firm scrutiny. A patient once claimed her narcotics were stolen when her purse was taken from her car. I expressed sympathy and told her I would gladly refill her prescription; all she needed to do was provide a copy of the police report. She never returned. No lie detector was necessary. Her story collapsed under the weight of its own implausibility.

Meanwhile, responsible patients (many of them elderly) are left untreated, stigmatized, or abandoned. Policies driven by fear of audits or “pharmacy policing” have led to unintended consequences. Patients with legitimate pain are driven to alcohol or to the street, where fentanyl contamination makes every pill potentially lethal. In trying to avoid one tragedy, we have created another.

For patients 65 and older who have never misused drugs, the benefit of narcotics under medical supervision far outweighs the risk of addiction. Quality of life (the ability to walk, to sleep, to live without agony) is more important than appeasing auditors or regulators.

The solution is simple: use objectivity. If the problem is abuse, say no. If the problem is pain, say yes. Anything else abandons patients to needless suffering.

Claude E. Lett III is a physician assistant.