It's crazy.
Just got back from skiing. Got in a massive wipeout and felt like I got hit by a bus by the time I got to the bottom of the mountain. I ain't no spring chicken, I thought I had broken all the bones.
Go to the nearest ER which is a dumpy Colorado vet or miner hospital on the border of New Mexico and the doc there is awesome. Do a full trauma workup (as if I got in a car wreck) and full scan. Turns out I'm fine, just bruised and battered, but no tears, breaks, fractures, nothing. Just very sore.
Nurse: "Mr. Vegas, we can't give you any norco or pain meds like that because you took some Advil (or Tylenol) a few hours ago before coming in, but we have a bunch of fetanayal we can push in your IV"
Me: Um wut? You want to give me fet?
Nurse: "The only thing we can give you, it's this or nothing. I've sent a muscle relaxer to the pharmacy, but if you want anything now it's this or nothing"
Me: "I'm fine, thank you"
I couldn't believe how easy they dispense with it and no wonder rural communities are lousy with it.