THe reason people don't use local docs is because it's hard to find one who will prescribe on a long term basis & be willing to deal with issues like tolerance, I live in a major metropolitan area, population over a million....with multiple hospitals & clinics with state of the art medical technology....even the Mayo clinic is here...but the PM clinics (and I've been to just about all of them) don't "believe in using narcotics for long term pain managment". So I fly to a small town with a teaching institution and have a compassionate PM doc who prescribes what I need to keep me working full time & managing my life....THAT"S why people don't use local docs