Thirty-nine states, including my own state of New York, have adopted PDMPs. The data collected can help states to fashion targeted education programs as well as to identify and intervene with doctors whose prescribing patterns suggest that they are "pill mills," conveying to too many patients, collectively, massive doses of controlled drugs, making a lot of money for the provider. The databases also allow doctors to know if one of their patients is receiving the same medication from another doctor, or many, as people dependent on opioids often go "doctor shopping." When something needs to be done, stop thinking about it, analyzing it, and trying to find the right time to do it. Just get the ball rolling. Get started. Start making it happen. You will figure it out as you go. The more you think about it, the more you hesitate, stall, think yourself out of it, and the longer it takes. What you're actually doing is more powerful than what you're planning on doing. What you're planning on doing holds no weight. Get out of your head, lose the mental chatter, lose the emotional chatter, and just get to it. Brian Tracy says, "When you decide you're going to do something, do it. They've done dozens and dozens of studies over the years and they find that there's one major difference between successful people and unsuccessful people is successful people launch. They start. They get on with it. They just do it. Unsuccessful people get the same ideas and the same information but they've always got an excuse for not starting." If a particular operation or procedure is complicated and requires time to think about and figure out, by all means, do so. Failing to plan would be dumb. But for repetitive and mundane tasks, just get on with them.

If you have a physical job, stop thinking about how your knees and back hurt, how it's hot, and how that task sucks. It doesn't matter. Those thoughts and emotions don't get the job done. They don't contribute in any way. The easiest thing to do is to turn your brain off, suck it up, move forward, ignore the weak and useless thoughts, and get it done. The more you stop thinking about what has to be done and you just do it, the more it becomes second nature. The most productive people are the ones who get to it and make progress before everyone else is done thinking about it. Many states now require specific prescription forms or only permit electronic ordering of medications. These mandates complement the PDMPs. In some jurisdictions, the number of pills that can be prescribed, especially for initial prescriptions for acute pain, is limited (e.g., a seven-day supply), and a new prescription, not a refill, is required for further medication, unlike for many other drugs such as heart medications, antidepressants, and blood-sugar control agents. Across the country, we have seen in recent years significant reductions in the prescription of opioid medications. In my public appearances, on radio and in community talks, many patients with chronic pain that had been on these drugs have voiced concerns that their doctors won't give them the medication they need and have used, nonabusively, for years. Such is one unintended and unfortunate consequence of surveillance of doctors: inappropriate prescribing may be reduced as well as appropriate prescribing. The pendulum may have swung a bit too far from where it was and may take time to swing back to what might be regarded as equipoise. Critics of PDMPs (as a singular solution) also note that while opioid prescriptions are down, overdose deaths continue to rise. However, that appears to be related to the growth in illegal use of opioids, including of pills fabricated abroad, and users' progression to heroin and fentanyl--and fentanyl's more novel forms, which are far more deadly drugs than the others. Drug courts are another useful policy intervention. Eligible drug-addicted persons may be sent to drug court, in lieu of the traditional justice system, and be directed to long-term treatment under close supervision. For a minimum term of one year, participants are provided with intensive treatment and other services to help them get and stay clean and sober; are held accountable by the drug court judge for meeting their obligations to the court, society, themselves, and their families; are regularly and randomly tested for drug use; are required to appear in court frequently so that a judge may review their progress; and are supported for doing well or sanctioned when they do not meet their obligations. I used to believe that by worrying, I was being productive.

Instead of planning, I worried. Instead of thinking what I should do next, I worried. And instead of acting, I worried even more. But worrying does not yield results, because it's counter-productive to planning and acting. In the short term, worrying had its rewards, because when I couldn't do anything else, I could always worry. However, there were times when my worrying spun out of control, so much so, that I became paralyzed with fear at even the thought of dealing with a task. Of course, worrying was actually a substitute for action. So in a certain way, it actually made me feel good to worry, because in spite of filling my mind with anxiety, it felt like I was accomplishing something. There are a few problems with this way of thinking. The first is that worrying is not a productive activity. While it may provide you with something to do, that something is not "do"-ing. Secondly, constant worrying can lead to feelings of helplessness and hopelessness. At my own worst, I would actually worry over how much time I was losing to almost ceaseless worrying. Many procrastinators spend hours at a time lying in bed, wallowing in despair. One procrastinator described these worrying sessions as "listening to my body," as if he were listening for a signal or a cue to say, "take action"; however, that signal never came. I too used to lie awake in bed, while my mind played and replayed scenarios that involved seemingly insurmountable tasks, as though my mind were continuously spinning the dial of a combination lock back and forth in a futile attempt to open the shackle through sheer persistence. Concurrent with my worrying was an inability to calm down. It was as though my mind could instantly go from relative calm into high-speed anxiety drive, yet it was almost impossible for it to reverse back into calm. In fact, the only way I could stop worrying was to lie down and try to sleep--a sleep that came more from nervous exhaustion than from anything else. As one sufferer put it, "One-half of my brain produces B.S., while the other half buys it." As we have already seen in the Introduction, depression seems virtually universal and has even been seen in many nonhuman species.

In fact, just about any pet owner or animal breeder can tell stories about the deep emotions that animals seem to experience, including depression and grief following the death of a loved one. Along with the learned helplessness often seen in animals kept in cages, especially when isolated or deprived of normal social stimulation, researchers studying animals in the wild have recorded numerous instances of grief and despondency in many animals, suggesting that these are truly universal traits. Certainly, photographs showing elephant calves grieving for mothers who have been killed by poachers demonstrate how real this emotion can be. Researchers have identified numerous different causes for depression, ranging from genetic and biochemical factors to psychological causes, including the influence of stress, trauma, life changes, and even the amount of sunlight we happen to be getting. But can we understand more about why we become depressed by looking at possible clues from our evolutionary history? Some researchers have suggested that we can. For example, one proposed explanation is the "behavioral shutdown" hypothesis. This suggests that depression can actually be a healthy coping mechanism under some circumstances, as it helps us adapt to extreme situations by reducing activity as much as possible. In other words, being depressed leads us to take time out of our lives to recover and regain the inner resources needed to cope in future. Being in a depressed state can also force us to ruminate about our lives and give us the time needed to make effective changes. Our ability to survive depression also depends on the support we receive from family and friends, something often seen with animals living in social colonies in the wild as well. There is also the "psychic pain" hypothesis which suggests that the kind of emotional distress seen in depression is very similar to how physical pain affects the body. For example, the physical pain we experience after being burned forces us to withdraw from the fire to prevent being injured further. In much the same way, the psychic pain that can lead to depression can also act as a warning that certain activities may harm us if we are not careful. Say no to escalators. Walk over and talk to a colleague instead of calling or emailing. Find a walk buddy. A walking partner can be a strong incentive to walk daily, especially when the sky is grey or you find another excuse not to. Take the scenic route. There are apps (try Kamino and Field Trip) that will tell you not the fastest route but the prettiest.

Make Wednesdays Walking Wednesdays: a day when your family, friends or just you go for an after-dinner stroll. Go on a coin-flip safari. This is a great way to get to see new parts of your neighbourhood. We tend to walk the same routes when we go for a stroll so, next time, take a coin with you and, at every junction, let the coin decide where you go. Getting to know your neighbourhood better will make you feel even more at home there, and you might discover new places where you love to go. Bring a podcast, if you are by yourself. There are many great free ones. My favourites are RadioLab and This American Life. Walk, don't wait. If you arrive early for an appointment - at the doctor's, for example - take a walk around the block rather than simply sitting in the waiting room. Meet your friends for a walk, not a coffee - or just have the coffee while you're walking. Join a walking group or a hiking club. There might already be a walking group in your neighbourhood - if not, ask your neighbours if they are interested in forming one. Eric Thomas says, "Everybody wants to be a beast until it's time to do what beasts do. When it gets hard, they quit. When it gets boring, they quit. When it's no longer fun, they quit. Being a beast isn't just killing the gazelle, it's the hunt. It's remaining calm and strong during the process." Understandably, you will have boring moments in everything you do. EVERYONE has boring moments.