Possibly not the use-case you're thinking of, but I've been using a Wacom Intuos tablet as a mouse replacement for a few years now on MacOS and on Linux. I use it in pen mode (where the area of the tablet maps to the screen) - you can also configure it in mouse mode (like a touchpad, where the movement is relative to where the cursor is on the screen) which should work better with multi-display setups, though it's not to my preference. I have my pen/stylus setup so that tapping it onto the tablet acts as a left/primary click, the larger button on the pen is right click, and holding the smaller button and dragging on the tablet is scroll/pan).

MacOS is well-supported once the drivers are installed, though sometimes the driver doesn't seem to pick up tablet (either after the laptop or tablet goes to sleep). Restarting the driver fixes this, though this bug seems to have been fixed in the latest driver release. Linux works out of the box (at least on KDE/Arch), though sadly customization support on Wayland isn't quite there yet compared with what you could do on X11 (with the xsetwacom utility). For drawing support though it should work perfectly but as far as I know you can't the the button functionality, which is a bummer when using it as a pointing device.

The main benefit for me is that it feels much more ergonomic compared with a regular mouse or even a vertical mouse or trackball and I don't get anywhere near as much wrist or shoulder pain - especially in the cold temps in the middle of winter where I am. There is a bit of an adjustment period and I find for interacting with small UI elements such as buttons it can be a bit tricky, but for me the benefits outweigh the downsides. The only other downside I can think of is that when using the tablet over bluetooth (wired is also an option and tracks a little more smoothly) the battery only lasts 1½ days compared with the weeks/months a wireless mouse would go for.