My original comment was unclear, I can see that from both replies I got. I was not claiming that opiates were effective for long-term pain relief. I wasn't addressing their ability to relieve pain at all. I was referring only to the toxicity and health consequences of long-term opiate use alone. I also do not specifically consider 'dependence' to be a negative consequences in the scenario I described because I specifically mentioned a reliable, known clean supply. SSRI anti-depressants are similarly heavily prescribed and cause tremendous dependence. That only becomes an issue if a substance has other health consequences, or supply is disrupted.

There are a surprisingly large number of long-term wealthy opiate addicts who are not suffering from any sort of physical pain they are trying to cure. They are addicted, certainly, but manage their addiction like an alcoholic or smoker manages theirs. Unlike the alcoholic or smoker, however, they are unlikely to develop any cancers, cirrhosis, or other significant complications other than the constipation I mentioned. Constipation is inevitable because the gut has opioid receptors just like the brain does, only when those in the gut meet a receptor agonist, they stop gut movement. That's how Immodium A-D works. It's actually an opiate. But one formulated such that it will not cross the blood-brain barrier.

Also, my later statement, about the people who want to make sure no one is having it easier than they are, was in reference to the moralizers and the original drives to make various substances illegal as well as the 1980s 'war on drugs' push and similar. Drugs are not illegal because they're bad for you. That was never the basis of any of the laws. Poisons are not illegal to produce, possess, or ingest, generally speaking. Only chemicals which make people happy are.

Those concerned with dealing with the current opiate crisis certainly are not among that group of people simply angry that they didn't have the 'easy out' of popping a pill to be happy. I count myself among those deeply concerned. I live in West Virginia, a state with one of the highest rates of deaths from heroin overdose due to the restriction of the availability of prescription opiates with absolutely no attempt to provide any alternative to those dependent upon prescription opiates other than turning to heroin.

Dependence is simply a fact of opiate use. It's not evil. And it's not intractable. It CAN be dealt with by doctors, if they educate themselves through sources other than lying pharma company reps and avoid the inane moral stance that a patient should be able to stop taking them suddenly and any failure to do so is a moral one. Taper their dosage down. Do it over 6 months or a year if necessary. They're not blowing out their liver or kidneys or anything, and opiates are among the cheapest drugs there are (the non-synthetics at least), so there is no reason to hurry and try to force the patient to bear the discomfort of withdrawal. There is a hidden big problem behind that, though. It will only really work with patients who do not have other issues in their life which make stopping the use of opiates untenable. As we know from animal research, if you put mammals in a restrictive, unstimulating environment, they will naturally turn to addiction. If put in a stimulating, pleasant environment, they will avoid addiction and even wean themselves off automatically... but that requires providing people with a better life. The simple fact is that many people have terrible lives and desperately want an escape. I'm not sure what can be done in those situations... it almost seems immoral to ask them to drop the only thing that makes them feel good and simply bear their situation because we don't like the idea the pills are helping them.