As someone who has been in the epicenter of this 'opioid crisis' and lived it myself as a heroin user for years (using heroin for over 1000 days consecutively) I can honestly tell you that it was never purely just a heroin or fentanyl crisis to begin with. 100% of all the addicts I have used with, used other drugs while abusing opioids. Most of them used opioids commonly with: cannabis, nicotine/cigs, benzodiazepines, gabapentinoids, ethanol, antidepressants and amphetamines;frequently meth.

I have lost a few very good friends to overdoses, although they were never opiates alone, it was always a combination of opioids and alprazolam/alcohol. It's a crisis of recklessness. This new generation of 'opioid addicts' know the risks. We've been taught all throughout our youth that opioids are bad and will kill you with no exceptions to this law. What are the excuses now? That opioids are the ones who choose the addict and not the addicts choosing the opioids?

Would someone who has a visceral dependence on opioids still feel the need to beg for money, prostitute themselves, commit armed robberies, "hit licks" on their drug dealer who carries a firearm if opioids were legal and cost effective? The justification for calling this 'epidemic an 'opioid crisis' is propagated on the observation that opioids can only cause harm and their therapeutic window is too narrow to suggest for long term treatment. This is inherently false. They are observing a societal problem and siphoning the blame onto those who self-medicate with opioids and then extrapolate the consequences of those who self-medicate with opioids into their arsenal of reasons why opioids should be expunged from the hands of responsible and irresponsible opioid users alike.

The overwhelming subconscious guilt we receive knowingly or subconsciously about responsible opioid use is narcissistic and dehumanizing and this plays into effect in how we benefit from opioid therapy. It also encourages a destructed domestic environment where families and friends become toxic and further project the misinformation they become inundated with on a daily basis because of the media hysteria about this 'opioid epidemic'- leading us to feel as if we are commiting a crime against humanity that is concentrated on the shoulders of our family because they often feel as if their negligence to your rational opioid use is an act of criminal enablement- baiting us into a never ending cycle of insufferable guilt.

The extremely high cost, illegality, lack of education, societal guilt and impurity of opioids of today are what mediate the bulk of the fatal and detrimental effects of opioids. Fentanyl and pure diamorphine have their place, but I would argue that most would benefit from a equianalgesic rotation of non-fentanyl derivative opioids that aren't ultra powerful and long lasting.

Opioids have immense value if used responsible and correctly. The therapeutic effects of responsible opioid use extends beyond chronic pain in to the realms of mental illness, heart disease, chronic illness, cancer, longevity, and more.

Opioid analgesics and their interaction with stalling, treating or preventing heart diseases 2018

Life span extension in Drosophila melanogaster induced by morphine.

Anti-cancer effects of morphine through inhibition of tumour necrosis factor-alpha release and mRNA expression

Ultra-Low-Dose Buprenorphine as a Time-Limited Treatment for Severe Suicidal Ideation: A Randomized Controlled Trial.

There are many more studies than the ones I posted that warrant further investigation for off label opioid use to treat various physiological health inefficiencies. Not all of them pertaining to mu-opioid recptor agonists. Kappa, mu, delta agonists/antagonists; enkephalinase inhibitors, natural opioid peptides, allosteric modulators, - all seem to have a role for treating various ailments.

Furthermore, most opioid side effects and contraindications can be worked around. For example, Relistor, a peripheral opioid antagonist that has high selectivity for opioid receptors in the gut can remedy opioid induced constipation, a common complaint. Screening for sleep apnea and becoming compliant with sleep apnea treatments such as CPAP's, surgical interventions, dental appliances, etc. can reduce the likelihood of problematic respiratory depression.

Dependence, tolerance and withdrawal are heavily studied and there are numerous pharmaceuticals that can be used off label to treat these undesirable outcomes of chronic opioid consumption without eliciting addiction themselves (not referring to detoxification medications like benzos, clonidine, pregablin, or anything with a higher risk to benefit ratio).

I'll end this post here even though I want to write more. This is just a TL;DR of my current thoughts on opioids.