Well, I can’t honestly say that the question is stupid.

The over-reaction to opiate over-use has been absurd. And it is true that with adherence to prescribed dosages and regular monitoring, opiates aren’t as bad as people think they are.

That being said, they are among the most addictive substances out there, and without restraint and monitoring, they will het away from a significant segment of users.

However, you’ve made the claim in comments that it’s people getting bad illegal drugs that’s the big problem. This simply isn’t the case. I’ve dealt with opiates from the outside and the inside. I took care of the disabled, injured, and dying for twenty years. That accelerated the ruin of my body, and I’m a chronic pain sufferer myself now.

Even low dose stuff like vicodin can seriously fuck people up without any need for illegal access. People die from it. Long term use has predictable and nigh inevitable effects on the body and brain. When you’re inside that, it is far harder to monitor your own usage. As your tolerance increases, and you deal with reduced efficacy because of that, you run into an escalation that isn’t tenable.

If they were OTC, you’d see massive jumps in hospitalizations and deaths, just from those less addictive forms. Hell, I lost patients to vicodin solely because they had a bad weekend pain wise, and lost track of what they were taking. I saw the log book one of them used to keep track, and over two days, it turned into a jumbled mess with the times becoming impossible. They were taking enough that they thought days were passing, but it was hours.

That’s the worst case scenario, obviously, but that’s also the least dangerous version of opioids.

You can’t just have unfettered access and expect anything else to happen. It would kill more people than it helped.

Now, it is true that as tolerance and dependence build, those that switch to stronger versions, particularly the ones that are illegal, have worse outcomes than people that have good support with access to stronger opioids with industrial consistency. There’s folks that can go most of a lifetime on things like morphine or methadone as long as they have a good team helping them. I’ve seen those successes.

Don’t get me wrong, I’m 100% behind decriminalization of all drugs. Even the horror show that is meth. They need regulation and a switch away from legal problems into treating it like the health issue it is. But unfettered access is not the same thing. Nor is pretending that there won’t still be a problem if it’s prescribed rather than street level. Opiates are not a fucking joke.