I have some friends who fall into this category. They end up using stuff like Kratom, which I guess is fairly effective. The DEA almost made it illegal recently, but I guess enough are helped by it, a letter writing campaign ended with a rare reversal. I've tried it for fun (and back pain); seems pretty effective to me. Suspect it's hard on the liver.

It is messed up how the medical profession is with its incentives. ~15 years ago my doctor wanted to give me oxys for just about any complaint ("doc they canceled Star Trek Enterprise" here have some oxys). More recently, a nurse ex-gf informs me half her job is saying no to people who are trying to get opiate handouts.