They are extremely addictive. No one disputes that.

The actual drugs here - I’m talking pure, regulated pharmaceutical versions - are pretty benign physiologically. Constipation is about the worst of it.

The combination products (opioid plus something else) are a bit worse - but in those cases it’s the other thing (usually Tylenol) that’s actually hard on your body, especially the liver.

Although it’s much less common these days due to all the regulation, many doctors kept a up successful practices for decades while self medicating heavily.

What gets people killed are either things sold as other things (e.g. heroin laced with fentanyl, which is much stronger) or propel who quit for a while and then go right back to their old dose and OF because their tolerance is gone.

> Set against a background of assumptions that heroin use is inevitably problematic, there is significant evidence of its controlled use. This paper attempts to draw together the literature on patterns of heroin use which avoid physical and psychological dependence.

https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1360-0443....

This paper is a great read on the topic. Some suggest more than 50% of heroin users are casual users.

Moderate opioid use is possible if you take long enough breaks to avoid physical dependence. That of course requires the self-discipline to say no to the psychological pull. As far as I recall, I felt some mild withdrawals after about 3 consecutive days of poppy tea use, so the physical dependence does set in pretty quickly. But if you know your boundaries, it’s easy to avoid. I would wager a guess that you could do strong opioids once a week indefinitely without any negative repercussions.

> as a result it's nearly impossible to be a "casual" user

I wonder about the truth of this. I've done a lot of reading at places like Bluelight (for research and curiosity), and it seems there really are a lot of people who set strict guidelines for their drug use and are able to use opioids periodically without addiction.