I do not disagree with that.

> if you have the right mix of brain chemistry and genetics, you might be screwed.

Right. I experience no euphoria whatsoever from any opiates (in any dose)[1]. Blessing or a curse? I personally call it a blessing because I have an addictive personality so I would get hooked up on it too. It works for my pain and my depression & anxiety, and for that I am grateful, all while not causing euphoria, all it seems to do is just mood stabilization, i.e. I am less likely to be emotionally volatile.

The constipation side-effect can really be frustrating though, but thankfully I can manage it through diet and skipping doses.

[1] It possibly has to do with my neuro{biology,chemistry} and my brain lesions but who knows. Psychiatric medications never affected me the way they typically affect others and I have gone through _a lot_. It might be genetic, metabolic (as well), I have no clue.

I had an opiate after surgery once and the constipation was so bad, it was worse than the pain it was supposed to be treating. I switched to Aleve instead, which was both better at pain management and had fewer side effects.

"an opiate"? You do not get constipation from one pill that is "so bad".

Plus it depends on the opioid. Hydrocodone and oxycodone for example leaves the system pretty quickly (ER, too), and once it does, you can defecate without issues. Morphine on the other hand causes awful constipation but can be treated with proper diet. Hydrate, plum jam, magnesium citrate, or laxatives if serious. You can skip a dose or two so you can defecate.

When I had my wisdom teeth out, they gave me percocet (oxycodone + tylenol). "Take one every 4-6 hours." I split the pills in half and took one just as the pain was starting to come back, generally right after 2 hours. It worked great. Then after several days the pain started coming back in my knees and other joints. Wait... I don't generally have joint pain. I guess that's withdrawal from developing a tolerance, aka addiction. I quickly ramped down and stopped using them shortly thereafter.

Of course it would be tempting to wax poetic about how I just needed to use my willpower to stop, and so can anyone else - just-world-fallacy while singing my own praises. But it's more honest to admit that while things worked out fine that time, control can be quite illusory. I wouldn't hesitate to use opiates again for extreme pain, but I sure would set up some social accountability systems beforehand.