As a way-too-simplified answer, I would also posit that opiods in general kill pain, so you don't get shit done, but you don't care about getting shit done. Amp

As a way-too-simplified answer, I would also posit that opiods in general kill pain, so you don't get shit done, but you don't care about getting shit done. Amphetamines in general provide some euphoria, though not as much as opiods, and provide energy, so one can get done a lot more stupid boring shit and work harder while still having a bit of fun doing it. Take that overly broad comment and apply it to socioeconomic trends as you will. In terms of rx opioid DEATHS which is what this is about(nothing here about prevalence of use), I would posit totally anecdotal possibly BS theories like this: most people that seek out heroin addicts and are addicts do heroin at least a little smartly. I'm not saying every junkie carries a bottle of Narcan, though I've known many that do, but when you are doing heroin in a group full of people and building up conventional wisdom over years, you know how much to take and what happens if shit goes sour. Prescription opiods on theother hand come with a doctor's signature that says - hey, this is basically safe, don't worry about it (in the mind of the user) -- your average 18 year old experimenting with drugs kid is much more likely to take a few too many oxys than inject too much heroin. Fentanyl is a whole different thing and pretty much, even though I'm a libertarian in terms of drug use and prohibition, I'd be happy to snap my fingers and make it go away. I /know/ it is useful as a pain reliever of last resort, but it is just so damn strong to be on the street, especially when not sold as Fentanyl. To put more simply, responsible use of all substances is possible, but requires both self-control and some knowledge about those substances. If I have to do some research about responsible dosing or I have friends around that do that research, I'm likely to stay within pretty safe margins. However, if I'm an opiate naive person that's given a few pills in a prescription bottle, I'm much more likely to think that they are "safe" even though they are functionally the same substance in my body. This may just be conjecture, but I've been around drug users and abusers my whole life, and have been dedicated to harm reduction, and I rarely have seen people be as reckless with heroin as they are crushing up oxys and doing lines.