You didnt say anything at all in this comment about physical consequences, so I am lost in the discussion. Doctors are rationally ok with such prescriptions be

You didnt say anything at all in this comment about physical consequences, so I am lost in the discussion. Doctors are rationally ok with such prescriptions because the effects are not as bad as alcohol. Simply put: opiate abusers and users don't need liver transplants or get such severe brain damage; alcohol is more damaging in a myriad of ways for both uses and abusers. There is plenty of data supporting this, and it is valid to use data regarding medical grade opiates. The risks of heroin are almost entirely side-effects of the war on drugs rather than the drug itself.