Man-made opiates are (IMO, anyway) much more dangerous than their natural counterparts, all other things being equal. In a lab, the pharmaceutical companies can tweak something to make it actually more addictive than its natural counterpart.
I don’t have a cite, but I remember reading about (and seeing a documentary) on addiction and the ability for people to get off of various drugs. The comparison drug was methadone vs. heroin. Addicts could get methadone from a clinic for free or for a nominal charge, but most of them couldn’t stop taking the methadone. Various opinions are out there, but people who have been addicted to heroin and methadone at one point in their lives seem to agree that getting away from methadone is much harder than heroine.
This could be a product of a small sample size, or maybe addicts who know they can get free methadone don’t have the motivation they need to get off the drug, like they would if they were spending a fortune on heroine. I don’t know.
However, not all prescription opiates are cheap. A drug like oxycontin, which is still being made under patent protection, is very expensive, depending on your insurance co-pay. Percocet, on the other hand, is now made generically and it is much more affordable. Supposedly, percocets are faster acting, but don’t last as long, whereas the oxycontins are extended release.
It is unfortunate that doctors are hesitant to write scripts for opiods/opiates, but i am sure they don’t want the liability. Plus, the Pain Management industry is booming, so a regular doctor can just make you go see one of these specialty doctors instead.
From what I’ve heard, though… People with chronic pain issues are now forced to add another doctor to their list. And once you are established as a patient, the doctor doesn’t even come in to see you to write a script. A PA comes in, sees the patient for 5 minutes, and writes the scripts, and the patient is on his/her way. Insurance companies are billed for a specialty office visit, and if there is no change in meds for the patient, it resembles little more than paying for a visit to a legalized pusher.
(I have a relative suffering from chronic pain, and this info is from a conversation I had with them.). IANAD, IANAL, IANADU, IANAS.
The biggest problem with street drugs (at least in my eyes) is I wouldn’t have any way to test the drug to see how weak or strong a dose is. This would make using street drugs as a long term solution to managing pain a risky proposition at best. I don’t know how people can risk their lives by taking something they buy off someone on the street, but I guess when someone gets to that point, they aren’t all that concerned with dying as much as they are concerned with dealing with their situation.