And they also have a LOT more interactions with other drugs.
It’s a messy opioid med, it’s not a non-addicting alternative to opioids, which is what the pharma guys try to push it as.
Pain’s tough to treat. I’ve taken hundreds of Continuing Medical Education hours on the topic, and worked with and treated hundreds of chronic pain patients, both legitimate, drug-seekers, and drug-seekers who also had legitimate chronic pain.
As far as pharmaceuticals go, I find 4 main pain drug types in my armamentarium:
NSAIDs (aspirin, motrin, naproxen, indocin, etc. etc. etc.)
Acetaminophen (aka tylenol, APAP, paracetimol)
opioids (morphine, oxycodone, vicodin, codeine, dilaudid, fentanyl, heroin, tramadol, and a few dozen others)
neuropathic pain meds, particularly tricyclics and gabapentin.
Others may have niche use here and there, but in 99.5% of the cases, those are the drugs uses as analgesics (anesthetics like topical lidocaine also may have a role.)