You’re right. And I have a few chronic pain patients whom I have on opiates. But it’s never the first tool in my toolbox for treating chronic non-malignant pain, even in patients with zero abuse problems.
Opiates tend to work better for folks with well-defined, regionalized chronic pain problems like a radiculopathy, where a specific nerve root is damaged, and causing problems, or for the painful sequella of arachnoiditis, inflammation of the brain and spinal cord lining.
Opiates tend to not be so hot for poorly defined, generalized pain syndromes such as chronic daily headaches, musculo-skeletal back pains, fibromyalgia, and chronic fatigue.