Oh sure, there are far less heroin/opiate users than smokers and drinkers. But even if those numbers were equal, in a scenario where heroin was available LEGALLY and produced under strict regulations, if anything there'd be LESS drug-related deaths, proportionally speaking. The reason being nicotine and ethanol are inherently harmful to the human body but the same isn't true of heroin so long as it is pure. None of the harms related to heroin use are due to the pharmacology of the drug itself - apart from the risk of overdose due to it being a CNS suppressant, and that could be prevented in most cases if it had a consistent known potency.
The reason there's so many overdoses with illegal heroin compared to morphine back in the day when that was still legal, is due to precisely the fact that it's an unregulated substance. The strength is completely unpredictable from one batch to the next. That's what makes it so risky; it's basically impossible to accurately (and therefore safely) dose yourself. That, and you don't know what the fuck else is in it, again because it's an illegal product.
'Interestingly' enough, the only fatality so far in a safe injection site wasn't due to the opiate, but due to the user suffering anaphylactic shock from the quinine the drug had been cut with.
Exactly. Nearly all of the risk of death from heroin is due to its illegality. Because it's illegal, you get pushed t the margins of society. People end up homeless, sharing needles, which produces infections, and of course the damage done from being homeless... you get thrown in jail, you have to deal with dangerous areas and people to get the drug. And when you do get the drug, you have absolutely no way of knowing its strength even if it IS heroin... and today, most of it is fentanyl. So you can have a bag and one shot is fine, the next shot is a fentanyl hot spot and you die.
Contrast that with if it was legally available and regulated. You could be 100% sure you have pure heroin every time. You know your dose, you do your dose, you get high. You won't die randomly because it's stronger one day. Obviously people could still die if they're dumb and they don't have a tolerance and their friend tells them to do the amount they're used to doing... or some other mistake is made. But nearly all of the opiate deaths are due to the fact that you have no idea what you're taking, and that is 100% due to the fact that it is illegal and controlled/supplied by cartels and gangs and other people who don't give a fuck about anything except how they can make money, and are not subjected to any quality controls.
To be sure, opiate addiction carries its own problems. You become a slave to a substance. You have horrible withdrawals when you can't get it anymore. But back before drug prohibition, in the 1800s and early 1900s, morphine, heroin and cocaine were all sold over the counter. They made many brands called things like "mother's little helper", which were advertised as tonics to get you feeling motivated and pain free and stuff like that. Literally marketed to housewives to help them have a better day or treat sleeplessness or fatigue. These would contain pharmaceutical grade cocaine, morphine, and/or heroin. There were addicts who didn't really even understand what they were taking, who kept at it for decades, with no problems unless they stopped taking it, at which point they felt awful, of course.
Meanwhile, through this whole time, continuing to today, the damage done from being an alcoholic is profound. Alcohol kills the most people of any drug. In fact there are more alcohol deaths than all other drugs combined. Yes, it's because it's the most widely used drug. But still. Alcohol kills you slowly over time with abuse. It utterly destroys your health until your organs shut down and you die. Heroin/opiates do not do any damage to your organs, unless you overdose, in which case your breathing shuts down and you die from that, since you're unconscious and can't force yourself to breathe.
The ONLY reason alcohol is such an accepted part of society and will never be illegal is because it is the oldest drug and has been a part of human society since before civilization times. This is because it is made naturally, surely by accident at first, by natural yeasts in the air eating sugary liquids and producing ethanol as a byproduct. If alcohol was a synthetic substance that was just discovered now, it would be labeled "the new drug that's KILLING OUR KIDS" and would be schedule 1 so fast your head would spin. And rightfully so, honestly.
Almost all of the harms from opiates come from their illegality. Even if it were legal and regulated, people would still become addicts, but the problem would be reduced to feeling like shit if you couldn't afford to buy some, or couldn't get access to it for a while. There is also the problem of chronic opiate addiction feeling like it steals your soul... being a slave to any substance slowly does serious damage to your sense of self-esteem and so forth. This is problem from any addiction, really, but with drugs it's worse because of all the receptor downregulation and messing with the reward/pleasure systems. These are problems, to be sure, but the problems caused by opiates being illegal are great by orders of magnitude. The drug war is an abysmal failure and needs to stop. Let people choose whether or not to put something in their body.
My vote is for legalizing and regulating ALL drugs. Absolutely DO NOT allow advertising for drugs (including tobacco and alcohol), and make them available in special stores, like the government liquor stores in some states that are the only places you can buy liquor. Make those stores unobtrusive and out of the line of sight for people going about their days. If that was done, we would eliminate most of the societal problems that drugs cost (incarceration, cartel/gang violence from the drug trade, contaminated drug/accidental overdosing, diseases spread by dirty drug paraphernalia, even the high incidence of kids getting into hard drugs to be "cool" or rebel). After all, the drug war doesn't work, prohibition doesn't work, this has been irrefutably proven time and time again. All it has led to is a far worse problem: fentanyl, and entire countries in central America where there are kidnappings and random beheadings of innocent bystanders. And huge taxpayer cost. It would be a net positive right from the get-go. People who want to use drugs can and will, you can't stop that. But what you can do is minimize the harm to individuals and society.
