> taking too much will generally be because of a chemical dependence, not a conscious choice.

This is an oversimplification and not universally true, but I do not wish to get into the details of it and addiction in general. We could brush away every decisions based on "chemical imbalances", too, if we so want. :)

> we should prefer opiates over ibuprofen/acetaminophen when the latter will do the job

Yes, after a careful risk assessment. If you are likely to get ulcers, or a stroke, or any cardiovascular events from NSAIDs, then you might want to consider something safer. Tylenol would be safer in this case, but what if that does not help with the pain at all? In any case, I do not necessarily disagree, and I was not advocating for blind consumption of opioids. If Tylenol works, take it with milk thistle (with high silybilin content) and you will be fine, even if you take it on the daily.