I have also lost a friend to heroin (well, probably fent... it was the early days of that, and we suspect that nobody knew how to dose properly...) and so I appreciate your tangent.

One of the things we've learned up here in Canada over the last couple decades is the need to understand that some people just cannot be sober. They will not be, and they will do anything to not be, ranging from the familiar drugs to whatever they can find (gasoline, inhalants, etc). Obviously, there are worse and better choices in this range of options, and there are more and less self destructive outcomes. Harm reduction has become a key strategy; what can we do that will help keep these people from hurting themselves and others?

We've achieved some manner of success helping prevent people from OD'ing, getting needle-transmitted drugs, etc. which helps them and helps all of us at large (in the most utilitarian sense, it keeps social healthcare costs lower). What we've failed at is preventing them from hurting others, unfortunately.

In the long run, I think that what we're going to need is better drugs. We have to find something that makes people feel as good as they need to feel, without all the massively negative side effects of heroin, meth, etc. that result in wrecked lives. Healthcare and the pharmaceutical industry should seriously be looking at it this way; not just working on antidepressants and other clinical meds that are trying to get people to a stable "normal", but drugs that actually make you feel good so that they can displace heroin / fentanyl, without the downsides.

Yes, we would still see people addicted to that.... <sips coffee> <watches guy across the street smoking>