My argument isn't that opioid use in the time of opium dens was harmless, nor that opioids can be used willy-nilly without any harms. I am well familiar with some of the dangers of opioid use and do not wish to discount them at all. My argument is that opioid prohibition in the 21st century in the US is a legal regime that
amplifies those dangers -- it kills lots of people quite effectively (and keeps killing more every year).
The number of people who use opioids regularly is a second-order concern (if only because fent-laced heroin certainly gets that number down) to me, frankly -- reducing morbidity and mortality due to drug use is a lot more important. With a decent medical infrastructure, addicts should be able to get opioid maintenance therapy with the right drugs and dosage and be able to lead actual interesting lives beyond trying to score the next hit.
I'd so much rather live in a country where people who want to get high on opioids can buy cheap, pure, precisely metered opioids that won't kill them rather than smashing car windows to be able to pay for overpriced fentanyl-laced drugs sold by criminals that might overdose them in the street (which will cause even more expense and load on the already-awful USian medical system).