The problems derive from the prohibition, which takes several forms. The forms add up for big profits and bad incentives, for which the consumer pays.
FDA approval is the first layer of prohibition. Very expensive, this keeps a lot of competitors out. Lots of market (read: pricing) power is conferred to the winners. Great incentive is provided for regulatory capture.
The second layer is patent protection. Again, competition becomes illegal, with outcomes similar to above.
Third is scheduling it as a prescription drug. The incentives of the drug company are now to influence doctors, in ways that may be more or less overt. Docs get a cut of the outsize profits, de facto.
The fourth layer is opiates being illegal in general. Competitors out.
Of course there are legitimate reasons for prohibition, even if I don’t agree with them. One can make an argument for protecting people from harming themselves.
But these arguments are naive and static. By “dynamically scoring” the cost of prohibition – following the incentives and the outcomes – we might choose differently.