"This is the doctrine of the true church on the subject of opium: of which church I acknowledge myself to be the only member—the alpha and the omega: but then it is to be recollected that I speak from the ground of a large and profound personal experience: whereas most of the unscientific authors who have at all treated of opium, and even of those who have written expressly on the materia medica, make it evident, from the horror they express of it, that their experimental knowledge of its action is none at all."
-Thomas de Quincey "Confessions of an English Opium Eater"
To be a member of the true church of opium one must be acquainted with opium, intimately. With due respect to the occasional user, the dabbler, and the chipper, that is the "recreational" users, one must have a large and profound personal experience opiates to be a member of the true church. In the second edition of the Confessions, de Quincey elevated himself to pope (consequently infallible). This article examines the religious or spiritual  aspect of opiate use and contrasts it with the medical or therapeutic use of opiates. For the purposes of this discussion, the occasional or "recreational" users are omitted.
"One of the most important aspects of ceremonial drug use is that the desire for the drug is experienced as issuing from the very depth of the user; whereas, in the case of therapeutic use of drugs, the user experiences external necessity, or even compulsion, as the motive for drug taking. It is precisely this experience of an inner need or 'craving' that justifies our placing this behavior in the same class with other patterns of religious conduct and observance; what all these behaviors- that is, drug use recognized as religious, drug 'addiction' and habitual drug 'abuse'- share with other kinds of religious behaviors is the experience of a profound inner desire or urge, whose satisfaction gratifies the user's deepest sense of existence or being in the world. And herein, too, lies the reason why both the religious fanatic and the 'dope fiend' go to such great lengths to satisfy their desires; and why each feels fully justified in the moral righteousness of his conduct. This 'call' or 'craving'- which to the observer seems to come from without, from the voice of God or the lure of a drug, but which to the subject comes from within, from the recognition of the subject's 'calling' or from the conviction contrasted, if we are to appreciate its real import, with the universal human experience it opposes, and indeed tries to annihilate; namely, the experience of helplessness and powerlessness and of being manipulated by external agents and their hostile interests."
-Thomas Szasz, "Ceremonial Chemistry". p 40, from chapter on Communions, Holy and Unholy
If Szasz is indeed right, we can make a distinction between two types of "addicts," the religious/spiritual and the medical/therapeutic. The distinction can be elucidated by examining the motives of the individual. The medical user experiences an external need, be it pain or depression, and finds that the condition is relieved by the pain killing and mood elevating properties of opiates. After the medicine is metabolized the individual finds that the symptoms recur, thus necessitating repeated dosing and setting up the conditions for dependence ("addiction"). When the original condition abates, the drug may be tapered and discontinued.
Superficially the medical and spiritual opiate "addicts" are indistinguishable. Without regular access to opiates they will exhibit similar drug-seeking behaviors . Pain is a great motivator, to alleviate pain people will pay outrageous prices, both literally and metaphorically. Spirituality is similarly a great motivator, one does not need to look far to witness people making great sacrifices in the name of their religion. It is only by examining the motivations of the drug user does this distinction become clear.
The religious "addict" uses the drug as part of a ritual, properly called in this context a ceremony. The motivation behind performing such a ceremony is to be whole. Similar to the religious Christian who does not feel "normal" without conversing with God in prayer, the religious opiate "addict" does not feel "normal" without performing their ceremony of opiate consumption. A pre-20th century conception of "addict" was not limited to drugs, but meant something closer to "fan" or "devotee." It is this conception of addiction that we then return to, the religious opiate user is addicted (devoted) to the ceremony of opiate consumption just as the Christian is addicted (devoted) to the ceremony of prayer. Both of these ceremonies are performed to make the individual feel whole.
It should be noted that these views of addiction are not mutually exclusive. One can be (self-)medicating and participating in the religion of the true church of opium. This also explains the seeming contradiction of the individual who struggles for years to break the habit, then one day following a "moment of clarity" gives up the habit for good. The church is open to all races and creeds, and members are free to join or leave at their will. To the extent that Alcoholics Anonymous (AA) and its off-shoots (NA) work, and the evidence that they work any better than nothing at all is debatable, they work by substituting one religion for another.
There are also people who, for whatever reason, perhaps for "gonzo" journalism or for "life experience," decide to addict themselves to heroin. Contrary to popular belief, this is not an easy task. Overcoming the nausea and vomiting takes time, and not everyone experiences intense euphoria, though opiates are generally experienced as pleasurable. Such people may then walk away from the "addiction" with the same nonchalance as they walked in. It is the people who experience heroin intoxication as feeling "normal," sometimes for the first time in their lives, who are at risk for "addiction."
The "drug abuseologists" claim that opiate use, outside some very narrow parameters, is a disease. While claiming it is a disease (drug "abuse" or "addiction"), it is not treated like other diseases. It is treated like a moral failing and crime. Drug abuse can hardly be called abuse in the sense that it is used in other contexts (sexual abuse, child abuse), most drug use causes little to no harm to the users. As I have said before, drug abuse is a "wrongful custom" in the sense that it is drug use that deviates from cultural norms (why is tobacco smoking never call drug abuse?). In the case of opiates, especially heroin, users are not so much choosing the wrong drug as the wrong ceremony.
This is evidenced by the ritual performed to make a drug holy, the physician's prescription. Whether a drug is holy (good and therapeutic), or unholy (bad and toxic) has little to do with the drug. After all heroin and percocet are, pharmacologically, more similar than dissimilar; and drugs do not work differently just because they come from a doctor. It is the physician's prescription that completes the ritual between what is therapeutic, and thus the correct ceremony, and what is drug "abuse," and thus the wrong ceremony. An example of this, also offered by Szasz, is Dr. Max Jacobson and President John F. Kennedy:
"Mutual friends introduced JFK to [Dr. Max] Jacobson during the 1960 campaign. The first shot elevated his mood. From then on, it was clear sailing. Miracle Max shot up the president before the Kennedy-Nixon debates, the major state addresses, and even the 1961 Vienna summit meeting with Nikita Khrushchev. Secret Service files and the White House gate log confirm that Jacobson saw JFK no fewer than 34 times through May 1962.
"Did Kennedy experience any of the impatience, irritability, and grandiosity, an exaggerated sense of personal power, that amphetamines so often produce? Clearly not: Kennedy's court historians maintain that his illnesses and drug use didn't affect his presidency. In any case, in June 1962, when Attorney General Robert Kennedy advised his brother to stop using Jacobson's concoctions, the president replied, 'I don't care if it's horse piss. It works.' ""Dr. Feelgood" William Bryk. The New York Sun Spt 20th, 2005 [Link]
When a doctor injects amphetamines into the bloodstream of a powerful politician, it is ostensibly done for medical reasons. In this case the amphetamines were administered not for treatment of a medical disease (eg narcolepsy), but to enhance the performance of a healthy man. When a college student takes Adderall or Ritalin to improve their concentration in preparing for an exam, or a truck driver uses illicitly manufactured methamphetamine to remain alert for long periods of time, it is drug "abuse." The same basic drug, amphetamine, is being used for the same reason, to enhance performance. It is the physician's prescription that differentiates drug "abuse" from medicine. Clearly this is not defensible on pharmacological grounds.
The prescription is a magic ritual, one that sanctifies a behavior (drug taking) as being holy (healthy, medicinal), provided it is done under the auspices of the high priest (the physician) . While similarly self-medicating is declared illicit healing, particularly because it is done without the authority of the high priest (physician). Only a priest has the power to make ordinary water holy. Only a physician has the power to decide what drugs are therapeutic, and who gets what drug. The appropriate analogy is Holy Communion. To a true believer bread and wine is literally transubstantiated into the body and blood of Christ. The heathen observer sees only bread and wine. Similarly the "drug abuser" sees no legitimacy in the physician's prescription, the wine ("dangerous and addictive" drugs) is still wine, not the blood of Jesus ("therapeutic" drugs).
If an individual asserts their will to circumvent the doctor's prescription and self-medicate with illicit opiates, this is drug "abuse." It matters not how knowledgeable the individual is, the individual may be a professor of pharmacology and know more about drugs than most doctors. We have taken the right to be sovereign over our own bodies, to decide for ourselves what drug or treatment is therapeutic, and given that authority to the medical profession and government agencies. Verily we have turned a fundamental human right into a crime.
Heroin users are persecuted not due to the pharmacological properties of heroin (after all heroin rapidly converts to morphine, considered by the World Health Organization to be an essential drug), but because they are performing a heretical ceremony in a prohibited religion. This is what Szasz has called the "religious nature of the war on drugs." This also explains why drug legalization is opposed even after arguments in its favor have been refuted by logic, pharmacological and sociological research. It matters little that alcohol and tobacco are among the most toxic drugs regularly consumed, reason has never been successful in toppling religious belief.
In a world where individuals are constantly reminded of their helplessness and powerlessness, of human fragility and mortality, people develop strong attachments to things which oppose these feelings. It is this strong attachment, or devotion, that is the meaning of "addiction." The number of things people may become "addicted" (devoted) to is truly immense. These attachments are expressed by certain ritual behaviors, rituals which may include certain chemicals we call drugs. By completing the ritual, it reinforces the individual's sense of belonging in the world. This is true of peyote and the Native American Church, Wine and the Christian ceremony of Holy Communion, Coca and the ceremonies of the indigenous people of South America; it is no less true of opiates and the modern day drug culture in the modern world.
The war on certain drug users is a war on our right to self-medicate. The fact that a majority of Americans seem willing to concede that right in no way invalidates the the minority who choose to assert sovereignty over their bodies, minds and medical decisions. Fundamental human rights cannot be legislated away. The drug war is also a religious war, waged against chemical ceremonies deemed heretical. Because it is ostensibly waged in the name of public health, its religious nature has been obfuscated as much as possible. It is only when the arguments of the prohibitionists are refuted by logic that the true motivation behind the war on drugs becomes clear. Truly the only way to end such a conflict is to tolerate a diversity of spiritual views, and the associated chemical ceremonies each entails.
 I am using the words "spiritual" and "religious" more-or-less interchangeably in this article.
 Opiates do not so much "kill" pain as change the perception of pain. People on opiates will still experience pain, but it does not bother them. Opiates widen the emotional experience of pain, creating an emotional "distance" between the painful stimulus and the emotional response. This is also why people who have experienced horrific childhood abuse respond so well to opiates. There is a false dichotomy between physical pain and emotional/psychological pain, using opiates for the former is grudgingly accepted by the medical establishment, using opiates to treat the latter is considered drug "abuse" and to be exterminated with the full force of the state's medical and law enforcement apparatus.
 Such a person is in an unenviable position, taken advantage of by both criminals and quacks, all the while serving as a scapegoat for all of societies ills. In the words of Dr. Charles E. Terry, "That to supply this drug is not only necessary, but is vital, that to deny it is to cause a physical and possibly a moral wreck, while to heap contumely upon narcotic drug addicts as a whole is to drive them to the underworld for their supply, It never must be lost sight of that among the sufferers from this disease are numbered many of the highest intellectual types of men and women in the business and professional worlds..."