I know someone who takes it on a daily basis. You would not be able to tell that he uses. It makes him productive (he works in IT), he takes it to combat anxiety and depression. It works for him. He voluntarily goes through withdrawal occasionally so he will not have to increase the dose. He is in a healthy relationship, and so forth. He might be an exception, I do not know.

All the side-effects are a result from the War on Drugs: not knowing the purity of the batch, adultered products, and so forth. This is why accidental overdoses happen. This is why it is bad for your health for the most part, because God knows with what it is mixed. Intentional overdoses happen too, but that happens with OTC medications, too, so heroin is not so special in that regard.

You mention "horribly dysfunctional" further down. That's what I have a problem with.

I see these cardboard sex-simulacra trapping, for example, young men in local optima where they never go and talk to a real girl- even young men who could, if they tried, and who'd be happier in the end for it.

Anything that increases the number of incels in the world is a bad thing, for everyone.