It's not the drug that feels good; it's the respite from pain, and that only by contrast. Lacking that contrast, the drug induces only a profound, if temporary, physical and emotional numbness. It's not pleasurable, because it's not anything; it's as close as anyone alive can get to being dead. Unless that's something you want, you need have little fear of prescription opiates - just as much as is consistent with a healthy respect for, and avoidance of, the risks that come with their benefits.
I don't know if that is consistent. The first time I ever had vicodin (which isn't really that strong a drug in the grand scheme of things, I guess), I felt good. Not just no pain, but more relaxed, carefree, happy than I can remember ever feeling naturally.
My immediate reaction was to say out loud to my girlfriend "Umm, not taking any more of this, because oh my god this is way too good." Oddly enough, since then (it's been 20 years now, I've had vicodin a few times) it doesn't ever have the same effect. Just that once. Now it's just pain relief. Which is a relief.
This is very specific to the person and cannot really be generalized.
I LOATHE opiates. I mean really hate them. They make me feel like my brain is encased in concrete and they do nothing for my pain until you hit the hydromorphone level. And all hydromorphone does is suppress the pain enough that I go "Thanks. <snore>" and finally pass out. Lather, rinse, repeat every two hours until the surgeon finally cut me open.
However, that experience is not universally shared. I have met people just like me, but I have also met people who just LOVE oxycontin (which has zero upside for me--I'm still in pain and I can't think).
That certainly hasn't been my experience, and I have a quite extensive history with opiates. They feel fucking awesome. But obviously the pleasure received is different for different ingestion methods, and also different types of opiates.
I think there's more variance to it than just that. I wouldn't call my experience with them "extensive", but neither am I a blushing naïf, and I've never found them to be pleasurable for their own sake. Granted, this may in part be due to the fact that my only encounter with heroin was as part of a luckily failed attempt at sexual assault, but it's not as if I've never tried prescription opiates for recreational purposes, and I'm told by those who should know that IV Dilaudid, which I was once given during an ER visit for what turned out to be a stuck kidney stone, is comparable to heroin in its effects and subjective experience. Later in the same visit, I was offered a second dose, but turned it down; something about the CT contrast I'd been given had by then moved the stone and alleviated the pain, or maybe it had just moved on its own, and I found nothing in the effects of the drug to desire for its own sake.
On the other hand, I've known people who haven't been so lucky, and have ended up badly hooked. I suppose I shouldn't have spoken so positively about what opiates are like, when I can only really speak with confidence about what they're like for me.
There is substantial genetic variation in responsiveness to opiates. For some (an estimated 1% in Norway, at least [0]) the standard dosing comes with all the side effects and none of the benefits.
When I was recovering from sinus surgery, my wife handed me oxy on the prescribed schedule, and it was worse than nothing — pain still there, plus brain fog and massive constipation. Tylenol worked an absolute wonder, though.
Pain is a bitch. I hope we come up with something better than these blunt instruments soon.
For what it's worth, it's not that they don't suppress pain when I take them. They do, quite effectively; it's just that I don't find anything else about the experience to be at all pleasant.
To your point about genetic variation, I'm told I have an unusually high pain tolerance; at that same ER visit, when the doctor came in to discuss the CT results showing the size of the stone, she expressed some surprise that I hadn't done any screaming. My mother tells me that she's the same way. So maybe it's something to do with that? I really don't know. In any case, it's clear from the responses I've gotten that to generalize from my own experience here is unwise, and I won't repeat the error.
It's not the drug that feels good; it's the respite from pain, and that only by contrast. Lacking that contrast, the drug induces only a profound, if temporary, physical and emotional numbness. It's not pleasurable, because it's not anything; it's as close as anyone alive can get to being dead. Unless that's something you want, you need have little fear of prescription opiates - just as much as is consistent with a healthy respect for, and avoidance of, the risks that come with their benefits.