I think a lot of the time people get prescribed pain killers for legitimate injuries then they become addicted to opiates and when the prescription runs out they seek them from another source ex. Heroin

You should check out path of exile 2 it seems like they might be addressing a lot of your concerns with the genere. And GGG (the makers of poe2) are actually a really good company to support

Cataclysm dark days ahead