I think OPs point is to employ shame to prevent % of potential users and future addicts of hard drugs in the first place. Won't stop everyone but may subtantially mitigate. But I also think you're right, modern US culture is particularly shameless. Which isn't a value judgement, just that shame won't be effective given US context. Not to mention shame isn't going to prevent big pharma from engineering opiate crisis from legitmate medicine for non shameful use.