On the one hand, great presentation and thank you for making this specialist information so readily accessible. On the other, what's conspicuously absent is an explanation of why naloxone is built into this "first line" treatment. If it's because people will still try to supplement with traditional full agonists, shouldn't we ask why buprenorphine fails to meet their needs to begin with? If people prefer faster acting, shorter duration drugs, why not simply allow people more than one dose a day, not to mention more user autonomy in general? There are people who use opioids non-medically who are not and don't want to be physically dependent. No OAT/iOAT for them? The way "euphoria" is viewed in this context is quite strange to me, and I don't see the desire to feel well a "disorder". Second count again Bupe & Methadone: Many who have experience with dependence report that full agonists are actually easier in withdrawal/detox than slower/longer forms. The problem in practice is that the opioids people actually prefer to use are hard to legally obtain in any quantity (and now quality) that facilitates a gradual, safe taper over a long period. Could we not make other safe, legal options available that would help a much wider variety of cases? I'm not saying these things have no place, but a big part of the reason people are still being harmed and dying is because the barriers within the (treatment) system.
On the one hand, great presentation and thank you for making this specialist information so readily accessible.
On the other, what's conspicuously absent is an explanation of why naloxone is built into this "first line" treatment.
If it's because people will still try to supplement with traditional full agonists, shouldn't we ask why buprenorphine fails to meet their needs to begin with? If people prefer faster acting, shorter duration drugs, why not simply allow people more than one dose a day, not to mention more user autonomy in general? There are people who use opioids non-medically who are not and don't want to be physically dependent. No OAT/iOAT for them? The way "euphoria" is viewed in this context is quite strange to me, and I don't see the desire to feel well a "disorder".
Second count again Bupe & Methadone: Many who have experience with dependence report that full agonists are actually easier in withdrawal/detox than slower/longer forms. The problem in practice is that the opioids people actually prefer to use are hard to legally obtain in any quantity (and now quality) that facilitates a gradual, safe taper over a long period. Could we not make other safe, legal options available that would help a much wider variety of cases?
I'm not saying these things have no place, but a big part of the reason people are still being harmed and dying is because the barriers within the (treatment) system.