Also, all forms of buprenorphine (aka Suboxone) often end up being a heroin substitute rather than weaning the addict from heroin. Kinda like how Oxy functions in real-world application.
The difference is, Suboxone is mandated in alternative sentencing programs by the judiciary of certain states. And in some states, with no consideration of whether the addict was addicted to opiates/opioids.
Do you have a source on that last part I could read more about? The idea of a court mandating opiate treatment because someone smoked weed is terrifying.
plenty of people successfully use buprenorphine to taper off heroin. some people do end up going on long term buprenorphine maintenance, but the harm there is radically less than an active oxy/heroin addiction. even in the worst case scenario, any day that an opioid addict takes buprenorphine is a day where they have far less risk of fatal overdose.
It also drastically decreases the likelyhood of potential harm from the government's use of violence in it's drug war. This is not an insignificant part of the danger of opioid use.
Exactly. Additionally, methadone increases cardiac mortality by increasing the QT interval, so the drug with better efficacy and safety profile should fully replace it.
Buprenorphine is good. And someone can’t get on it if they’re too addicted to opiates because as a partial agonist it can precipitate accelerated withdrawal, which acts as a protective mechanism, I imagine.
Buprenorphine also increases cardiac mortality by increasing the QT interval. Buprenorphine is used over methadone mostly because its a partial agonist of the mu-opioid receptor which basically limits how high you can get.
You’re right! I hadn’t known that buprenorphine also caused it, but it seems all of the drugs used for that purpose. I did find a 2013 study stating that the effect was significantly less than that from methadone, but it’s good to know that both come with cardiac risks.
I would disagree that buprenorphine is safer than oxycodone or pharmacologially pure heroin. Buprenorphine has more dangerous potential side effects than either of them, meaning it would be safer to use heroin or oxycodone. Also, the reduced risk of overdose isn't because of the drug, it's because the user isn't dosing it themselves.
This happened to a friend of mine. He does heroin recreationally and isn't addicted and doesn't get withdrawal symptoms. The court mandated he go to treatment and was basically required to take buprenorphine during treatment regardless of him needing it. The treatment facility also didn't believe him when he told them how much he used and thought he was still using in the facility because he didn't have withdrawal symptoms even though the drug tests said otherwise.
On the methadone program I'm on, before they could start the treatment, I had to take multiple toxicology screens to show I was addicted to heroin. These places are incredibly worried about opiate-naive individuals overdosing, which can happen even with the small initial doses on these programs. Note that this is in the UK, which has a much less litigious medical culture USA as well...
Not to cast aspersions on your friend, but have you considered that he may be lying to you about only using recreationally, and using this story to explain why he's on a treatment program? One thing about heroin is that it's pretty much impossible to use regularly without becoming addicted. As a heroin addict myself I know that unfortunately deception can easily become a normal part of your life.
> You said pretty much impossible which means it's possible.
Is that how it works? If the sentence had been "walking through a wall via quantum tunneling is pretty much impossible" would you have also translated that to "walking through a wall via quantum tunneling is possible"? Would this have been a helpful translation?
A test to show you are addicted to opiates does not exist, and also your own experiences do not represent the experiences of every person that ever used drugs.
Yes, technically the tests are to show the opposite - that you are (not) opiate naive. Someone who can pass multiple closely spaced toxicology screens for heroin (i.e. opiates are not detected) is never going to be admitted to one of these maintenance programs due to the incredibly high risk of death by overdose.
> One thing about heroin is that it's pretty much impossible to use regularly without becoming addicted.
I'm happy to hear that your treatment is going well -- opioids can be incredibly hard to kick. On the other hand, you might be interested in some of the newer science of what drives addiction:
Not every person who uses a particular drug recreationally can or will get addicted to it. It depends on brain chemistry and a variety of other factors.
As far as noticable withdrawals, it takes a lot longer than 4 days for someone who’s new to it. If you’ve ever been an addict to opiates before though, yeah that’s about right.
If they were immediately addictive, everyone that got a morphine shot in the hospital would need to seek treatment. It isn't a "one use and you are addicted" or even "occasional (recreational) use will get you addicted". A portion of folks will seek it out more often, but most folks will just seek it out occasionally.
With opiates, the bigger danger is daily or consistent use over a period of time. The period depending on how often you take it and how you are using it and the strength of your dose.
Yes, but it is the same with things like alcohol. Most folks that smoke pot daily don't start out that way either. Most folks that wind up with a coke habit only do it occasionally at first as well. Lots more people do these things in an actual recreational pattern - every so often. Only a portion get addicted because only a portion ever do it that often.
Yet, if someone has an incident with alcohol (for example), they might be required to attend AA meetings even if they aren't a regular drinker. Same with other drugs.
This is true even if heroin withdrawal symptoms start after just a few days. Recreational use generally isn't daily use or two days in a row.
Oxycodone (present in oxycontin and percocet) is a full opioid agonist. Buprenorphine is a partial agonist and actually blocks most of subsequent opioid's effects.
The difference is, Suboxone is mandated in alternative sentencing programs by the judiciary of certain states. And in some states, with no consideration of whether the addict was addicted to opiates/opioids.