Tchort- I'm going to be a drug counselor soon and will be working with a lot of opiate users/addicts... I see you write frequently about maintenance but what are your thoughts about detox/tapering? Do you think they are better options for detox/tapering purposes or like maintenance, do you think that basically any short or long acting opioid would be useful for this purpose?
Much to my surprise, one of professors didn't even know that buprenorphine is used commonly for maintenance, she thought it was almost only used for detox. Most of my professors and classmates are very anti-maintenance programs and its quite disheartening, I constantly hear "its trading one addiction for another" and all this 12-step, "you're not clean on methadone" bullshit.
I am very happy to hear you are going to be a counselor for addicts- and that you have a very good idea of the actual situation regarding medical efficacy for different treatments and harm reduction.
It sounds like your peers and most likely professors are using rhetoric and ideology rather than science to back up their treatment goals and protocol/methodology.
My personal opinion with maintenance is that any opioid or combination of opioids can be used successfully if the appropriate dosing and RoA protocol is used (i.e. I fully support IV Heroin maintenance, the Dutch vaporizing Heroin maintenance where they provide freebase Heroin and a harm-reduction related smoking/vaporizing apparatus, etc, not just oral or extended release dosing, and so on).
I do think the same can be said of tapering. The reason I often recommend long half life opioids to people on BlueLight, especially those in the US, is that those are the
only options they have.
I think that tapering, like maintenance, is successful only when the protocol is consistent. Meaning, you can't give someone oral Heroin once a day like you would Methadone in MMT, then say Heroin maintenance doesn't work when the patient gets withdrawals, or quits the program, etc.
Likewise, you cannot use short acting opioids in a way similar to long acting opioids in a taper aimed at detox. I am convinced that as far as personal comfort goes, a short acting opioid like Hydromorphone or Fentanyl, if given in minutely decreasing dosages with frequent dosing can result in just as if not a more comfortable detox taper than with the infrequent dosing of long half-life opioids with larger gaps in doses as you go down (i.e. in a 21 day period, a Methadone taper may go down 5 or 10 mg every day or two or three, whereas with a Hydromorphone taper, giving an injection every 4 to 6 hours with maybe 1/8 of a mg going down every second injection, or 1/4mg every two or three days, may be an equal protocol in terms of patient comfort).
So, I think any opioid can be used to taper comfortably,
if appropriate doses, route of administration, and most importantly protocol is used. However, outside of very brave doctors doing so with individual patients, this doesn't happen in the US, it is illegal to do so.
Wait, what country are you in? Using levorphanol in the US to treat addiction is more than a little illegal.
Definitly. However, another poster here in OD awhile back claimed to be a doctor who used Oxycodone via OxyContin combined with Methadone to taper opioid addicts- however he did not use Oxycodone for the express purpose of treating narcotic addiction (which is illegal), he used it to treat 'pain', which is legal. Certainly a grey area, as there is nothing illegal about maintaining or detoxing a pain patient on opioids, and withdrawal is pain that can be treated with narcotic analgesics. Though the Feds have arrested doctors for much less, so it all comes down to if you get caught or not.
