Thread by @RyanMarino

Recently had a patient who was really suffering from very miserable opioid withdrawal after stopping heroin (on top of some other unpleasant things) tell me their family had convinced them not to start buprenorphine (suboxone) therapy because “it’s just legal heroin”

A thread...

So we have a condition associated with human suffering and also associated with high rates of death.

For those against drugs, know that untreated withdrawal is a big driver of recurrent drug use.

And we have old, evidence-based medicines that treat withdrawal. Why not use them?

Bup (suboxone) is actually very unlike other opioids bc it is a partial-agonist at traditional opioid receptors, so has a ceiling effect for things that cause overdose (like respiratory depression) in adults. I’ve seen someone take a 90 day supply at once with no adverse effects.

Methadone, too, is not the same because it has slower uptake & a long half life so that it doesn’t lead to ups & downs or withdrawal (that’s associated with deaths). Methadone is also a regulated product and people know they are getting methadone, not something like carfentanil.

Taking this a step further, “legal heroin” is a thing that exists in a number of countries & is far safer than untreated withdrawal but is also much safer than illegal heroin. Again, most of the time because you can guarantee it’s not carfentanil & it’s not from the black market.

To summarize:

Using medicines to treat withdrawal or addiction is not just “replacing one addiction/drug with another”

“Legal heroin” should be the goal, not a perjorative. Criminalizing heroin & destroying the supply was the #1 driver of our current synthetic overdose crisis

@michaelbmarlin @st4reintoabyss @UnaDispatch I can even accept increased use if it means decreased deaths. Use is manageable, death is less so.

@michaelbmarlin @st4reintoabyss @UnaDispatch In the case of opium specifically this was also pushed really hard as a multinational foreign policy and by large corporations to control Chinese citizens.

@michaelbmarlin @UnaDispatch @st4reintoabyss From a pure numbers standpoint criminalization has never had better outcomes

@michaelbmarlin @UnaDispatch @st4reintoabyss Then the question is how do we let people access those things? I don’t think everyone should need a prescription to get heroin or whatever because then it’s creating an identical issue where people who don’t want to provide access will make it impossible.