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Wonder if anyone will see this, but I have a general question I might as well ask here. What if, you put an addicted person in a padded cell, and supply progre

Wonder if anyone will see this, but I have a general question I might as well ask here. What if, you put an addicted person in a padded cell, and supply progressively decreasing doses of the drug(s) the person is addicted to? The dosage gradient could be mathematically computed to find the lowest possible harmful withdrawal effects. The person would stay in the cell environment until completely past the hardest phases of withdrawal (however long this takes, whether days, weeks, months(?)), but they would be free to move around (within the secure complex) as they please, and have limited access to technology (anything enabling communication would be heavily vetoed, but eg unlimited access to a video library could work well). It seems that the current models in use depend entirely on the will of a person who is heavily compromised. I honestly have to say, that seems fundamentally and ridiculously broken, and yeah, even suspiciously so: it's so obvious that this approach is not going to work for most, so why does every "treatment center" continue down this path? The only caveat I can think of with the suggestion above is about the violent phase of withdrawals, and sedating a person enough when in that phase so they can eat/drink/etc. (I'm not sure how long it is - I vaguely recall it's just a couple of days right?) Also, about the padded room - I'm not talking "psychotically mad-proof" padding, but just enough for this context. Obviously that's going to change per drug and person, and maybe thick padding is what would be required. I'm just thinking about cost here (cost of sedation and padding), because I know that a) everything health-related in the US seems to attract the most markup and overhead in any field in the world, and b) because (as per my notation that the current model is _suspiciously_ broken) I wouldn't be surprised if anyone who tried this would find it mysteriously hard to get funding. On the other hand, I must admit that I've never really tried to find out if this idea has been attempted or not. Would/does it not work?

girvo 9y ago
I am doing a version of this myself (minus the padded room), using buprenorphine under the supervision of an excellent case worker and doctor. It's taken 5 years, but I'm down to 1.6mg from 32mg at the start, and 24 works in the future I'll be off it entirely (and taking a month off to go down to my family's holiday home on the beach here in Australia, for the final withdrawal symptoms). One weird thing: even with my much lower dose, the acute withdrawals every morning are mostly the same. A little less bad, sure, but still rather terrible. I just put up with it, because it's better to be productive and able to move forward with my life after 6 years of heroin addiction than go back to where I was. Interestingly, opiate replacement therapy done with heroin itself has had quite good results. The downsides to buprenorphine and methadone is that the withdrawals are rather "drawn out" compared to heroin and morphine. The upside is that the fact they last so long in terms of binding is what makes them excellent at stopping a user from bouncing back and forward between the two (in theory anyway; a given users metabolism means this isn't always true. I could've easily used heroin any time during my treatment as I metabolise bupe and methadone extremely rapidly -- I just chose not to. It wasn't worth it.)
- exikyut 9y ago
  > I am doing a version of this myself (minus the padded room), using buprenorphine under the supervision of an excellent case worker and doctor. Wow, that's absolutely awesome. > It's taken 5 years, but I'm down to 1.6mg from 32mg at the start, and 24 works in the future I'll be off it entirely (and taking a month off to go down to my family's holiday home on the beach here in Australia, for the final withdrawal symptoms). Niiice. (I'm actually in .au too (Sydney area), I agree that some of the beach environments are really nice. Cool.) > One weird thing: even with my much lower dose, the acute withdrawals every morning are mostly the same. Hah. I figured it might be like that! (Unfortunately!) > A little less bad, sure, but still rather terrible. Mmm. > I just put up with it, because it's better to be productive and able to move forward with my life after 6 years of heroin addiction than go back to where I was. Indeed. And kudos for having the strength - as I said in my previous comment, not everyone has the willpower to strong-arm a rewired reward center into doing things completely differently. Survival of the fittest :D > Interestingly, opiate replacement therapy done with heroin itself has had quite good results. The downsides to buprenorphine and methadone is that the withdrawals are rather "drawn out" compared to heroin and morphine. The upside is that the fact they last so long in terms of binding is what makes them excellent at stopping a user from bouncing back and forward between the two (in theory anyway; a given users metabolism means this isn't always true. I could've easily used heroin any time during my treatment as I metabolise bupe and methadone extremely rapidly -- I just chose not to. It wasn't worth it.) I see. Yeah, buprenorphine isn't heroin. It's very good to distance oneself. So... when you say buprenorphine works great in terms of binding, I get the impression that you mean that the effect lasts longer, and that it is needed less frequently? That would have helpful practical ramifications, yeah.
  - girvo 9y ago
    > So... when you say buprenorphine works great in terms of binding, I get the impression that you mean that the effect lasts longer, and that it is needed less frequently? That would have helpful practical ramifications, yeah. Exactly, yeah. For most people it will "hold" them for 24-48 hours. Unfortunately for me, it only holds me for about 12, but that should hopefully mean that my final withdrawal symptoms are more acute and less drawn out. I'd rather a week or two of agony than months of less-intense but still terrible shit!

girvo 9y ago

I am doing a version of this myself (minus the padded room), using buprenorphine under the supervision of an excellent case worker and doctor. It's taken 5 years, but I'm down to 1.6mg from 32mg at the start, and 24 works in the future I'll be off it entirely (and taking a month off to go down to my family's holiday home on the beach here in Australia, for the final withdrawal symptoms). One weird thing: even with my much lower dose, the acute withdrawals every morning are mostly the same. A little less bad, sure, but still rather terrible. I just put up with it, because it's better to be productive and able to move forward with my life after 6 years of heroin addiction than go back to where I was. Interestingly, opiate replacement therapy done with heroin itself has had quite good results. The downsides to buprenorphine and methadone is that the withdrawals are rather "drawn out" compared to heroin and morphine. The upside is that the fact they last so long in terms of binding is what makes them excellent at stopping a user from bouncing back and forward between the two (in theory anyway; a given users metabolism means this isn't always true. I could've easily used heroin any time during my treatment as I metabolise bupe and methadone extremely rapidly -- I just chose not to. It wasn't worth it.)

exikyut 9y ago
> I am doing a version of this myself (minus the padded room), using buprenorphine under the supervision of an excellent case worker and doctor. Wow, that's absolutely awesome. > It's taken 5 years, but I'm down to 1.6mg from 32mg at the start, and 24 works in the future I'll be off it entirely (and taking a month off to go down to my family's holiday home on the beach here in Australia, for the final withdrawal symptoms). Niiice. (I'm actually in .au too (Sydney area), I agree that some of the beach environments are really nice. Cool.) > One weird thing: even with my much lower dose, the acute withdrawals every morning are mostly the same. Hah. I figured it might be like that! (Unfortunately!) > A little less bad, sure, but still rather terrible. Mmm. > I just put up with it, because it's better to be productive and able to move forward with my life after 6 years of heroin addiction than go back to where I was. Indeed. And kudos for having the strength - as I said in my previous comment, not everyone has the willpower to strong-arm a rewired reward center into doing things completely differently. Survival of the fittest :D > Interestingly, opiate replacement therapy done with heroin itself has had quite good results. The downsides to buprenorphine and methadone is that the withdrawals are rather "drawn out" compared to heroin and morphine. The upside is that the fact they last so long in terms of binding is what makes them excellent at stopping a user from bouncing back and forward between the two (in theory anyway; a given users metabolism means this isn't always true. I could've easily used heroin any time during my treatment as I metabolise bupe and methadone extremely rapidly -- I just chose not to. It wasn't worth it.) I see. Yeah, buprenorphine isn't heroin. It's very good to distance oneself. So... when you say buprenorphine works great in terms of binding, I get the impression that you mean that the effect lasts longer, and that it is needed less frequently? That would have helpful practical ramifications, yeah.
- girvo 9y ago
  > So... when you say buprenorphine works great in terms of binding, I get the impression that you mean that the effect lasts longer, and that it is needed less frequently? That would have helpful practical ramifications, yeah. Exactly, yeah. For most people it will "hold" them for 24-48 hours. Unfortunately for me, it only holds me for about 12, but that should hopefully mean that my final withdrawal symptoms are more acute and less drawn out. I'd rather a week or two of agony than months of less-intense but still terrible shit!