5 ms·

I'd make suboxone available OTC, no questions asked. Low cost, or even just free if you register as an addict. Same for naloxone/narcan/whatever "overdose sto

I'd make suboxone available OTC, no questions asked. Low cost, or even just free if you register as an addict. Same for naloxone/narcan/whatever "overdose stopper" autoinjectors. Which, I'm reliably told, are the opposite of a good time. Suboxone is not a drug you can really abuse in any fun way, and a lot of folks won't engage "formally" with addiction services due to stigma, paranoia, worries about their medical records being tainted forever, etc. The addicts you see on the streets are just the tip of the iceberg. Much like alcoholism, the vast majority of users are "hidden". There are multiples more users who are still functioning within society, holding down jobs, etc.

cudder 4y ago
Addicts will find a way. Buprenorphine is the most abused opioid in Finland. Which by the way has the most youth drug deaths in Europe[1]. Granted it's usually Subutex (just buprenorphine) rather than Suboxone (buprenorphine + naloxone) but there's not much difference unless you're using intravenously because buprenorphine has such a high binding affinity. I agree that there's a huge problem with opiates and am in favor of legalizing everything, but it's good to realize that buprenorphine is not a magic candy that fixes everything - you're just replacing an addiction to a deadly feel-good opiate with an addiction to a slightly less feel-good opiate with a larger therapeutic index. [1]: https://www.euronews.com/2023/03/16/why-are-so-many-young-finns-dying-from-drug-abuse https://www.euronews.com/2023/03/16/why-are-so-many-young-fi...
- nibbleshifter 4y ago
  TIL about the abuse in Finland. I was aware it was sometimes abused by prisoners, but that's new. In another comment I went into a bit more detail around ways of dealing with the issue, using Finland's homeless housing policy as part of it. Its a complex issue that certainly isn't going to be resolved through the criminal system.
- nicoburns 4y ago
  Isn't the purpose of making opioids available to addicts to allow addicts to "find a way" (i.e. manage their addiction)? We have no easy/effective treatments for such addictions so harm reduction is the best we can hope for.
  - cudder 4y ago
    Yes absolutely, I'm all for giving addicts the help they need. I just don't think haphazardly making it available OTC without a prescription like the GP suggested would be the right decision in the current situation. People already abuse OTC medications with a lot less recreational potential, stuff like whippits and DPH. Adding Suboxone to the mix would, in addition to helping the addicts that want to quit, raise a new generation of buprenorphine addicts. Despite its miraculous efficacy for addiction treatment it certainly has some recreational potential and the long lasting opioids used for maintenance are a bitch to quit. Many people stay on the stuff for life because while you can taper down it's really, really hard to drop the last bit. While milder than with the fast-acting opioids, the physical withdrawals go on for weeks. With heroin or fentanyl they're over by day 3 or 4 and it's all mental after that. In my ideal gay luxury space communist world most drugs would be available for anyone after a doctor's consultation where you learn basic harm reduction and such. Currently people abuse OTC medications or buy fentanyl laced stuff of the street to get high even though they're absolute trash for that. Safer options exist.
    - nibbleshifter 4y ago
      I suggested making it OTC without a prescription largely due to a couple of practical reasons - many users of illicit drugs who are not "street junkies" want to keep the whole thing hidden for various reasons (social stigma, worries about health insurances, medical discrimination), etc. Not sure about where you are, but in the countries in EU/UK I've lived, OTC can mean either "behind the counter" (where you must speak with the pharmacist), or "in front of the counter" (you just pick it up and buy it). Depending on country, different drugs are sold differently. In Germany and Ireland, to buy normal antihistamines or pretty much any good OTC painkiller, I have to request it and usually get asked some questions, depending on the drug, whereas in the UK I can buy the same medications in Tesco. I'm also of the view that a lot more drugs should simply be available via the model of informed consent or just "available by asking for them". Waiting weeks and paying 60 euros for a GP to toss a coin on if they are going to agree with you about a medicine is a nightmare. Though that may be due to the broken health system here making me wait 4 weeks for a GP appointment so I could get a fucking salbutamol inhaler after my asthma came back, among other things. Interesting aside, the "mental" addiction can be harder to kick than the physical. Some former opiate and gabapentin users I know have mentioned this - psychological cravings for even years after stopping. Anyone who has ever tried quit nicotine will also know this.
rubatuga 4y ago
suboxone can be abused due to the differences in half life's of the components.
nsvd 4y ago
Narcan will be available OTC in the US starting later this year. https://www.fda.gov/news-events/press-announcements/fda-approves-first-over-counter-naloxone-nasal-spray https://www.fda.gov/news-events/press-announcements/fda-appr...

cudder 4y ago

Addicts will find a way. Buprenorphine is the most abused opioid in Finland. Which by the way has the most youth drug deaths in Europe[1]. Granted it's usually Subutex (just buprenorphine) rather than Suboxone (buprenorphine + naloxone) but there's not much difference unless you're using intravenously because buprenorphine has such a high binding affinity. I agree that there's a huge problem with opiates and am in favor of legalizing everything, but it's good to realize that buprenorphine is not a magic candy that fixes everything - you're just replacing an addiction to a deadly feel-good opiate with an addiction to a slightly less feel-good opiate with a larger therapeutic index. [1]: https://www.euronews.com/2023/03/16/why-are-so-many-young-finns-dying-from-drug-abuse https://www.euronews.com/2023/03/16/why-are-so-many-young-fi...

nibbleshifter 4y ago
TIL about the abuse in Finland. I was aware it was sometimes abused by prisoners, but that's new. In another comment I went into a bit more detail around ways of dealing with the issue, using Finland's homeless housing policy as part of it. Its a complex issue that certainly isn't going to be resolved through the criminal system.
nicoburns 4y ago
Isn't the purpose of making opioids available to addicts to allow addicts to "find a way" (i.e. manage their addiction)? We have no easy/effective treatments for such addictions so harm reduction is the best we can hope for.
- cudder 4y ago
  Yes absolutely, I'm all for giving addicts the help they need. I just don't think haphazardly making it available OTC without a prescription like the GP suggested would be the right decision in the current situation. People already abuse OTC medications with a lot less recreational potential, stuff like whippits and DPH. Adding Suboxone to the mix would, in addition to helping the addicts that want to quit, raise a new generation of buprenorphine addicts. Despite its miraculous efficacy for addiction treatment it certainly has some recreational potential and the long lasting opioids used for maintenance are a bitch to quit. Many people stay on the stuff for life because while you can taper down it's really, really hard to drop the last bit. While milder than with the fast-acting opioids, the physical withdrawals go on for weeks. With heroin or fentanyl they're over by day 3 or 4 and it's all mental after that. In my ideal gay luxury space communist world most drugs would be available for anyone after a doctor's consultation where you learn basic harm reduction and such. Currently people abuse OTC medications or buy fentanyl laced stuff of the street to get high even though they're absolute trash for that. Safer options exist.
  - nibbleshifter 4y ago
    I suggested making it OTC without a prescription largely due to a couple of practical reasons - many users of illicit drugs who are not "street junkies" want to keep the whole thing hidden for various reasons (social stigma, worries about health insurances, medical discrimination), etc. Not sure about where you are, but in the countries in EU/UK I've lived, OTC can mean either "behind the counter" (where you must speak with the pharmacist), or "in front of the counter" (you just pick it up and buy it). Depending on country, different drugs are sold differently. In Germany and Ireland, to buy normal antihistamines or pretty much any good OTC painkiller, I have to request it and usually get asked some questions, depending on the drug, whereas in the UK I can buy the same medications in Tesco. I'm also of the view that a lot more drugs should simply be available via the model of informed consent or just "available by asking for them". Waiting weeks and paying 60 euros for a GP to toss a coin on if they are going to agree with you about a medicine is a nightmare. Though that may be due to the broken health system here making me wait 4 weeks for a GP appointment so I could get a fucking salbutamol inhaler after my asthma came back, among other things. Interesting aside, the "mental" addiction can be harder to kick than the physical. Some former opiate and gabapentin users I know have mentioned this - psychological cravings for even years after stopping. Anyone who has ever tried quit nicotine will also know this.

rubatuga 4y ago

suboxone can be abused due to the differences in half life's of the components.

nsvd 4y ago

Narcan will be available OTC in the US starting later this year. https://www.fda.gov/news-events/press-announcements/fda-approves-first-over-counter-naloxone-nasal-spray https://www.fda.gov/news-events/press-announcements/fda-appr...