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Is it possible to keep an addict satisfied with a lower tier drug? Genuine question. My understanding is that opiates become less effective over time as your b

Is it possible to keep an addict satisfied with a lower tier drug? Genuine question. My understanding is that opiates become less effective over time as your body adapts, so you seek out stronger drugs in larger doses.

vidarh 3y ago
It really depends both on what you mean by "lower tier" drug, and what people are seeking, and how frequent users they are. But I suspect a reliable potency alone would do a lot for slowing the upward creep than shunting people to a drug dealer who might decide you'll be a more profitable customer if they raise your expectations of the high to seek by selling you "heroin" without telling you it's not pure heroin but cut with fentanyl (tens of times as strong) or carfentanil (thousands of times the potency). Even with an upwards creep, there are vastly different strength levels and harm profiles for different opioids, and a strategy of what is available focused on slowing advancement and steering around the most dangerous options might well allow for keeping people on far milder options for far longer and/or give more options for shunting people onto interventions if they want to stop. The first step is really to accept it's a healthcare problem, and recognise that it's a worse healthcare problem if people go to drug dealers because you refuse them. If so, the question becomes not necessarily about a free for all, but about how many hoops you can get people to jump through to shunt as many as possible in a healthier direction without making too many decide it's easier to buy from a dealer.
alephnullshabba 3y ago
Larger doses yes, but the opiates being consumed are almost entirely a result of cost/availability. Genuine prescription pills are by far the most desirable choice amongst opiate addicts, but tight control on supply post opiate-crisis has made them practically nonexistent in illegal drug markets. The extent of prescription opiates desirability is somewhat evidenced by most "street" fentanyl being consumed in counterfeit oxycodone/vicodin pressed-pills. And then of course there is cost--why smuggle 50 packages of heroin when a single package of fentanyl contains an equivalent number of opiate doses and can be manufactured far more efficiently/discretely? But in general the opiate market is defined by the practical constraints of cost and availability. Fentanyl is a synthetic opioid that has been used in hospitals for decades, but its emergence as a street drug in recent times is the result of precursors and synthesis methodology becoming very accessible
trogdor 3y ago
>Is it possible to keep an addict satisfied with a lower tier drug? Yes, but the person has to want to make the change, since the ‘lower tier drug’ (buprenorphine) doesn’t get them high. It just stops cravings and withdrawal symptoms, while largely blocking the effects of most other opioids. Another benefit of buprenorphine is that it has a ceiling effect in relation to respiratory depression. For most opioids, if you take enough, you will stop breathing and die. Buprenorphine’s dose/response curve for respiratory depression and sedation turns flat after ~24mg, which makes the drug very difficult to overdose on.

vidarh 3y ago

It really depends both on what you mean by "lower tier" drug, and what people are seeking, and how frequent users they are. But I suspect a reliable potency alone would do a lot for slowing the upward creep than shunting people to a drug dealer who might decide you'll be a more profitable customer if they raise your expectations of the high to seek by selling you "heroin" without telling you it's not pure heroin but cut with fentanyl (tens of times as strong) or carfentanil (thousands of times the potency). Even with an upwards creep, there are vastly different strength levels and harm profiles for different opioids, and a strategy of what is available focused on slowing advancement and steering around the most dangerous options might well allow for keeping people on far milder options for far longer and/or give more options for shunting people onto interventions if they want to stop. The first step is really to accept it's a healthcare problem, and recognise that it's a worse healthcare problem if people go to drug dealers because you refuse them. If so, the question becomes not necessarily about a free for all, but about how many hoops you can get people to jump through to shunt as many as possible in a healthier direction without making too many decide it's easier to buy from a dealer.

alephnullshabba 3y ago

Larger doses yes, but the opiates being consumed are almost entirely a result of cost/availability. Genuine prescription pills are by far the most desirable choice amongst opiate addicts, but tight control on supply post opiate-crisis has made them practically nonexistent in illegal drug markets. The extent of prescription opiates desirability is somewhat evidenced by most "street" fentanyl being consumed in counterfeit oxycodone/vicodin pressed-pills. And then of course there is cost--why smuggle 50 packages of heroin when a single package of fentanyl contains an equivalent number of opiate doses and can be manufactured far more efficiently/discretely? But in general the opiate market is defined by the practical constraints of cost and availability. Fentanyl is a synthetic opioid that has been used in hospitals for decades, but its emergence as a street drug in recent times is the result of precursors and synthesis methodology becoming very accessible

trogdor 3y ago

>Is it possible to keep an addict satisfied with a lower tier drug? Yes, but the person has to want to make the change, since the ‘lower tier drug’ (buprenorphine) doesn’t get them high. It just stops cravings and withdrawal symptoms, while largely blocking the effects of most other opioids. Another benefit of buprenorphine is that it has a ceiling effect in relation to respiratory depression. For most opioids, if you take enough, you will stop breathing and die. Buprenorphine’s dose/response curve for respiratory depression and sedation turns flat after ~24mg, which makes the drug very difficult to overdose on.