[drooogs]

plenty of people successfully use buprenorphine to taper off heroin. some people do end up going on long term buprenorphine maintenance, but the harm there is radically less than an active oxy/heroin addiction. even in the worst case scenario, any day that an opioid addict takes buprenorphine is a day where they have far less risk of fatal overdose.

[superkuh]

It also drastically decreases the likelyhood of potential harm from the government's use of violence in it's drug war. This is not an insignificant part of the danger of opioid use.

[stochastic_monk]

Exactly. Additionally, methadone increases cardiac mortality by increasing the QT interval, so the drug with better efficacy and safety profile should fully replace it.

Buprenorphine is good. And someone can’t get on it if they’re too addicted to opiates because as a partial agonist it can precipitate accelerated withdrawal, which acts as a protective mechanism, I imagine.

[mveety]

Buprenorphine also increases cardiac mortality by increasing the QT interval. Buprenorphine is used over methadone mostly because its a partial agonist of the mu-opioid receptor which basically limits how high you can get.

[stochastic_monk]

You’re right! I hadn’t known that buprenorphine also caused it, but it seems all of the drugs used for that purpose. I did find a 2013 study stating that the effect was significantly less than that from methadone, but it’s good to know that both come with cardiac risks.

[mveety]

I would disagree that buprenorphine is safer than oxycodone or pharmacologially pure heroin. Buprenorphine has more dangerous potential side effects than either of them, meaning it would be safer to use heroin or oxycodone. Also, the reduced risk of overdose isn't because of the drug, it's because the user isn't dosing it themselves.

[drooogs]

> Buprenorphine has more dangerous potential side effects than either of them

genuinely curious, what are these?

> the reduced risk of overdose isn't because of the drug

it is significantly harder to overdose on buprenorphine, especially in formulations that contain naloxone.

[pharrington]

Well, the answer to this particular unasked riddle is to just administer the naloxone.

[drooogs]

works great unless the person is alone. then they die.