Heroin or Buprenorphine?

That is the question.

Conventional thinking suggests that a patient should only take prescription medication, especially a controlled substance, when under the care of a physician, but we need to think outside the box when it comes to buprenorphine.

I do not encourage former opiate addicts to discontinue buprenorphine maintenance even after years clean, but some taper to minuscule doses and stop anyway. When they no longer need me to prescribe the drug, few need me at all for anything.

Suppose this patient, after weeks, months or even years, feels a craving for opiates that might lead to relapse with heroin or Oxy. Do we want them to white knuckle it until they can find a new prescriber, make an appointment, and get to the office for reinduction, all of which could take weeks, assuming they can find someone at all? More likely they will relapse, and maybe die.

I argue that such a patient should hang on to a small supply of bupe for months or even years to tide them over, prevent relapse, and maybe save their life.

Better yet, make bupe available over the counter like more addictive nicotine and more dangerous alcohol.

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