Kokaino, I think the problem is the different approaches we are all taking to the problem. You have a very analytical perspective. I am not saying this is the incorrect approach but it is inappropriate when considering real-life situations as opposed to writing a paper in my opinion.
In practice, it is rare to find a perfect study illuminating the exact clinical query you have. Even if you do, study conditions are not equivalent to real life and even the best designed study cannot ever be entirely free of any bias or confounding factors, nor can it take into account every variable. It's a good skill to be able to pick apart a paper and I respect your ability to do that, but you can't see the wood for the trees.
You yourself said "not for everyone and not for all benzos" - not for everyone being the key here. Real life =/= studies, as there are so many variables, so focusing on one study is not helpful.
I am not entirely sure what you are trying to argue here as you said:
kokaino said:
We already know that sublingually taken drugs have a faster onset than regular tablets. I was just making that point.
So you agree sublingual is a faster ROA than oral (if a sublingual prep is used). Are we therefore debating whether oral tablets used sublingually are as effective as specially designed sublingual tablets? If so, then ALL the studies posted support our point - that yes, they are. Also, that is quite a sweeping statement to make, no? Not going to get into a debate about whether it is correct or not, but it seems you do use generalisations when you want to, yet attack others when you feel they are doing the same.
The alprazolam study is indeed small, and this is obviously a drawback. It did not reach statistical significance because of this.
kokaino said:
what if we added 13 more? It is likely that we get the same result. That's what that study means.
If we added enough, and the same results were obtained, then they would reach statistical significance and it would show that SL alprazolam does reach peak plasma concentration faster than oral.
I am not saying we need to take this study as proof. However, just as statistically nonsignificant results =/= proof, they are also not definitely incorrect. When you look at the results there, plus the body of evidence we've gathered so far, plus the personal experience of people on Bluelight, plus the opinions of psychiatric doctors, it seems
more likely that the results are in fact correct. Clinical medicine is all about probabilities, not hard facts, because as you quite rightly say, not everyone is the same.
I also think you are misinterpreting this:
In clinical terms, sublingual and oral dosages of alprazolam are likely to be therapeutically equivalent.
This paper is not specifically looking just at speed of onset. Statements like this "setting the tone" as you say in abstracts have to cover the entirity of the findings and "therapeutically" is a very broad term. You can't extrapolate that to say that it proves sublingual alprazolam does not have a faster speed of onset. Again, I feel you are focussing on the detail and missing the point.
I am 28, by the way - not that this has any bearing on anything at all, but as one of your arguments seems to be that you know better as you are older, I thought I would throw it out there.
Your experience is not more or less valid than anyone else's, but let's consider everything here - to me, it is clear that there is good reason for thinking sublingual alprazolam would kick in faster than oral.
Obviously there is a little bit of a difference in life experience, sometimes, but you're making it out like its the only factor. I guarantee you there are people half your age who have twice the life experience. Don't undermine someones intelligence based on age alone.
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