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Opioids Maintenance, Recovery, Harm Reduction -- What Do & What Would You Prefer To Use for OST?


Apr 18, 2019
A question I have for opioid agonist replacement therapy people and those considering it, in its maintenance and standard detox protocols (I was hoping I could make a poll like on some other sites) is what do you get for OST, was that your first choice, and from the list below of what is used different places worldwide. A lot of countries allow doctors to treat patients for dependence and anything else could be used. For example, I am aware of one person who takes tilidate orally and another who gets nicomorphine tablets, suppositories and injection. And did I miss anything:

  1. Methadone PO
  2. Methadone IV/IM
  3. Levomethadone PO
  4. Levomethadone IM
  5. Buprenorphine SL
  6. Dihydroetorphine
  7. Heroin IV
  8. Dihydrocodeine ER PO
  9. Dihydrocodeine IR for acute craving episodes
  10. Morphine Sulphate/Hydrochloride/Tartrate ER PO
  11. Morphine salts IR PO/IV for acute craving episodes
  12. Tramadol ER PO
  13. Tramadol liquid concentrate
  14. Dextromoramide SL/IV for acute craving episodes
  15. Dextropropoxyphene concentrated linctus PO
  16. Piritramide
  17. Hydromorphone Polymer Implant
  18. Hydromorphone 24 Hour Capsules
  19. Hydromorphone 12 Hour Capsules
  20. Hydromorphone IR for craving episodes
  21. Hydromorphone IV
  22. levo-α-acetylmethadol
  23. Paregoric
  24. Opium
  25. Codeine HCl ER
  26. Codeine HCl/Phosphate/Sulphate/Tartrate + Glutethimide
  27. Dipipanone Syrup Concentrate
  28. Phenadoxone
Last edited:


Aug 3, 2017
I started maintenance on buprenorphine/nal when I was 21 or so. After a couple of years I switched to methadone because the buprenorphine was no longer supressing cravings effectively (in addition to the fact that for whatever reason buprenorphine's blocking effect is not very effective at all for me).

Now, the methadone is a huge improvement for me and I do enjoy the effects of methadone as an opioid but it is far from my ideal maintenance regime, it makes me sweat to an unpleasant degree and the dry mouth effect is much more pronounced than any other opioid I have been dependent on leading to a much higher rate of tooth decay (I brush 1-2 times a day and floss once per day) than when I was on buprenorphine.

Ideally I would like slow release oral morphine (or potentially a high dose of Dihydrocodeine extended release) in combination with an injectable opioid like diacetylmorphine.

Your list is very comprehensive Nico, so in this theoretical scenario I would of course be inclined to 'taste' the other 'dishes' as it were to determine which drugs were most effective before deciding on drug choice :)


May 15, 2016
Is tilidate the same as tilidin(e)?

Buprenorphine has certain properties that make it appealing for maintenance, but ideally I'd probably opt for substitution with long-acting morphine sulfate, like the Substitol capsules they have in central Europe. Tramadol maintenance is also interesting; bupe + tramadol might be worth some study as well.

Of course, one part of me would like the self-administered IV/IM hydromorphone program they experimented with in Vancouver (finding it indistinguishable from heroin maintenance), but I have a feeling I'd spend a lot of my life watching the clock between clinic visits...