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

[Nicomorphinist]

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

 

[Quere]

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

 

[JTemperance]

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...