Buprenorphine in Overdose?

Fellow devotees of "Addiction" magazine will have shared my fascination for a case report in this month's edition of a heroin addict whose life was apparently saved by the timely administration of buprenorphine by his mate..... as we all know, most injecting heroin users have themselves experienced overdose or been with someone else who has, and the majority of most overdoses that end up dead are witnessed long before calling an ambulance. This has led many to distribute naloxone injection with education to those in treatment, so that they can identify signs of overdose in others, and administer it before emergency services arrive.
But this is the first time I know of where a resourceful user (on take-out bupenrorphine) recognised the state of his friend with the blue lips, crumbled up one of his tablets and placed it under the tongue of his unrousable colleague. The subject woke up "all angry" within 10 minutes....
We all know of the paradoxical antagonism of buprenorphine at dose initiation, and this of course makes sense.... I wonder if we can make better use of this "off piste" use of buprenorphine?

“Recovery” – what’s in a name?

Some of you will have been bored by me banging on from various platforms, about the idiotic mud slinging that goes on between the ultra orthodox abstentionists, and the similarly entrenched harm reductionists. The slurs of danger and ineffectiveness have reached the public whose knee jerk take on all this, is that treatment of drug misuse simply doesn’t work.
In an attempt at some sort of mutually agreeable interpretation of the word “recovery”, Professor John Strang and various professionals and service users from ALL across the divided treatment spectrum got together in a smoke filled room for two days to thrash it out. Known as the UKDPC Consensus group, this is what they came up with:

Recovery is a process, characterised by voluntarily maintained control over substance use, leading towards health and well-being and participation in the rights, roles and responsibilities of society.

And I rather like it. It means that recovery, being a continuous process of accruing benefits, may begin well before abstinence (indeed abstinence may never occur in some cases, despite big recovery gains), and similarly, there may be further recovery to take place after abstinence has been achieved.

So that’s the end of the arguments then………..!

Ketamine

Either I am just looking for it, or there really is a phenomenon going on out there.... I seem to hear of more and more people using ketamine. What was once just one of many chemicals used occasionally at raves seems to be becoming much more widely used. You will recall that it was popular with anaesthetists as a safe short acting anaesthetic that didnt depress respiration - but because many people found the onset of anaesthesia very frightening, reporting hallucinations, nightmares and out of body experiences, it fell from favour but was taken up by vets, presumably because either animals like dissociative experiences, or more likely, they can't tell us about them afterwards.

But clearly some of our patients love the stuff: usuall snorted, it can cause an unpleasant inflammatory sinusitis, and if injected, getting the dose right is tricky or anaesthesia follows rapidly and you can injure yourself. Long term heavy use often causes a painful and non infective cystitis. But noone seems to know what more harms can follow the use of this drug, and perhaps websites such as this can help. So if you have come accross any stories of ketamine related harms, please let me know and I will spread the word.