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This is a really interesting and challenging article. I think it shows just how confused addiction medicine is. I would tend to trust Dr Willenbring's advice - what he is saying makes a good point from the pharmacology point of view. However, I think that the studies that show a 90% relapse rate require further analysis. Dr Junig and Dr Paul make very good points around perception of OST - this is an area of my current research. Also, Dr Junig has a huge amount of experience in this area. I do think that the influence of the belief that abstinence is king is seen in these comments and I am concerned about the suggestions around naltrexone for a number of reasons. I also think that dependence and "addiction" are being conflated in some of these arguments. Personally I think that people can fully recover from heroin use disorders, and many do so without substitution. Many do down- titrate once finding stability on OST, but I think that there needs to be a resolution of other life issues first before it is worth risking. And what is "infusion detox" is it just another term for the snake-oil "cure" called rapid detox? If so, run a mile.