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i too treat more aggressively but in a different way- i send the pt to the pharmacy with a script for 8 2mg films- i have them return and take the first in the office- after an hour, they can take another- after another hour, if no improvement i have them take a third- i send them home with instructions to take a fourth later that day but not after 6pm. i tell them to try to go to sleep as normal, but when they wake up, to take the same number of strips they took on day one and then come see me- so basically they can take up to 16mg in the first full 24 hours- how many they have taken and how they look when they come in next is usually enough for me to extrapolate a daily dose. it is a little more costly- but i have gotten sedation by giving too much on the first day- using the 2mg strips has avoided this.
personally I don't see much difference in above regard between big users of iv heroin and same iv pills..and I push induction vigorously,usually 8 at once and maybe another 4 in 1h and 2nd day 12 or 16 in am dose ...mostly all feeling much better than when entered rather than worse...to me this more logical and effective than the original standards,
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