Alberta's deputy minister of health is getting a lot of flack from my leftist cohorts for saying that naloxone causes disordered opiate users to consume more fentanyl. I hear he says they OD on purpose and then take naloxone to get back home so to speak. Clients tell me it's called "yo-yoing" (note well: I just used yo-yo as a verb.). Some of my cohorts say it doesn't happen. Some call for his resignation.
Let's think about this. I believe I operate the oldest established private psychology clinic in Alberta. Throughout my career and at present I routinely work with people whose use of substances is disordered. I've never met such a person whose use is confined to one substance. Not once. So: People with substance use disorder using multiple substances in a disordered way isn't a big surprise to me.
What would surprise me is if such people (who are notorious under-reporters of their use) told me they did it falsely. So, I believe them when they report doing it. Ergo the deputy minister is right to say that it happens.
Unlike many therapists, I don't think Substance Use Disorder is a disease. I think it's a wound. However, it's such a deep wound that most people lack either the stamina and/or the motivation and/or the resources and therefore will not be able to do what it takes to heal that wound. Also, testing whether the wound is healed undeniably risks a dangerous relapse, which many would argue outweighs any benefit it might promise. Those people (i.e. most people with Substance Use Disorder) do best to think of it as an incurable disease for which the safest treatment is abstinence. Either way, Substance Use Disorder is a medically significant condition and people who have it need care. Without it, too many die.
Saying that the disordered use of a substance is caused by the disordered use of another substance is stupid, mean-spirited, and wrong. The causal wound predates the disordered use. Also, I don't believe any opiate user used naloxone first. By definition causes precede effects. So, naloxone can't figure in the cause. Ergo, the deputy minister is stupid, mean-spirited, and altogether wrong about that.
Opiate users who OD, if they are fortunate enough to receive treatment, are ipso facto exposed/introduced to naloxone. And there you go. Some of them like the experience I guess. Why? Ah, answer that question and you're on the way to finding the source of the wound.
Good luck with that. In my experience, every case is unique. I'll give you one hint: Compassion is the right approach. Blame is not.