Yes, if you so-called “fail” injected heroine—free heroine—that makes you pretty complicated for me to look after and to try to get HIV meds into you every day.
I don't have the same experience of a lot of our potential programs being effective for everyone. I have patients now who were given a whole lot of hydromorphone from some prescriber, and who have just gone on opioid substitution and are now way more interested in going to the free hydromorphone provision site.
At the individual level, everything has an effect that we can't always predict. I have experience with people who are very committed drug users and have very difficult health issues that need to be supported lifelong or until death, and others who are very committed drug users and are thrilled that we may be providing no opioid replacement, but really their drugs of choice. We should, perhaps, but there are effects on stabilizing.