My dad used to tell a joke about a bunch of soldiers sitting around the barracks.

One old guy yelled 31! – and the place broke out in laughter.  After a moment or two, another guy yelled 52! – and more laughter erupted.  Then a depressed-looking guy in the corner yelled 29! — followed by silence.  He yelled again, 68!—and again, the room was silent.

The new recruit asked the guy in the next bunk what was going on.  The guy answered, “we’ve been together so long that we know each others’ jokes too well—we decided to just number ‘em and save us the time.”

The new guy asked again, “but what about that guy in the corner?”

“Oh—that’s just Slim—he never could tell a joke.”

I recently exchanged emails with a patient about his complaints of back pain.  After reading about his symptoms and history by email, I told him– prior to his first visit– that I would consider treating his back pain and his use of opioids using buprenorphine, but I would not prescribe opioid agonists.

We met and started buprenorphine, but after the second or third visit, he began asking for opioid agonists.