This chapter proposes a Powhatan theory of power and suggests links to the archaeology and ethnohistory of towns in the lower Chesapeake. Early colonial-era sources highlight a recurring process whereby powerful outside forces, materials, and people were socialized within the Powhatan settlements known as Kings’ Houses. We suggest that a key Algonquian concept for understanding this process is manitou—the vital spiritual force manifest in dangerously potent people, animals, objects, and places. Within the Kings’ Houses of the colonial-era, Powhatan leaders harnessed manitou by orchestrating ritual, trade, and the built environment. Archaeological evidence of feasting, ditches, and palisades points toward similar practices associated with the construction of boundaries—ditches and palisades—within prominent settlements, starting in the thirteenth century AD. By transforming the objects and people that transgressed these boundaries, religious practitioners and political leaders exercised a “tactical power” grounded in Kings’ Houses and animated by manitou.

Aim To discuss the use of 6‐monthly buprenorphine implants for maintenance treatment of opioid use disorder and the potential clinical implications if approved in Australia. Data sources MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature and Web of Science were searched using the key terms ‘buprenorphine implant’, ‘opioid dependence’ and ‘Probuphine’ for articles published between January 2000 and August 2017. Study selection English‐language, peer‐reviewed articles were eligible for inclusion if they evaluated the effectiveness of buprenorphine implants for opioid dependence. Results After implantation, an initial pulse is followed by an exponential decline to a non‐fluctuating buprenorphine plasma concentration sustained over 6 months. In a double‐blind randomised controlled trial, buprenorphine implants were non‐inferior to low‐to‐moderate doses of sublingual buprenorphine (SLB) in clinically stable abstinent patients, with 6‐month abstinence being superior to SLB. Adverse effects are comparable to established buprenorphine preparations, although local issues from surgical implantation and explantation procedures appear commonplace, necessitating risk evaluation and mitigation strategies. No studies compared implantable buprenorphine to methadone, which retains patients in therapy more effectively than SLB at a fixed and low dose. Implants offer potential cost savings over SLB, with biannual dosing and tamper‐proof characteristics poised to address issues such as poor adherence, misuse, diversion and inadvertent exposures. Conclusion Buprenorphine implants have expanded the therapeutic repertoire for opioid use disorder, offering greater opportunity for treatment individualisation. Implants are currently indicated for a small subset of patients who have first demonstrated clinical stability on low‐to‐moderate doses of SLB. Preliminary data highlight their potential to hypothetically supersede existing treatment modalities in appropriately selected candidates.

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