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Understanding Comorbid Substance Use Disorders and ...
Presentation Q&A
Presentation Q&A
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So, Donna and Amanda, a few questions have come in, so just to start, can someone become addicted to Suboxone, and also along that line, why do some patients say that Suboxone gives them a high? I can take that one. So when thinking about addiction, some people think addiction goes with a substance use disorder, but ultimately when you're taking Suboxone, it is a partial agonist, so if someone has been taking Suboxone for a period of time, if they decide they eventually wanted to come off of it, it would need a tapering schedule. You can't just discontinue that suddenly because there is going to be a physiological dependence and tolerance that occurs. So that is true, it happens physiologically, and you'd want to be very mindful about educating your patient about how they, that they shouldn't just discontinue that suddenly, and that they'd need to taper off. If you've heard that patients are abusing it, it's more likely that they were potentially taking Buprenorphine. A lot of patients, and I also know as clinicians, will use Suboxone, Subutex, Buprenorphine, all interchangeably. So I usually try to dig down a little bit more if they said they were abusing their Suboxone, is that were they actually taking Suboxone, which is in combination with the Naloxone? Most of the time I find out they were actually taking Subutex, which is purely Buprenorphine, and there's potential for abusing that. And that's why I encourage to prescribe Suboxone, which has the Naloxone component also in it in an outpatient setting. Terrific. What's the definition of physical dependence in the context of substance use? Is physical dependence the same thing as tolerance and or withdrawal? So I can also discuss that one. Can you repeat that second piece for me real quick? Sure. So what is physical dependence? And then is physical dependence the same or different from tolerance or withdrawal? So I have always understood it as physical dependence is the umbrella that tolerance with and withdrawal are going to go under. So yes, they're synonymous, and that's why it got a little dicey as we switched from the DSM-4 to the DSM-5. People are still using dependence, which in fact is describing tolerance, you know, needing an increased dose over a period of time and withdrawal. But in fact, we're trying to move more towards using the DSM-5 language, which we need to specify tolerance and withdrawal. So to answer that, dependence is the same as tolerance and withdrawal, but we're trying to move more towards the latter language in the DSM-5. So this one's sort of related. So can someone, wait, let me just get up to it for a second here. Is it possible for someone to have OUD, an opioid use disorder, without having tolerance and withdrawal symptoms? And the person goes on to say, I thought every quote unquote addiction necessarily means there's physical dependence. Like an addiction is a circle within a bigger circle of physical dependence. Right. So the first part is, is OUD, can you have OUD without tolerance and withdrawal? So technically, yes, yes, because I practice, I mean, my whole practice is with substance use disorders. I'll say it's incredibly rare. More often it's other substances, for example, methamphetamine. People don't really get a tolerance and withdrawal, or if they do, it's like a day they feel kind of fatigued, but it's not the same type of physiological withdrawal people go through with opioid use disorder and alcohol use disorder. So that's a very specific question with opioid use disorder, and I would say in the realm of reality, it's possible, it's just incredibly unlikely that if someone is demonstrating the other issues, the other criteria that we discussed, that it's going to come with also the physical dependence just because of the mechanism of action of that substance. Makes sense. So someone else reflected back on that idea of the suboxone high and just wanted to revisit. So is it possible, this is what the person is asking, is it possible that even a regular prescribed dose of suboxone, so they're taking the usual dose that they're prescribed, could make a patient feel the same quote-unquote high that they felt when they were abusing heroin or opioids? Have you heard of that? No. If they're taking the appropriate amount that it's been, if that medication has been induced properly, which again, when you get wavered, you learn about this. If they're getting a high off of it, it's potentially being dosed too high. So I have never come across that, but again, that's when it's being initiated according to the standards of the waiver of going up on that medication. And again, the only time I've heard individuals say if they get a high as if they keep trying to push their buprenorphine dose or subutex dose that does not have the naloxone in combination with the medication. Right. So for you, that is an alert to check on something. Yes. Okay. Sounds good. All right. Well, we're coming towards the end of the time we have for questions.
Video Summary
In this video, Donna and Amanda answer questions related to Suboxone and substance use disorders. They discuss whether someone can become addicted to Suboxone and why some patients claim it gives them a high. They explain that Suboxone is a partial agonist and should be tapered off gradually to avoid physiological dependence and withdrawal symptoms. The misuse and abuse of Suboxone are often due to confusion with other medications like Subutex. They also clarify the relationship between physical dependence, tolerance, and withdrawal in the context of substance use. Lastly, they address whether a regular dose of Suboxone can give a patient the same high as heroin or opioids, noting that it is unlikely if the medication is properly prescribed and dosed. Overall, the video provides insights into the complexities of Suboxone use and its effects. No credits are mentioned in the transcript.
Keywords
Suboxone
substance use disorders
addiction
partial agonist
physiological dependence
Funding for SMI Adviser was made possible by Grant No. SM080818 from SAMHSA of the U.S. Department of Health and Human Services (HHS). The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, SAMHSA/HHS or the U.S. Government.
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