[1] 00:00:00:00 00:00:00:00 [2] 00:00:00:00 00:00:01:18 ♪ [3] 00:00:01:19 00:00:04:11 Hi there, welcome to Basecamp Recovery Center's [4] 00:00:04:12 00:00:06:08 "Begin Your Climb" series. [5] 00:00:06:09 00:00:07:22 I'm Brian Borland and I have the pleasure [6] 00:00:07:23 00:00:09:09 of serving as the Medical Director [7] 00:00:09:10 00:00:12:22 here at Basecamp Recovery Center in Columbus, Ohio. [8] 00:00:12:23 00:00:16:08 Today we're going to talk about an important topic [9] 00:00:16:09 00:00:20:06 involving a medication that we use called Suboxone. [10] 00:00:20:07 00:00:23:20 There's a lot of concern and there's a lot of questions [11] 00:00:23:21 00:00:26:09 surrounding the use of Suboxone, [12] 00:00:26:10 00:00:29:18 and so I really want to go over sort of five questions. [13] 00:00:29:19 00:00:31:04 What is it? [14] 00:00:31:05 00:00:33:00 Why do we use it? [15] 00:00:33:01 00:00:34:15 Is it necessary? [16] 00:00:34:16 00:00:36:09 Can you get high from it? [17] 00:00:36:10 00:00:40:05 And aren't you just switching from one drug to another? [18] 00:00:40:06 00:00:44:22 So to begin, Suboxone is a combination medication. [19] 00:00:44:23 00:00:47:17 It involves buprenorphine [20] 00:00:47:18 00:00:50:10 and naloxone. [21] 00:00:50:11 00:00:54:21 Buprenorphine is an opioid in and of itself. [22] 00:00:54:22 00:00:58:19 Naloxone is an opioid blocker. [23] 00:00:58:20 00:01:01:08 So the question is: [24] 00:01:01:09 00:01:03:19 "Why would you put an opioid with an opioid blocker? [25] 00:01:03:20 00:01:06:06 That doesn't make a lot of sense." [26] 00:01:06:07 00:01:08:20 The theory behind it is that [27] 00:01:08:21 00:01:12:05 Suboxone is taken in a very specific manner. [28] 00:01:12:06 00:01:15:21 It's placed under the tongue and let dissolved completely. [29] 00:01:15:22 00:01:19:05 In taking the medication like that, [30] 00:01:19:06 00:01:22:10 you get primarily absorption of buprenorphine [31] 00:01:22:11 00:01:25:08 and less absorption of naloxone [32] 00:01:25:09 00:01:29:01 because it doesn't do as well absorbing through that route. [33] 00:01:29:02 00:01:32:02 However, if you were to melt it down [34] 00:01:32:03 00:01:34:09 and try and shoot it in a vein, [35] 00:01:34:10 00:01:36:17 that's how naloxone likes to be used, [36] 00:01:36:18 00:01:38:10 and it's Narcan essentially, [37] 00:01:38:11 00:01:42:07 so it prevents and deters people from melting the medicine [38] 00:01:42:08 00:01:45:07 and shooting it up into a vein. [39] 00:01:45:08 00:01:48:08 So why do we use it? [40] 00:01:48:09 00:01:52:16 Suboxone is a partial opioid agonist, [41] 00:01:52:17 00:01:56:00 which means that when it binds to an opioid receptor, [42] 00:01:56:01 00:02:00:06 it fires at about, let's say, 30 percent. [43] 00:02:00:07 00:02:03:20 Whereas if you're using a drug like fentanyl, [44] 00:02:03:21 00:02:05:19 or morphine, or heroin, [45] 00:02:05:20 00:02:07:17 those are full agonists, [46] 00:02:07:18 00:02:09:23 so when they bind to the opioid receptor, [47] 00:02:10:00 00:02:12:01 you get, like, 100 percent, [48] 00:02:12:02 00:02:15:07 and so it's substantially more. [49] 00:02:15:08 00:02:17:00 So why would we use it? [50] 00:02:17:01 00:02:19:00 Well, for number one, [51] 00:02:19:01 00:02:21:21 once it binds it's like concrete, [52] 00:02:21:22 00:02:24:11 and so it sits on that opioid receptor [53] 00:02:24:12 00:02:28:19 and it doesn't allow other drugs to get onto the opioid receptor. [54] 00:02:28:20 00:02:31:01 So if you are on Suboxone [55] 00:02:31:02 00:02:33:07 and you were to use, [56] 00:02:33:08 00:02:35:15 such as fentanyl or heroin, [57] 00:02:35:16 00:02:38:19 you would have far less of an effect, [58] 00:02:38:20 00:02:41:14 and it would basically be like a waste of money. [59] 00:02:41:15 00:02:43:17 In addition, as long as that Suboxone [60] 00:02:43:18 00:02:45:17 is bound to those receptors, [61] 00:02:45:18 00:02:48:13 it stays there for a very long time, [62] 00:02:48:14 00:02:52:13 and because of that, if you were to have [63] 00:02:52:14 00:02:56:17 a lethal dose of fentanyl or heroin, [64] 00:02:56:18 00:02:59:03 which would normally cause an overdose, [65] 00:02:59:04 00:03:03:10 that Suboxone on those receptors would allow you to still be okay [66] 00:03:03:11 00:03:07:01 because you didn't get the full effect of that dose. [67] 00:03:07:02 00:03:11:10 So we use it for patients who have opioid addiction [68] 00:03:11:11 00:03:14:07 and who are struggling to be able [69] 00:03:14:08 00:03:16:04 to work a treatment program. [70] 00:03:16:05 00:03:19:12 This happens because opioid addiction [71] 00:03:19:13 00:03:22:17 has significant withdrawal symptoms [72] 00:03:22:18 00:03:25:20 when a person abruptly stops using the opioid. [73] 00:03:25:21 00:03:28:22 For example, after a person stops using opioids [74] 00:03:28:23 00:03:33:00 with anywhere from six hours to a day or two, [75] 00:03:33:01 00:03:36:04 they're going to start having symptoms of sweatiness, [76] 00:03:36:05 00:03:38:15 cold chills, restless legs, [77] 00:03:38:16 00:03:41:07 nausea, vomiting, diarrhea, [78] 00:03:41:08 00:03:44:04 body aches, body pains, chills, [79] 00:03:44:05 00:03:47:01 and these symptoms are going to continue to increase [80] 00:03:47:02 00:03:49:14 over the period of the next few days [81] 00:03:49:15 00:03:51:19 to the point where it's almost intolerable, [82] 00:03:51:20 00:03:53:20 it's almost like torture. [83] 00:03:53:21 00:03:57:20 So there's no way a person is just going to lay there [84] 00:03:57:21 00:04:00:14 and suffer through that for as many days [85] 00:04:00:15 00:04:03:18 as it's going to take, up to 7 to 10 days, [86] 00:04:03:19 00:04:06:03 and then try and go to treatment. [87] 00:04:06:04 00:04:09:16 So if we don't use Suboxone, Suboxone being an opioid, [88] 00:04:09:17 00:04:11:09 it binds to the receptors, [89] 00:04:11:10 00:04:13:03 and so the person doesn't necessarily [90] 00:04:13:04 00:04:15:07 go through withdrawal because they've got [91] 00:04:15:08 00:04:19:03 enough opioid on board that it will allow them [92] 00:04:19:04 00:04:22:07 to not suffer really bad withdrawal symptoms, [93] 00:04:22:08 00:04:24:18 and if it's bound to the receptor, [94] 00:04:24:19 00:04:27:16 that tells the brain that there's something there, [95] 00:04:27:17 00:04:29:13 and it helps with cravings [96] 00:04:29:14 00:04:31:13 because the brain no longer goes searching [97] 00:04:31:14 00:04:33:19 for other opioids because it's got things [98] 00:04:33:20 00:04:37:04 bound to its opioid receptors. [99] 00:04:37:05 00:04:40:05 So that sort of crosses into "Is it necessary?" [100] 00:04:40:06 00:04:42:12 Well, unfortunately it is. [101] 00:04:42:13 00:04:45:14 We've known for a while [102] 00:04:45:15 00:04:48:12 that patients who do not receive any sort of Suboxone, [103] 00:04:48:13 00:04:51:14 if they just try and withdraw cold turkey, [104] 00:04:51:15 00:04:55:05 or if they just do a rapid taper of Suboxone, [105] 00:04:55:06 00:04:57:18 like, they show up, they get a day or two of it, [106] 00:04:57:19 00:05:00:08 then they take them off of it really fast, [107] 00:05:00:09 00:05:02:20 patients will not stay sober. [108] 00:05:02:21 00:05:05:14 They need longer term treatment, [109] 00:05:05:15 00:05:08:21 detox, and this rapid detox is not treatment. [110] 00:05:08:22 00:05:11:01 That's simply trying to help someone [111] 00:05:11:02 00:05:13:10 with the symptoms of withdrawal, [112] 00:05:13:11 00:05:15:19 but it in no way helps treat [113] 00:05:15:20 00:05:18:08 their disease of substance use disorder. [114] 00:05:18:09 00:05:22:04 So therefore we shouldn't think that a rapid Suboxone taper [115] 00:05:22:05 00:05:26:08 or making them go cold turkey is going to fix anything [116] 00:05:26:09 00:05:28:23 because they still need to have real treatment [117] 00:05:29:00 00:05:30:10 for their substance use disorder, [118] 00:05:30:11 00:05:33:15 which involves inpatient, or IOP, or PHP, [119] 00:05:33:16 00:05:36:21 or various other levels of care. [120] 00:05:36:22 00:05:39:07 Now the question, "Can you get high on it?" [121] 00:05:39:08 00:05:41:01 Yes, you can, [122] 00:05:41:02 00:05:43:13 and I know that that's probably surprising, [123] 00:05:43:14 00:05:47:00 but let's take a look at how that works. [124] 00:05:47:01 00:05:51:16 So 0, 30 percent, 100 percent. [125] 00:05:51:17 00:05:55:09 Most of the people that we're putting Suboxone on [126] 00:05:55:10 00:05:57:16 are coming from here [127] 00:05:57:17 00:06:01:09 and coming down to 30 percent, [128] 00:06:01:10 00:06:03:10 and then they're going to stay there. [129] 00:06:03:11 00:06:05:06 These people can actually go through [130] 00:06:05:07 00:06:06:23 precipitated withdrawal, [131] 00:06:07:00 00:06:09:23 which means if they take the Suboxone too soon, [132] 00:06:10:00 00:06:12:05 it will push the opioids out of their system [133] 00:06:12:06 00:06:14:08 off the opioid receptors, [134] 00:06:14:09 00:06:16:04 replaced with Suboxone, [135] 00:06:16:05 00:06:18:16 and they can actually drop from 100 percent, [136] 00:06:18:17 00:06:20:09 drop straight down to 30 percent, [137] 00:06:20:10 00:06:24:08 and suffer from really, really bad withdrawal symptoms. [138] 00:06:24:09 00:06:26:06 On the contrary, if you are a person [139] 00:06:26:07 00:06:28:06 who does not have opioid tolerance. [140] 00:06:28:07 00:06:31:03 Let's say you've only used pain pills a couple times, [141] 00:06:31:04 00:06:34:01 or you've never had an opioid before, [142] 00:06:34:02 00:06:36:08 you're going to be down here at 0, [143] 00:06:36:09 00:06:38:17 and so if you use it, [144] 00:06:38:18 00:06:41:23 yes, you are going to feel high from it. [145] 00:06:42:00 00:06:45:19 But that is not the patient population [146] 00:06:45:20 00:06:47:19 which we use Suboxone for. [147] 00:06:47:20 00:06:49:21 We use Suboxone on people who already have [148] 00:06:49:22 00:06:53:10 tolerance to opioids and are having difficulty [149] 00:06:53:11 00:06:55:01 with going through the withdrawal process [150] 00:06:55:02 00:06:57:11 because it's gotten too bad, [151] 00:06:57:12 00:06:59:23 where these patients, literally they would be [152] 00:07:00:00 00:07:01:22 doing it recreationally, [153] 00:07:01:23 00:07:04:09 and they don't have an opioid tolerance, [154] 00:07:04:10 00:07:06:06 so if they did need early treatment [155] 00:07:06:07 00:07:09:08 for substance abuse disorder, they wouldn't need Suboxone [156] 00:07:09:09 00:07:10:23 because their withdrawal would be mild [157] 00:07:11:00 00:07:15:09 and could be treated with some comfort medications. [158] 00:07:15:10 00:07:17:04 Then the question always comes, "Aren't you just [159] 00:07:17:05 00:07:20:11 switching one drug for another drug?" [160] 00:07:20:12 00:07:22:06 In this case, [161] 00:07:22:07 00:07:25:06 it is switching one drug for another one. [162] 00:07:25:07 00:07:29:08 However, the benefits being with Suboxone [163] 00:07:29:09 00:07:33:08 and its 30 percent agonist effect. [164] 00:07:33:09 00:07:35:16 Let's say, for easy example, [165] 00:07:35:17 00:07:38:02 you have five opioid receptors in your body [166] 00:07:38:03 00:07:40:05 and you get Suboxone. [167] 00:07:40:06 00:07:42:11 On each one of those receptors, [168] 00:07:42:12 00:07:46:17 once it's there it's stuck there like concrete, [169] 00:07:46:18 00:07:51:02 and so it helps people decrease cravings, [170] 00:07:51:03 00:07:54:15 it helps with the withdrawal process, [171] 00:07:54:16 00:07:58:11 not allowing them to go through such a horrible withdrawal, [172] 00:07:58:12 00:08:01:07 and if you don't use it, [173] 00:08:01:08 00:08:03:00 no one gets sober. [174] 00:08:03:01 00:08:06:09 Unfortunately, what we know about this opioid epidemic [175] 00:08:06:10 00:08:10:13 is that there's a very, very high risk of death involved [176] 00:08:10:14 00:08:14:03 when someone has a low tolerance [177] 00:08:14:04 00:08:15:21 from maybe being in treatment or detox, [178] 00:08:15:22 00:08:18:11 and then they go right back to their same dose, [179] 00:08:18:12 00:08:20:20 they have a high likelihood of dying. [180] 00:08:20:21 00:08:23:12 Whereas if they are on Suboxone, [181] 00:08:23:13 00:08:27:19 are they switching one drug for a medicine? [182] 00:08:27:20 00:08:30:11 Yes, they are, but it makes sense [183] 00:08:30:12 00:08:32:20 because without it a lot of opioid addicts [184] 00:08:32:21 00:08:34:16 will never get treatment, [185] 00:08:34:17 00:08:36:17 they'll never get comfortable enough [186] 00:08:36:18 00:08:38:16 to understand what needs to be done [187] 00:08:38:17 00:08:40:18 to work a recovery program, [188] 00:08:40:19 00:08:43:06 and will continue to allow people [189] 00:08:43:07 00:08:46:15 with no medications to assist them [190] 00:08:46:16 00:08:49:12 who will then inevitably go right back out, [191] 00:08:49:13 00:08:51:00 use and overdose, [192] 00:08:51:01 00:08:52:23 and have the potential for dying. [193] 00:08:53:00 00:08:55:06 So there are a lot of benefits [194] 00:08:55:07 00:08:58:03 as to why we use Suboxone, [195] 00:08:58:04 00:09:02:02 and there are also some consequences [196] 00:09:02:03 00:09:05:07 and some things that we don't necessarily like about Suboxone. [197] 00:09:05:08 00:09:07:02 But what we do know is [198] 00:09:07:03 00:09:09:19 we do not get very many people sober [199] 00:09:09:20 00:09:12:01 and get them back to a successful life, [200] 00:09:12:02 00:09:14:20 get them back to their homes, and their families, [201] 00:09:14:21 00:09:16:13 and their jobs. [202] 00:09:16:14 00:09:20:05 Without Suboxone we get a very, very small percentage [203] 00:09:20:06 00:09:22:07 of those, even in the single digits, [204] 00:09:22:08 00:09:24:11 like, 8 to 10 percent. [205] 00:09:24:12 00:09:27:07 So I hope those answers to your five questions [206] 00:09:27:08 00:09:29:22 on Suboxone, and I look forward to [207] 00:09:29:23 00:09:31:17 talking about Vivitrol in another class [208] 00:09:31:18 00:09:33:05 that we have coming up. [209] 00:09:33:06 00:09:37:10 ♪