bclearmd

It generally includes counseling online, either group-based or individual. It also includes online visits with a doctor, PA, or NP, who specializes in addiction medicine and can provide medical treatment with buprenorphine (Suboxone). Of the 3 effective medical treatments for OUD, buprenorphine is the one that can be accessed and provided safely online.

That sounds adaptive! Congratulations on your long-standing recovery, and thank you also for sharing your experience with others through your work as a social worker. In my experience, I find that patients who have been on Suboxone effectively in the past with no intolerance, almost aways will continue to tolerate the medication well when there's a need to resume it. I've not observed any sort of acquired intolerance, at least not in sufficient numbers to suspect it's at all common. I have known many patients who are in stable, successful remission of their opioid use disorder, or their tobacco use disorder, to experience revulsion or even nausea, sometimes sweats or hives, when in the presence of a strong trigger or the drug they've previously moved on from. I think this likely has to do with the strong emotional association between the trigger and the pain that the drug previously caused, when the person has moved beyond the positive, euphoric feelings that were once associated with that drug use. I can only speculate though. I do advocate strongly for use of medication for opioid use disorder (MOUD), previously referred to commonly as MAT. Effective, appropriate use of these medications is what's going to turn the corner on the opioid crisis. The need is just incredible.

Wow that's an interesting question. I'm not aware of any inherent, or genetic, endogenous opioid deficiency condition. I think it's worth considering that opioids themselves have no primary effect at all on the body or mind (that we know of) Their effect is completely dependent on activation of the opioid receptor, which then causes a series of direct and indirect effects in the body. So when considering where someone's "normal" opioid homeostasis, or set-point, level is, we don't look at the amount of opioid in the body but the relative level of opioid receptor activation compared to that person baseline level of activation. A person who uses opioids frequently will actually have fewer, and much less responsive, opioid receptors than others as the body is working to adapt to the super-high amount of opioids typically present - So in the withdrawal state, the baseline level of activation is so high (because of tolerance), that a "normal" state of activation for a non-tolerant person is truly a severe opioid deficiency for that person. We know this severe opioid deficient state last 3-7 days after stopping exogenous opioid use before the body starts to adapt to the new, more normal set-point, by increasing receptor numbers and sensitivity again, but some residual level of deficiency (usually felt as fatigue) often continues for months. What that opioid receptor activation level looks like decades later has never been studied, but we do know that return to problematic use, even decades later, has a strong tendency to devolve very quickly into every-day habitual use, so ongoing support, trigger avoidance, a plan in the event of developing risk of return to problematic use, is important lifelong.

I love this article that gives a thorough review of the risk of diversion or misuse of treatment for opioid use disorder and puts it in perspective.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6800751/

Also beautifully well-stated by korndog42.

Methadone is extremely tightly regulated (when used for addiction treatment) so it's less commonly diverted or misused because it's less available. Buprenorphine (Suboxone) is more widely available so will be found more commonly on the street, but it also has much lower harm potential than methadone when used recreationally or as self-directed treatment. There will be more stories of misusing buprenorphine from the street and having a bad experience, but you'll hear the stories because the experience is survived. You won't hear many stories of mixing street methadone with fentanyl because it's extremely lethal.

yup, a micro-dosing start! The precipitated withdrawal reaction happens because of a very sudden shift from full opioid-receptor activation to the partial-activation state that buprenorphine provides. When the shift is abrupt, it's awful. The classic way to avoid this is to allow withdrawal to develop over anywhere from 6 to 72 hours, depending on the person and the opioid used, then start buprenorphine to quickly relieve the withdrawal state.

A micro-start instead very slowly starts buprenorphine which can be done while a person is still using other opioids, and it works well. The trick with a micro-start is that it involves complex directions that go on for a week or more before a stable dose is achieved. It can be a lot for some to manage, it takes longer than a classic start, and many prefer to stop illicit opioids immediately when they start treatment rather than potentially continuing to take them for a week while working up to an effective Suboxone dose.