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Tolerate THIS

By J.T. Junig, MD, PhD

I recently accepted a young man as a patient who was addicted to hydrocodone (the opioid in Vicodin), prompting a discussion about treatment options for someone who hasn’t been using very long, and who hasn’t pushed his tolerance all that high.  Perhaps it will be informative to share my thought process when recommending or planning treatment in such cases.

In part one I’ll provide some background, and in a couple days I’ll follow up with a few more thoughts on the topic.

Most people who have struggled with opioids learn to pay attention to their tolerance level—i.e. the amount of opioid that must be taken each day to avoid withdrawal or to cause euphoria (the latter about 30% more than the former).  For someone addicted to opioids, the goal is to have a tolerance of ‘zero’—meaning that there is no withdrawal, even if the person takes nothing.

That zero tolerance level serves as a goal, making having a high tolerance a bad thing, and pushing tolerance lower a good thing.

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Tolerate THIS

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  1. I can’t wait for Part II. I was just like this young man when I started on suboxone. I had taken 20-35 norcos/day for years, and decided to break the habit by getting on suboxone. The 2 mg tablet had me high as a kite and I hated it. Because of the stickiness effect, I was high as a kite for several days. I hated the edginess and inability to sit still that I got from it. So I changed my dose to .5 mg/day, then I took only .25 mg/day for a few months, then .1 mg/day for a few months, and then tapered down to stopping within 6 months of starting. It’s true that at low doses I got a slight high, but the high doses got me super high and edgy. In hindsight, I should have just taken xanax, as that is what I needed in the end anyway to detox off the suboxone.

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