Psych/SUD/Pain Follow-up Q&A

Dr. Steven Prakken presented at the Addiction Medicine 2021 conference held virtually on April 8-10. He spoke on “Safe Sailing in the Tricky Waters of the Psych/SUD/Pain World”. We followed up with him with a question that we didn’t have time for.

Q: Has any research been done on those high users of care through the lens of Al-Anon and the wearing of the self-image of being a victim and having a very poor sense of self-power? Did these individuals learn this very young or after they acquired all these illness/conditions?” 

A: There is certainly the sense of powerlessness for many within the high utilizer group, though it is not as much as you would think.  Powerlessness certainly comes with the disability of these painful conditions, and most commonly following the disability, not previous to it. We worked commonly with empowerment in the face of disability, and it was very helpful.  There are no studies I know of that looked at the Al-Anon lens specifically, but the work within catastrophizing likely has overlap. 

Hope this answers your question.



Buprenorphine Q&A

Dr. Sandra Bishop-Freeman, Deputy Chief Toxicologist at the NC Office of the Chief Medical Examiner, and addiction psychiatrist Dr. Stephen Wyatt led a session on buprenorphine at the Governor’s Institute’s recent Addiction Medicine Conference held in April 2021. We ran out of time for questions so passed one on to Dr. Bishop-Freeman after the conference.

Q: Is there any circumstance under which bupe alone at high dose is lethal? E.g. when there’s low tolerance and the respiratory depression threshold is lower than the bupe ceiling?

A: We had 8 cases out of 131 that were buprenorphine alone and the case histories showed what appeared to be naïve users (taken at parties, borrowed from friend). I think there is a certain point where despite the so-called ceiling effect, there is still respiratory depression. Even the highly cited references that initially discussed the ceiling show some respiratory depression experimentally. This is not a drug that should be taken by non-opioid tolerant individuals. At a certain dose the ceiling effect may not always be protective is my impression from the research in the literature.

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