- I find it's very helpful to explain both to patients
and sometimes their family members
about the underlying biologic changes
in opiate use disorder
and the way the medications that we use
address those changes.
Typically a patient with an opiate use disorder,
every six to eight hours is going to go through
a terribly symptomatic withdrawal.
So oftentimes I'll use my hand as an example
and say that this is an opioid receptor
and that they have millions of opioid receptors
all over their body.
There's a very high concentration in their brain.
And if there's nothing on that opioid receptor,
then they often feel craving and withdrawal.
If they get access to
morphine or oxycodone
or heroin or hydrocodone,
those molecules go and bind on the opioid receptor
and they prevent the craving and the withdrawal,
if they get access to enough of them,
they'll start to feel high or euphoria.
The medications that we use
to treat opiate use disorder,
such as buprenorphine,
they also act at the opioid receptor.
They bind to that receptor, but,
sort of fit in a different way.
They're what we call a partial opioid.
And so they kind of fit sideways
because they're sitting on the receptor,
they prevent the craving and withdrawal.
and also because they're on the receptor,
if a patient were to try to use another opioid,
the medication would block the effect.
So they would decrease
or no longer experience the high that they would get.
And I have to say as a primary care physician,
there are very few things
that I do in my regular practice,
where I see such profound changes,
on a short term basis
as a provision of these types of medications,
to patients with opiate use disorder,
where I see rapid improvements
in their functional status
over a very short period of time.
I'm Dr. David Fiellin,
I'm a primary care physician at Yale medicine.