Clinical practice Carlat Reports

Expert Q&A

Practical Approaches to Vetting Clinical Research

From The Carlat Child Psychiatry Report, Depression in Children and Adolescents

CCPR: Tell us a bit about your current work. What is your population? Whom do you treat? Dr. Courtney: My clinical population are patients with concurrent addictions and mental health issues. These patients present complex clinical challenges, and so I have made efforts to use a method to think about and sort through those problems. CCPR: Please sha

Research Update

A Psychosocial Intervention for Chronic Pain and SUD

From The Carlat Addiction Treatment Report, Stimulant Use Disorder

Topics: Clinical practice | Marijuana | observational study | Pain | quality of life

REVIEW OF: Ilgen MA et al, JAMA Psychiatry 2020; published online July 29, 2020 Co-occurring substance use disorders (SUD) and chronic pain can be tough to treat. Little research has focused directly on this phenomenon, since most studies of pain exclude individuals with SUD. However, a few small, open studies of psychotherapeutic pain management in

Expert Q&A

Supporting Patients With Pain and Addiction

From The Carlat Addiction Treatment Report, Pain and Addiction

Topics: Buprenorphine | Clinical practice | Opioid Use Disorder | Opioids | Pain

CATR: What kind of work do you do, Dr. Manhapra? Dr. Manhapra: I run a clinic at the Hampton VA Medical Center helping patients with treatment-resistant chronic pain and disability. We see patients who have trialed many pain management treatments including injections, procedures, surgeries, and psychological pain treatments, all of which have failed. T

Clinical Update

Medical Marijuana for Chronic Pain: The Cart Before the Horse?

From The Carlat Addiction Treatment Report, Pain and Addiction

Topics: Clinical practice | Harm reduction | Marijuana | Pain

In 2019, 17.5% of the American population used cannabis in the past year—up from 11.0% in 2002 (www.samhsa.gov/data/release/2019-national-survey-drug-use-and-health-nsduh-releases). As more states legalize cannabis for medical or recreational use, it’s becoming more common for our patients to add medical marijuana to their medication regimen for var

Research Update

Medical Cannabis for Chronic Pain and Quality of Life

From The Carlat Addiction Treatment Report, Pain and Addiction

Topics: Clinical practice | Marijuana | observational study | Pain | quality of life

REVIEW OF: Safakish R et al, Pain Medicine 2020 Jun 18;pnaa163. Epub ahead of print. Although chronic pain affects 10%–30% of the adult population and contributes to a host of physical and mental health problems, we often find ourselves with limited options to assist the patient with pain in front of us. While medical cannabis (MJ) has shown promis

Clinical Update 2

When to Stop Addiction Treatment: How Long Is Enough?

From The Carlat Addiction Treatment Report, Alternative Treatment in Addiction

When a patient with a substance use disorder (SUD) has that “reachable moment” and/or recognizes the need to seek help, we know the importance of decreasing barriers to start treatment. However, what is less clear is when to stop treatment. What indicators suggest stable recovery? Recovery process The DSM-5 definition of remission from SUD is ba

Clinical Update

The “Z-Drugs”: Safety Issues and Misuse Potential

From The Carlat Addiction Treatment Report, Emerging Risks for Old Medications

Originally marketed as safer alternatives to benzodiazepines, the Z-drugs—eszopiclone (Lunesta), zaleplon (Sonata), and zolpidem (Ambien)—were considered devoid of misuse potential. But recent data and FDA warnings suggest we’ve been hitting the snooze on them for too long. Here, we review their risks and discuss safe prescribing. Medical risks

Clinical Update

Muscle Relaxants: Sedatives Often Under the Radar

From The Carlat Addiction Treatment Report, Emerging Risks for Old Medications

Muscle relaxants are a diverse group of medications with varying mechanisms of action (see Commonly Prescribed Muscle Relaxants table below). They are indicated for short-term treatment (2–3 weeks) of acute, painful muscle spasms, as well as some chronic neurologic conditions associated with spasticity. However, many patients with chronic pain are on

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Primer: Confidentiality in Addiction Treatment