Opioid epidemic Carlat Reports

Clinical Update

From The Carlat Addiction Treatment Report, Personality Disorders and Addiction

Topics: Harm reduction | Opioid epidemic | Safe Consumption Site

The recent opening of the first US supervised consumption site (SCS) in New York City was big news (Mays JC, Newman A. Nation’s first supervised drug-injection sites open in New York. The New York Times. November 30, 2021.). But what exactly is an SCS, and can it help patients? In this article, we’ll review the purpose of these sites, the evidence b

Research Update

Opioid Agonist Treatment and Decreased Mortality

From The Carlat Addiction Treatment Report, Laboratory Testing

Topics: Free Articles | Medication for Opioid Use Disorder (MOUD) | Opioid epidemic | Opioid Use Disorder

Opioid agonist treatments, namely methadone and buprenorphine, save the lives of people with opioid use disorders. In this study, researchers break down how exactly these medications decrease mortality, and it’s not just by reducing overdoses. REVIEW OF: Santo T et al, JAMA Psychiatry 2021;78(9):979–993 STUDY TYPE: Systematic review and meta-ana

Expert Q&A

Perioperative Management of Patients on Buprenorphine Maintenance

From The Carlat Addiction Treatment Report, Medical Issues in Addiction Practice

CATR: Can you tell us about your background? Dr. Acampora: I used to work as a cardiac anesthesiologist. Later, my interest turned to addiction medicine, and I trained in psychiatry and addiction psychiatry. I currently work in a pain clinic where I helped develop a strategy for managing buprenorphine in the perioperative period. CATR: Where does th

Research Update

Predicting and Preventing Fatal Opioid Overdoses

From The Carlat Addiction Treatment Report, Substance Use in Health Professionals

Topics: Opioid epidemic | Overdose | Prevention

Review of: Larochelle MR et al, Drug and Alcohol Depend 2019;204:107537 The epidemic of opioid-related deaths has been declared a public health emergency. Research has already described risk factors—or “touchpoints”—associated with an increased risk of opioid overdose: for example, certain clinical scenarios or incarceration. What’s less cl

Expert Q&A

Drug Overdoses in the US: Trends and Prevention Strategies

From The Carlat Addiction Treatment Report, Opioid Epidemic Update

Topics: fentanyl | Harm reduction | Naloxone | Opioid epidemic | Opioids

CATR: Welcome, Dr. Sharfstein. Tell us about your background. Dr. Sharfstein: I am professor of the Practice of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health. I’m a pediatrician by training and have worked in the public sector. I was a health policy advisor for Congressman Henry Waxman and the health commissioner

Expert Q&A

Naloxone Prescribing

From The Carlat Addiction Treatment Report, Addiction in Pregnancy

Topics: Harm reduction | Naloxone | Opioid epidemic | Opioid Use Disorder

CATR: Welcome, Dr. Coffin. Tell us what you do. Dr. Coffin: I’m a physician boarded in addiction medicine, infectious disease, and internal medicine. I am the director of substance use research at the San Francisco Department of Public Health, and on faculty at UCSF. My research is mainly in substance use, and I have various projects dealing with tre

Clinical Update

“What About the Implant, Doc?” Appraising Various Formulations of Buprenorphine

From The Carlat Addiction Treatment Report, Opioid Use Disorder Treatment

With other epidemics in the world dominating our attention, let’s not forget the epidemic of opioid-related deaths. Unlike the current viral epidemic, the opioid epidemic is eminently treatable. The figure on page 3 shows the reduction in heroin overdoses in Baltimore, MD, as increasing numbers of patients received opioid agonist treatment (Schwartz R

Clinical Update

Updated Guidelines for Treating Opioid Use Disorder

From The Carlat Addiction Treatment Report, Opioid Use Disorder Treatment

Before the COVID-19 pandemic, America was in the grip of an opioid crisis. Now, the medical community is sounding alarms that shelter-in-place orders may have triggered drug and alcohol relapses (Silva MJ et al, Am J Manag Care 2020;26(7):1–3). The American Medical Association has noted that at least 30 states have reported increases in opioid-related

Research Update

A Possible Option in Opioid-Related Harm Reduction

From The Carlat Addiction Treatment Report, Opioid Use Disorder Treatment

Topics: Harm reduction | Heroin | Opioid epidemic | Opioid Use Disorder | Pharmacology

REVIEW OF: Oviedo-Joekes E et al, JAMA Psychiatry 2016;73(5):447–455 We have effective FDA-approved medications for opioid use disorder (OUD): buprenorphine, methadone, and injectable naltrexone. Yet some patients with severe OUD decline these options. Many other countries offer a more controversial treatment—medically supervised IV administratio

Expert Q&A

Gabapentin Misuse and Diversion

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

CATR: Could you start by telling us a little bit about yourself and your current work? Dr. Vickers-Smith: I am an epidemiologist, and my work has primarily been on gabapentin as an emerging drug of recreational and unhealthy use. This interest came about while I was working for Dr. Jennifer Havens on her cohort of about 500 individuals in central Appal

Clinical Update

SAMHSA Relaxes Regulations on Methadone and Buprenorphine During COVID-19 Emergency

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

The Substance Abuse and Mental Health Services Administration (SAMHSA) has changed some prescribing rules to help minimize in-person contact while maintaining access to medications for opioid use disorder (OUD). Methadone Patients starting methadone continue to require an in-person medical evaluation at an opioid treatment program (OTP) prior to sta

Expert Q&A

Benzodiazepines: Old Medicines, New Concerns

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

CATR: To begin, tell us about the research and clinical work you do. Dr. Morford: I am an assistant professor at the Yale School of Medicine in the Program of Addiction Medicine. I trained as a general internist, and I see patients primarily at a large opioid treatment program and in an inpatient setting on an addiction consult service. I’m involved

Clinical Update

Harm Reduction Strategies—A Primer

From The Carlat Addiction Treatment Report, Harm Reduction

As is frequently the case with chronic diseases, cure is often neither possible nor an appropriate goal in addiction treatment. That’s where the concept of “harm reduction” comes in. Such strategies can help prevent death, serious injury, or other negative consequences of substance use in patients who are continuing to use drugs or struggle with a

Expert Q&A

The Clinician’s Role: Reducing Harm Among People Who Use Drugs

From The Carlat Addiction Treatment Report, Harm Reduction

Topics: Hepatitis | HIV | Opioid epidemic | Overdose | Prevention

CATR: You came out with a book last September called Getting Wrecked: Women, Incarceration, and the American Opioid Crisis (University of California Press). What lessons from your book might be relevant to the practicing clinician? Dr. Sue: The book is based on my PhD work in sociocultural and medical anthropology. I spent a lot of time in Massachusett

Clinical Update

How to Talk to Patients About the Risk of Opioid Overdose

From The Carlat Addiction Treatment Report, Harm Reduction

Topics: Hepatitis | HIV | Opioid epidemic | Overdose | Prevention

There were 47,600 deaths due to opioid-related overdoses in 2017. Put another way, in the time it’ll take you to read this issue of CATR, almost 5 Americans will die from an opioid overdose (www.cdc.gov/drugoverdose/data/statedeaths.html). One important way to reduce risk is by empowering patients with the knowledge, skills, and tools to prevent and m

Expert Q&A

Treating Addiction in Patients Transitioning to/from Incarceration

From The Carlat Addiction Treatment Report, Legal Issues in Addiction Medicine

CATR: Could you tell us a bit about your background in working with people with addiction in the criminal justice system? Dr. Cropsey: I am a clinical psychologist and professor in the Department of Psychiatry at the University of Alabama at Birmingham. I conduct research and provide clinical care to patients with addiction within the criminal justice

News of Note

New Generic Versions of Naloxone

From The Carlat Addiction Treatment Report, Legal Issues in Addiction Medicine

Naloxone, a rescue medication effective for reversing opioid overdoses, will soon be available in two generic forms for layperson use. Naloxone nasal spray is the generic version of branded Narcan Nasal, which currently sells for $150 for two doses. The generic version will be much cheaper. Naloxone auto-injector is the generic version of Evzio au

News of Note

Opioid Use Disorder: Is There an App for That?

From The Carlat Addiction Treatment Report, Legal Issues in Addiction Medicine

In December 2018, the FDA announced its approval of reSET-O, a new mobile medical app marketed by Pear Therapeutics to treat opioid use disorder (OUD). Mobile medical apps (MMAs) are a rapidly expanding class of smartphone apps intended to improve patient health and wellness. The FDA defines MMAs as software programs that run on smartphones and “trans