Opioid Agonist Treatment and Decreased Mortality

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

Oral vs Extended-Release Naltrexone for Opioid Use Disorder

Topics: Addiction Treatment | Naltrexone | Opioid Use Disorder | Research Update

Review of: Sullivan MA et al, Am J Psychiatry 2017;174(5):459–467 Extended-release (XR) naltrexone (Vivitrol) is FDA approved for opioid use disorder and has shown efficacy in several trials. It works best for patients who have already successfully detoxed from opioids and who are highly motivated to abstain. But what about oral naltrexone? While i

Perioperative Management of Patients on Buprenorphine Maintenance

Topics: Addiction | Addiction Treatment | Buprenorphine | Medical Comorbidities | Medication | Opioid epidemic | Opioid Use Disorder | Opioids | Pain | Pharmacology | Suboxone | Substance Use | Substance use disorders

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

Reducing the Stigma of Addiction Through Language and Terminology

Topics: Disparities | Engagement | Free Articles | Opioid Use Disorder | Stigma

The words we use in discussing addiction shape the way our patients, fellow clinicians, and communities think about substance use disorders. Addiction has long been viewed as a moral failing, and the terminology of addiction has reinforced this belief. Here, we review the evidence that documents how terminology can perpetuate—or reduce—the stigma as

Personal Privacy Versus Public Safety: Addiction Among Health Professionals

Topics: Abstinence | Addiction Treatment | Alcohol use disorder | Legal issues | Opioid Use Disorder | Special populations

CATR: Tell us how your interest in addiction came about. Dr. Earley: When I started working in the world of addiction treatment 35 years ago, there wasn’t much specific training. I was trained as a neurologist and always had an interest in patients with substance use disorders. Ultimately, I decided to shift my specialty and wound up cobbling togethe

Learning From the Successes of Physician Health Programs

Topics: Abstinence | Addiction Treatment | Alcohol use disorder | Legal issues | Opioid Use Disorder | Special populations

The rate of substance use disorders among physicians is around the same if not slightly higher than in the general population. Impaired physicians, however, are a public health threat, and in most states there is mandated reporting of impaired ­physicians (­Mossman D, Current Psychiatry 2011; 10(9):67–71). So what is to be done for an addicted or im

Unintended Pregnancies in Opioid Use Disorder

Topics: contraceptive services | Medication for Opioid Use Disorder | Opioid Use Disorder | Pregnancy

REVIEW OF: Heil SH et al, JAMA Psychiatry 2021;78(10):1071–1078 STUDY TYPE: Randomized controlled trial Among women with opioid use disorder, nearly eight out of every 10 pregnancies are unintended (Fischbein RL et al, Contracept Reprod Med 2018;3:4). The complications and potential adverse outcomes of these pregnancies include neonatal opioid w

Buprenorphine Treatment

Topics: Addiction Treatment | Buprenorphine | Buprenorphine Induction | Detoxification | Medication for Opioid Use Disorder (MOUD) | Opioid Use Disorder

CATR: Dr. Capurso, given your role as an expert on various things related to addiction and the editor-in-chief of The Carlat Addiction Treatment Report, we’ve had several discussions about buprenorphine treatment. To begin with the basics, why use buprenorphine at all? Dr. Capurso: Buprenorphine binds to the mu-opioid receptor, the very same receptor

A New Buprenorphine Dosing Strategy for Easier Induction From Fentanyl

Topics: Buprenorphine | fentanyl | induction | medication of opioid use disorder (MOUD) | Opioid Use Disorder

REVIEW OF: Antoine D et al, Am J Addict 2021;30(1):83–87 The escalating rate of opioid overdose deaths has been linked to the rise of illicit fentanyl. Increasing evidence shows that fentanyl and its analogues, such as carfentanil and acetylfentanyl, are fast replacing heroin as the most commonly used illicit opioid for many people with opioid use

Buprenorphine Induction Without Withdrawal

Topics: Buprenorphine | Buprenorphine Induction | medication of opioid use disorder (MOUD) | Opioid Use Disorder

REVIEW OF: Ahmed S et al, Am J Addict 2021;30(4):305–315 Buprenorphine is notorious for precipitating withdrawal in patients who have recently taken opioids. Its high receptor affinity and partial agonism at the mu receptor can make inductions tricky. Giving it too soon can cause severe withdrawal, yet giving it too late means patients are in disco

Suboxone vs. Vivitrol for Opioid Use Disorder: How Do you Choose?

Topics: Addiction Treatment | Buprenorphine | Medication for Opioid Use Disorder | Naltrexone | Opioid Use Disorder

REVIEW OF: Nunes EV Jr et al, Am J Psychiatry 2021;178(7):660–671 For decades, methadone and buprenorphine (Bup) have been upheld as the gold standard of opioid use disorder (OUD) treatments, with naltrexone largely considered second line. However, a pair of landmark studies challenged that wisdom by showing the non-inferiority of long-acting injec

Naloxone Prescribing

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

A New High-Dose Naloxone: Life Saver or Punishment?

Topics: Harm reduction | Naloxone | Opioid Use Disorder

The FDA approved a new intranasal formulation of naloxone on April 30, 2021. Called KLOXXADO, this formulation distinguishes itself from other delivery systems by its higher dose, with each nasal spray containing 8 mg of naloxone. In comparison, the most widely used naloxone product, Narcan Nasal Spray, contains 4 mg of naloxone. What’s the rationa

Starting Buprenorphine: Is Timing Everything?

Topics: Buprenorphine | Dosage Timing | Opioid Use Disorder

Review of: Jakubowski A et al, J Subst Abuse Treat 2020;119:108140 Buprenorphine is a safe and effective treatment of opioid use disorder (OUD), but studies show that less than two-thirds of patients treated with buprenorphine are still in treatment 6 months later (Timko C et al, J Addict Dis 2016;35(1):22–35). Since the highest rate of dropout is

Perioperative Pain Management in Opioid Use Disorder

Topics: Buprenorphine | Collaborative care | Free Articles | Methadone | Opioid Use Disorder | Opioids | Pain

When your patients with opioid use disorder (OUD) develop pain due to medical illness or trauma, pain management can get tricky. When they seek pain control, they may be perceived as “drug seeking” in medical settings. Studies have shown that providing adequate pain management for these patients is a particular challenge (Department of Veterans Affa

Management of Opioid Withdrawal in the Emergency Setting

Topics: Collaborative care | Detoxification | Harm reduction | Opioid Use Disorder | Opioids | Withdrawal

Opioid withdrawal is being seen more frequently in emergency settings. From 2005 to 2014, it is estimated that the rate of US emergency department (ED) visits due to opioids doubled from 89.1 per 100,000 people to 177.7 per 100,000 (Agency for Healthcare Research and Quality, www.tinyurl.com/2xr8hp8h). For many patients, the ED is their only contact wit

Supporting Patients With 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

Can Assertive Treatment Improve Treatment Adherence in Young Adults With Opioid Use Disorder?

Topics: Adherence | Opioid Use Disorder | Randomized controlled trial | Youth

Review of: Fishman M et al, Addiction 2020 Jul 4. https://doi.org/10.1111/add.15181 We often use injectable extended-release naltrexone (XR-NTX, or Vivitrol) for management of opioid use disorder (OUD). However, XR-NTX has not been widely used in young adults with OUD, possibly due to low patient engagement and treatment adherence. This study evaluat

Despair, Loneliness, and Substance Use Disorders

Topics: Alcohol | Alcohol use disorder | Opioid Use Disorder | Opioids | Relationships | Special populations | treatment

Despair and loneliness are underappreciated contributors to substance use disorders (SUD). Their impact can be seen particularly in rural areas hit hard by industrial restructuring and poverty. This article will explore the interplay between despair, loneliness, and SUD and will review some strategies to use in your patients. Hardship From 1999 to 2

Faith and Addiction

Topics: Alcohol | Alcohol use disorder | Connections | Opioid Use Disorder | Opioids | treatment

Discussing a patient’s spiritual life might not be something you do routinely. Conversations can be time-consuming, uncomfortable, or seemingly irrelevant to treating a substance use disorder (SUD). But studies have shown that faith can be an asset in addiction treatment. Patients may want to discuss their spiritual lives with you or have questions ab