Opioid-use-disorder - Articles

Clinical Update

Xylazine: An Emerging Threat in the Opioid Overdose Epidemic

October 31, 2023

Roberto Sanchez, MD and Noah Capurso, MD

Roberto Sanchez, MD. Addiction psychiatry fellow, Yale University School of Medicine, New Haven, CT.

Noah Capurso, MD, MHS. Assistant professor of psychiatry, Yale University, New Haven, CT; Editor-in-Chief, The Carlat Addiction Treatment Report.

Dr. Sanchez and Dr. Capurso have no financial relationships with companies related to this material.

Xylazine is the latest contaminant being found in the American illicit drug supply. A non-opioid itself, xylazine is usually combined with fentanyl, with which it has synergistic sedative effects. Patients using xylazine can have profound levels of sedation and develop severe peripheral wounds. In this article, we discuss xylazine essentials and cover harm reduction strategies to help keep your patients safe.

Unintended Pregnancies in Opioid Use Disorder

March 1, 2022

Peter J. Farago, MD.

Peter J. Farago, MD. Dr. Farago has disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Rates of unintended pregnancies are high among patients with opioid use disorder (OUD). In this study, researchers tested the efficacy of co-locating contraceptive services with treatment for OUD as well as the efficacy of providing financial incentives.

Buprenorphine Treatment

November 5, 2021

Noah Capurso, MD

Noah Capurso, MD

Assistant Professor of Psychiatry at Yale University, CT. Editor-in-chief of The Carlat Addiction Treatment Report.

Dr. Capurso has disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Buprenorphine is a first line medication for the treatment of opioid use disorder yet remains vastly under-prescribed. Here, Dr. Capurso reviews the pharmacologic principles relevant to buprenorphine prescribing and lays out how to start patients on the medication both in the clinic and at home.

A New Buprenorphine Dosing Strategy for Easier Induction From Fentanyl

November 5, 2021

Oluwole Jegede, MD, PhD

Oluwole Jegede, MD. Dr. Jegede has disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Avoiding buprenorphine induced withdrawal during induction can be particularly tricky for those using fentanyl. Researchers describe a novel induction dosing strategy that mitigates this risk.

Buprenorphine Induction Without Withdrawal

November 5, 2021

David Moltz, MD.

David Moltz, MD. Dr. Moltz has disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Making the switch from full opioid agonist to buprenorphine usually involves a period of withdrawal prior to starting the medication. Here, researchers describe a method of switching from full to partial opioid agonist by using small “microdoses” in order to avoid withdrawal.

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

November 5, 2021

Gregory Lande, MD.

Gregory Lande, MD. Dr. Lande has disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Buprenorphine and long acting injectable naltrexone are both effective for the treatment of opioid use disorder; however, until now, we had little data to predict which patients would do better on which medications. Here, researchers identify patient characteristics predictive of success on buprenorphine versus naltrexone.

Naloxone Prescribing

July 3, 2021

Phillip Coffin, MD

Phillip Coffin, MD
Director of Substance Use Research, San Francisco Department of Public Health, San Francisco, CA. Dr. Coffin has disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Dr. Coffin provides our readers with everything there is to know about the nuts and bolts of naloxone prescribing for opioid use disorder. He tells us how patients can get their hands on naloxone, reviews the pros, cons, and costs of various naloxone formulations, and covers current naloxone laws.

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

July 3, 2021

Noah Capurso, MD

Noah Capurso, MD

Dr. Capurso has disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

The FDA recently approved a nasal spray formulation of naloxone. Called Kloxxado, each spray delivers 8mg, twice as much as the most widely used formulation, Narcan. Whether or not this higher dose is necessary, is debatable.

Starting Buprenorphine: Is Timing Everything?

July 3, 2021

John O’Neal, MD

John O’Neal, MD Dr. O’Neal has disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

When is an optimal time to start buprenorphine in order to keep patients in treatment? In this retrospective study, researchers compared treatment retention as a function of whether or not buprenorphine was prescribed on the day of initial evaluation. Same day prescription trended non-significantly towards improved retention.

CLINICAL UPDATE

Perioperative Pain Management in Opioid Use Disorder

March 19, 2021

Rehan Aziz, MD.

Rehan Aziz, MD. Associate Professor of Psychiatry and Neurology, Rutgers Robert Wood Johnson Medical School. Dr. Aziz has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Previously, clinicians commonly stopped opioid agonists (methadone and buprenorphine) to simplify pain control during and after surgery. New guidance from the American Society of Addiction Medicine now suggests otherwise.