Opioids - Articles | CARLAT PUBLISHING

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Expert Q&A

Xylazine and Peripheral Wounds

April 1, 2025

Joseph D’Orazio, MD, Associate Professor of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ. Dr. D’Orazio has no financial relationships with companies related to this material.

Xylazine is a non-opioid sedative commonly added surreptitiously to illicit opioids. One particularly challenging adverse effect of xylazine exposure is the development of peripheral wounds, some of which can be severe, necessitating surgical intervention and even amputation. In this interview, Dr. D’Orazio teaches us how these wounds might be caused, how to discuss them with your patients, and the best treatment approach.

Expert Q&A

Managing Withdrawal From Multiple Substances

January 1, 2025

Darius Rastegar, MD

Darius Rastegar, MD

Associate professor of medicine, Johns Hopkins University School of Medicine, Baltimore, MD.

Dr. Rastegar has no financial relationships with companies related to this material.

Substance use disorders are highly comorbid with one another and it is therefore common to have patients presenting for care withdrawing from multiple substances at one time. Here, Dr. Rastegar discusses how to assess patients with multiple withdrawal syndromes and how to treat them.

Clinical Update

Three Buprenorphine Dosing Strategies When Transitioning From Other Opioids

April 1, 2024

Monthe Kofos, DO and Noah Capurso, MD

Monthe Kofos, DO. Addiction Psychiatry Fellow, Yale University, New Haven, CT.

Noah Capurso, MD, MHS. Associate Professor of Psychiatry, Yale University, New Haven, CT; Editor-in-Chief, The Carlat Addiction Treatment Report.

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

The process of starting a patient on buprenorphine, called an induction, can be a bit tricky and puts a patient at risk of a precipitated opioid withdrawal. In this article, we discuss the three most common buprenorphine induction approaches, review the pros and cons of each, and include straightforward guidance that will help you perform a successful buprenorphine induction for your patients.

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.

Expert Q&A

Managing Substance Use in Older Adults

May 9, 2023

Louis Trevisan, MD.

Louis Trevisan, MD.

Clinical professor of psychiatry, Creighton University School of Medicine, Omaha, NE; associate professor of psychiatry, adjunct, Yale School of Medicine, New Haven, CT.

Dr. Trevisan has no financial relationships with companies related to this material.

How do we best approach screening for substance use disorders in older adults? Dr. Trevisan walks us through his approach to choosing the right screening tools and speaking with patients.

Elvis Presley and Pharmacokinetics - Part 2

February 5, 2023

Chris Aiken, MD and Kellie Newsome, PMHNP

This common pharmacokinetic reaction will help you manage many bad medication reactions in psychiatric practice. But did it lead to Elvis Presley’s death?