Over the counter medications are commonly misused, particularly among younger patients. Dextromethorphan, first generation antihistamines, and nasal decongestants are the most frequently encountered. We cover the clinical features of each and discuss treatment strategies.

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Dr. Forray gives readers a comprehensive refresher on fetal effects of alcohol, tobacco, opioid, cannabis, and stimulant use during pregnancy. She then lays out the current evidence for various treatments and provides recommendations for how to treat pregnant patients with addiction.

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.

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.

Psychotherapy has had a mixed track record of efficacy for substance use disorders. This meta-analysis suggests that CBT is only modestly effective when combined with medications and likely no better than any other form of therapy. Although it’s unlikely be a magic bullet, CBT is very low risk, and reasonable to offer alongside other more established treatments.

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.

Cocaine use disorder is notoriously difficult to treat. The authors of this study asked, might cannabidiol be helpful in treating the cravings that prompt cocaine use? While this might seem like an unusual question at first, there is some supportive preclinical data that makes the premise plausible. Unfortunately, the results were negative in this small study.