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Note From the Editor-in-Chief

June 10, 2020
Benjamin Oldfield
Benjamin Oldfield Editor-in-Chief of CATR. Clinical Instructor in Medicine and Pediatrics at Yale School of Medicine; Chief Medical Officer at Fair Haven Community Health Care, CT. Dr. Oldfield has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.
The expansion of telemedicine—which health systems had been slow to adopt and payers had been reluctant to reimburse for years—has zoomed ahead in recent weeks. Sure, it’s not perfect: The video connections can be finicky, and learning new digital platforms can pose challenges for both patients and providers. But with...
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The “Z-Drugs”: Safety Issues and Misuse Potential

June 10, 2020
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.
Once heralded for their relative safety compared to benzodiazepines, the “Z-drugs” are now known to be one of the most common causes of adverse drug events. Here we review the risks of Z-drugs and highlight updated dosing recommendations for zolpidem.
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EXPERT Q&A

Gabapentin Misuse and Diversion

June 10, 2020
Rachel Vickers-Smith, PhD, MPH

Rachel Vickers-Smith, PhD, MPH
Assistant Professor at University of Louisville, KY. Dr. Vickers-Smith has disclosed that she has no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Clinicians are increasingly turning to gabapentinoids as non-opioid alternatives for pain treatment. Yet we may be inadvertently introducing new risks in so doing. Dr. Vickers-Smith reviews current epidemiology of gabapentinoid use and offers some clues regarding how to turn the tide on gabapentin misuse.
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SAMHSA Relaxes Regulations on Methadone and Buprenorphine During COVID-19 Emergency

June 10, 2020
Benjamin Oldfield
Benjamin Oldfield Editor-in-Chief of CATR. Clinical Instructor in Medicine and Pediatrics at Yale School of Medicine; Chief Medical Officer at Fair Haven Community Health Care, CT. Dr. Oldfield has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.
In the context of a pandemic, how can and should our practices change to continue to meet the needs of patients with opioid use disorder? We summarize recent changes to the regulations surrounding medications for opioid use disorder: buprenorphine and methadone.
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Muscle Relaxants: Sedatives Often Under the Radar

June 10, 2020
Michael Weaver, MD, FASAM.
Michael Weaver, MD, FASAM. Professor and medical director at the Center for Neurobehavioral Research on Addictions at the University of Texas Medical School. Author of Addiction Treatment (Carlat Publishing, 2017). Dr. Weaver has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Muscle relaxants encompass medications with different mechanisms of action—many of which have been used for decades. Yet most are sedating, can have significant side effects, and can interact with opioids and other substances to worsen CNS and respiratory depression.
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EXPERT Q&A

Benzodiazepines: Old Medicines, New Concerns

June 10, 2020
Kenneth Morford, MD

Kenneth Morford, MD
Assistant Professor and Program Director, Collaborative Behavioral Health & Addiction Medicine in Primary Care (CHAMP) at Yale School of Medicine. Dr. Morford has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Benzodiazepine use is on the rise, and is implicated with a significant portion of opioid-related overdose deaths. Dr. Morford gives the latest on benzodiazepine prevalence and suggests strategies to employ in addiction treatment settings when working with patients who use benzodiazepines.
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E-Cigarettes vs Nicotine Replacement for Smoking Cessation

June 10, 2020
Jason Mallo, DO
Jason Mallo, DO. Dr. Mallo has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Quitting smoking remains extremely difficult. This multicenter randomized controlled trial evaluates the efficacy of using e-cigarettes compared to nicotine replacement among adults (average age 41) seeking help to quit smoking.
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Amphetamines and Topiramate for Cocaine Use Disorder

June 10, 2020
Rehan Aziz, MD.
Rehan Aziz, MD. Dr Aziz has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Small studies have shown promise for treating cocaine use disorder with combination amphetamine salts/topiramate. In this larger trial, the combination was tested against a placebo.
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Does Baclofen Titrated to High Doses Reduce Alcohol Use?

June 10, 2020
Thomas Jordan, MD.
Thomas Jordan, MD. Dr. Jordan has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Previous trials of baclofen for alcohol use disorder have used fixed or rather low doses, and the results have been mixed. This was the first randomized trial to allow up-titration of the dose depending on the patient’s response.
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Gabapentin for Alcohol Use Disorder, Redux

June 10, 2020
Rehan Aziz, MD.
Rehan Aziz, MD. Dr Aziz has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Which patients with alcohol use disorder might benefit from gabapentin most? This randomized controlled trial focused on gabapentin’s impact on alcohol use among patients with alcohol use disorder and who had also had alcohol withdrawal symptoms in the past.
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