Clinical practice

Expert Q&A

Practical Approaches to Vetting Clinical Research

Topics: adolescents | children | Clinical practice | inquiry | pediatric | PICOT | Practice Tools and Tips | Research | teens

CCPR: Tell us a bit about your current work. What is your population? Whom do you treat? Dr. Courtney: My clinical population are patients with concurrent addictions and mental health issues. These patients present complex clinical challenges, and so I have made efforts to use a method to think about and sort through those problems. CCPR: Please sha

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Expert Q&A

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

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Clinical Update

Medical Marijuana for Chronic Pain: The Cart Before the Horse?

Topics: Clinical practice | Harm reduction | Marijuana | Pain

In 2019, 17.5% of the American population used cannabis in the past year—up from 11.0% in 2002 (www.samhsa.gov/data/release/2019-national-survey-drug-use-and-health-nsduh-releases). As more states legalize cannabis for medical or recreational use, it’s becoming more common for our patients to add medical marijuana to their medication regimen for var

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Research Update

Medical Cannabis for Chronic Pain and Quality of Life

Topics: Clinical practice | Marijuana | observational study | Pain | quality of life

REVIEW OF: Safakish R et al, Pain Medicine 2020 Jun 18;pnaa163. Epub ahead of print. Although chronic pain affects 10%–30% of the adult population and contributes to a host of physical and mental health problems, we often find ourselves with limited options to assist the patient with pain in front of us. While medical cannabis (MJ) has shown promis

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Clinical Update 2

When to Stop Addiction Treatment: How Long Is Enough?

Topics: Addiction Treatment | Alcohol use disorder | Buprenorphine | Clinical practice | Medication adherence | retention

When a patient with a substance use disorder (SUD) has that “reachable moment” and/or recognizes the need to seek help, we know the importance of decreasing barriers to start treatment. However, what is less clear is when to stop treatment. What indicators suggest stable recovery? Recovery process The DSM-5 definition of remission from SUD is ba

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Clinical Update

The “Z-Drugs”: Safety Issues and Misuse Potential

Topics: Anxiety | Clinical practice | Deprescribing | Free Articles | Pharmacology | polypharmacy | prescribing patterns | Risk Management | Sleep | Sleep Disorders

Originally marketed as safer alternatives to benzodiazepines, the Z-drugs—eszopiclone (Lunesta), zaleplon (Sonata), and zolpidem (Ambien)—were considered devoid of misuse potential. But recent data and FDA warnings suggest we’ve been hitting the snooze on them for too long. Here, we review their risks and discuss safe prescribing. Medical risks

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Clinical Update

Muscle Relaxants: Sedatives Often Under the Radar

Topics: Clinical practice | Deprescribing | Opioids | Pain | Pharmacology | polypharmacy | prescribing patterns | Risk Management

Muscle relaxants are a diverse group of medications with varying mechanisms of action (see Commonly Prescribed Muscle Relaxants table below). They are indicated for short-term treatment (2–3 weeks) of acute, painful muscle spasms, as well as some chronic neurologic conditions associated with spasticity. However, many patients with chronic pain are on

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Article

Primer: Confidentiality in Addiction Treatment

Topics: Addiction | Addiction Treatment | Clinical practice | Confidentiality | HIPAA

Addiction remains stigmatized. In order to safeguard and encourage patient access to care, there are special privacy protections for individuals with substance use disorders (SUDs). This update will cover what you need to know using clinical vignettes. Clinical Scenario 1a: A 36-year-old man with heroin use disorder presents to your office for pharma

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Expert Q&A

Treating Addiction in Patients Transitioning to/from Incarceration

Topics: Addiction | Addiction Treatment | Buprenorphine | Clinical practice | Incarceration | Methadone | Naltrexone | Opioid epidemic | Opioid Use Disorder | Opioids | Overdose | Prison | Substance use disorders

CATR: Could you tell us a bit about your background in working with people with addiction in the criminal justice system? Dr. Cropsey: I am a clinical psychologist and professor in the Department of Psychiatry at the University of Alabama at Birmingham. I conduct research and provide clinical care to patients with addiction within the criminal justice

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News of Note

New Generic Versions of Naloxone

Topics: Addiction | Addiction Treatment | Clinical practice | Medication | Naloxone | News of Note | Opioid epidemic | Opioid Use Disorder | Opioids | Overdose | Pharmacology

Naloxone, a rescue medication effective for reversing opioid overdoses, will soon be available in two generic forms for layperson use. Naloxone nasal spray is the generic version of branded Narcan Nasal, which currently sells for $150 for two doses. The generic version will be much cheaper. Naloxone auto-injector is the generic version of Evzio au

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News of Note

Opioid Use Disorder: Is There an App for That?

Topics: Addiction | Addiction Treatment | Clinical practice | Cognitive Behavioral Therapy | News of Note | Opioid epidemic | Opioid Use Disorder | Opioids | Technology

In December 2018, the FDA announced its approval of reSET-O, a new mobile medical app marketed by Pear Therapeutics to treat opioid use disorder (OUD). Mobile medical apps (MMAs) are a rapidly expanding class of smartphone apps intended to improve patient health and wellness. The FDA defines MMAs as software programs that run on smartphones and “trans

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Research Update

Gabapentin Enacarbil XR Efficacy Less Than Expected for AUD

Topics: Addiction | Addiction Treatment | Alcohol | Alcohol use disorder | Alcoholism | Clinical practice | extended-release | Medication | Novel Medications | Pharmacology | Psychopharmacology | Research Update

Review of: Falk DE et al, Alcohol Clin Exp Res 2019;43(1):158–169 Gabapentin enacarbil extended-release (GE-XR) (Horizant) is an extended-release version of gabapentin. GE-XR is a prodrug, meaning that once ingested it is metabolized into gabapentin. It is currently approved for treatment of postherpetic neuralgia and restless legs syndrome. It di

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Clinical Update

A Guide to Online and Overseas Pharmacies

Topics: Clinical practice | Generics | Insurance | Internet | Pharmacy | Practice Tools and Tips | Prescription costs

You’ve probably seen these scenarios in your practice. A patient doing well on Latuda can’t afford the $800 monthly cost with a new insurance plan. Another patient on disulfiram can’t find the medication because there is a nationwide shortage. Someone else expresses interest in medications used in other countries like amisulpride, tianeptine, or a

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