Opioid Use Disorder

Research Update

Oral vs Extended-Release Naltrexone for Opioid Use Disorder

Topics: Addiction Treatment | Naltrexone | Opioid Use Disorder | Research Update

Review of: Sullivan MA et al, Am J Psychiatry 2017;174(5):459–467 Extended-release (XR) naltrexone (Vivitrol) is FDA approved for opioid use disorder and has shown efficacy in several trials. It works best for patients who have already successfully detoxed from opioids and who are highly motivated to abstain. But what about oral naltrexone? While i

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Expert Q&A

Perioperative Management of Patients on Buprenorphine Maintenance

Topics: Addiction | Addiction Treatment | Buprenorphine | Medical Comorbidities | Medication | Opioid epidemic | Opioid Use Disorder | Opioids | Pain | Pharmacology | Suboxone | Substance Use | Substance use disorders

CATR: Can you tell us about your background? Dr. Acampora: I used to work as a cardiac anesthesiologist. Later, my interest turned to addiction medicine, and I trained in psychiatry and addiction psychiatry. I currently work in a pain clinic where I helped develop a strategy for managing buprenorphine in the perioperative period. CATR: Where does th

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Clinical Update

Reducing the Stigma of Addiction Through Language and Terminology

Topics: Disparities | Engagement | Free Articles | Opioid Use Disorder | Stigma

The words we use in discussing addiction shape the way our patients, fellow clinicians, and communities think about substance use disorders. Addiction has long been viewed as a moral failing, and the terminology of addiction has reinforced this belief. Here, we review the evidence that documents how terminology can perpetuate—or reduce—the stigma as

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Expert Q&A

Personal Privacy Versus Public Safety: Addiction Among Health Professionals

Topics: Abstinence | Addiction Treatment | Alcohol use disorder | Legal issues | Opioid Use Disorder | Special populations

CATR: Tell us how your interest in addiction came about. Dr. Earley: When I started working in the world of addiction treatment 35 years ago, there wasn’t much specific training. I was trained as a neurologist and always had an interest in patients with substance use disorders. Ultimately, I decided to shift my specialty and wound up cobbling togethe

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Clinical Update

Learning From the Successes of Physician Health Programs

Topics: Abstinence | Addiction Treatment | Alcohol use disorder | Legal issues | Opioid Use Disorder | Special populations

The rate of substance use disorders among physicians is around the same if not slightly higher than in the general population. Impaired physicians, however, are a public health threat, and in most states there is mandated reporting of impaired ­physicians (­Mossman D, Current Psychiatry 2011; 10(9):67–71). So what is to be done for an addicted or im

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Clinical Update

Despair, Loneliness, and Substance Use Disorders

Topics: Alcohol | Alcohol use disorder | Opioid Use Disorder | Opioids | Relationships | Special populations | treatment

Despair and loneliness are underappreciated contributors to substance use disorders (SUD). Their impact can be seen particularly in rural areas hit hard by industrial restructuring and poverty. This article will explore the interplay between despair, loneliness, and SUD and will review some strategies to use in your patients. Hardship From 1999 to 2

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Clinical Update

Faith and Addiction

Topics: Alcohol | Alcohol use disorder | Connections | Opioid Use Disorder | Opioids | treatment

Discussing a patient’s spiritual life might not be something you do routinely. Conversations can be time-consuming, uncomfortable, or seemingly irrelevant to treating a substance use disorder (SUD). But studies have shown that faith can be an asset in addiction treatment. Patients may want to discuss their spiritual lives with you or have questions ab

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Clinical Update

“What About the Implant, Doc?” Appraising Various Formulations of Buprenorphine

Topics: Buprenorphine | extended-release | Medication | Medication adherence | Opioid epidemic | Opioid Use Disorder | Pharmacology | safety | Side Effects

With other epidemics in the world dominating our attention, let’s not forget the epidemic of opioid-related deaths. Unlike the current viral epidemic, the opioid epidemic is eminently treatable. The figure on page 3 shows the reduction in heroin overdoses in Baltimore, MD, as increasing numbers of patients received opioid agonist treatment (Schwartz R

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Clinical Update

Updated Guidelines for Treating Opioid Use Disorder

Topics: Addiction Treatment | Buprenorphine | Medication | Methadone | Opioid epidemic | Opioid Use Disorder | Pain | Pharmacology

Before the COVID-19 pandemic, America was in the grip of an opioid crisis. Now, the medical community is sounding alarms that shelter-in-place orders may have triggered drug and alcohol relapses (Silva MJ et al, Am J Manag Care 2020;26(7):1–3). The American Medical Association has noted that at least 30 states have reported increases in opioid-related

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Research Update

A Possible Option in Opioid-Related Harm Reduction

Topics: Harm reduction | Heroin | Opioid epidemic | Opioid Use Disorder | Pharmacology

REVIEW OF: Oviedo-Joekes E et al, JAMA Psychiatry 2016;73(5):447–455 We have effective FDA-approved medications for opioid use disorder (OUD): buprenorphine, methadone, and injectable naltrexone. Yet some patients with severe OUD decline these options. Many other countries offer a more controversial treatment—medically supervised IV administratio

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Expert Q&A

Gabapentin Misuse and Diversion

Topics: Deprescribing | gabapentin | Opioid epidemic | Opioid Use Disorder | Opioids | Pain

CATR: Could you start by telling us a little bit about yourself and your current work? Dr. Vickers-Smith: I am an epidemiologist, and my work has primarily been on gabapentin as an emerging drug of recreational and unhealthy use. This interest came about while I was working for Dr. Jennifer Havens on her cohort of about 500 individuals in central Appal

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Clinical Update

SAMHSA Relaxes Regulations on Methadone and Buprenorphine During COVID-19 Emergency

Topics: Buprenorphine | Coronavirus | COVID-19 | Methadone | Opioid epidemic | Opioid Use Disorder | Opioids | Outpatient | pandemic | Patient relationship

The Substance Abuse and Mental Health Services Administration (SAMHSA) has changed some prescribing rules to help minimize in-person contact while maintaining access to medications for opioid use disorder (OUD). Methadone Patients starting methadone continue to require an in-person medical evaluation at an opioid treatment program (OTP) prior to sta

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Expert Q&A

Benzodiazepines: Old Medicines, New Concerns

Topics: Anxiety | Anxiety Disorder | Benzodiazepines | Deprescribing | Generalized Anxiety Disorder | Opioid epidemic | Opioid Use Disorder | Opioids | Overdose | prescribing patterns

CATR: To begin, tell us about the research and clinical work you do. Dr. Morford: I am an assistant professor at the Yale School of Medicine in the Program of Addiction Medicine. I trained as a general internist, and I see patients primarily at a large opioid treatment program and in an inpatient setting on an addiction consult service. I’m involved

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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

Can Buprenorphine Improve PTSD Symptoms?

Topics: Addiction | Addiction Treatment | Antidepressants | Buprenorphine | Co-occurring disorders | Comorbidity | Dual diagnosis | Medication | Opioid Use Disorder | Pharmacology | PTSD | Research Update | SSRIs

Review of: Lake EP et al, Am J Addict 2019;28(2):86–91 For many years, the mainstay of treatment for PTSD has been the SSRI class of medications, but many of our patients still suffer crippling symptoms despite optimal antidepressant medication dosing. PTSD is often accompanied by opioid misuse, sometimes in an effort to self-treat the hyperarousal

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