S2 Ep16: #27- Recap: ACAAM Lightning Round

Level up your treatment for people with alcohol use disorder. Learn about medication options beyond the first line, when they’re appropriate and not, and how to work with your patients to set goals that fit them. We’re joined by Dr Stephen Holt (Yale University School of Medicine) Claim CME for this episode at curbsiders.vcuhealth.org! By listening to this episode and  completing CME, this can be used to count towards the new DEA 8-hr requirement on substance use disorders education. Episodes | Subscribe | Spotify | iTunes | [email protected] | Free CME! Credits Written, produced, show notes, cover art and infographics by: Shawn Cohen MD  Hosts: Carolyn Chan, MD. MHS, Shawn Cohen MD, and Paul Williams MD Reviewer: Kento Sonoda MD Showrunner: Carolyn Chan, MD, MHS Technical Production: PodPaste Guest:  Stephen Holt MD Sponsor: Pretty Litter Go to Prettylitter.com/curb to save twenty percent on your first order and get a free cat toy.  Sponsor: Quince Go to Quince.com/curb for 365-day returns, plus free shipping on your order.  Sponsor: American College of Physicians Inc Internal Medicine Board Review Courses and offered in the Greater Chicago area May 13-17 and, new for 2025,  Philadelphia, July 14-18. • Enter code COURSECS25 toSave $75 dollars when registering for the Philadelphia course by 6/1.  Registration is open now at acponline.org Sponsor: Ezresus Listeners of the Curbsiders get access to a 2-month free trial, letting them use 100% of the features of the app. Go to .ezresus.com/curbsiders and use promo code Curbsiders

Join us to hear the latest pearls and best practices on talking to patients about vaping, if e-cigarettes can be used to stop smoking cigarettes, and every other question you hadn’t thought to ask about vaping with Drs. Pam Ling (UCSF) and Maya Vijayaraghavan (UCSF).   Claim CME for this episode at curbsiders.vcuhealth.org! By listening to this episode and  completing CME, this can be used to count towards the new DEA 8-hr requirement on substance use disorders education. We are thrilled to produce Season 3 with support and partnership from The American College of Academic Addiction Medicine (ACAAM)! Episodes | Subscribe | Spotify | iTunes | [email protected] | Free CME! Credits Producer/Writer: Era Kryzhanovskaya, MD Show Notes: Zina Huxley-Reicher, MD; Era Kryzhanovskaya, MD CME: Era Kryzhanovskaya, MD Infographic and Cover Art: Zina Huxley-Reicher, MD Hosts: Carolyn Chan, MD, MHS and Era Kryzhanovskaya, MD Reviewer: Kento Sonoda, MD Showrunner: Carolyn Chan, MD, MHS Technical Production: PodPaste Guests:. Pam Ling, MD; Maya Vijayaraghavan, MD Show Segments 00:11 Intro, disclaimer 02:22 Guest bios 04:28 Guest one-liners 10:28 Case from Kashlak 11:55 Vape info and definitions 14:32 How to discuss vaping with patients 17:53 FDA authority over vapes 20:37 Development of nicotine (via vaping) use disorder 23:29 Questions to ask about use disorder  30:53 E-cigarettes for tobacco cessation 35:39 Exploring ways to quit smoking (+/- vapes) 39:53 Screening for vaping use disorder; research measures 43:10 Resources for e-cigarette cessation  45:33 Medication approaches  48:25 Behavioral supports for e-cigarette cessation  1:00:31 Take Home Points 1:05:08 Outro

From Recreational Use to Possible Therapeutic Interventions Learn how different hallucinogens act in the body and common dosing strategies. Appreciate the risks of use and the current state of hallucinogen research. We are joined in this episode by Dr. Albert Garcia-Romeu (Johns Hopkins Center for Psychedelic and Consciousness Research)  We are thrilled to produce Season 3 with support and partnership from The American College of Academic Addiction Medicine (ACAAM)!  Claim CME for this episode at curbsiders.vcuhealth.org! By listening to this episode and completing CME, this can be used to count towards the new DEA 8-hr requirement on substance use disorders education. Episodes | Subscribe | Spotify | iTunes | [email protected] | Free CME! Show Segments Intro, disclaimer, guest bio Case from Kashlak; Definitions of hallucinogens and psychedelics Examples of hallucinogens and mechanisms of action Dosing strategies Risks of Use Psychedelic Assisted Therapy Outro Credits Producer, Writer, Show Notes, Infographic, Cover Art: Kat Mullins, MD Hosts: Shawn Cohen, MD and Kat Mullins, MD Reviewer: Kento Sonoda, MD Showrunner: Carolyn Chan, MD, MHS Technical Production: PodPaste Guest: Albert Garcia-Romeu, PhD

Maximize your treatment of alcohol-associated liver disease. Learn how to evaluate liver disease in patients with alcohol use disorder (AUD), choose AUD medications that are safe and effective, and identify patients who may be eligible for early liver transplantation. We’re joined by Dr. Lamia Haque, @lykhaque (Yale School of Medicine). We are thrilled to produce Season 3 with support and partnership from The American College of Academic Addiction Medicine (ACAAM)! Claim CME for this episode at curbsiders.vcuhealth.org! By listening to this episode and completing CME, this can be used to count towards the new DEA 8-hr requirement on substance use disorders education. Episodes | Subscribe | Spotify | iTunes | [email protected] | Free CME! Show Segments Intro, disclaimer, guest bio 0:00  Guest one-liner 3:10 Case from Kashlak 6:30 Epidemiology of alcohol-associated liver disease (ALD) 7:40 How does alcohol affect the liver? 11:11 Spectrum of ALD 13:10 Risk factors for ALD 16:13 Evaluating for ALD 19:35 When to refer to hepatology 33:08 Medications for AUD in patients with ALD 37:00 Monitoring liver tests for naltrexone 44:27 Optimizing treatment for patients who continue drinking 47:18 ALD and liver transplantation 50:45 Post-transplant care 1:00:15 Take-home points 1:02:30 Outro 1:04:56 Credits Writer and Producer: Kenneth Morford, MD Show Notes: Kenneth Morford, MD Infographic and Cover Art: Natalie Stahl, MD, MPH Hosts: Carolyn Chan, MD. MHS and Kenneth Morford, MD Reviewer: Sarah Leyde, MD Showrunner: Carolyn Chan, MD, MHS Technical Production: PodPaste Guest: Lamia Haque, MD, MPH

Spark your learning! We cover clinical pearls from graduating addiction medicine fellows by covering ACAAM’s annual lighting round presentation.  Learn about tianeptine, buprenorphine starts in patients with acute hepatitis, vaccinations for persons who inject drugs, and more!  We are thrilled to produce Season 3 with support and partnership from The American College of Academic Addiction Medicine (ACAAM)!  Claim CME for this episode at curbsiders.vcuhealth.org! Listening to this episode and completing CME, can be used to count towards the new DEA 8-hr requirement on substance use disorders education. Episodes | Subscribe | Spotify | iTunes | [email protected] | Free CME! Credits Producer, Show Notes, Infographics: Carolyn Chan Hosts: Carolyn Chan, MD. MHS, Shawn Cohen, MD, Kenneth Morford, MD, Natalie Stahl, MD MPHS Reviewer: Sarah Leyde, MD Showrunner: Carolyn Chan, MD, MHS Technical Production: PodPaste Show Segments 00:00 Intro, disclaimer 03:00 Picks of the week 07:00 Buprenorphine and hepatitis 16:30 Ketamine for withdrawal 24:00 Hepatitis B 28:20 Tianeptine 35:30 Hepatitis C treatment 39:00 PETH 47:40 Unintended phenobarbital consequences 53:40 TBI and overdose risk 58:00 Outro

Expand your practice to include wound care for xylazine-related wounds and learn how to talk to your patients about harm reduction for xylazine. We are joined by Dr. Raagini Jawa (@Raaginizzle, UPMC) and Tehya Johnson, NP (@TehyaRJohnson, Boston Health Care for the Homeless).  We are thrilled to produce Season 3 with support and partnership from The American College of Academic Addiction Medicine (ACAAM)!  Claim CME for this episode at curbsiders.vcuhealth.org! By listening to this episode and completing CME, this can be used to count towards the new DEA 8-hr requirement on substance use disorders education. Episodes | Subscribe | Spotify | iTunes | [email protected] | Free CME! Credits Show notes, infographics, cover art, writer and producer:  Zina Huxley-Reicher, MD  Hosts: Carolyn Chan, MD. MHS, Zina Huxley-Reicher, MD and Shawn Cohen, MD  Reviewer: Payel Jhoom Roy, MD, MSc Showrunner: Carolyn Chan, MD, MHS Technical Production: PodPaste Guests: Raagini Jawa, MD MPH and Tehya Johnson, NP  Show Segments Intro, disclaimer, guest bios - 01:42  Guest one-liners - 03:22 Case from Kashlak - 7:56 Definition of xylazine, overview of xylazine in the drug supply and experience of use - 08:38 Xylazine test strips and other harm reduction strategies - 15:48 Natural history of xylazine wounds - 19:15 Creating a welcoming wound care environment - 21:05 Red flag symptoms indicating need for oral antibiotics and higher levels of care - 26:18 Steps for wound care - 33:27 Frequency of wound care - 46:16 Pain control in the setting of dressing changes - 51:01 Route switching, harm reduction around injecting at the site of the wound - 52:20 When to refer to other wound care specialists/plastic surgery - 55:00 Take home points - 57:05 Outro - 1:00:17 

OTP yea you know me Make methadone a part of your practice. Learn how the methadone system in the US works and how you can play an active role in improving care for people with opioid use disorder treated with methadone. We’re joined by Dr. Ruth Potee @DrRuthPotee (website) and Dr. David Frank @highway_dave    We are thrilled to produce Season 3 with support and partnership from The American College of Academic Addiction Medicine (ACAAM)!  Claim free CME for this episode at curbsiders.vcuhealth.org! By listening to this episode and  completing CME, this can be used to count towards the new DEA 8-hr requirement on substance use disorders education. Episodes | Subscribe | Spotify | iTunes | [email protected] | Free CME! Show Segments Intro, disclaimer, guest bio 5:00 Guest one-liner 10:25 Case from Kashlak; Definitions 11:19 Methadone pharmacology and evidence 17:08 What an OTP feels like 20:25 OTP intake 24:45 Talking through methadone with a patient 28:15 Personal impact of methadone 30:20 Requirements at an OTP 33:43 What your patient needs to access an OTP 37:25 The line 39:06 Dosing/Take homes 44:48 Loss of take homes 48:39 How to interact with an OTP as a PCP 52:50 Methadone at STRs 57:03 How to clinicians use their voice to improve things 1:00:45 Take home points 1:03:00 Plugs 1:04:24 Outro Credits Producer, Writer, Show Notes, Infographic, Cover Art: Shawn Cohen MD  Hosts: Carolyn Chan, MD. MHS and Shawn Cohen MD Reviewer: Payel Jhoom Roy MD, MSc Showrunner: Carolyn Chan, MD, MHS Technical Production: PodPaste Guest:  Ruth Potee MD, David Frank PhD

Keep saving lives by prescribing methadone and buprenorphine. Learn how initiations of each have changed in the era of high-potency synthetic opioids (HPSOs) like fentanyl and how to continue to provide person-centered care to people with opioid use disorder. We’re joined by Dr Melissa Weimer, @DrMelissaWeimer (Yale University). This episode is in honor of National Addiction Treatment Week (treataddictionsavelives.org). Claim CME for this episode at curbsiders.vcuhealth.org! By listening to this episode and completing CME, this can be used to count towards the new DEA 8-hr requirement on substance use disorders education. Episodes | Subscribe | Spotify | iTunes | [email protected] | Free CME! Credits Producers: Shawn Cohen MD,  Kenneth Morford MD Writer: Carolyn Chan MD MHS Show Notes: Shawn Cohen MD Infographic and Cover Art: Kenneth Morford MD Hosts: Carolyn Chan MD. MHS Shawn Cohen MD, Natalie Stahl MD, Kenneth Morford MD Reviewer: Kento Sonoda MD Showrunner: Carolyn Chan, MD, MHS Technical Production: PodPaste Guest: Melissa Weimer DO MCR Show Segments Intro, disclaimer, guest bio 00:00 Guest one-liner 05:02 National Addiction Treatment Week  06:00 Case from Kashlak; Definitions 08:30 Starting methadone  11:01 Common methadone pitfalls 15:00 Buprenorphine precipitated opioid withdrawal  23:50 High-dose buprenorphine 32:20 Treating buprenorphine precipitated withdrawal 36:50 Low-dose buprenorphine 41:50 Maintenance dose of buprenorphine 48:15 ER buprenorphine 49:00 Take home points 53:31

Prevent opioid overdoses in your community! We discuss opioid overdose prevention and treatment so you can counsel patients who use substances on ways to decrease their risk of overdose. We discuss optimal ways to respond to hospital overdoses, ideal doses of naloxone, and how to monitor a patient experiencing an overdose clinically.  We’re joined by Dr. Alex Walley, MD MsC @AlexanderWalley (Boston University School of Medicine). Claim free CME for this episode at curbsiders.vcuhealth.org! By listening to this episode and completing CME this can be used to count towards the new DEA 8-hr requirement on substance use disorders education. Credits Producer: Natalie Stahl, MD, MPH Show Notes, Infographic, Cover Art: Carolyn Chan, MD, MHS Hosts: Carolyn Chan, MD, MHS and Natalie Stahl, MD, MPH Reviewer: Sarah Leyde, MD Showrunner: Carolyn Chan, MD, MHS Technical Production: Podpaste Guest: Dr. Alex Walley Show Segments Intro, disclaimer, guest bio: 00:00 Guest one-liner: 05:10 Case from Kashlak: 07:20 Overview of the Overdose Crisis: 08:13 Changes in Messaging for Fentanyl OD Prevention: 16:10 Naloxone formulations: 22:15 Dose and frequency of naloxone: 24:50 Counseling a patient on overdose response/prevention: 31:25 Good Samaritan Laws:  38:00 Responding to hospital overdoses: 40:45 OTC naloxone: 51:14 Take Home Points: 55:50 Outro: 59:19

Accelerate your knowledge on low-dose buprenorphine starts for individuals with opioid use disorder. We cover the physiology of how low-dose starts work, different 4-7 day protocols, and how to troubleshoot challenges patients may face.  We’re joined by Dr. Eleasa Sokolski, MD (Oregon Health and Sciences University) and Amelia Goff, MSN, FNP (Oregon Health and Sciences University). Claim free CME for this episode at curbsiders.vcuhealth.org! By listening to this episode and completing CME, this can be used to count towards the new DEA 8-hr requirement on substance use disorders education. Episodes | Subscribe | Spotify | iTunes | [email protected] | Free CME! Credits Producer: Era Kryzhanovskaya, MD Show Notes, Infographic, Cover Art: Carolyn Chan, MD, MHS & Kenny Morford, MD Hosts: Carolyn Chan, MD, MHS and Era Kryzhanovskaya, MD Reviewer: Sarah Leyde, MD Showrunner: Carolyn Chan, MD, MHS Technical Production: PodPaste Guest: Dr. Eleasa Sokolski, MD and Amelia Goff, MSN, FNP Show Segments Intro, disclaimer, guest bio:  0:55 Guest one-liner: 5:10 Case from Kashlak: 9:05 Buprenorphine and fentanyl:  10:20 Methods to start buprenorphine: 16:00 4-day low-dose buprenorphine protocol:  18:20 Buprenorphine formulations: 22:30 Counseling patients on low dose start: 26:10 Patient population considerations: 28:20 Troubleshooting;  30:15 Outpatient low dose starts:  36:55 Take Home Points:  45:14 Outro:  50:48