S2 Ep23: #498 Opioid Withdrawal with Dr. Ashish Thakrar

Grow your management tools for opioid withdrawal in the hospital. Investigate how to decide between methadone and buprenorphine, additional medications to manage symptoms and how and when to use short-acting opioids for management of withdrawal. We’re joined by Ashish Thakrar, MD at the University of Pennsylvania.  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] | CME! Show Segments Intro, disclaimer, guest bio Guest one-liner Case from Kashlak; Definitions Symptoms of opioid withdrawal Medications for the management of opioid withdrawal Buprenorphine precipitated withdrawal Starting Buprenorphine: Experiences and Strategies  Titrating Methadone: Dosage and Adjuncts Adjunctive short-acting opioids Emerging Trends in Drug Supply: Xylazine and Medetomidine Outro Credits Producer, Show Notes: Zina Huxley-Reicher Infographics: Zina Huxley-Reicher MD and Zoya Surani Hosts: Carolyn Chan, MD MHS, Zina Huxley-Reicher MD, Shawn Cohen, MD Reviewer: Payel Jhoom Roy, MD, MSc Showrunner: Carolyn Chan, MD, MHS Technical Production: PodPaste Guest: Ashish Thakrar, MD MHSP

In this high-yield episode of Curbsiders Addiction Medicine, we dive deep into a practical and compassionate approach to caring for patients using methamphetamines and/or living with methamphetamine use disorder. We explore the latest pharmacologic options, harm reduction strategies, contingency management, and innovative ideas for monitoring and supporting patients. Whether you’re in primary care or other subspecialty settings, this episode is packed with pearls for every clinician with our amazing guest, Dr. Phillip Coffin, Director of the Center on Substance Use and Health in the SFDPH.  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] | CME! Show Segments Intro, disclaimer, guest bio Guest one-liner Case from Kashlak; Definitions Four-tier approach to taking care of patients with methamphetamine use/use disorder Medications for treatment Psychosocial treatment Harm reduction New horizons in treatment  Outro Credits Producer/Script Writer/Show Notes: Era Kryzhanovskaya, MD Infographic and Cover Art: Zoya Surani Hosts: Carolyn Chan, MD. MHS and Era Kryzhanovskaya, MD Reviewer: Sarah Leyde MD Showrunner: Carolyn Chan, MD, MHS Technical Production: PodPaste Guest: Dr. Phillip Coffin

Dive into practical, evidence-based approaches to managing pain in patients with opioid use disorder, bust common myths, and explore strategies to support patients. This episode will enhance your skills in providing holistic, patient-centered care. We’re joined by Dr. Jessica Merlin, @JessicaMerlinMD (University of Pittsburgh).  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] | CME! Credits Producer, Show Notes, Infographics: Carolyn Chan MD, MHS Hosts: Carolyn Chan, MD, MHS and Shawn Cohen MD Reviewer: Payel Jhoom Roy MD, MSc Showrunner: Carolyn Chan, MD, MHS Technical Production: PodPaste Guest: Jessica Merlin MD, PhD, MBA Sponsor: JournalFeed Try JournalFeed free for 7 days — and get 20% off your first year with code CURB25 at journalfeed.org/curb. Sponsor: Freed Usecode: CURB50 to get $50 off your first month when you subscribe at freed.ai Sponsor: Mint Mobile Get your summer savings and shop premium wireless plans at MINTMOBILE.com/CURB.

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