S2 Ep4: #15 Buprenorphine for Chronic Pain with Dr. Will Becker

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

Gain insight into how racialized US drug policies, the War on Drugs, and media portrayals of substance use impact our patients in ongoing ways. Learn how you can take action and intentionally promote equity as a clinician! We’re joined by Dr Myra Mathis, @DrMyraMathis (University of Rochester Medical Center) 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, Writer, Show notes, Infographic, Cover Art: Katherine Mullins, MD Hosts: Carolyn Chan, MD, MHS and Katherine Mullins, MD Reviewer: Kento Sonoda, MD Showrunner: Carolyn Chan, MD, MHS Technical Production: PodPaste Guest: Myra Mathis, MD Show Segments Intro 0:00  Disclaimer 2:00   Guest bio 3:30   Episode Pearls 4:36   Guest One-Liner and Intro 5:15  Definitions (race and racism) 7:13   The War on Drugs 9:09   AntiDrug Abuse Act of 1986 11:47   Fair Sentencing Act of 2010 14:10   Policy in the Fentanyl Era 15:15   Mass Incarceration + Downstream Effects 17:30   Media Portrayals 19:24   Current Treatment Landscape 23:29   Disparities in Overdose Deaths 25:50   The Parallel System of White Supremacy 26:41   The Clinician’s Role: Advocacy on the Policy Level 27:40   The Clinician’s Role: Advocacy on the Clinic Level 29:22   Harm reduction 30:25 - 32:44

Learn about long-acting injectable (LAI) buprenorphine for the treatment of opioid use disorder with Dr. Ken Lee, an addiction medicine provider in Canada. We go over the basics of using LAI buprenorphine, tips and tricks for troubleshooting with patients as well as newer protocols that Dr. Lee and his colleagues use.   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 | Swag! | iTunes | [email protected] | Free CME! Credits  Show Notes, Cover Art, Infographics, Producer: Zina Huxley-Reicher, MD Hosts: Carolyn Chan, MD, MHS and Zina Huxley-Reicher, MD Reviewer: Payel Jhoom Roy, MD Showrunner: Carolyn Chan, MD, MHS Technical Production: PodPaste Guest: Dr. Ken Lee Show Segments Intro, disclaimer, guest bio - 1:58 Guest one-liner - 4:15 Case from Kashlak; Definitions - 5:27 Injectable MOUD - 6:14 Plasma levels of buprenorphine - 7:14 Relative contraindications to LAI buprenorphine- 8:51 Tips for Patient Counseling - 12:28 Starting LAI buprenorphine - 16:01 Side effects of LAI bup - 25:45 Administering LAI bup - 29:06 Dosing Interval - 31:53 Other LAI considerations - 42:19 Take home points - 47:24 Outro - 49:18

Jumpstart your knowledge on how to counsel patients in primary care to help decrease their risk of returning to substance use! Learn how to help patients identify triggers, develop plans on how to navigate high-risk situations & so much more! We are joined by psychologist Dr. Eve Lasswell PsyD at the University of California San Diego! 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, Infographics, Cover Art: Carolyn Chan, MD, MHS Hosts: Carolyn Chan, MD, MHS and Era Kryzhanovskaya, MD Reviewer: Kento Sonoda, MD Showrunner: Carolyn Chan, MD, MHS Technical Production: PodPaste Guest: Dr. Eve Lasswell, PsyD Show Segments Intro, disclaimer, guest bio 00:00 Guest one-liner  5:30 Case from Kashlak  8:25 Preparing for a visit 9:22 Pre - Planning At Risk Scenarios 17:25 Marlatt’s Framework 18:50 People, places, and things 22:55 Pearls and Pitfalls 27:30 Virtual Visits 31:50 Time Limited Visits 35:20 Mutual Support Groups  38:35 Sustained Remission 45:50 Substance Specific Tips 47:15 Take Home Points 49:20 Outro  53:30

Interpret urine drug tests (UDT) like a toxicologist! Learn how to approach interpreting positive opiates, opioids, and benzodiazepines in UDT. We discuss the nuances of interpreting UDT, false positives,  and how to counsel a patient prior to ordering the test. We’re joined by Dr. Timothy Weigand @TwToxMD (University of Rochester Medical Center). 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: Natalie Stahl, MD, MPH Show Notes, Cover Art, Infographic: Carolyn Chan, MD, MHS Hosts: Carolyn Chan, MD, MHS, and Natalie Stahl MD, MPH Reviewer: Kento Sonoda, MD Showrunner: Carolyn Chan, MD, MHS Technical Production: PodPaste Guest: Dr. Timothy Wiegand Show Segments Intro, disclaimer, guest bio 00:00 Guest one-liner: 05:17 Case from Kashlak: 09:42 Types of Urine Drug Testing (UDT): 10:37 Detection Window 22:07 Interpreting Opiates and Opioids UDT 25:26 Resources to Interpret UDT 39:20 False Positives  43:29 Discussing Results with a Patient 45:52 Interpreting UDT - Buprenorphine 48:47 Specimen Validity Testing  50:22 Saliva Testing 54:56 Outro 1:01:28

Learn to take a trauma-informed criminal legal history, tailor your MOUD prescribing to meet the needs of patients impacted by the criminal legal system, and advocate for high-quality care in the carceral system and the community. We’re joined by Dr. Lisa Puglisi, @pugleesa (Yale 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 | Swag! | iTunes | [email protected] | Free CME! Credits Producer, writer, show notes, infographic, cover art: Shawn Cohen MD Hosts: Carolyn Chan, MD and Shawn Cohen MD Reviewer: Sarah Leyde MD Showrunner: Carolyn Chan, MD Technical Production: Podpaste Guest:  Lisa Puglisi MD Show Segments Intro, disclaimer, guest bio 0-3:50 Learning points 3:50-4:40 Case from Kashlak 4:40-5:51 Mass incarceration as context 5:51-7:45 Taking a criminal legal history 7:45-16:27 Addressing law enforcement in the hospital 16:27-18:00 Health risks of incarceration 18:00-24:39 Opioid Use Disorder and the criminal legal system 24:39-36:00 Documentation 36:00-39:53 Parole, probation, and advocacy 39:53-43:10 Transitioning home 43:10-46:42 Addressing law enforcement in the hospital part 2 46:42-49:45 MOUD when leaving the hospital 49:45-57:28 Take homes 57:28-59:05 Plugs 59:05-1:01:15 Guest one-liner, Picks of the Week* 1:01:15-1:03:43 Outro 1:03:43-1:04:54

Distill the management of inpatient alcohol withdrawal down to its core with Dr. Shawn Cohen (@ShawnCohen_MD, Yale University). This episode is full of practical pearls, and we discuss the ins and outs of managing alcohol withdrawal in the hospital setting.  Learn how to triage patients in the hospital, which benzodiazepines to select, the pathophysiology of alcohol withdrawal, and phenobarbital for the management of alcohol withdrawal.  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 | Swag! | iTunes | [email protected] | Free CME! Credits Producer, writer, show notes, cover art, and infographic: Zina Huxley-Reicher, MD Hosts: Carolyn Chan, MD and Zina Huxley-Reicher, MD Reviewer: Payel Jhoom Roy, MD, MSc Showrunner: Carolyn Chan, MD Technical Production: Podpaste Guest: Dr. Shawn Cohen Show Segments Intro 0:00 Guest bio - 3:17 Case 1- 5:20 Alcohol withdrawal pathophysiology - 6:10 Kindling effect -  9:05 Diagnosing alcohol withdrawal and clinical withdrawal scales - 10:12 Severe alcohol withdrawal definition - 15:26  Triaging a patient - 16:50 Medication management for alcohol withdrawal syndrome- 19:37 Decisions between benzodiazepines and phenobarbital and formulation - 23:47 Choices of benzodiazepines in hepatic impairment - 26:30  Symptom triggered vs. fixed protocol - 28:10 Benzodiazepine resistant alcohol withdrawal - 33:33 Timeline of alcohol withdrawal syndrome symptoms - 42:38 ICU management of alcohol withdrawal - 46:27 Discharge planning and management of alcohol use disorder - 48:50 Take home points - 51:45 Lightning round- 53:43 Outro - 56:01

Crush chronic pain with buprenorphine. Learn how to assess chronic pain and opioid use disorder (OUD) in patients on long-term opioid therapy, when to consider buprenorphine, and how to make the switch. We’re joined by addiction medicine and pain management expert, Dr. William Becker (Yale 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. Episodes | Subscribe | Spotify | Swag! | iTunes | [email protected] | Free CME! Show Segments Disclaimer 0:52 Intro, guest bio 1:18 Case from Kashlak; Definitions 4:22 Assessing chronic pain and long-term opioid use 5:22  Treatment options when patients are not benefitting from opioids 11:55  Buprenorphine for chronic pain 14:28 Assessing OUD in patients on long-term opioid therapy 15:54 Buprenorphine mechanism of action 19:17 When to consider buprenorphine for chronic pain 21:12 Buprenorphine formulations 24:25 Switching from full agonist opioids to buprenorphine 29:02 Adding full agonists to buprenorphine 39:30 Take Home Points 46:07 Plug 47:38 Lightning round 48:32 Outro 50:20 Credits Show Notes, Writer, Producer, Cover Art, Infographics: Kenneth Morford, MD Hosts: Carolyn Chan, MD and Kenneth Morford, MD Reviewer: Payel Jhoom Roy, MD, MSc Showrunner: Carolyn Chan, MD Technical Production: Podpaste Guest: Dr. William Becker