substance use disorder | CARLAT PUBLISHING

Clinical Update

Effective Management of Buprenorphine-Precipitated Opioid Withdrawal

January 1, 2025

Jaewon Lee, MD, MPH. PGY-2, psychiatry resident, University of Rochester Medical Center, Rochester, NY.

Dr. Lee has no financial relationships with companies related to this material.

Buprenorphine is a first-line treatment for opioid use disorder, however, given buprenorphine to a patient who still has opioids in their system can precipitate severe withdrawal. Careful assessment of withdrawal can minimize the risk, but despite our best efforts, precipitated withdrawal can still occur. In this article, we review what to do for our patients experiencing buprenorphine-precipitated opioid withdrawal.

Clinical Update

Drug Testing and the Legal System

July 1, 2024

Paul A. Bryant, MD

Paul A. Bryant, MD, Assistant Professor of Psychiatry; Stephanie Eng, MD, Fellow in Forensic Psychiatry; Melissa Lavoie, MD, Fellow in Forensic Psychiatry. Yale University, New Haven, CT.

Drs. Bryant, Eng, and Lavoie have no financial relationships with companies related to this material.

Urine drug screens are frequently ordered for patients receiving addiction treatment. However, the results of these everyday tests can have outsized consequences for patients involved in the legal system. Here, we provide an overview of how drug testing is used in the legal system and how you can be an advocate for your patient.

How to Fulfill the DEA's One Time, 8-Hour Training Requirement for Registered Practitioners

Satisfy the DEA requirement for 8 hours of training in opioid or other substance use disorders

May 24, 2024

Clinical Update

A Spotlight on Two Emerging Nootropics

February 10, 2024

Jeremy Weleff, DO., Akhil Anand, MD., and Julian J. Raffoul, MD, PhD.

Jeremy Weleff, DO. Yale School of Medicine, New Haven, CT; Cleveland Clinic, Cleveland, OH. Akhil Anand, MD. Cleveland Clinic, Cleveland, OH. Julian J. Raffoul, MD, PhD. Vanderbilt University Medical Center, Nashville, TN.

Dr. Weleff, Dr. Anand, and Dr. Raffoul have no financial relationships with companies related to this material.

Nootropics are a broad class of medications encompassing many different mechanisms of action that are marketed as cognitive enhancers. Not only do most nootropics lack evidence of efficacy, but some can have dangerous side effects and addictive potential. Here, we discuss some of the most concerning nootropics being widely used today.

Clinical Update

Controlled Substances: Handling Red Flags

October 3, 2023

Jesse Koskey, MD.

Jesse Koskey, MD. Associate Clinical Professor, Department of Psychiatry and Behavioral Sciences, UC Davis Health.Dr. Koskey has no financial relationships with companies related to this material.

It’s a dilemma that will challenge the most seasoned psychopharmacologist: “My Adderall spilled down the sink.” We clarify how to respond in the post-lockdown landscape.

EXPERT Q&A

Motivational Interviewing: A Tool to Help Treat Substance Use Disorders

June 29, 2023

William Miller, PhD

William Miller, PhD. Dr. Miller is Emeritus Distinguished Professor of Psychology and Psychiatry at the University of New Mexico. His publications include 65 books and over 400 articles and chapters including the first descriptions of the method of motivational interviewing. He was co-founder of UNM's Center on Alcoholism, Substance Abuse and Addictions (CASAA) and has 50 years of experience in addiction research and treatment. He is a senior advisor to The Change Companies.

Dr. Miller has disclosed that he receives royalties for books published by Guilford Press. This educational activity has no commercial bias related to this material.

Therapists should not miss small steps in the right direction, as change often happens in smaller increments. The cofounder of motivational interviewing offer insights.

Expert Q&A

Substance Use Disorders in Older Adults: A Growing Concern

May 11, 2023

Olivera J. Bogunovic, MD

Olivera J. Bogunovic, MD.

Medical director of ambulatory services in the Division of Alcohol, Drugs, and Addiction at McLean Hospital, Belmont, MA; assistant professor of psychiatry, Harvard Medical School, Boston, MA.

Dr. Bogunovic has no financial relationships with companies related to this material.

Older adults with substance use disorders present to clinicians in various stages of change. Dr. Bogunovic discusses brief clinical interventions including motivational interviewing and how to approach harm reduction.

Clinical Update

Screening Tools, Assessment, and Brief Interventions for Substance Use Disorders in Older Adults

May 9, 2023

Julia Cromwell, MD

Julia Cromwell, MD. Inpatient geriatric psychiatrist, Mass General Brigham Salem Hospital, Salem, MA.

Dr. Cromwell has no financial relationships with companies related to this material.

How do you choose a screening tool for substance use disorders in older adults, and what do you do when a patient screens positive? We discuss common screening tools, assessments, and interventions based on an older adult’s risk level.

Expert Q&A

Recognizing and Treating Substance-Induced Psychosis

April 1, 2023

David Beckmann, MD, MPH

David Beckmann, MD, MPH.

Assistant professor of psychiatry and human behavior, Sidney Kimmel Medical College, Thomas Jefferson University. Philadelphia, PA.

Dr. Beckmann has no financial relationships with companies related to this material.

Clinical pearls on how to assess and treat substance-induced psychosis when you come across them in your clinic.

CLINICAL UPDATE

What to Know About Injectable Buprenorphine (Sublocade)

January 30, 2023

Audrey Abelleira, PharmD, BCPP

Audrey Abelleira, PharmD, BCPP. Clinical pharmacist practitioner, Pain Management and Opioid Safety Program Coordinator, VA Connecticut Healthcare System. Clinical instructor, Yale School of Medicine. New Haven, CT.

Dr. Abelleira has no financial relationships with companies related to this material.

Various formulations of buprenorphine abound, and a new long-acting injectable form (Sublocade) is one of the latest arrivals. But does it actually work? Here, we review the pharmacology behind it, go over efficacy data, and provide guidance on how to decide when to consider long-acting injectable buprenorphine for your patients.