Addiction Medicine: Beyond the Abstract

In this episode, Dr. Charles Schauberger discusses the difficulties clinicians face when identifying and treating inhalant use in pregnant patients, and the findings from his recent article Systematic Review of Obstetric and Child Outcomes of Prenatal Exposure to Inhalants in the Context of a Use Disorder.   Dr. Charles Schauberger lives and practices in La Crosse, Wisconsin.  He is board-certified in both Obstetrics and Addiction Medicine, and has developed a specialized pregnancy addiction clinic that champions a patient-centered approach to addiction care for pregnant women.  While he is mostly retired from obstetrics, he continues to provide addiction care and continues his interest in performing research studies to advance our knowledge of treatment for substances in pregnancy. - Article Link: Systematic Review of Obstetric and Child Outcomes of Prenatal Exposure to Inhalants in the Context of a Use Disorder

In this episode, Dr. Mishka Terplan discusses initiation of MAUD for pregnant patients, and the findings from his recent article Medications for Alcohol Use Disorder Among Birthing People With an Alcohol-related Diagnosis.   Dr. Mishka Terplan  is board certified in both obstetrics and gynecology and in addiction medicine. His primary clinical, research, public health, and advocacy interests lie along the intersections of reproductive and behavioral health. He is Medical Director at Friends Research Institute and adjunct faculty at the University of California, San Francisco where he is a Substance Use Warmline clinician. He is Co-Founder and Co-Director of Doing Right By Birth, a non-profit that seeks to flip the script from drug exposure to early childhood development. Dr. Terplan has spoken at local high schools and before the United States Congress and is internationally recognized as an expert in the care of pregnant and parenting people who use drugs. - Article Link: Medications for Alcohol Use Disorder Among Birthing People With an Alcohol-related Diagnosis

In this episode, Dr. Ryan Alexander joins the show to discuss findings from his new study Withdrawal Signs and Symptoms Among Patients Positive for Fentanyl With and Without Xylazine.    Dr. Ryan Alexander is an addiction medicine specialist and is currently the medical director for substance use services at McNabb Center in Knoxville, TN and is an assistant professor at the University of Tennessee Graduate School of Medicine. He completed medical school at the DeBusk College of Osteopathic Medicine in East Tennessee, his residency in preventive medicine and public health at Griffin Hospital/Yale School of Medicine, and a fellowship in addiction medicine at Yale University School of Medicine. In addition, he completed a Masters of Public Health at Yale School of Public Health. In addition to treating patients, Dr. Alexander conducts clinical research and has published multiple articles related to addiction medicine. He also regularly teaches medical students, residents, and other medical professionals about treating substance use disorders, reducing community stigma toward individuals with substance use disorders, and expanding access to medication treatments. - Article link: Withdrawal Signs and Symptoms Among Patients Positive for Fentanyl With and Without Xylazine

In this episode, Dr. Ekaterina Pivovarova joins host Shawn McNeil to discuss the findings from her new article Collaborating With Jails to Provide Community-based Medication for Opioid Use Disorder: Qualitative Perspectives From MOUD Treatment Providers. Dr. Pivovarova is a licensed clinical psychologist and an associate professor in the Department of Family Medicine and Community Health at the University of Massachusetts Chan Medical School. - Article link: Collaborating With Jails to Provide Community-based Medication for Opioid Use Disorder: Qualitative Perspectives From MOUD Treatment Providers

In this episode, Dr. Christine Neeb sits down to discuss integrated treatment programs and how this model could potentially be adapted to other populations with SUD. Dr. Neeb is a Visiting Associate Professor and the Director of Integrated Primary Care and Addiction in the Division of General Internal Medicine at the University of Colorado Anschutz. She is board certified in Family Medicine and Addiction Medicine and focuses on novel strategies to expand access to treatment of substance use disorders, including methadone maintenance therapy, in underserved populations and in the primary care setting. - Integration of a Community Opioid Treatment Program Into a Federally Qualified Health Center

Podcast host Shawn McNiel, MD, is joined by Michael Incze, MD, MSEd to discuss his new article Expert Panel Consensus of the Effectiveness and Implementation of Models to Support Posthospitalization Care Transitions for People With Substance Use Disorders which aimed to establish a hierarchy of existing SUD care transition models in 2 categories-effectiveness and implementation-using an expert consensus approach. Dr. Michael Incze is a primary care physician in the Division of General Internal Medicine who is board certified in internal medicine and addiction medicine. His clinical interests include patient education, high value care, and caring for vulnerable populations including people experiencing homelessness and people with substance use disorders. He regularly volunteers at the Fourth Street Clinic, a federally qualified health center that specialized in providing care to people experiencing homelessness. He is a volunteer physician at the Rosebud Indian Health Service hospital in South Dakota. He also founded a clinic that focuses on providing primary care-based addiction treatment at Sugarhouse Health Center.

In this episode of Beyond The Abstract, Dr. Joji Suzuki stops by the show to discuss his recent co-authored review on GLP-1 agonists and their potential role in addiction treatment. Dr. Suzuki is the founding Director of the Division of Addiction Psychiatry in the Department of Psychiatry, Brigham and Women's Hospital (BWH), and an Associate Professor of Psychiatry at Harvard Medical School (HMS). He is board certified in both Addiction Psychiatry and Addiction Medicine, and has continued to maintain his clinical role as an inpatient addiction consultant at BWH. He has received NIH funding continuously since 2017, having completed a K23 Career Development Award to receive training in conducting clinical trials with an emphasis on research to improve the care of hospitalized patients. He is now a principal investigator on multiple NIH funded trials to evaluate novel pharmacologic and psychosocial treatments for substance use disorders.   The Efficacy of GLP-1 Agonists in Treating Substance Use Disorder in Patients: A Scoping Review   Journal of Addiction Medicine 18(5):p 488-498, 9/10 2024   Sept-Oct 2024

Host Shawn McNeil, MD, is joined by Michelle Lofwall, MD, DFAPA, DFASAM,  a professor in the Department of Behavioral Science and Psychiatry at the University of Kentucky and Medical Director of UK's Robert Straus and First Bridge Clinics, which provide comprehensive OUD treatment within the UK Center on Drug and Alcohol Research. Dr. Lofwall and  her co-authors examined the relationship between the dose in the early stages of treatment and the subsequent risk of death and found some surprising results.   Higher First 30-Day Dose of Buprenorphine for Opioid Use Disorder Treatment Is Associated With Decreased Mortality   Journal of Addiction Medicine 18(3):p 319-326, 5/6 2024 May-June 2024

Podcast host Shawn McNiel, MD, is joined by Noa Krawczyk, PhD, an assistant professor in the Department of Population Health at NYU Grossman School of Medicine, and an author of Initiatives to Support the Transition of Patients With Substance Use Disorders From Acute Care to Community-based Services Among a National Sample of Nonprofit Hospitals. Dr. Krawczyk discusses the gap in transition of acute care to community care services among most US hospitals, efforts to increase acute care interventions, and how clinicians providing SUD treatment can help hospitals identify and implement best practices to support continuity of care.   Follow Dr. Krawczyk on Twitter @noakrawczyk     Article, Authors, and Links: Initiatives to Support the Transition of Patients With Substance Use Disorders From Acute Care to Community-based Services Among a National Sample of Nonprofit Hospitals. Krawczyk, Noa PhD; Rivera, Bianca D. MPH; Chang, Ji E. PhD; Lindenfeld, Zoe MPH; Franz, Berkeley PhD Journal of Addiction Medicine 18(2):p 115-121, 3/4 2024

Xylazine Use Among People Who Inject Drugs, Philadelphia 2022   Host Shawn McNiel, MD,  is joined by Marissa Tan, DO, an Epidemiology Intelligence Service (EIS) Fellow for the Center of Disease Control and Prevention through the Philadelphia Department of Public Health. Dr. Tan and her co-authors sought to help clinicians better identify individuals at risk and inform patients and clinicians about xylazine risk factors. Dr. Tan discusses their findings from National HIV Behavioral Surveillance Survey among persons who inject drugs data and offers recommendations for clinicians and public health professionals.    Show Links: Xylazine Use Among People Who Inject Drugs, Philadelphia 2022 Journal of Addiction Medicine, 18(2):p 194-200, 3/4 2024. March-April 2024

Podcast host Shawn McNeil, MD, is joined by Joshua Sharfstein, MD, and Sara Whaley, MPH, from Johns Hopkins Bloomberg School of Public Health who delve into the strategic allocation of $56 billion from opioid litigation settlements. As they discuss the principles for effective fund utilization, they highlight opportunities for addiction medicine specialists to play a pivotal role in guiding state and local governments to spend these resources wisely to save lives.   Journal of Addiction Medicine, November-December 2023 Opioid Settlements: The Role for Addiction Medicine in Guiding Effective Spending   Also of Interest Principles for the Use of Funds From the Opioid Litigation Developed by a coalition of organizations across the spectrum of the substance use field including physicians, addiction medicine specialists, recovery, treatment, and harm reduction.

In episode 28 of  Addiction Medicine: Beyond the Abstract, host Shawn McNeil, MD is joined my Ashish Thakrar, MD, MS, an addiction medicine specialist and Assistant Professor of Medicine with the University of Pennsylvania. Dr. Thakrar discusses the outcome of his research, which aimed to determine whether fentanyl concentration is associated with the severity of opioid withdrawal.   Article Link: https://journals.lww.com/journaladdictionmedicine/abstract/2023/07000/association_of_urine_fentanyl_concentration_with.18.aspx   Ashish Thakrar, MD,  X (Twitter) Handle: @especially_APT   Journal of Addiction Medicine. 17(4):447-453, July/August 2023.

The language used to describe people with substance use disorder impacts stigma and influences clinical decision-making. Host Dr. Shawn McNeil, MD discusses with Dr. Scott G. Weiner, MD the presence of stigmatizing language in clinical notes and detects patient- and provider-level differences. ----more---- Based on original research published in the Journal of Addiction Medicine July/August 2023 - Volume 17 - Issue 4   The Incidence and Disparities in Use of Stigmatizing Language in Clinical Notes for Patients With Substance Use Disorder

The language used to describe people with substance use disorder impacts stigma and influences clinical decision-making. Host Dr. Shawn McNeil, MD discusses with Dr. Scott G. Weiner, MD the presence of stigmatizing language in clinical notes and detects patient- and provider-level differences.   Based on original research published in the Journal of Addiction Medicine July/August 2023 - Volume 17 - Issue 4   The Incidence and Disparities in Use of Stigmatizing Language in Clinical Notes for Patients With Substance Use Disorder

Examining the Primary Care Experience of Patients With Opioid Use Disorder: A Qualitative Study In episode 26 of Addiction Medicine: Beyond the Abstract, host Shawn McNeil, MD, is joined by Michael Incze, MD, MSEd. Dr. Incze is a primary care physician at the University of Utah Health Division of General Internal Medicine. He is board certified in internal health and addiction medicine. Dr. Incze will discuss the advantages of primary care-based SUD treatment, focusing on both the perspective of patients and clinicians.   Journal of Addiction Medicine, July/August 2023   https://journals.lww.com/journaladdictionmedicine/pages/articleviewer.aspx?year=2023&issue=07000&article=00009&type=Fulltext&context=featuredarticles&collectionid=1

Meet JAM Editor-in-Chief, David A. Fiellin, MD, FASAM   Dr. Fiellin is an internist, board certified in addiction medicine. He is professor of Medicine and Emergency Medicine at Yale School of Medicine, and Public Health at Yale School of Public Health; vice chief of Faculty Affairs for the Department of Internal Medicine's Section of General Internal Medicine; and serves as the inaugural director of the Program in Addiction Medicine at Yale. Dr. Fiellin has focused his scholarly work on improving access to and the quality of substance use prevention and treatment, especially in general healthcare settings. His research focuses on the efficacy, effectiveness, and implementation of treatments for opioid use disorder and alcohol use disorder in office-based, primary care, Emergency Department, hospital, obstetrical and gynecologic practices, and HIV specialty settings. He has served and is serving as principal investigator and co-investigator on multiple NIH-funded research projects using a variety of research designs including clinical trials, observational studies, pharmacoepidemiology, qualitative methods, and implementation science. His work has been published in journals that include NEJM, JAMA, The Lancet, Annals of Internal Medicine, and BMJ.

In episode twenty-four of Addiction Medicine: Beyond the Abstract, host Shawn McNeil, MD is joined by Dr. Jed Barash, a Neurologist from Massachusetts. In his paper, Dr. Barsh and his colleagues discuss using an existing syndromic surveillance system to monitor for possible cases of opioid-associated amnestic syndrome in the state of Massachusetts.   Article: LINK Guest Twitter: @JedBarash

In episode twenty two of Addiction Medicine: Beyond the Abstract, host Shawn McNeil, MD, is joined by Amy Kennedy, MD, MS. Dr. Kennedy is an Acting Assistant Professor of Medicine at the University of Washington and Director of GMS Addiction Medicine Program at the VA Puget Sound Healthcare System. In her paper, Dr. Kennedy discusses barriers and facilitators of the prescription of HIV preexposure prophylaxis to high-risk injection drug users by buprenorphine prescribers. Journal of Addiction Medicine, May/June 2021 Article Link Twitter: @AmyJoKennedy

February 14, 2022 In episode twenty-three of Addiction Medicine: Beyond the Abstract, host Shawn McNeil, MD is joined by Catalina Lopez-Quintero, MD, PhD, MPH. Dr. Lopez-Quintero is an Assistant Professor of Epidemiology at the University of Florida. In her paper, Dr. Lopez-Quintero discusses racial-ethnic differences in reasons for misuse of prescription medications among a nationally representative sample of US adults.

Addiction Medicine: Beyond the Abstract (Episode 21). Host Shawn McNeil, MD, is joined by Simeon Kimmel, MD, who discusses a trend of referral rejections for post-acute medical care among patients with substance use disorders and patients receiving opioid agonist treatment Dr. Kimmel (@simkimmel) is an Assistant Professor of Medicine at Boston University School of Medicine and Attending Physician at Boston Medical Center. Journal of Addiction Medicine, January/February 2021, Rejection of Patients With Opioid Use Disorder Referred for Post-acute Medical Care Before and After an Anti-discrimination Settlement in Massachusetts.

In episode 20 of Addiction Medicine: Beyond the Abstract, we are joined by Tami Mark, PhD. She is a Senior Fellow of Behavioral Health Financing and Quality Measurement for RTI International. Dr. Mark discusses patient placement criteria for addiction treatment and multidimensional assessments, which was published in the March/April 2021 issue of Journal of Addiction Medicine. Article: LINK

In episode 19 of Addiction Medicine: Beyond the Abstract, we are joined by MacKenzie Peltier, PhD. She is an Assistant Professor of Psychiatry at Yale School of Medicine. In her paper, Dr. Peltier discusses sex-specific vulnerabilities observed among individuals with opioid use disorder.

Journal of Addiction Medicine Journal of Addiction Medicine. 14(5):401-408, September/October 2020 In episode eighteen of Addiction Medicine: Beyond the Abstract, we are joined by Kimberly Spence, MD. She is an Associate Professor of Pediatrics at the Saint Louis University School of Medicine. In her paper, Dr. Spence discusses the benefits of treating neonates with Neonatal Opioid Withdrawal Syndrome (NOWS) on the mother-baby unit rather than admitting them to the NICU.

Journal of Addiction Medicine  In episode seventeen of Addiction Medicine: Beyond the Abstract, we are joined by Kathleen Carroll, PhD. She is the Albert E. Kent Professor of Psychiatry at Yale University School of Medicine. In her paper, Dr. Carroll discusses the feasibility of implementing computer-based treatments for substance use disorders in primary care settings.

In episode sixteen of Addiction Medicine: Beyond the Abstract, we are joined by Itai Danovitch, MD, MBA. He is the chairman of the Department of Psychiatry and Behavioral Neurosciences at Cedars-Sinai Medical Center in Los Angeles. In his paper, Dr. Danovitch discusses some of the challenges facing the study of opioid overdose events in the hospital setting.   To learn more, click here.

In episode fifteen of Addiction Medicine: Beyond the Abstract, we are joined by Dr. Tricia Wright, MD, MS, FACOG, DFASAM. She is a professor of clinical medicine at the University of California San Francisco. In her recent commentary, Dr. Wright discusses some of the challenges facing women in opioid treatment programs and the need for the provision of reproductive healthcare to this population. To learn more, click here.  

In episode fourteen of Addiction Medicine: Beyond the Abstract, we are joined by Dr. Babak Tofighi. He is an assistant professor in the departments of medicine and population health at the NYU School of Medicine. In his recent article, Dr. Tofighi discusses the use of technology-based interventions to optimize the treatment of substance use disorders (SUDs) and related comorbidities. To read more, click here.      

In episode thirteen of Addiction Medicine: Beyond the Abstract, we are joined by Dr. Jessica Gray. She is a family medicine physician and an addiction specialist in the departments of Medicine at Massachusetts General Hospital (MGH) and Pediatrics at Massachusetts General Hospital for Children (MGHfC). She is also Associate Program Director for the MGH Addiction Medicine Fellowship and Clinical Director of the HOPE Clinic at MGH. In her recent article, Dr. Gray discusses a case of a woman who was able to continue opioid agonist treatment during the postpartum period while she remained incarcerated, in a system that generally did not allow for opioid agonist treatment during incarceration except during pregnancy. To learn more, click here. 

In episode twelve of Addiction Medicine: Beyond the Abstract, we are joined by Dr. Hendrée Jones, a professor in the Department of Obstetrics and Gynecology at the University of North Carolina and the Director of UNC Horizons Program. In her recent article, Dr. Jones and her colleagues discuss the treatment of women in opioid use treatment programs in North Carolina and their utilization of reproductive and sexual health services.  To read the article, click here.  

In episode eleven of Addiction Medicine: Beyond the Abstract, we are joined by Dr. Honora Englander, an Associate Professor of Medicine at Oregon Health & Science University and the Director and Principal Investigator of the Improving Addiction Care Team (IMPACT). In her recent article, Dr. Englander and her colleagues discuss using hospitalization as a "reachable moment" for highly vulnerable patients who are not engaged in treatment elsewhere and utilizing the IMPACT team in this process.    To read more, click here.

In episode ten of Addiction Medicine: Beyond the Abstract, we are joined by Dr. Caleb Banta-Green, principal research scientist at The Alcohol and Drug Abuse Institute at the University of Washington. In his recent study, Dr. Banta-Green and his colleagues surveyed syringe exchange program (SEP) clients to gauge interest in receiving help with cessation or reduction of opiate use. Data from this study produced valuable conclusions about subgroups that are more likely to take advantage of available interventions.   Read more here. 

  In episode nine of Addiction Medicine: Beyond the Abstract, we are joined by Dr. John McCarthy, an associate professor of psychiatry and volunteer clinical faculty at the University of California Davis. In his recent study, Dr. McCarthy and his colleagues examined the significance of serum methadone/metabolite ratios (or MMRs). In particular, they looked at the changes in these ratios for the expecting mother throughout pregnancy and sought to use these ratios to objectively guide methadone dosing. To read the full article, click here. 

In episode eight of Addiction Medicine: Beyond the Abstract, we are joined by Dr. Lisa Marsch. She is a professor at Dartmouth and Director of both the Center for Technology and Behavioral Health and the Dartmouth Psychiatric Research Center. In her recent study, Marsch and her colleagues took a look at relevant randomized controlled trials and observational studies which evaluated the use of buprenorphine in adolescents and young adults. To learn more, click here.

In episode seven of Addiction Medicine: Beyond the Abstract, we are joined by Barrett Raymond. He is a nurse practitioner and graduate of Brigham Young University. In his recent study, Raymond analyzed e-cigarette liquid samples from popular online manufacturers and distributors in the United States. He compared the expected nicotine content with the measured levels. He also discussed regulatory changes and the potential impact on the industry.   To read the full article, click here. 

In episode six of Addiction Medicine: Beyond the Abstract, we are joined by Kelly Moore, Ph.D. of Yale University School of Medicine. Her new study takes a look at the implementation of continued methadone maintenance treatment (MMT) upon incarceration. Often, inmates undergo forced withdrawal once they are placed in a correctional setting. Her study sought to measure the difference in behavior both during incarceration and after release for inmates in a methadone maintenance group compared to those in a forced withdrawal group. To read the article, click here.

In episode five of Addiction Medicine: Beyond the Abstract, we are joined by Leo Beletsky, JD, MPH of Northeastern University. His commentary from the latest issue of the journal addresses common challenges that influence the delivery of substance use treatment in the primary care setting. He details underlying concepts of behavioral economics that may impact the decisions made by healthcare providers. Specifically, he addresses choice architecture as it relates to decisions regarding substance use treatment.   Read more here.

In episode four of Addiction Medicine: Beyond the Abstract, we are joined by Dr. Gerald Cochran of the University of Pittsburgh. His recent article details a pilot study which assesses a patient navigation intervention model for pregnant women with opioid use disorder. This represents a novel application for patient navigation. He details the clinical relevance of these techniques and discusses the potential impact of his findings.   To read more click here. 

In episode three of Addiction Medicine: Beyond the Abstract, we are joined by Dr. Sarah Bagley of Boston Medical Center and Boston University School of Medicine. Her recent commentary addresses the approach clinicians take in treating adolescents with opioid use disorder and perceptions about the use of medication management. She also discusses the recent policy statement by the American Academy of Pediatrics concerning the use of pharmacotherapy with buprenorphine/naloxone, methadone, and naltrexone in this population. Read more here.

In episode two of Addiction Medicine: Beyond the Abstract, we are joined by Dr. Stefan Kertesz of the University of Alabama Birmingham and the Birmingham VA Medical Center. In his recent piece from the Journal, Dr. Kertesz discusses the challenge of treating patients who obtain benzodiazepines from another provider in addition to known prescribed opiates. He addresses this issue in the context of the results from a recent study by McClure, et al. in the same issue of the Journal which analyzes patterns of urine drug test results from a national laboratory. Read more here. ASAM developed the Appropriate Use of Drug Testing in Clinical Addiction Medicine document to provide guidance about the effective use of drug testing in the identification, diagnosis, treatment and promotion of recovery for patients with, or at risk for, addiction. Click here.

In this episode of Addiction Medicine: Beyond the Abstract, we are joined by Dr. Daniel Alford of Boston Medical Center and Boston University School of Medicine. His new study takes a closer look at the continuation of opiate agonist treatment in the perioperative setting among women undergoing cesarean section. Dr. Alford talks about the study, its limitations and applicability, and how the findings compare to current trends in practice. He also discusses his career in studying and treating patients with these issues.