The Addiction Connection

Drs. Bell and DeVine are again joined by their Augsburg University Physician Assistant student, Mika. This discussion will dive into the concept of ‘compassion fatigue'. Is it truly a ‘thing?' Who is at highest risk of developing compassion fatigue and what does the data say? To learn more about the doctors as well as keep up with current happenings follow on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com Part of the Ars Longa Media Productions.

Drs. Bell and DeVine are joined by their Augsburg University Physician Assistant student, Mika, to start the discussion on substance use disorders in transgender and gender non-conforming populations. This segment, the first of two, will give background information and lay out the basics to better help listeners understand this patient population. To learn more about the doctors as well as keep up with current happenings follow on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com Part of the Ars Longa Media Productions.

Drs. Bell and DeVine, thank you to Ruth Merick from the American Farm Bureau Federation, return for part 2 of our rural America and Opioids two part series. This episode will delve into the bias and perceptions of opioids and opioid use disorder(s) felt by adults in rural MN. It will also highlight some of the ideas that these same rural adults have in terms of solutions to the epidemic. To learn more about the doctors as well as keep up with current happenings follow on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com Part of the Ars Longa Media Productions.

Drs. Bell and DeVine, thank you to Ruth Merick from the American Farm Bureau Federation, will discuss the data on mental health access and opioid use in rural America. This will be followed next week by the perceptions of opioid use in rural America as well as possible solutions to the opioid epidemic in this particular niche. To learn more about the doctors as well as keep up with current happenings follow on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com Part of the Ars Longa Media Productions.

Drs. Bell and DeVine return to the topic of suicide. Previously we discussed suicide risk in relation to opioids, this episode will discuss suicide risk with individuals with nicotine, stimulant and/or cannabis use disorder. The statistics and data are quite alarming, again showing the importance of screening for and assessing for use disorders and mental health. To learn more about the doctors as well as keep up with current happenings follow on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com Part of the Ars Longa Media Productions.

Drs. Bell and DeVine follow up with even more information about the harms of Kratom outside of the substance itself. Where it is grown and how it is processed can lead to many additional health complications, some of which will surprise you. We will finish with a discussion on harm reduction as well in relation to Kratom. To learn more about the doctors as well as keep up with current happenings follow on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com Part of the Ars Longa Media Productions.

Drs. Bell and DeVine return with Kratom 2.0. With what seems like an increase in the amount of Kratom that is being seen in the clinic and healthcare setting, this will review what Kratom is as well as take a deeper dive into the effects and withdrawal states. To learn more about the doctors as well as keep up with current happenings follow on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com Part of the Ars Longa Media Productions.

Drs. Bell and DeVine came across, initially, one article alluding to an association between eye color and the risk for alcohol use disorder, interestingly finding that they both would be considered “higher risk” (listen to hear our eye color disclosure!) Upon further research, there does seem to be a genetic linkage and association between the two. To learn more about the doctors as well as keep up with current happenings follow on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com Part of the Ars Longa Media Productions.

Drs. Bell and DeVine will discuss another system in the body that is not typically thought of in relation to alcohol consumption. Interestingly enough, alcohol consumption can and does have a significant impact on the eyes, and the “optic” system, in several different ways. To learn more about the doctors as well as keep up with current happenings follow on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com Part of the Ars Longa Media Productions.

Drs. DeVine and Bell will discuss a theme in medical practice, shared-decision making, that continues to grow in its practice in medicine. This idea incorporates and includes the patient in their own medical decisions. This episode will explore the shared decision making concept in relation to non-cancer pain chronic opioid therapy and how health and safety outcomes are improved when it's utilized. To learn more about the doctors as well as keep up with current happenings follow on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com Part of the Ars Longa Media Productions.

Drs. Bell and DeVine, this week, will take a dive into prazosin, a medication FDA approved only for the treatment of hypertension, and how it may actually aid in the treatment of alcohol use disorder. Although this medication is approved only for hypertension, it is often used off label for things like PTSD and Benign Prostatic Hypertrophy (BPH). We will review recent studies that look at the efficacy, however, of its use for the treatment of AUD both with and without co-occurring PTSD. To learn more about the doctors as well as keep up with current happenings follow on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com Part of the Ars Longa Media Productions.

Drs. Bell and DeVine discuss “Dry January.” Is this just a fad or does it actually have merit? We will discuss how it started, the data behind who ‘typically' does it, and what health, and life, benefits are realized. Hint: the concept behind ‘dry January' is somewhat of a ‘self-reflection' but we will discuss the hows and the whys! We also have a bit of a challenge for the listeners at the end! To learn more about the doctors as well as keep up with current happenings follow on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com Part of the Ars Longa Media Productions.

Drs. Bell and DeVine will start a review of some new research being done for different use disorder treatments. This episode will review a journal article recently released on how Ketamine, currently being done for depression and chronic pain, may potentially help or aid in the treatment of alcohol use disorder. To learn more about the doctors as well as keep up with current happenings follow on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com Part of the Ars Longa Media Productions. All referenced articles will be listed in the show notes of Part 4 of the Perioperative Series.

Drs. Bell and DeVine bring you part 2 of gambling disorders. We describe who is at [higher] risk for developing gambling disorder. Also, is there tolerance and what does withdrawal actually looks like? Finally, we will review the best treatments for this addiction. To learn more about the doctors as well as keep up with current happenings follow on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com Part of the Ars Longa Media Productions. All referenced articles will be listed in the show notes of Part 4 of the Perioperative Series. https://www.ncpgambling.org/help-treatment/help-by-state/ Source: Korman, Collins, et al., (2008) www.icrg.org Www.divisionaddiction.org www.mnapg.org MN Helpline: 1800-333-HOPE

Drs. Bell and DeVine come back after a bit of a hiatus and bring you Gambling Disorder Part 1: The Facts and Consequences. Information courtesy of Ted Hartwell from the Nevada Counsel on Problem Gambling. Why is Gambling Disorder the only behavioral addiction in the DSM-V? We will discuss the facts of gambling including the prevalence and negative consequences data. To learn more about the doctors as well as keep up with current happenings follow on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com. Part of the Ars Longa Media Productions. All referenced articles will be listed in the show notes of Part 4 of the Perioperative Series.

Drs. Bell and DeVine return for Part 4 of Perioperative Considerations, Management, and Process for patients on buprenorphine. This final (for now) episode discusses the ‘other' patient situations concerning perioperative times. How do you manage patients who have an undiagnosed opioid use disorder or are on very high doses of chronic opioids? What about patients who are opioid naive but who are high-risk for development of an OUD? These patients may be those who, personally, do not want opioids for any reason either due to a history of another substance use disorder or those who just do not want opioid exposure. Teaser- there will likely be a part 5 of this series of Perioperative Considerations… Below you will find the resources used for the development of this series. To learn more about the doctors as well as keep up with current happenings follow on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com Part of the Ars Longa Media Productions. Articles for Perioperative Series: •Bentzley BS et al. Discontinuation of buprenorphine maintenance therapy: perspectives and outcomes. J Subst Abuse Treat 2015;52:48-57. •Buresh M, et al. Treatment perioperative and acute pain in patients on buprenorphine: narrative literature review and practice recommendations. J Gen Intern Med 2020;35(12):3635-3643. •Champagne K, et al. Patients on buprenorphine formulations undergoing surgery. Current Pain and Headache Reports 2022;26:459-468. •Engle AL, et al. The divided dose approach to perioperative buprenorphine management in patients with opioid use disorder. Journal of Opioid Management 2021;17(7):101-107. •Evans E, et al. Mortality among individuals accessing pharmacological treatment for opioid dependence in California, 2006-10. Addiction 2015;110:996. Goel A et al. The perioperative patient on buprenorphine: a systematic review of perioperative management strategies and patient outcomes. Can J Anaest 2019;66:201-17 •Greenwald M et al. Buprenorphine duration of action: mu-opioid receptor availability and pharmacokinetic and behavioral indices. Biol Psychiatry. 2007 Jan1;61(1):101-10. •Katz A, et al. Tobacco, alcohol, and drug use and willingness to change. J Hosp Med 2008;3:369-75. •Kubalanza K et al. Sublingual buprenorphine vs. morphine for acute pain. Am Fam Physician. 2012;86(7):682. •Liebschutz JM, et al. Buprenorphine treatment for hospitalized, opioid-dependent patients: a randomized clinical trial. JAMA Intern Med 2014;174:369-76. •Machado FC et al. Transdermal buprenorphine for acute postoperative pain: a systematic review. Braz J Anesthesiol. Jul-Aug 2020;70(4):419-428. Pergolizzi J et al. Current knowledge of buprenorphine and its unique pharmacological profile. Pain Pract. Sep-Oct 2010;10(5):428-50.

Drs. Bell and DeVine return for Part 3 of Perioperative Considerations, Management, and Process for patients on buprenorphine. So now that the question and the science have been discussed, what do we do? As previously stated, there isn't a set guideline, just expert recommendations. Over time we have developed protocols and resources to help navigate the maintenance of buprenorphine through the perioperative and postoperative period. Please email us if you would like any protocols or forms we have developed! To learn more about the doctors as well as keep up with current happenings follow on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com Part of the Ars Longa Media Productions. All referenced articles will be listed in the show notes of Part 4 of the Perioperative Series.

Drs. Bell and DeVine return for Part 2 of Perioperative Considerations, Management, and Process for patients on buprenorphine. We continue the “what does it mean” from the previous episode which focused on the science of buprenorphine. What happens if buprenorphine is continued in terms of pain mitigation and what happens if buprenorphine is discontinued, both in terms of analgesia but also in terms of relapse potential. To learn more about the doctors as well as keep up with current happenings follow on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com. Part of Ars Longa Media Productions. All referenced articles will be listed in the show notes of Part 4 of the Perioperative Series.

Drs. Bell and DeVine start another series, Perioperative Considerations, Management, and Process for patients on buprenorphine. This episode reviews the science, particularly the buprenorphine and mu receptor neurobiology, of analgesia management post-op for patients going into, or coming out of, surgery. What has historically been done, and what do articles say? To learn more about the doctors as well as keep up with current happenings follow on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com Part of the Ars Longa Media Productions. All referenced articles will be listed in the show notes of Part 4 of the Perioperative Series.

Drs. Bell and DeVine sadly bring you the last installment of “Sugar Addiction!” Part 5 attempts to make the information more applicable to humans, with a few touches of the rats as well! How and why can and should sugar be an addiction? What does it mean in terms of food addiction and eating disorders? To learn more about the doctors as well as keep up with current happenings follow on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com Part of the Ars Longa Media Productions

Drs. DeVine and Bell will discuss how the risk of suicide can be reduced by treating patients with opioid use disorder with medications for opioid use disorder. They will also discuss the differences in the type of MOUD in relation to suicide risk. To learn more about the doctors as well as keep up with current happenings follow on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com Part of the Ars Longa Media Productions

Drs. DeVine and Bell discuss how to assess patients for suicide risk. They also discuss the question of whether or not an overdose is intentional or unintentional - what is the "intent?" Finally, does being on opioids impact depression and/or suicidality? To learn more about the doctors as well as keep up with current happenings follow on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com Part of the Ars Longa Media Productions

Drs. DeVine and Bell shift focus to start their series on suicidality. In part 1 they discuss the data of opioids and suicide risk, depression, and suicide risk with opioid prescriptions, as well as the hows and whys of this worsening phenomenon. To learn more about the doctors as well as keep up with current happenings follow on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com Part of the Ars Longa Media Productions

Drs. Bell and DeVine are back with part 4 of Sugar Addiction. Ok, let's bring you the science, the true DMS-V diagnostic criteria for an “addiction.” Does sugar fit or not? And why or why not? To learn more about the doctors as well as keep up with current happenings follow us on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com

Drs. DeVine and Bell bring up a common yet infrequently discussed topic: the overlap of alcohol and opioids in older adults. This is a topic with high risk and significant complications that isn't discussed, screened for, or understood. To learn more about the doctors as well as keep up with current happenings follow us on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com

Drs. Bell and DeVine return to finish (for now) common pearls in buprenorphine practice. In Part 4 we will discuss co-occurring mental health diagnosis with opioid use disorder and when to treat it.  Also, what about those urine drugs screens?  Which meds cause false positives and which false positives should we be most aware of - especially in a patient on MOUD? To learn more about the doctors as well as keep up with current happenings follow us on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com

Drs. Bell and DeVine return to the common pearls in buprenorphine practice.  Part 3 will bring to you the discussion on false negatives UDAS (what substances could patients be on that are not in their urine that you need to be aware of). We spend much of the discussion also discussing inductions in the fentanyl era. How we do it and why! To learn more about the doctors as well as keep up with current happenings follow us on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com

Drs. Bell and DeVine are back with part 3 of "Sugar Addiction."  What is it that makes us feel full; what is it that makes us want more; how do these same feeding behaviors - both adaptive and maladaptive - compare to drugs of abuse?  To learn more about the doctors as well as keep up with current happenings follow us on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com

Drs. Bell and DeVine are back with part 2 of ‘Sugar Addiction'. We will dive deeper into the evolution of genetics and how this has impacted how and what we eat. By the end, we will tie it back to the pleasure center of the brain, the limbic system, and continue the pathway into the “addiction” debate over sugar. To learn more about the doctors as well as keep up with current happenings follow us on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com

Drs. Bell and DeVine start with part 1 of "sugar addiction." Although not truly classified on the DSM-V, we will spend several podcasts breaking down all aspects of it and how it ‘could' meet many criteria. This episode focuses on the overview of sugar consumption as well as the evolution of obesity and finishes with the first theory into why many consider sugar to be addictive - the Nutrition Transition Theory. To learn more about the doctors as well as keep up with current happenings follow us on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com

Drs. Bell and DeVine have a discussion about the common questions that come up in the day-to-day management of patients on buprenorphine products. In Part 2, we have a discussion about where to do inductions on to buprenorphine (home vs clinic) and how that has changed over time and then we discuss UDAS. Do you get a UDAS every time? When do you/should you get a confirmatory UDAS? More parts to come! To learn more about the doctors as well as keep up with current happenings follow us on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com

Drs. Bell and DeVine have a discussion about the common questions that come up in the day-to-day management of patients on buprenorphine products. In Part 1, we discuss ‘firing' of patients, urine drug screens, and treatment. More parts to come! To learn more about the doctors as well as keep up with current happenings follow us on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com

Drs. DeVine and Bell PROMISE you this will be the last (at least for awhile) episode on off-label use of medications for the treatment of alcohol use disorder. This episode will surprise you as to what all makes the list both in studies and anecdotally.  Do we have a new ‘favorite' off-label treatment now? To learn more about the doctors as well as keep up with current happenings follow us on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com

Drs. Bell and DeVine with Dr. Charlie Reznikoff, organically fell into this very interesting, anecdotal experience, real-life and clinical practice discussion on the whys and hows of methadone to buprenorphine transitions. What are the pitfalls? Should it even be done? How do you stay patient focused? To learn more about the doctors as well as keep up with current happenings follow us on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com

Drs. DeVine and Bell, with Dr. Charlie Reznikoff, address the changes that one particular methadone clinic (OTP) made during the COVID pandemic. From crowded clinics to social distancing, how was it even possible? And then in follow up, how has that changed since? Are patients being cared for in a patient centered manner or are they overly monitored for other reasons? To learn more about the doctors as well as keep up with current happenings follow us on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com

Drs. DeVine and Bell, with Dr. Charlie Reznikoff, explain a methadone clinic (OTP)- what does a clinic ‘look like', what is the work flow, and what are the logistics? We will describe one methadone clinic with the understanding they are not all required to be the same. This episode will set the stage for what resulted when the pandemic happened. To learn more about the doctors as well as keep up with current happenings follow us on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com

Drs. Bell and DeVine describe how opioids have been used as weapons. It is very well known that opioids can cause significant morbidity and mortality, but how can this be preyed upon intentionally? And why? We will also tangent into describing other chemical weapons examples. To learn more about the doctors as well as keep up with current happenings follow us on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com

Drs. DeVine and Bell, again joined by Dr. Reznikoff, finalize the ‘off-label' medications for alcohol use disorder (AUD). This episode will highlight a couple anti-anxiety/anti-depressant medications, a medication typically used to treat ADHD and a final medication, one which happens to be tried as a treatment for nearly everything! This is a fantastic way to wrap up AUD [medication] treatment options! To learn more about the doctors as well as keep up with current happenings follow us on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com

Drs. Bell and DeVine highlight XYLAZINE, the ‘new player on the street.' A non-opioid, with similar pharmacology as clonidine, it is easy to purchase in bulk and is often added to opioids to extend the ‘high;' but like most substances, it can have very dire consequences. To learn more about the doctors as well as keep up with current happenings follow us on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com

Drs. DeVine and Bell now bring you a few antipsychotics that are, at times, used to treat alcohol use disorder (AUD). Joined by THE Dr. Charles Reznikoff, we not only bring you the mechanisms of action of how and why they “work” but also give you our clinical experience and thoughts! To learn more about the doctors as well as keep up with current happenings follow us on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com

Drs. DeVine and Bell review THREE current non–FDA approved medications for alcohol use disorder. All in the anticonvulsant category, we describe the mechanism of action in relation to alcohol use disorder, side effects, and why would you choose an anticonvulsant as a treatment option? To learn more about the doctors as well as keep up with current happenings follow us on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com

Drs. Bell and DeVine explore the use of varenicline (Chantix) for the treatment of cocaine dependence. There are no current FDA approved medications for the treatment of cocaine dependence and several smaller studies have reviewed varenicline as a possible treatment. What does this most recent article, published April 2022, show? To learn more about the doctors as well as keep up with current happenings follow us on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com

Drs. DeVine and Bell review the THREE current FDA approved medications for alcohol use disorder. They explain each one's mechanism of action, indications [why you would consider choosing one over the other], common and rare side effects, and can they be combined for a ‘better' response? To learn more about the doctors as well as keep up with current happenings follow us on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com

Drs. DeVine and Bell highlight another group of patients that all providers need to be aware of: patients with a history of gastric bypass or weight loss surgery. Is it physiology, psychology, or something else? To learn more about the doctors as well as keep up with current happenings follow us on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com

Drs. Bell and DeVine walk you through the barriers, the whys and the hows of “capturing the patients at the biggest impact” - the Emergency Room. Why is this standard of care not seen this way and not already happening? To learn more about the doctors as well as keep up with current happenings follow us on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com

Drs. Bell and DeVine, on episode 100 (:-) (-:) Fill you in on the current projects and passions they are working on and in! They also discuss their “lessons learned”, why they tend towards certain use disorders to care for (trauma differences between the two), and finally, what defines “success”?! To learn more about the doctors as well as keep up with current happenings follow us on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com

Drs. DeVine and Bell answer the age old question, “what is the ceiling effect?” Buprenorphine has such a high morphine equivalent, but why don't patients overdose on it via respiratory depression? This is sometimes a difficult thing to explain to patients or healthcare professionals, but we bring you the data! To learn more about the doctors as well as keep up with current happenings follow us on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com

Drs. Bell and DeVine, back in episode 34, discussed the impact of chronic opioids on testosterone. Now, they discuss how medications for opioid use disorder (Methadone, buprenorphine) impact testosterone levels. To learn more about the doctors as well as keep up with current happenings follow us on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com

Drs. Bell and DeVine discuss a case study on a patient who had anaphylaxis to opioid products, including buprenorphine, who also had severe opioid use disorder. Seriously, how these allergists were able to desensitize this patient in order for her to maintain recovery is remarkable, especially since the mechanism is not what you'd think! To learn more about the doctors as well as keep up with current happenings follow us on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com

Drs. Bell and DeVine dive into the literature and guidelines on what to do if a patient has adverse events or side effects with buprenorphine-naloxone (Suboxone). The guideline recommends transitioning to methadone, but what about transitioning to the monoproduct of buprenorphine (Subutex) instead? What's the risk to the patient, the provider, or society? To learn more about the doctors as well as keep up with current happenings follow us on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com

Drs. DeVine and Bell piggyback on last week's discussion on benzodiazepines with buprenorphine and bring up the topic of benzodiazepines combined with prescribed full-agonist opioids. Let's look at the data and the risk to patients, even “legacy” patients who take their medications exactly as prescribed. To learn more about the doctors as well as keep up with current happenings follow us on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com