Module Archives

12: Lab Testing in Assessment of Substance Use Disorders

Presenter(s): Kevin A. Sevarino, MD, PhD

Lab testing in the assessment of substance use disorders may involve many different substrates, though urine drug testing (UDT) dominates clinical practice. This module is meant to provide a short guide to effective use of lab testing in treatment of the patient with a substance use disorder, which to a surprising degree is often misused or misunderstood. The module describes the clinical role of lab testing to guide treatment and not to be punitive. To properly use and interpret UDT, it reviews common false positive and false negatives that might occur in the immunologic-based first step in UDT. To understand confirmatory gas chromatography/mass spectrometry, it goes on to describe the metabolism of common opioids and benzodiazepines, because the detected confirmed moiety often is just a downstream metabolite of several possible parent compounds to which the patient was exposed. The module concludes with a discussion of the difference between UDT for clinical purposes versus forensic ones. Read more

14: Medical Considerations for Patients with Opioid Use Disorder

Presenter(s): Jeanette Tetrault, MD, FACP, FASAM

Medical comorbidities are common among patients with opioid use disorder. Signs and symptoms of acute or chronic infectious diseases often prompt patients to seek medical care. Addiction providers should have a firm understanding of recognition of and treatment approaches for patients with medical comorbidities. The addiction provider can play a role in education, prevention and treatment of medical comorbidities of patients with opioid use disorder. This module will review features of skin and soft tissue infections among people who inject drugs, review risk factors for HIV and Hepatitis C (HCV), describe prevention interventions for HIV and HCV, and discuss treatment approaches for HIV and HCV in patients with opioid use disorder. Read more

15: Managing Common Psychiatric Conditions in Patients with Substance Use Disorders

Presenter(s): John A. Renner Jr., MD

Co-occurring psychiatric conditions are frequently seen in patients with substance use disorders. Clinicians should be alert to the signs and symptoms of common psychiatric disorders and should understand how to distinguish independent psychiatric disorders from substance-induced disorders. Depressive disorders and anxiety disorders, including post-traumatic stress disorder, are the most common co-occurring conditions, though ADHD is often encountered across the range of substance use disorders. Substance use disorder patients with co-occurring psychiatric disorders will respond to most standard psychological and pharmacological treatments for these psychiatric conditions, though clinicians should avoid the use of medications with an abuse potential and must always focus on sobriety as a primary treatment goal. Treatment that integrates addiction and psychiatric care is the most effective. Read more

16: Management of Other Substance Use Disorders: Benzodiazepines, Cocaine and Other Stimulants, and Cannabis

Presenter(s): Edward V. Nunes, MD

This educational activity reviews other substance use disorders that often co-occur with opioid use disorder (OUD), including benzodiazepines and other tranquilizers, cocaine and stimulants, and cannabis. The presentation will also discuss principles of diagnosis and evaluation of treatment for each of these by themselves and in the context of OUD. Read more

17: Nicotine and Stimulant Use in Adolescents

Presenter(s): Nicholas Chadi, MD, FRCPC, FAAP

With the recent increase in popularity of e-cigarettes, nicotine use remains prevalent in adolescents and young adults. While rates of use of illicit stimulants including cocaine, ecstasy/MDMA and methamphetamine have decreased in adolescents in recent years, misuse of prescription stimulants remains common in this age group. This modules reviews recent trends in nicotine and stimulant use in adolescents in young adults. It also presents a summary of the neurobiology of nicotine, discusses the different health effects and risks of harm of nicotine and stimulants (including illicit stimulants, prescription stimulants and caffeine) and offers an overview of evidence-based prevention and treatment strategies for youth. Read more

18: Adolescent Substance Use

Presenter(s): Sharon Levy, MD, MPH

Brain development during adolescence makes youth particularly vulnerable to both initiating substance use and developing substance use disorders. Alcohol and cannabis use are both common and the impacts of these substances on the developing brain leads to a predictable set of consequences. However, adolescent substance use is not inevitable. Various prevention strategies, interventions to prevent substance use disorders and substance use disorder treatment modalities are effective in this age group. This module discusses the Screening, Brief Intervention, and Referral to Treatment (SBIRT) method, its implementation, and its success in clinical trials alone and in combination with prescribed medication for addiction. Read more

19: Substance Use Disorders in Older People

Presenter(s): Louis A. Trevisan, MD

Substance Use disorders in Older Adults is a growing problem not only in the United States throughout the developed world. The Baby Boomer generation, born between 1946 and 1964 is turning 54-72 years of age this year. This group will present with more substance use disorders and need for substance use treatment going forward. The use of an artificial cut off age of 65 years of age as the definition of elderly or old is somewhat arbitrary and this will be discussed. The module will look at the prevalence, screening and treatment of tobacco, alcohol, opioids, non-medical use of prescription drugs and illicit opioids as well as stimulants and cocaine, marijuana and non-opioid sedative hypnotic agents. A case vignette will drive the CME portion and elucidate the tenants of the module. Read more

20: Treating Women for Opioid Use Disorder During Pregnancy: Clinical Challenges

Presenter(s): Hendrée E. Jones, PhD

Opioid use disorder (OUD) among women who become pregnant is increasing in prevalence in clinical settings. The standard of care is to provide buprenorphine or methadone as a part of a complete treatment approach during pregnancy and beyond the postpartum period. This module reviews the historical and current context of opioid use among women and during pregnancy. It compares pharmacological treatment options for women who become pregnant with an OUD and also discusses the issues with detoxification or medically assisted withdrawal from opioids during pregnancy. Issues related to the treatment of OUD during pregnancy and in the postpartum period for the mother, fetus and child will also be discussed (e.g., induction, dosing, pain management, neonatal withdrawal syndrome and how to reduce its severity). Read more

21: Introduction to the Criminal Justice System and MAT

Presenter(s): Debra A. Pinals, MD

There is an over-representation of individuals with substance use disorders in the criminal justice system. This can be true for individuals with opioid use disorders in need of MAT. Healthcare practitioners treating justice-involved patients may have limited information about how the criminal justice system is constructed and how best to help their patients who are at risk for disruption in care and treatment due to arrest, court oversight and incarceration. This information can be helpful given challenges when MAT becomes difficult to access due to the constraints of the justice system. Although the justice system is becoming more aware of the importance of MAT, it is important also for healthcare providers to have awareness of the justice system to best help support their patients. This educational activity provides an overview and basic information about the criminal justice system from arrest to incarceration to re-entry. Read more

22: Preventing Opioid Overdose with Education and Naloxone Rescue Kits

Presenter(s): Alexander Y. Walley, MD, MSc

Overdose is the leading cause of accidental injury death in the United States surpassing motor vehicle crashes. Opioids, prescribed for pain and used illicitly, are driving the increases in overdose deaths. Overdose prevention education and prescribing naloxone rescue kits to people at risk for opioid overdose is an emerging strategy to address opioid overdose. Read more