Module Archives

6: Integrating Opioid Use Disorder Treatment in Clinical Care

Presenter(s): Todd Korthuis, MD, MPH

This module discusses models for integrating opioid use disorder (OUD) pharmacotherapy into primary care settings, reviews keys to successful OUD pharmacotherapy implementation in clinical practice, and identifies strategies for preventing diversion of buprenorphine/naloxone. Participants are encouraged to adapt this information for use in their own clinical practices. Read more

7: Treatment of Tobacco Use Disorder in Primary Care

Presenter(s): Jill Williams, MD

Tobacco use disorder is still a major cause of preventable death that affects individuals with mental illness or other addictions to a great degree. Treatments are effective yet underutilized. Practice guidelines recommend that all smokers trying to quit should use pharmacotherapy as a first-line treatment. However, reviews suggest that use is much less; fewer than one out of every 3 smokers who try to quit uses an FDA-approved smoking cessation medication. Tobacco withdrawal causes clinically significant symptoms of agitation, anxiety, restlessness, and impaired concentration. Medications are effective in reducing these withdrawal symptoms and at least doubling the smoker’s chance of success in quitting smoking. Pharmacotherapy may be even more important in smokers with mental illness or other addictions as they have higher levels of dependence than other smokers. This educational activity will review updates in evidence based treatments for tobacco use disorder. Read more

8: Standard Medical Management for Opioid Use Disorder in Primary Care

Presenter(s): Michael Pantalon, PhD

Utilization of evidence-based counseling to effectively manage buprenorphine-maintained primary care patients with Opioid Use Disorders (OUD) provides the best chance of improving motivation for change, treatment engagement and ultimate remission. Standard Medical Management (SMM) is one such option that is seldom offered, but one that is relatively easily integrated into primary care practice. The goal of this module is to prepare participants to deliver the assessment and treatment components of the initial and subsequent 15-minute SMM sessions. Participants will also review brief motivational strategies to manage resistance and/or lack progress, as well as common issues when treating OUD. Read more

9: Principles of Motivational Interviewing: Useful for Primary Care Physicians

Presenter(s): Joji Suzuki, MD

Motivational interviewing (MI) has emerged as one of the most critical evidence-based approaches when working with patients to promote behavior change. Originally developed in the context of treating substance use disorders, MI is a collaborative method of communication that pays particular attention to the language of change. MI helps to strengthen intrinsic motivation for change by exploring the patient’s own reasons for change within an atmosphere of acceptance, partnership, evocation and compassion. This educational activity will introduce key MI principles, including the four processes, the spirit of MI, patient-centered communications skills, and the importance of evoking change talk. Read more

10: Helping Patients Get to and Utilize Twelve-Step Programs

Presenter(s): Richard Ries, MD

Twelve Step programs (Alcoholic Anonymous and others) are ubiquitous across the United States and are found in small, medium, and large cities. They can be a great addition to treatment plans and extend the reach of the physician by providing their patients paths to recovery, sober social support, and valuable skills. This presentation provides education about what 12 step programs are and how the physician can help their patients get to and best utilize these programs, including for those patients taking medications. Read more

11: Opioids for Pain: Understanding and Mitigating Risks

Presenter(s): Roger Chou, MD

Opioids are commonly prescribed for chronic pain, but are also associated with a risk for serious harms including overdose and opioid use disorder. This module reviews risk factors for opioid misuse, opioid use disorder, and overdose in patients with chronic pain, explains methods for screening and assessing for problematic opioid use, reviews methods for mitigating risks associated with prescribed opioids, and details non-opioid treatment approaches for pain. The module is based on principles in the Center for Disease Control and Prevention’s guideline on opioids for chronic pain and reviews recent evidence on benefits and harms of opioids. Read more

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

13: Regulatory Issues and Medication Assisted Treatment (MAT)

Presenter(s): Laura McNicholas, MD, PhD

At the conclusion of this activity participants should be able to describe the legal differences between an opioid treatment program (OTP) and office based practice; demonstrate if, and when, the prescriber can increase the number of patients to be treated with buprenorphine products; list which medical professionals may prescribe or dispense buprenorphine products, and under which conditions they may prescribe or dispense; explain the needed confidentiality of patient records for patients in substance use treatment; and demonstrate how to appropriately practice using telemedicine. 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