Addiction Medicine Made Easy | Fighting back against addiction

In this episode we tackle opioid use disorder during pregnancy with OB-GYN Dr. Kenneth Spielvogel. Dr. Grover and Dr. Spielvogel discuss multiple topics including the use of methadone and buprenorphine during pregnancy, overdoses during pregnancy, fentanyl exposure during pregnancy, and breastfeeding while taking buprenorphine.

Dr. Grover was asked to speak at a high school on the topic of food, nutrition, eating disorders, and how ultra processed food can be addictive. He recorded the lecture while giving it - so here it is as a bonus episode.

We tried to cover counseling and talk therapy as a part of treatment for addiction in a single episode - but it was too big of a topic! This episode is part 2 of Dr. Grover's interview with Andrew Finley, LMFT on the topic of counseling and talk therapy as a part of treatment for addiction.

Ok...so you have a patient using nicotine, cannabis, alcohol, and methamphetamine. What substance should you focus on helping the patient stop first? Or should the patient stop everything at once? In this episode Dr. Grover interviews Addiction Medicine physician Dr. Lee Goldman on the topic of how to treat patients who use multiple substances.

In this episode, we take a second look at cannabis withdrawal. Dr. Grover covered this topic on a previous episode, but as cannabis use is very common, and many people don't realize that cannabis has a withdrawal syndrome - it needed another look. This episode is an up to date review of cannabis withdrawal, including options for treatment.

How much do you know about talk therapy and counseling? How does it work? How does a therapist decide what to talk about? How does one define a successful therapy session? In this episode, Dr. Grover interviews Andrew Finley, LMFT, about how counseling and talk therapy work for patients with addiction. And since it's such a big topic, it will take several episodes to cover.

Are you familiar with Bromazolam? Carfentanil? Isotonitazene? Flualprazolam? What do all these substances have in common? They are showing up in the illicit drug market, and we'll likely be seeing more of them in the future. Dr. Grover gives an update on what's coming next in the illicit drug supply

Dr. Grover was asked to speak at a high school to parents on how to talk to kids about drugs and alcohol - and this episode is a recording of that lecture. Dr. Grover reviews how to talk to kids about substance use in general, as well as how to talk to kids who are actively using substances. Pardon the raspy voice - Dr. Grover is getting over pneumonia :)

We finally came up with a new and better name for the podcast! Addiction in Emergency Medicine and Acute Care is now Addiction Medicine Made Easy. Dr. Grover shares his thoughts on the why behind the name change.

We all know that the illicit drug supply is full of contaminants, some more dangerous than others. I am seeing, in my practice, more of my patients who use stimulants test positive for fentanyl. In this episode, we review a study that analyzes specimens of meth and cocaine to see how often they are laced with fentanyl. Spoiler alert...it's pretty common :(

Do your patients use whippets? Have they ever mentioned that they use nitrous? Not quite sure what we're talking about? In this episode we look at recreational use of nitrous oxide, also known as laughing gas or whippets.

Have you heard of the drug Iso? Is it isofentanyl? Or maybe it's isotonitazene? Or is it just fentanyl cut with who knows what? In this episode we discuss the drug being sold as "Iso" - and try to figure out what's in it.

Have you heard that giving teenagers alcohol in the home under parental supervision can teach them to use alcohol safely and reduce the risk of addiction to alcohol? Many parents believe this to be true. In this episode, we review the evidence in the literature to find out if this is true or not.

How does a drug deal work? How do people with addiction find out what their drugs are cut with? Can you ask your dealer if your drugs have fentanyl in them? In this episode Dr. Grover interviews Jeremy, who is a former injection drug user about what it's like buying drugs in the illicit market.

In this episode we speak with Araceli, a Substance Use Navigator in California, about her work taking care of substance use patients in her Emergency Department. We talk about how to connect with patients with substance use - both in terms of building trust and how to work with patients who do not speak English as their first language.

Have you heard of P2P methamphetamine? It has turned out to be a major destructive force in the world of addiction and in society in general. In this article we tell the story of how P2P meth came to be the dominant stimulant in the US, and how it has produced devastating mental health effects in those who use it.

Have you heard of peer support? It's AWESOME! Such a huge help for patients with mental health conditions and substance use disorders. In this episode Dr. Grover provides an overview of peer support for the treatment of substance use, and we hear from Ceil - a woman in recovery who is providing peer support.

How often have you seen a patient you think has cannabinoid hyperemesis syndrome - and when you tell them you think they need to stop using cannabis they tell you..."it's not the weed". In this episode we review what patients with suspected cannabinoid hyperemesis syndrome think about the condition and how you can help them to stop using cannabis

If you don't have a Substance Use Navigator (SUN) at your hospital, you need one! They are awesome! In this episode Dr. Grover speaks with Austin, a Substance Use Navigator, who shares his experience taking care of patients with substance use. Spoiler alert! Substance Use Navigators do incredible work!

Naloxone saves lives! In this episode, Addiction Medicine and Emergency Medicine physician Dr. Reb Close joins Dr. Grover to discuss naloxone - how to use it, how to get it into the hands of patients, and how to distribute it in the community.

Have you heard of Phenibut? Did you know that it can be bought online as an unregulated supplement and yet regular use causes dependence? Any idea how to manage Phenibut withdrawal? In this episode we review the literature on Phenibut, including Phenibut toxicity and withdrawal.

In this episode we review the risk of having opioids in the home. As in – when you prescribe an opioid to a patient – what is the risk to the other people and family members in that patient’s home?

Have you heard about using baclofen for alcohol use disorder? Does it work? How do you dose it? What are the contraindications? In this episode we do an evidence based review of the use of baclofen to treat alcohol use disorder

So...how much do you know about urine drug screens? Can selegiline cause a false + for meth? Can quinolones cause a false + for opioids? Can putting visine in urine cause a false negative? What should you do if you think you've gotten a false positive result on a urine drug screen. In this episode - we tackle all these questions and more

A really quick bonus episode! Dr. Grover shares a poem written about addiction that reminds us why treating patients with substance use disorders matters so much.

Have you ever been worried that when you prescribe a controlled substance that your patient might sell it on the street or to a friend? Of course you have. What about when you prescribe buprenorphine? In this episode we review the topic of buprenorphine diversion - how common is it, and what actually happens when patients use diverted buprenorphine?

In this episode Dr. Casey Grover and child psychiatrist Dr. Susan Swick discuss the topic of talking to kids about drug use. They discuss how health care providers can connect with kids who are using substances, how to work with the parents of a child who is using substances, and when parents should start discussing substance use with their kids before substance use starts.

Have you ever wondered what it's like growing up with parents who have addiction? Have you ever talked to patients about what it's like parenting while in recovery? How often have you seen one generation with addiction lead to the next generation having addiction too? In this episode Dr. Grover interviews a colleague who discusses her strong family history of addiction, her own addiction, and how she is raising her kids in a healthy drug/alcohol free home.

In this episode Dr. Grover does a follow up interview with Aiden, a young man in recovery. Aiden shares more of his recovery story, including how music keeps him focused on recovery, what it was like to be incarcerated, how being incarcerated has affected his recovery, how he deals with regret looking back on his time with active addiction, and what his goals are for the future.

As we've discussed many times on this podcast there is a lot of concern - from both patients and medical providers - that patients with opioid use disorder using fentanyl will have an increased risk of precipitated opioid withdrawal when they start buprenorphine. And finally, we have a study looking directly at this topic!! In this episode we review a recent paper from JAMA Network Open that looks at the rate of precipitated opioid withdrawal during buprenorphine inductions in patients with opioid use disorder using fentanyl.

In this episode Dr. Grover interviews Aiden, a young man in recovery. Aiden shares his story of how his addiction developed, what it's like living with addiction, how his recovery started, and what life is like as a young man in recovery.

How much do you know about Kratom? Who takes it and why? How does Kratom withdrawal present and how do you treat it? And what do you do in the case of a Kratom overdose? In this episode we do an evidence based review on Kratom to answer all of these questions and more.

Have you had a patient ask you about using Topiramate to treat their alcohol use disorder? Or maybe you've heard a colleague talk about it, but don't know much about it? In this episode we review the use of the medication topiramate in treating alcohol use disorder. Spoiler alert! This may be practice changing!

How often do you see patients who regularly use cannabis who get recurrent abdominal pain, nausea, and vomiting? It seems like this comes up at least every other shift in the Emergency Department. In this episode we review all aspects of Cannabinoid Hyperemesis Syndrome, from pathophysiology, to diagnosis, to treatment. 

Have you heard reports of first responders having overdoses on fentanyl after just touching it? Do you actually know how well fentanyl is absorbed through the skin? What PPE should first responders use if they know they are going to be exposed to fentanyl? In this episode we do a mega deep dive to find out what is the risk of fentanyl exposure to first responders and what can we do to mitigate that risk?

How familiar are you with cannabis toxicity? Do you know the symptoms of a cannabis overdose? If your patient told you that she "greened out" last night, would you know what she was talking about? In this episode we do an evidence-based review of cannabis toxicity, including what it means to "green out"

Pink Elephants anyone? In this episode we review Delirium Tremens, also know as alcohol withdrawal delirium. It's not too common, but it makes people impressively sick when it develops. Listen in for an evidence based review of the diagnosis and treatment of delirium tremens. 

Have you heard about microdosing buprenorphine? Have your patients asked you if it's an option for them? In this episode we do a deep dive on the topic of microdosing buprenorphine...including how it might be the best option for patients using illicit fentanyl to start bupe without experiencing precipitated withdrawal.

Have you heard of Xylazine? I sure don't remember it from pharmacology in medical school. It turns out Xylazine is a veterinary medicine that is being increasingly cut into the illicit drug supply in the US. Why is it being cut into drugs, what does it do, and how is a Xylazine overdose treated? We cover everything you need to know about Xylazine in this episode. 

Have you found all the different formulations of buprenorphine confusing? What is Zubsolv and how is it different from regular sublingual buprenorphine? And what about Belbuca? Or BuTrans? When can you use injectable Buprenex? What about Sublocade? In this episode we do a deep dive into all the different formulations of buprenorphine, including what they are used for and how to dose them. We also discuss how challenging it can be to convert between different formulations. 

Another bonus episode! I was asked to give a lecture on medications for alcohol use disorder to some of my colleagues in my area. We have made such incredible improvements in how we treat opiate use disorder with medication...it's time to do the same with alcohol use disorder. So...in this lecture I tried to convince my colleagues that we need to start routinely treating patients with alcohol use disorder with medication for alcohol use disorder. Take a listen...hopefully I can convince you too. 

We need more Addiction Medicine physicians, both here in the United States and all over the world. In the United States, board certification in Addiction Medicine is supervised by the American Board of Preventative Medicine (ABPM). In this episode we review the process for how to obtain board certification in Addiction Medicine in the US. It turns out that the ABPM has a practice pathway that allows for board certification in Addiction Medicine without having to do a fellowship for those who already are doing addiction medicine in their current practice. Could you be eligible to apply for board certification in Addiction Medicine? Listen in and find out!

I don't know about you but I was taught stimulants didn't have a withdrawal syndrome, and yet many of my patients - after a post methamphetamine crash - will complain of being in withdrawal. So...how much do you know about stimulant withdrawal? In this episode we review stimulant withdrawal - how to diagnose it, how to treat it, and how it feels to patients. 

A follow up to Episode #27 on labs and alcohol use disorder. So you're at work and you have a patient who you're pretty convinced has an alcohol use disorder, but you're not sure which test you should order to assess their alcohol use. LFTs? Carbohydrate deficient transferrin? Ethyl glucuronide? Phosphatidylethanol? In this episode we take another look at lab tests that can help you with your assessment of patients who use alcohol...including some lab tests that you probably have never heard of (but might find useful)

A bonus episode! This isn't really on the topic of addiction...but it does involve opioid sparing and alternative to opioid treatment protocols (and avoiding a new start of opioids may prevent someone from developing opioid dependence or opioid use disorder). 

I put together a lecture on the non-opioid management of renal colic a few months back. I thought the topic was really useful, so I presented it to the docs that I work with where I practice as a part of our monthly physician education. I literally just recorded my presentation with my iPad while I was giving the lecture to my group (thus the lousy audio...my apologies). In any case - I hope you find this lecture helpful. I review non opioid pain management of renal colic in detail, including NSAIDs, lidocaine infusions, antispasmodics, and tamsulosin. 

How much do you know about hallucinogens? Do you know the differences between LSD, psilocybin, and MDMA? In this episode we review hallucinogens as a general class of drugs, specific hallucinogenic drugs, and how to manage the acutely intoxicated in the ED and acute care setting. 

Given how prevalent methamphetamine use is, this topic is WAY overdue. In this episode we take a broad look at methamphetamine use disorder - how methamphetamine affects the brain, the clinical features of methamphetamine use disorder, and how to treat methamphetamine use disorder. 

You just had a patient arrive via ambulance on an involuntary hold who is clearly psychotic. As the paramedics are giving report, you hear that the patient was found using methamphetamine on scene. So...is this schizophrenia? Or is it meth psychosis? Can you tell the difference? In this episode, we do a deep dive into methamphetamine psychosis, to review the clinical features, prognosis, risk factors, and treatment - including a discussion of the differences between primary psychotic disorders and methamphetamine induced psychosis. 

This episode is on the topic of the label "drug-seeking" that is often given to patients. Dr. Grover reviews a clinical case and reviews a perspective piece written on this topic. How would you handle a patient in pain who has an allergy to multiple medications, is refusing non-opioid options, and is asking for morphine? Is it addiction? Severe pain? Or is the patient in withdrawal? In this episode we delve into the complex and nuanced topic of the so-called "Drug-Seeking" patient. 

You've probably heard patients talking about going to AA (Alcoholics Anonymous), but how much do you actually know about what AA does? In this episode we review mutual support groups and 12 step programs (such as AA) - what they are and how they work.