Author name: Era Kryzhanovskaya

Getting into the holiday SBIRT: how do you help patients cut back on drinking?

You met Ivy two years ago. Your clinic had just implemented universal screening for unhealthy alcohol use as per the 2018 USPSTF recommendation using the National Institutes on Alcohol Abuse and Alcoholism (NIAAA) single item screening question “How many times in the past year have you had *** (4 for women, or 5 for men) or more …

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How do you talk with patients about their substance use?

You log in to Zoom for the morning clinic video visits and meet Zeke, a 28 yo man without much medical history, here to establish care with you. As he’s sharing his daily routine, Zeke says that after work–he’s a 4th grade teacher–he comes home so overwhelmed with what’s going on for his students that …

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Chaos with Cannabis? How to diagnose and treat cannabis use disorder

Jake is a 28 yo man with a history of anxiety since adolescence who comes to you to establish care. He is generally healthy and uses cannabis every evening to “help calm down.” He started smoking heavily in high school. For the last decade, he has smoked one joint nightly. His partner doesn’t like his smoking, and …

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Coke and Subs: Is Suboxone maintenance for opioid use disorder contraindicated in someone with cocaine on urine screen?

Joe is a 42M who comes to see you to establish care after moving for work. He has a history of HTN, chronic pain from hand injuries at work, and opioid use disorder (OUD) maintained on buprenorphine-naloxone (SuboxoneⓇ, often referred to as “subs”) 16mg-4mg twice a day without any un-prescribed opioid use. He is a …

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What medication is FDA approved to help people drink less?

A 55-year old woman with a history of atrial fibrillation, cirrhosis from Hepatitis C, and at-risk alcohol use presents to the clinic for follow up. She takes her metoprolol and apixaban regularly. She has noticed occasional fatigue and nausea in the morning. You ask her about alcohol use. She says that with recent work stress …

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