While there are no FDA approved medications for cocaine use disorder and contingency management has the best evidence as behavioral treatment, there is a signal for topiramate (up to doses of 300mg/day) for promoting cocaine nonuse days.
Snow and Sauce: What medications can help patients reduce cocaine (and alcohol) use? Read More »
While the only FDA approved medications for AUD are naltrexone (best evidence!), acamprosate, and disulfiram, non-FDA approved topiramate and gabapentin can also help reduce heavy drinking with emerging evidence for GLP-1 agonists.
Long-acting injectable buprenorphine (1st gen Sublocade; 2nd gen Brixadi) can improve medication adherence, treatment retention, quality of life, and treatment satisfaction for patients with OUD.
While a traditional buprenorphine start requires the patient waiting for moderate opioid withdrawal, newer approaches feature buprenorphine started with very low-doses that slowly increase over several days and overlap with ongoing use of full agonist opioids to minimize withdrawal in patients with fentanyl use disorder.
How do you start buprenorphine for someone with fentanyl use disorder? Read More »
Buprenorphine is a life-saving medication for people with OUD and can be started by YOU w/ an Rx for 4mg SL to take only when in moderate opioid withdrawal.
How do you start buprenorphine for a patient with opioid use disorder? Read More »
Offer long-acting controller medication (varenicline 1st line, most effective, esp for women, and no worse for pts w/ mental health problems than bupropion or NRT) plus short acting agents to help pts meet their goals to reduce or stop tobacco use.
What options can be considered to help women stop smoking? Read More »
Contingency management (incentivizing and rewarding positive behavior change) is the standard of care, most evidence-based treatment for pts w/ stimulant use disorder (StUD). While there are no FDA-approved medications for StUD, mirtazapine and naltrexone+bupropion Xl show promise for reduction in stim use.
What treatments help patients stop using methamphetamine? Read More »
Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based tool to help care for, identify, and address unhealthy or high risk use in pts who use substances, esp alcohol, in primary care. BI steps include: establish rapport, raise subject, provide feedback (“your drinking is above healthy limits”), enhance motivation, negotiate (a goal), and advise.
Getting into the holiday SBIRT: how do you help patients cut back on drinking? Read More »
To discuss substance use w/ a pt, start with a non-judgmental attitude, non-stigmatizing and person-first language, and acknowledging the pt is the expert in their experience; consider using RIP-TEAR framework for wording to guide your visit and conversation: RIP-TEAR stands for RISK-INITIATION-PATTERN — — TREATMENT EPISODES-EFFECTS-ABSTINENCE-RETURN TO USE:
How do you talk with patients about their substance use? Read More »
To make the dx of SUD, you can use the DSM criteria or if you like mnemonics, look for the 4 R’s (Role failure, Relationship trouble, Risk of bodily harm, Repeated attempts to cut back) and 4 C’s ((loss of) Control, Craving, Compulsion to use, Consequences of use) in a patient’s history to make a SUD diagnosis.
Chaos with Cannabis? How to diagnose and treat cannabis use disorder Read More »
