The Curbsiders Internal Medicine Podcast #259 Addiction Medicine Triple Distilled
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Mar 1, 2021 Carolyn Chan, an addiction medicine fellow at Yale University, shares her insights on managing addiction treatment. She dives into effective strategies for treating alcohol and opioid use disorders, emphasizing personalized care. The discussion highlights the complexities of alcohol withdrawal management and the importance of patient involvement in treatment. Carolyn also unpacks the challenges of opioid tapering, using real-life cases to illustrate the need for clear communication and ethical considerations in care. It's a deep dive into addiction medicine with practical pearls for healthcare professionals!
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Outpatient Alcohol Withdrawal Management
- Manage low-risk alcohol withdrawal outpatient with a diazepam taper: 10 mg four times day 1, then taper down over four days.
- Use symptom-triggered approach and avoid high-risk patients with history of seizures or DTs for outpatient management.
Benzodiazepine Strategies for Withdrawal
- Use fixed-dose benzodiazepine taper for high-risk inpatient alcohol withdrawal, usually diazepam for its longer half-life.
- Avoid mixing different benzodiazepines in symptom-triggered dosing due to variable receptor activity.
Starting Alcohol Use Disorder Medications
- Start alcohol use disorder medications like naltrexone inpatient when patients are interested, to improve follow-through.
- Naltrexone contraindicated in opioid users and cautious in severe liver disease; common side effects are mild nausea.