Addiction Medicine Made Easy | Fighting back against addiction

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. 

We all know that buprenorphine is an effective medication to treat opiate withdrawal, yet most of us only use buprenorphine to treat opiate withdrawal from abstinence from opioids. It turns out that buprenorphine can also treat the opiate withdrawal that patients experience when they are given naloxone after an opioid overdose. In this episode we review the literature on using buprenorphine after naloxone rescue, and how to actually do it in your practice. We also take on a few other topics around this issue, including whether or not naloxone can be given electively to induce withdrawal to facilitate a rapid buprenorphine induction. 

Wait, what??? Drinking Alcohol + Naltrexone = Cure for Alcohol Use Disorder??? In this episode we do a detailed review of a different way to use naltrexone for alcohol use disorder, which is to continue drinking while using naltrexone. This method is often referred to as the Sinclair Method, and may be effective in up to 80% of patients to reduce alcohol consumption or stop drinking entirely. This episode is based on the book "The Cure for Alcoholism" by Roy Eskapa, PhD

Have you ever had this case in your ED? A patient purchases a cannabis edible candy bar or pastry. She or he eats a small amount and waits 30-60 minutes. Feeling nothing, the patient proceeds to eat the whole bar and then comes to the ED via ambulance or with a friend about an hour later completely panicked and hallucinating. In this episode we dig in to Cannabis Induced Psychosis - why it happens, how THC content contributes to the development of psychosis, how common it may be, and how to treat it. 

We all have had this scenario...a patient comes to the ED or is getting admitted for a medical complaint...and you notice a few findings on their lab tests that make you wonder if they have an alcohol use disorder. An elevated MCV. An elevated AST. Have you ever asked yourself - how accurate are these tests are detecting and diagnosing an alcohol use disorder? Or on the flip side - how often do we see a patient presents to the ED requesting help with alcohol after years of heavy drinking and has essentially normal labs? In this episode we dig into the limited literature on this topic and try to answer the question - how accurate are lab tests in determining if a person is consuming alcohol, and if so how much?