The Curbsiders Internal Medicine Podcast

#74: Opioid use disorder, pain, detox, tapers, health policy, and more!

December 22, 2017
75 min

Combat opioid use disorder and the opioid epidemic as we review common clinical scenarios with addiction medicine specialists, Dr. Stefan Kertesz, University of Alabama at Birmingham School of Medicine and Dr. Ajay Manhapra from the VA Hampton Medical Center in Hampton,Virginia. We need all hands on deck, and that means you! Learn the basics of opioid use disorder treatment as Dr. Manhapra gives us the scoop on “bup, bup, bup” (buphrenophine), and Dr. Kertesz primes us on opioid related health care policy and reminds us that “We can all do something about the opioid crisis”. Plus, Stuart and Paul express some concerns about how to approach these patients. Do not miss this episode filled with clinical pearls, policy, and joy! Special thanks to writers and producers, Dr. Carolyn Chan and Elena Gibson (MD Candidate, MS4), for their hard work on both of our addiction medicine episodes.

Full show notes available at http://thecurbsiders.com/podcast

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Time Stamps

  • 00:00 Intro
  • 01:35 Guest Bios
  • 03:10 Picks of the week
  • 06:22 Case from Kashlak Memorial
  • 07:20 Controversy: Is opioid addiction a real disease?
  • 10:16: Vietnam Heroin Study (4)
  • 12:52 Counseling patients on treatment options for opioid use disorder
  • 17:32 Detox and initiation of medical treatment
  • 18:50 Psychosocial needs and treatment (5)
  • 20:50 How effective is Narcotic Anonymous?
  • 21:36 80/20 rule
  • 25:50 Inpatient vs outpatient treatment, complex discharge planning
  • 27:03 Shared decision making for treatment options
  • 31:50 Medical treatment is strongly recommend for OUD
  • 32:17 Viewpoint: harms reduction in residential programs with polysubstance use
  • 32:29 Taper, abstinence, and long-term treatment with buprenorphine
  • 34:50 How to prescribe buprenorphine - Take the leap!
  • 39:30 Medical education and the opioid epidemic
  • 42:02 1980 NEJM article (6)
  • 43:00 Complex persistent dependence patients (7)
  • 46:40 Post-op pain and risk of addiction
  • 51:34 Approach to increasing pain medications
  • 54:50 Health Policy Intro
  • 54:59 Opioid thresholds for patients and policy
  • 61:39 Medicaid expansion and opioid epidemic (10)
  • 66:25 Take home points
  • 69:50 Round Table
  • 73:56 Outro

Tags: opioid, use, abuse, addiction, disorder, dependence, buprenorphine, suboxone, naloxone, methadone, taper, abstinence, heroin, fentanyl, drug, substance, overdose, chronic, pain, assistant, care, education, doctor, family, foam, foamed, health, hospitalist, hospital, internal, internist, nurse, meded, medicine, medical, primary, physician, policy, resident, student

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