ASAM Practice Pearls

In recognition of International Overdose Awareness Day, the Season 1 finale of ASAM Practice Pearls explores recent trends in overdoses. Drs. Stephen Taylor and Alexander Walley discuss the increase of fentanyl and other contaminants in the drug supply, the impact of racial and geographic disparities, and the importance of community-specific responses. They highlight the value of compassionate overdose care, data-driven interventions, and strategies to help individuals post-overdose. Together, they discuss the need to lower barriers to treatment and foster future leaders in addiction medicine. ----more---- Looking for this episode's transcript? Download it HERE We want to hear from you! Please take our short, five-minute survey HERE or email us at education@asam.org. Host Stephen M. Taylor, MD, MPH, DFAPA, DFASAM Dr. Stephen M. Taylor is ASAM's President and is board-certified in general psychiatry, child and adolescent psychiatry, addiction psychiatry, and addiction medicine. With over 30 years of practice experience, Dr. Taylor is dedicated to helping adolescents and adults overcome addiction and co-occurring psychiatric disorders. He has served as the Medical Director of the NBA and NBPA Player Assistance and Anti-Drug Program for 16 years and is the Chief Medical Officer of Pathway Healthcare, which operates multiple outpatient addiction and mental health treatment offices across six states.  Expert Alexander Y. Walley, MD, MSc, DFASAM  Dr. Alexander Y. Walley is Professor of Medicine at Boston University Chobanian & Avedisian School of Medicine, primary care physician and addiction specialist at Boston Medical Center focused on the medical complications of substance use, specifically HIV and overdose. He leads research studies on overdose prevention and the integration of addiction specialty care and general medical care. He is a founder of Boston Medical Center’s inpatient addiction consult service and walk-in substance use care bridge clinic. Dr. Walley was a founding director of the Grayken Addiction Medicine Fellowship and is the president of the American College of Academic Addiction Medicine. He serves as the medical director for the Massachusetts Department of Public Health’s Bureau of Substance Addiction Services, the Overdose Prevention Program, and the SafeSpot Overdose Prevention Hotline.  📖 Show Segments 00:05 - Introduction  00:17 - Epidemiology and Geographical Areas of Concern  07:15 - Racial, Geographic, and Socioeconomic Disparities 08:58 - Contaminants in the Drug Supply Affect Overdose Response 13:03 - Engaging Patients with Post-Overdose Care 18:18 - Approaching Conversations About Overdose Risk 23:42 - Tools for Overdose Prevention 26:19 - Policy, Protocols, and Treatment Innovationsr 30:41 - Training the Next Generation 33:23 - Final Thoughts on the Overdose Crisis 34:05 - Conclusion and Additional Learning Opportunities 📋 Key Takeaways Understand the Evolving Nature of the Opioid Epidemic: The overdose crisis has progressed through distinct waves, from prescription opioids, to heroin, to fentanyl, and now to increasingly complex combinations with stimulants and synthetic substances.  Address Racial, Ethnic, and Geographic Disparities: Marginalized populations and rural communities often face greater risk and reduced access to prevention, harm reduction, and treatment resources, requiring intentional, equity-focused interventions.  Respond to Emerging Drug Supply Contaminants: The presence of non-opioid substances like xylazine complicates overdose response, as naloxone may not reverse all effects, requiring expanded training and protocols for responders.  Promote Compassionate Overdose Response: In the event of an overdose, the priority is to restore breathing quickly and safely. Use only the amount of naloxone necessary and offer supportive, nonjudgmental care throughout the recovery process.  Encourage Practical Overdose Prevention Strategies: Most fatal overdoses occur when people use alone. Help patients develop practical safety plans, such as not using alone, developing safety plans, using drug checking tools, and maintaining access to naloxone to reduce overdose risk.   Leverage Real-Time Data for Community Action: Tools like OD Map and CDC dashboards provide real-time insights that can help inform timely, targeted community responses to emerging overdose patterns.  Lower Barriers to Evidence-Based Treatment: Expanding access to care through same-day treatment, low-barrier programs, and integrated support services, such as housing, education, and employment, helps improve outcomes and reduce overdose deaths.  Remove Barriers to Treatment and Support Systems: Expanding access to care, integrating social supports, and investing in workforce development, including training future addiction medicine leaders, are important for sustainable progress.  🔗 Resources The ASAM Principles of Addiction Medicine (Seventh Edition):  The Harm Reduction Approach to Caring for People Who Use Substances: Miller S, Rosenthal RN, Levy S, Saxon AJ, Tetrault JM, Wakeman SE. (Eds), The ASAM Principles of Addiction Medicine (Seventh Edition). American Society of Addiction Medicine, Inc.; 2024:1509-1529.  A Call for Compassionate Opioid Overdose Response: Russell E, Hawk M, Neale J, Bennett AS, Davis C, Hill LG, Winograd R, Kestner L, Lieberman A, Bell A, Santamour T, Murray S, Schneider KE, Walley AY, Jones TS.  Int J Drug Policy. 2024 Nov;133:104587. doi: 10.1016/j.drugpo.2024.104587. Epub 2024 Sep 18. PMID: 39299143.    Understanding and Addressing Widening Racial Inequalities in Drug Overdose: Friedman JR, Nguemeni Tiako MJ, Hansen H.  Am J Psychiatry. 2024 May 1;181(5):381-390. doi: 10.1176/appi.ajp.20230917. PMID: 38706336; PMCID: PMC11076008.  National Syndromic Surveillance Program (NSSP): Provides expertise and technical assistance to support public health professionals.  Safe Spot (1-800-972-0590): A toll-free, 24/7 confidential service that provides overdose safety planning and response to people using drugs alone.  State Unintentional Drug Overdose Reporting System (SUDORS): Provides detailed information on the characteristics and circumstances of overdose deaths to inform drug overdose prevention and response efforts.  📢 Join the Discussion Share your thoughts using #ASAMPracticePearls — we’d love to hear from you!  

In this episode of ASAM Practice Pearls, Dr. Stephen Taylor and Dr. Cara Poland explore the unique challenges of perinatal substance use care. They discuss the impact of stigma, the importance of compassionate care, and the use of medications for addiction treatment in pregnancy. Additionally, they address polysubstance use, physiological changes during pregnancy, and the critical postpartum period, sharing insights from their clinical experience and emphasizing a patient-centered, non-judgmental approach to improve treatment outcomes for mothers. ----more---- Looking for this episode's transcript? Download it HERE We want to hear from you! Please take our short, five-minute survey HERE or email us at education@asam.org. Host Stephen M. Taylor, MD, MPH, DFAPA, DFASAM Dr. Stephen M. Taylor is ASAM's President and is board-certified in general psychiatry, child and adolescent psychiatry, addiction psychiatry, and addiction medicine. With over 30 years of practice experience, Dr. Taylor is dedicated to helping adolescents and adults overcome addiction and co-occurring psychiatric disorders. He has served as the Medical Director of the NBA and NBPA Player Assistance and Anti-Drug Program for 16 years and is the Chief Medical Officer of Pathway Healthcare, which operates multiple outpatient addiction and mental health treatment offices across six states.  Expert Cara Poland, MD, MEd, FACP, DFASAM  Dr. Cara Poland is ASAM’s Vice President, is board-certified in Addiction Medicine, and is a faculty member at Michigan State University. In 2018, Dr. Poland identified the need to strengthen our country’s Addiction Medicine workforce. Dr. Poland leads MI CARES, which trains physician-level addiction specialists in Michigan and across the country. The program also teaches physicians-in-training, resident physicians, social work students, social work practitioners, APRNs, and PAs. Her didactic program involves purposeful education to train healthcare providers to treat persons with SUDs in a kind, compassionate, destigmatized way. Dr. Poland has a special interest in treating pregnant people and their families living with a substance use disorder.  📖 Show Segments 00:05 - Introduction  00:15 - New York Times Excerpt  03:07 - Substance Use and Overdose Risk During Pregnancy 04:07 - Addressing Stigma in Addiction Treatment 19:18 - Effective Support Systems for Pregnant People with Addiction 13:56 - Medication for Opioid Use Disorder During Pregnancy 18:00 - Postpartum Care and Overdose Risk 27:06 - Polysubstance Use and Alcohol Use Disorder 33:38 - Key Takeaways 35:10 - Conclusion and Additional Learning Opportunities 📋 Key Takeaways Recognize Pregnancy as a Motivator for Change: Pregnancy can inspire individuals to seek help and begin recovery. Leveraging this motivation through empowering, respectful care can improve outcomes for both parent and baby.  Understand Vulnerability in Substance Use: Addressing underlying vulnerabilities that often contribute to substance use, such as trauma, mental health conditions, and social factors, through compassionate care is essential to supporting recovery.   Foster Trust by Reducing Stigma: Creating nonjudgmental healthcare environments, along with respectful, supportive patient-provider relationships, encourages engagement and improves treatment outcomes.  Promote Evidence-Based Treatment During Pregnancy: Medications for opioid and alcohol use disorders are safe and effective during pregnancy. Addressing misinformation and normalizing these treatments can help improve access and reduce harm.  Normalize Return to Use as Part of Recovery: Recovery is rarely linear. Approaching return to use with empathy, as a step in the process, encourages long-term engagement and helps reduce shame.  Deliver Empathic, Individualized Care: Active listening, empathy, and individualized care planning help build trust, deepen understanding, and guide effective, patient-centered interventions.  Implement Team-Based Support: Pregnant individuals with substance use disorders often face complex medical, social, and behavioral health challenges. Coordinated, interdisciplinary care is essential for addressing these needs holistically.  🔗 Resources ASAM’s Clinical Tips Microlearning Video Series: Women and Addiction Engaging Families and Care Providers in Women’s SUD Treatment Substance Use Among Aging Women Pregnancy and Substance Use Disorders Dressing Motivated Behaviors in Women with SUD ASAM’s Women and Addiction Education and Resources: Explore HERE Patient-Centered Care for Women with Substance Use Disorders – Online Course Clinical Guidance for Treating Pregnant and Parenting Women with Opioid Use Disorder and Their Infants: Substance Abuse and Mental Health Services Administration. HHS Publication No. (SMA) 18-5054. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2018.  Your Words Matter – Language Showing Compassion and Care for Women, Infants, Families, and Communities Impacted by Substance Use Disorder: Offers tips on how to use person-first language and which terms to avoid using to reduce stigma and negative bias when discussing addiction or substance use disorder with pregnant women and mothers. The ASAM Principles of Addiction Medicine (Seventh Edition): Substance Use During Pregnancy: Weaver MF, Jones HE, Wunsch MJ. Substance Use During Pregnancy. In Miller S, Rosenthal RN, Levy S, Saxon AJ, Tetrault JM, Wakeman SE. (Eds), The ASAM Principles of Addiction Medicine (Seventh Edition). American Society of Addiction Medicine, Inc.; 2024:1509-1529. 📢 Join the Discussion Share your thoughts using #ASAMPracticePearls — we’d love to hear from you!  

In this episode of ASAM Practice Pearls, Dr. Peter Selby and Dr. Hendree Jones discuss the importance of implementing gender-responsive and trauma-informed care in addiction treatment. They offer insights on recognizing trauma in patients, creating safer treatment environments, addressing gender-specific treatment gaps, and emphasizing the importance of language and empathy in clinical practice. Together, they highlight the positive impact that a compassionate and inclusive approach can have on patient care and treatment outcomes. ----more---- Looking for this episode's transcript? Download it HERE We want to hear from you! Please take our short, five-minute survey HERE or email us at education@asam.org. Host Peter Selby, MBBS, CCFP(AM), FCFP, FASAM  Dr. Peter Selby is a Senior Scientist and Senior Medical Consultant at the Centre for Addiction and Mental Health (CAMH) and Vice-Chair, Research, and Giblon Professor in Family Medicine at the University of Toronto. His research focuses on innovative methods to understand and treat addictive behaviors and their comorbidities. He utilizes technology to scale and test health interventions, with his cohort of over 400,000 treated smokers in Ontario serving as an example. Dr. Selby has received over $100 million in grant funding from CIHR, NIH, and the Ministry of Health and has published more than 200 peer-reviewed articles. His most recent research program utilizes a Learning Health Systems approach to investigate how technology-equitable, collaborative care can enhance the delivery of evidence-based interventions to the patient while providing a more satisfying care experience for patients and providers across systems. Expert Hendree Jones, PhD Dr. Hendree Jones is a licensed psychologist and an internationally recognized expert in the development and examination of both behavioral and pharmacologic treatments for pregnant women and their children in risky life situations. She was the Division Director of UNC Horizons for a decade and, in May of 2023, stepped into a Senior Advisor role for Horizons to take on several national policy and international policy projects. Expertscape ranks Dr. Jones as a top world expert in neonatal abstinence syndrome and opioid-related disorders. She has received continuous National Institutes of Health funding since 1994 and has written more than 350 publications. Dr. Jones has also authored two books, one on treating patients for substance use disorders and the other on comprehensive care for women who are pregnant and have substance use disorders. She has also written multiple textbook chapters on the topic of pregnancy and addiction, as well as 17 courses for adult learners on topics of substance use disorder treatment (WISE, CHILD, PEERS, ALLIES, etc.). Dr. Jones has co-authored multiple national and international guidelines on the topic of caring for pregnant and post-pregnant patients with substance use disorders and their children, including those published by the WHO, SAMHSA, and ASAM. She also co-authored both the women’s and children’s section of the UN International Standards for the Treatment of Drug Use Disorders and the UN guidelines on prevention and treatment for girls and women. In 2020, Dr. Jones won the ASAM R. Brinkley Smithers and Distinguished Scientist Award. In 2024, she won the MED Brady-Schuster Division 28 American Psychological Association award for lifetime achievement for contribution to addiction science. She consults for the UN and the WHO and is a member of the NIH’s HEAL multidisciplinary working group and the Advisory Committee on Research on Women's Health. Dr. Jones has been involved in over 43 projects around the world focused on improving the lives of children, women, and families. 📖 Show Segments 00:05 - Introduction  01:09 - Patient Story: The Impact of Trauma on Women with Addictions 03:34 - Principles of Gender Responsive and Trauma-Informed Care 05:41 - Language and Communication in Addiction Treatment 08:06 - Challenges and Solutions in Implementing Trauma-Informed Care 17:17 - Biological and Gender Differences in Addiction 17:30 - Addressing Treatment Gaps for Women in Addiction Care 23:56 - Practical Steps for Trauma-Informed Care in Clinical Practice 27:08 - Conclusion and Additional Learning Opportunities 📋 Key Takeaways Implement Trauma-Informed Care: Trauma plays a significant role in women's addiction, requiring a trauma-informed approach to care that considers not just the events but also the lasting effects and individual experiences of trauma. Create Safe, Supportive Environment: Fostering a safe, transparent, and non-punitive environment is crucial for effective trauma-informed care. This includes considering physical surroundings, psychological safety, and the overall treatment environment to create a more welcoming and less anxiety-inducing environment. Use Respectful, Non-Stigmatizing Language: The language used by providers can significantly impact the comfort and dignity of patients. Avoiding stigmatizing terms and promoting respectful communication are essential to building trust between healthcare providers and patients. Implement a Gender-Responsive Approach: There are biological and social differences in how women experience addiction and substance use. Healthcare providers need to address these unique needs, such as offering targeted support and addressing gender-specific triggers. Address Systemic Issues and Barriers: Barriers to implementing trauma-informed care can be both systemic and cultural. Securing buy-in from all stakeholders, addressing staff concerns and fears, and ensuring consistent and positive reinforcement of new practices are important steps in overcoming organizational and cultural barriers. Foster Collaborative Care: Engaging patients as partners in their own treatment plans through shared decision-making and understanding their individual needs and triggers can enhance engagement and outcomes. This collaborative approach also applies to interactions with team members and creating a supportive work environment. Engage with Compassion and Curiosity: Maintaining empathy, validating patients' experiences, being genuinely curious about their needs and stories, and using mindfulness techniques can build stronger, more supportive patient-provider relationships, ultimately improving recovery. 🔗 Resources ASAM’s Women and Addiction Education and Resources: Explore HERE Trauma-Responsive Care for Women with Substance Use Disorders – Factsheet Patient-Centered Care for Women with Substance Use Disorders – Online Course ASAM’s Clinical Tips Microlearning Video Series: Women and Addiction Engaging Families and Care Providers in Women’s SUD Treatment Substance Use Among Aging Women Pregnancy and Substance Use Disorders Dressing Motivated Behaviors in Women with SUD NIDA Substance Use in Women Research Report: Provides an overview of how women not only use and respond to substances differently than men but also face unique biological, psychological, and social barriers in developing, experiencing, and treating substance use disorders. Your Words Matter – Language Showing Compassion and Care for Women, Infants, Families, and Communities Impacted by Substance Use Disorder: Offers tips on how to use person-first language and which terms to avoid using to reduce stigma and negative bias when discussing addiction or substance use disorder with pregnant women and mothers. Opioid-Use Disorders in Pregnancy: Management Guidelines for Improving Outcomes: Intimate Partner Violence, Pregnancy, and Substance Use Disorder: Soper R, Jones H. Intimate Partner Violence, Pregnancy and Substance Use Disorder. In: Wright (Ed.), Opioid-Use Disorders in Pregnancy: Management Guidelines for Improving Outcomes. Cambridge University Press; 2018:41-48. Treatment Approaches in Women with Substance Use Disorders Who Become Pregnant: Jones H. Treatment Approaches in Women with Substance Use Disorders Who Become Pregnant. In: Wright T (Ed.), Opioid-Use Disorders in Pregnancy: Management Guidelines for Improving Outcomes. Cambridge University Press; 2018:72-83. The ASAM Principles of Addiction Medicine (Seventh Edition): Substance Use During Pregnancy: Weaver MF, Jones HE, Wunsch MJ. Substance Use During Pregnancy. In Miller S, Rosenthal RN, Levy S, Saxon AJ, Tetrault JM, Wakeman SE. (Eds), The ASAM Principles of Addiction Medicine (Seventh Edition). American Society of Addiction Medicine, Inc.; 2024:1509-1529. 📢 Join the Discussion Share your thoughts using #ASAMPracticePearls — we’d love to hear from you!  

In this episode of ASAM Practice Pearls, Dr. Peter Selby and Dr. John Corrigan explore the intersection of brain injury and addiction treatment. They introduce the concept of neurologic-informed care and discuss how cognitive impairments from brain injuries impact addiction recovery. The episode explores practical strategies for screening, treatment, and creating supportive environments to enhance outcomes for individuals with co-occurring brain injury and substance use disorder. ----more---- Looking for this episode's transcript? Download it HERE Have an idea for a future episode? Share it with us at education@asam.org. Host Peter Selby, MBBS, CCFP(AM), FCFP, FASAM  Dr. Peter Selby is a Senior Scientist and Senior Medical Consultant at the Centre for Addiction and Mental Health (CAMH) and Vice-Chair, Research, and Giblon Professor in Family Medicine at the University of Toronto. His research focuses on innovative methods to understand and treat addictive behaviors and their comorbidities. He utilizes technology to scale and test health interventions, with his cohort of over 400,000 treated smokers in Ontario serving as an example. Dr. Selby has received over $100 million in grant funding from CIHR, NIH, and the Ministry of Health and has published more than 200 peer-reviewed articles. His most recent research program utilizes a Learning Health Systems approach to investigate how technology-equitable, collaborative care can enhance the delivery of evidence-based interventions to the patient while providing a more satisfying care experience for patients and providers across systems. Expert John Corrigan, PhD, ABPP Dr. John Corrigan is a professor in the Department of Physical Medicine and Rehabilitation at Ohio State University and Director of the Ohio Valley Center for Brain Injury Prevention and Rehabilitation. His research interests include a focus on education and treatment for individuals with co-occurring brain injury and substance use, a critical area in both clinical practice and public health. Dr. Corrigan is Editor-in-Chief of the Journal of Head Trauma Rehabilitation. He has been the PI and co-PI of the Ohio Regional Traumatic Brain Injury Model System since 1997 and chaired the Executive Committee of the TBI Model Systems Project Directors from 2007-2017. Dr. Corrigan is the National Research Director for the Brain Injury Association of America. Since 2013 he has served as the Director of the Ohio Brain Injury Program, which is the designated lead agency in the state of Ohio for policy and planning related to living with brain injury. He has more than 200 peer reviewed publications and has received many awards for his service and research in brain injury rehabilitation, including the Brain Injury Association of America’s William Fields Caveness Award, the 2007 Robert L. Moody Prize, the Gold Key Award from the American Congress of Rehabilitation Medicine, and the Lifetime Achievement Award from the International Brain Injury Association. 📖 Show Segments 00:05 - Introduction  02:20 - Understanding Neurologic-Informed Care 05:53 - The Hidden Epidemic in Addiction Medicine 08:03 - Anoxic and Hypoxic Brain Injuries 15:19 - Practical Screening and Treatment Modifications 22:05 - Accommodations and Environmental Factors 24:48 - Conclusion and Additional Learning Opportunities 📋 Key Takeaways Recognize and Screen for Brain Injuries: Brain injuries, including traumatic brain injuries (TBI) and anoxic/hypoxic injuries, are common but often overlooked in mental health and addiction treatment. Standardized screening at intake, using detailed patient histories and cognitive assessments, is crucial for accurate identification and effective care planning.  Implement Neurologic-Informed Care: Similar to trauma-informed Care, this approach integrates an understanding of neurologic impairments into all aspects of treatment. It highlights the importance of understanding cognitive limits, modifying care approaches, and fostering an environment that supports recovery for those with neurological impairments. Understand Cognitive Impacts on Recovery: Brain injuries often impair attention, memory, processing speed, and executive function—issues that can impact treatment adherence and be mistaken for a lack of motivation. These impairments can also increase the risk of substance misuse and make recovery more challenging. Adapt Treatment Environments and Methods: Creating supportive environments, such as reducing noise, adjusting lighting, and allowing for restlessness, along with practical strategies like visual aids, repetition, and hands-on tools, can help individuals with cognitive impairments better engage in treatment, retain information and make the behavior changes needed for successful recovery. Address Sleep Disorders: Sleep disturbances are common in both brain injury and substance use populations. Identifying and treating sleep disorders can improve cognitive functioning and support overall treatment success.  Individualized Care to Reduce Substance Use Risks: Individuals with brain injuries face an increased risk of substance misuse and relapse. Individualized, neurologically informed accommodations can reduce these risks and support more sustainable recovery outcomes.  🔗 Resources Accommodating the Symptoms of Traumatic Brain Injury: This booklet from the Ohio Valley Center for Brain Injury Prevention and Rehabilitation provides clear guidance on understanding the effects of TBIs and offers practical, individualized accommodation strategies to support full participation in work, school, and community life.  INROADS Issue Brief: Opioid Use Among Persons with Traumatic Brain Injury: In this brief, we will discuss the relationship between TBI, opioid use disorder, and targeted policy solutions to improve short- and long-term outcomes.  Modifying Clinical Interventions for TBI: This brief from the ACL's Traumatic Brain Injury (TBI) Technical Assistance and Resource Center (TARC) highlights considerations and best practices for diagnosing and treating behavioral health disorders in people with TBI.  SAMHSA Advisory: Treating Patients with TBI: This Advisory summarizes key elements of TBI and describes its relevance to behavioral health, including recommendations for behavioral health professionals. Traumatic Brain Injury and SUD Series: The Mid-America and Mountain Plains Addiction Technology Transfer Centers (ATTCs), in partnership with the National Association of State Head Injury Administrators (NASHIA), offer recorded webinars and a toolkit on the intersection between brain injury and substance use disorders. The ASAM Criteria: The most widely used and comprehensive set of standards for placement, continued service, and transfer of patients with addiction and co-occurring conditions. Chapter 19 of the 4th Edition Adult version addresses cognitive impairment and neurologic-informed care.  ASAM Criteria Curriculum: Explore the different trainings ASAM offers on both the 3rd and 4th Edition ASAM Criteria.   📢 Join the Discussion Share your thoughts using #ASAMPracticePearls — we’d love to hear from you!  

In this episode of ASAM Practice Pearls, Dr. Peter Selby and Dr. Emily Brunner explore behavioral addictions—including gaming, gambling, sex, and social media. They discuss how these behaviors impact the brain, how they present clinically, and how to recognize and treat them using evidence-based approaches. The episode emphasizes the importance of validating these conditions and offering appropriate care.  ----more---- Looking for this episode's transcript? Download it HERE Have an idea for a future episode? Share it with us at education@asam.org. Host Peter Selby, MBBS, CCFP(AM), FCFP, FASAM  Dr. Peter Selby is a Senior Scientist and Senior Medical Consultant at the Centre for Addiction and Mental Health (CAMH) and Vice-Chair, Research, and Giblon Professor in Family Medicine at the University of Toronto. His research focuses on innovative methods to understand and treat addictive behaviors and their comorbidities. He utilizes technology to scale and test health interventions, with his cohort of over 400,000 treated smokers in Ontario serving as an example. Dr. Selby has received over $100 million in grant funding from CIHR, NIH, and the Ministry of Health and has published more than 200 peer-reviewed articles. His most recent research program utilizes a Learning Health Systems approach to investigate how technology-equitable, collaborative care can enhance the delivery of evidence-based interventions to the patient while providing a more satisfying care experience for patients and providers across systems. Expert Emily Brunner, MD, DFASAM  Dr. Emily Brunner is board-certified in family medicine and a distinguished fellow in addiction medicine. She has experience treating addiction in both inpatient and outpatient settings. She specializes in trauma-informed clinical treatment of substance use disorders with a comprehensive and compassionate approach. Dr. Brunner has been involved in leadership of the Minnesota Society of Addiction Medicine and is now on the national board of the American Society of Addiction. She is a passionate advocate for improving the care of patients with substance use disorder across the healthcare system, specifically in advocating for increased utilization of medications for opioid use disorder across all levels of care. Minnesota Magazine recognized her as a Top Doctor for Addiction Medicine in 2020 and 2021. She is the medical director of Gateway Recovery and Recovering Hope and does training on behalf of the Hazelden Betty Ford Foundation.  📖 Show Segments 00:05 - Introduction  02:03 -  How Behavioral Addictions Compare to Substance Use Disorders 04:18 - Clinical Presentation and Initial Screening 06:19 - Emerging Neuroscience and Research 09:15 - Diagnostic and Screening Tools 12:56 - Patient Experience in the Healthcare System 14:13 - Evidence-based Interventions 19:11 - Co-occurring Conditions and Risk Factors 21:14 - Advice to Clinicians 23:40 - Regulation and Future Directions 25:53 - Conclusion and Additional Learning Opportunities 📋 Key Takeaways Behavioral Addictions are Real Diseases: Behavioral addictions such as gaming, gambling, and social media are increasingly recognized as legitimate disorders. They share similar brain mechanisms and clinical presentations with substance use disorders, including loss of control, impaired functioning, and continued use despite harm.  Emerging Neuroscience: Studies using fMRI have shown changes in brain structures in gaming and gambling disorders similar to those in substance addiction.  Screening and Diagnosis: Various validated screening tools exist for different behavioral addictions; it is crucial to familiarize oneself with and integrate them into clinical practice.  Treatment Approaches: Evidence-based treatments include cognitive-behavioral therapy (CBT), motivational interviewing, and contingency management. Additionally, certain medications, such as naltrexone and bupropion, have also shown some evidence of effectiveness. GLP-1 agonists may be another option in the future.   Co-Occurring Conditions: Individuals with behavioral addictions often have co-occurring mental health issues such as anxiety, depression, and other substance use disorders.  Regulatory Needs: There is a need for better regulation to protect young people from addictive technologies and predatory behaviors.  The Importance of Listening: Patients often feel dismissed when discussing behavioral addictions. Take patients' reports seriously and consider treatment options when appropriate.  🔗 Resources ASAM’s 56th Annual Conference Session - Games, Sex, and Social Media: Current Perspectives Register HERE  Bergen Social Media Addiction Scale: A screening instrument to measure dependence on social media.  Hypersexual Behavior Inventory: A screening instrument to help measure compulsive sexual behavior.  Lie-Bet Questionnaire: A screening instrument used to screen for gambling addiction.  The IGDT-10: A screening instrument to assess internet gaming disorder.  The South Oaks Gambling Screen: A 20-question screening instrument for gambling addiction.  Yale Food Addiction Scale: A screening instrument designed specifically to assess signs of addictive-like eating behavior.  Careless People: A Cautionary Tale of Power, Greed, and Lost Idealism by Sarah Winn-Williams  The ASAM Criteria: Call for Applications for Behavioral Addiction Volume Editors - ASAM is seeking experts in behavioral addictions (e.g., problem gambling, internet/social media addiction, problem gaming, compulsive sex, pornography addiction, and food addiction) to serve as Editors for the Fourth Edition of The ASAM Criteria, Behavioral Addictions Volume. This volume will propose principles for managing behavioral addiction and organizing the addiction treatment system.  📢 Join the Discussion Share your thoughts using #ASAMPracticePearls — we’d love to hear from you!  

In recognition of Sickle Cell Awareness Day (June 19), this episode of ASAM Practice Pearls features host Dr. Peter Selby and expert Dr. Andrew Smith as they explore the complex intersection of sickle cell disease (SCD), pain, and addiction. They discuss the challenges individuals with SCD face in accessing effective pain management, often compounded by stigma and opioid-related concerns. The episode provides insights into evidence-based treatments, the balance between pain relief and opioid dependence risks, and strategies for compassionate, patient-centered care. ----more---- Looking for this episode's transcript? Download it HERE Have an idea for a future episode? Share it with us at education@asam.org. Host Peter Selby, MBBS, CCFP(AM), FCFP, FASAM  Dr. Peter Selby is a Senior Scientist and Senior Medical Consultant at the Centre for Addiction and Mental Health (CAMH) and Vice-Chair, Research, and Giblon Professor in Family Medicine at the University of Toronto. His research focuses on innovative methods to understand and treat addictive behaviors and their comorbidities. He utilizes technology to scale and test health interventions, with his cohort of over 400,000 treated smokers in Ontario serving as an example. Dr. Selby has received over $100 million in grant funding from CIHR, NIH, and the Ministry of Health and has published more than 200 peer-reviewed articles. His most recent research program utilizes a Learning Health Systems approach to investigate how technology-equitable, collaborative care can enhance the delivery of evidence-based interventions to the patient while providing a more satisfying care experience for patients and providers across systems. Expert Andrew J. Smith, MDCM  Dr. Andrew J. Smith is a Staff Physician, Pain and Addiction Medicine and Medical Lead of the Interprofessional Pain and Addiction Recovery Clinic at the Centre for Addiction and Mental Health in Toronto. He comes from McGill Medicine, University of Washington Neurology, and UCLA Medical Genetics, initially focusing on neurodevelopmental medicine. Frustrated by how many of his young patients with learning disabilities would fall into substance use problems despite early successes, he retooled in the field of addiction medicine. He became the first in Canada to do a combined clinical fellowship in pain and addictions at CAMH and Mount Sinai Hospital. He now leads an Interprofessional team dedicated to helping people with substance use disorders, severe mental health conditions, and chronic pain improve their pain, function, and quality of life. Dr. Smith is passionate about improving access to better care for patients with chronic pain and addiction, educating patients, families, and clinicians about pain and addiction, and reducing stigma. He is an executive and hub member of ECHO Ontario Chronic Pain — a telementoring resource for primary care clinicians to enhance their skills and confidence in managing more of their own patients who have complex pain and opioid issues. 📖 Show Segments 00:05 - Introduction  00:26 - Dr. Selby’s Journey into Pain Management and Addiction Medicine 02:32 - Understanding Pain in SCD 04:40 - A Holistic Approach to Pain Management 06:15 - Reducing Stigma and Taking a Non-Judgmental Approach 09:16 - Discussing Opioid Use with Patients 12:36 - Assessing Patients with SCD 13:11 - Diagnosing Use Disorders in Patients with SCD 15:33 - Preparing for Emergency Room Visits 17:10 - The Importance of Patient Autonomy 18:31 - A Patient Success Story 21:41 - Conclusion and Additional Learning Opportunities 📋 Key Takeaways “Pain is Pain is Pain”: There are different kinds of pain in SCD. People with SCD experience acute pain from vaso-occlusive crises, chronic pain, sensitization-related pain, and acute flare-ups that may not necessarily be vaso-occlusive. Dual Diagnosis Complexity: Individuals with SCD may have co-occurring pain and addiction. Effective treatment plans need to address both components without invalidating the patient's experience of pain. Build Rapport and Use a Holistic Approach: Establishing a trusting and safe environment is crucial. Practitioners should take a trauma-informed and motivational approach to reduce stigma and defensiveness, addressing not only the physical aspects of pain but also the psychological, social, and contextual factors. Patient Autonomy and Collaboration: Empower patients by involving them in the decision-making process and providing them with information and options to improve treatment adherence and outcomes. Use of Buprenorphine: Buprenorphine has been effective in treating chronic pain in patients with SCD and can be used in divided doses or as a single dose, providing a safer alternative to traditional opioids. Universal Precautions Approach: Screening for risk factors and potential opioid misuse should be part of the assessment process. Practitioners should normalize discussions about substance use and develop a non-judgmental dialogue. Emergency Department Challenges: Educate both patients and emergency department staff about managing pain in patients with opioid use disorder. Care passports can help guide treatment during episodes of pain crisis. 🔗 Resources ASAM’s Pain and Addiction Curriculum: Explore the different courses and resources ASAM offers for treating patients with pain and addiction. ASAM’s Motivational Interviewing Courses: Explore the different courses and resources ASAM offers to develop techniques and practice skills in motivational interviewing. Sickle Cell Disease Association of America (SCDAA): A national organization dedicated to advocating for individuals affected by SCD. I Believe in Therapy Toolkit by SCDAA: A resource that addresses the stigma surrounding mental health in the Black community and encourages seeking therapy and support. June 19th is World Sickle Cell Awareness Day - check for local events on the Sickle Cell Disease Association of America 📢 Join the Discussion Share your thoughts using #ASAMPracticePearls — we’d love to hear from you!  

In this episode of ASAM Practice Pearls, Dr. Stephen Taylor welcomes Dr. Marc Fishman for an insightful conversation on improving engagement and retention of youth in medication treatment for opioid use disorder (MOUD). They examine the unique challenges young people face and present developmentally informed strategies—including prevention, family involvement, and assertive outreach. The discussion highlights the importance of a medication-first approach and building partnerships with schools and communities to foster long-term recovery. ----more---- Looking for this episode's transcript? Download it HERE Have an idea for a future episode? Share it with us at education@asam.org. Host Stephen M. Taylor, MD, MPH, DFAPA, DFASAM Dr. Stephen M. Taylor is ASAM's President and is board-certified in general psychiatry, child and adolescent psychiatry, addiction psychiatry, and addiction medicine. With over 30 years of practice experience, Dr. Taylor is dedicated to helping adolescents and adults overcome addiction and co-occurring psychiatric disorders. He has served as the Medical Director of the NBA and NBPA Player Assistance and Anti-Drug Program for 16 years and is the Chief Medical Officer of Pathway Healthcare, which operates multiple outpatient addiction and mental health treatment offices across six states.  Expert Marc Fishman, MD Dr. Marc Fishman is a specialist in addiction psychiatry and addiction medicine. He is a member of the faculty of the Department of Psychiatry at the Johns Hopkins University School of Medicine. He leads Maryland Treatment Centers, which offers programs for residential and outpatient treatment of SUD and co-occurring disorders in adolescents, young adults, and adults. He has been a principal investigator on numerous research studies in addiction and has published extensively in the field. His academic focus has been on medication treatment for OUD and other SUDs, treatment of opioid use disorder in youth, models of care, and treatment engagement strategies. Dr. Fishman served as a co-editor for past editions of ASAM’s Patient Placement Criteria, leading the adolescent section, and served as the chief editor for the ASAM PPC Supplement on Pharmacotherapies for Alcohol Use Disorders. He was a member of the Guideline Committee that developed the ASAM National Practice Guideline for the Treatment of OUD in 2015 and its update in 2020. He is the chair of the Adolescent SIG for ASAM. He is a Past President of the Maryland Society of Addiction Medicine and a current member of its Board. 📖 Show Segments 00:05 – Introduction 00:17 – Introductory Vignette: Pediatric Onset of Addiction  02:26 – Current Statistics and Challenges in Youth OUD  03:58 – Early Intervention  05:38 – Three Types of Prevention  06:17 – Barriers and Challenges to Effective Treatment for Youth  10:36 – The Role of Family in Treatment   15:47 – Unique Strengths of Youth  17:44 – Extended-Release Medications for OUD 21:21 – Motivating Youth in Treatment  24:49 – Engaging Schools in Care 26:56 – Assertive Approaches to Youth OUD Treatment 29:32 – Final Thoughts 31:47 – Conclusion and Additional Learning Opportunities 📋 Key Takeaways Initiate Early Intervention: Addiction is a developmental disorder of pediatric onset. Early intervention is necessary to prevent the disorder from progressing to its advanced stages.  Encourage Family Involvement: Incorporate family or a designated concerned significant other in the treatment process to support the young patient and improve adherence.  Implement Youth-Specific Treatment Approaches: Understand the unique developmental and psychological challenges youths face, and tailor engagement methods to include humor, their interests, therapeutic alliances, and empathy.  Promote Collaboration with Other Youth-Friendly Settings: Collaborate with schools, pediatricians, and other primary care practitioners to identify and support youth with substance use to promote treatment and facilitate their reintegration into educational environments.  Adopt an Assertive Approach: Utilize assertive outreach methods, such as frequent texting and continuous communication, to maintain young patients' engagement in their treatment plans.  Employ a Medication Forward Approach: Advocate for the use of medications for opioid use disorder (MOUD) early in the treatment process as a foundational step towards recovery.  Integrate Holistic Treatment Plans: Develop multi-component treatment plans that address not only the substance use but also the overall well-being and functional aspects of the young person’s life.  Utilize Extended-Release Medications: Extended-release medications, such as buprenorphine and naltrexone, are safe and effective options that can improve adherence and retention in treatment among young people. Promote Location-Based Interventions: Make treatments accessible by integrating them into environments where youths already are, such as schools, family practices, specialized addiction treatment settings, or juvenile justice settings.  Set Realistic Expectations: Medication doesn’t have to be a lifelong commitment. Focus on the present moment, setting realistic, short-term treatment goals to establish initial stabilization and momentum for recovery.  🔗 Resources ASAM’s 56th Annual Conference Session: Improving Outcomes for Youth OUD Treatment Register HERE Joint Meeting on Youth Prevention, Treatment, and Recovery: A conference focused on supporting youth in recovery from substance use. Youth Opioid Recovery Support (YORS) Intervention Study: A clinical trial designed to improve medication adherence in young adults 18–28 with opioid use disorder (OUD) through home delivery of extended-release medications, family involvement, digital communication outreach, and contingency management to increase treatment engagement and reduce return to use rates.  A Pilot Randomized Controlled Trial of Assertive Treatment Including Family Involvement and Home Delivery of Medication for Young Adults With Opioid Use Disorder: Fishman M, Wenzel K, Vo H, Wildberger J, Burgower R. Addiction. 2021;116(3):548-557. doi:10.1111/add.15181 An Assertive Community Intervention to Engage Youth with Opioid Use Disorder and Their Families: Wenzel K, Mallik-Kane K, Anderson K, Fishman M. Child Adolesc Psychiatr Clin N Am. 2024;33(4):709-728. doi:10.1016/j.chc.2024.02.007 Choice of Extended Release Medication for OUD in Young Adults (Buprenorphine or Naltrexone): A Pilot Enhancement of the Youth Opioid Recovery Support (YORS) Intervention: Wenzel K, Selby V, Wildberger J, Lavorato L, Thomas J, Fishman M. J Subst Abuse Treat. 2021;125:108306. doi:10.1016/j.jsat.2021.108306 Engagement, Initiation, and Retention in Medication Treatment for Opioid Use Disorder Among Young Adults: A Narrative Review of Challenges and Opportunities: Fishman M, Wenzel K, Gauthier P, et al. J Subst Use Addict Treat. 2024;166:209352. doi:10.1016/j.josat.2024.209352 The Use of Extended-Release Buprenorphine in the Treatment of Adolescent Opioid Use Disorder: A Case Series: Neptune A, Kaliamurthy S. J Addict Med. Published online February 3, 2025. doi:10.1097/ADM.0000000000001447 📢 Join the Discussion Share your thoughts using #ASAMPracticePearls — we’d love to hear from you!  

EP 04 🎙 Special Series: ASAM's 56th Annual Conference This episode is part of a special four-part series spotlighting key sessions from ASAM’s 56th Annual Conference.   In this episode of ASAM Practice Pearls, In this episode of ASAM Practice Pearls, Dr. Elizabeth Salisbury-Afshar is joined by Drs. Sarah Wakeman and Joshua Lee to review the most influential addiction medicine publications of 2024–2025. They discuss the criteria used to identify high-impact papers, highlight key findings, and explore how these insights can inform clinical practice and future research. ----more---- Looking for this episode's transcript? Download it HERE Have an idea for a future episode? Share it with us at education@asam.org. Host Elizabeth Salisbury-Afshar, MD, MPH, FAAFP, FACPM, DFASAM Dr. Elizabeth Salisbury-Afshar is a family medicine, preventive medicine/public health, and addiction medicine physician. She is an Associate Professor at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin. She is a core faculty member for the Addiction Medicine Fellowship at the University of Wisconsin, and her clinical roles include addiction medicine consult service and serving as medical director of a low-barrier walk-in clinic serving people who use substances. She is also the Program Director of the Preventive Medicine Residency at UW-Madison and Medical Director of Harm Reduction Services at the Wisconsin Division of Public Health. Dr. Salisbury-Afshar's work focuses on expanding access to evidence-based addiction treatment and harm reduction services. She has over 14 years of experience practicing in medically underserved settings. Dr. Salisbury-Afshar lectures nationally on addiction medicine topics, including the treatment of opioid use disorder, harm reduction, the intersection of addiction and the criminal legal system, and public health approaches to reduce overdose mortality. Dr. Salisbury-Afshar is actively involved in ASAM, where she currently serves as the Vice Chair of the Medical Education Council, Course Director of the ASAM-All Rise treatment courts courses, a member of the ASAM Conference Planning Committee, and the Chair of Harm Reduction Special Interest Group. Expert Sarah E. Wakeman, MD, FASAM Dr. Sarah Wakeman is the Medical Director for the Mass General Hospital Program for Substance Use & Addiction Services, Program Director of the Mass General Addiction Medicine fellowship, Senior Medical Director for Substance Use Disorder at Mass General Brigham, and an Associate Professor of Medicine at Harvard Medical School. She received her AB from Brown University and her MD from Brown Medical School. She completed residency training in internal medicine and served as Chief Medical Resident at Mass General Hospital. She is a diplomate and fellow of the American Board of Addiction Medicine and board-certified in Addiction Medicine by the American Board of Preventive Medicine. She served on Massachusetts' Governor Baker’s Opioid Addiction Working Group. Nationally, she serves on the American Society of Addiction Medicine Ethics Committee. Clinically, she provides specialty addiction and general medical care in the inpatient and outpatient setting at Mass General Hospital and the Mass General Charlestown Health Center. Her research interests include evaluating models for integrated substance use disorder treatment in general medical settings, low threshold treatment models, recovery coaching, physician attitudes and practice related to substance use disorder, and screening for substance use in primary care. Expert Joshua D. Lee, MD, MSc Dr. Joshua Lee is a Professor in the Department of Population Health and Medicine/General Internal Medicine and Clinical Innovation at the NYU Grossman School of Medicine. He is Co-Director of the Section on Tobacco, Alcohol, and Drug Use and Program Director of the NYU Fellowship in Addiction Medicine. He is a clinician-researcher focused on addiction pharmacotherapies in primary care and criminal justice populations.  📖 Show Segments 00:05 – Introduction 02:34 – History and Evolution of the Annual Review Session 03:44 – Methodology for Selecting High-Impact Articles 06:52 – Top Papers of the Year: Semaglutide and Fentanyl Seizures 11:44 – Emerging Trends in Addiction Medicine 14:40 – Innovations in Buprenorphine Initiation 18:52 – Landmark Clinical Trials on Reducing Overdose Deaths 26:38 – Impact of Addiction on Adolescents and Parental Loss 31:00 – Final Thoughts 31:50 – Conclusion and Additional Learning Opportunities 📋 Key Takeaways GLP-1s for Substance Use Disorders: Significant findings showed reduced alcohol consumption among non-treatment-seeking individuals randomized to treatment with semaglutide. Additional findings indicated a link between GLP-1 drugs and improved outcomes in those with cannabis, opioid, and tobacco use disorders, suggesting a potential for improved addiction outcomes.   Fentanyl Seizure Trends: Law enforcement data shows increasing fentanyl seizures, especially in pill form, predominantly in the Western U.S.  Buprenorphine Initiation Strategies: New studies found that in patients with minimal to mild opioid withdrawal, a seven-day injectable buprenorphine induction strategy was associated with a low rate of precipitated opioid withdrawal and kept patients more engaged in treatment after the first dose.  Consult Services Impact on Opioid Use Disorder: Studies show that having an addiction consult team, in addition to the usual care team, increased MOUD initiation rates and post-discharge engagement.  Differences in Overdose Death Rates: While data indicate that overall overdose death rates have declined, minority communities continue to experience an increase in overdose deaths.   Adolescents and Parental Loss to Overdose: Updated data shows that more than half a million children have lost parents in the last decade to drug overdoses.  Delta-8-THC Trends in Younger Populations: Data shows an increase in Delta-8-THC use among adolescents, particularly in non-legal states. We should continue to monitor these trends for future public health interventions.   Declining Rates of Tobacco Products and E-cigarette Use: Recent data shows declining rates of tobacco and e-cigarette use among adolescents; however, there has been an emerging uptick in the use of nicotine pouches, which should be monitored.  🔗 Resources ASAM’s 56th Annual Conference Session: Annual Review of Addiction Medicine: Highest Impact Publications 2024-2025 Register HERE Addiction Consultation Services for Opioid Use Disorder Treatment Initiation and Engagement: A Randomized Clinical Trial: McNeely J, Wang SS, Rostam Abadi Y, et al. JAMA Intern Med. 2024;184(9):1106-1115. doi:10.1001/jamainternmed.2024.3422  Adolescent ∆8-THC and Marijuana Use in the US: Harlow AF, Miech RA, Leventhal AM. JAMA. 2024;331(10):861-865. doi:10.1001/jama.2024.0865  Association of Semaglutide With Tobacco Use Disorder in Patients With Type 2 Diabetes: Target Trial Emulation Using Real-World Data: Wang W, Volkow ND, Berger NA, Davis PB, Kaelber DC, Xu R. Ann Intern Med. 2024;177(8):1016-1027. doi:10.7326/M23-2718  Association of Semaglutide with Reduced Incidence and Relapse of Cannabis Use Disorder in Real-World Populations: A Retrospective Cohort Study: Wang W, Volkow ND, Berger NA, Davis PB, Kaelber DC, Xu R. Mol Psychiatry. 2024;29(8):2587-2598. doi:10.1038/s41380-024-02498-5  Estimated Number of Children Who Lost a Parent to Drug Overdose in the US From 2011 to 2021: Jones CM, Zhang K, Han B, et al. JAMA Psychiatry. 2024;81(8):789-796. doi:10.1001/jamapsychiatry.2024.0810  Extended-Release 7-Day Injectable Buprenorphine for Patients With Minimal to Mild Opioid Withdrawal: D'Onofrio G, Herring AA, Perrone J, et al. JAMA Netw Open. 2024;7(7):e2420702. doi:10.1001/jamanetworkopen.2024.20702  Community-Based Cluster-Randomized Trial to Reduce Opioid Overdose Deaths: HEALing Communities Study Consortium, Samet JH, El-Bassel N, et al. N Engl J Med. 2024;391(11):989-1001. doi:10.1056/NEJMoa2401177  Hospital Addiction Consultation Service and Opioid Use Disorder Treatment: The START Randomized Clinical Trial: Ober AJ, Murray-Krezan C, Page K, et al. JAMA Intern Med. 2025. doi:10.1001/jamainternmed.2024.8586   National and Regional Trends in Fentanyl Seizures in the United States, 2017-2023: Palamar JJ, Fitzgerald N, Carr TH, Cottler LB, Ciccarone D. Int J Drug Policy. 2025;138:104417. doi:10.1016/j.drugpo.2024.104417  Once-Weekly Semaglutide in Adults With Alcohol Use Disorder: A Randomized Clinical Trial: Hendershot CS, Bremmer MP, Paladino MB, et al. JAMA Psychiatry. 2025;82(4):395-405. doi:10.1001/jamapsychiatry.2024.4789  Semaglutide and Opioid Overdose Risk in Patients With Type 2 Diabetes and Opioid Use Disorder: Wang W, Volkow ND, Wang Q, et al. JAMA Netw Open. 2024;7(9):e2435247. doi:10.1001/jamanetworkopen.2024.35247  Tobacco Product Use Among Middle and High School Students - National Youth Tobacco Survey, United States, 2024: Jamal A, Park-Lee E, Birdsey J, et al. MMWR Morb Mortal Wkly Rep. 2024;73(41):917-924. Published 2024 Oct 17. doi:10.15585/mmwr.mm7341a2  📢 Join the Discussion Share your thoughts using #ASAMPracticePearls — we’d love to hear from you!       

EP 03 🎙 Special Series: ASAM's 56th Annual Conference This episode is part of a special four-part series spotlighting key sessions from ASAM’s 56th Annual Conference.   In this episode of ASAM Practice Pearls, In this episode of ASAM Practice Pearls, Dr. Elizabeth Salisbury-Afshar is joined by Drs. Rachel Haroz, Bill Soares, and Ryan McCormack to discuss their session, Methadone Initiation for Opioid Use Disorder in the Emergency Department. The episode covers implementation strategies, regulatory considerations, and practical steps for introducing methadone as a treatment option in emergency care. ----more---- Looking for this episode's transcript? Download it HERE Have an idea for a future episode? Share it with us at education@asam.org. Host Elizabeth Salisbury-Afshar, MD, MPH, FAAFP, FACPM, DFASAM Dr. Elizabeth Salisbury-Afshar is a family medicine, preventive medicine/public health, and addiction medicine physician. She is an Associate Professor at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin. She is a core faculty member for the Addiction Medicine Fellowship at the University of Wisconsin, and her clinical roles include addiction medicine consult service and serving as medical director of a low-barrier walk-in clinic serving people who use substances. She is also the Program Director of the Preventive Medicine Residency at UW-Madison and Medical Director of Harm Reduction Services at the Wisconsin Division of Public Health. Dr. Salisbury-Afshar's work focuses on expanding access to evidence-based addiction treatment and harm reduction services. She has over 14 years of experience practicing in medically underserved settings. Dr. Salisbury-Afshar lectures nationally on addiction medicine topics, including the treatment of opioid use disorder, harm reduction, the intersection of addiction and the criminal legal system, and public health approaches to reduce overdose mortality. Dr. Salisbury-Afshar is actively involved in ASAM, where she currently serves as the Vice Chair of the Medical Education Council, Course Director of the ASAM-All Rise treatment courts courses, a member of the ASAM Conference Planning Committee, and the Chair of Harm Reduction Special Interest Group. Expert Rachel Haroz, MD, FAACT Dr. Rachel Haroz is an associate professor in the Department of Emergency Medicine at Cooper Medical School of Rowan University, the division head of toxicology and addiction medicine, and the center head of the Cooper Center for Healing. She is board-certified in Emergency Medicine, Medical Toxicology, and Addiction Medicine, obtaining her BA in Biology from Brandeis University, her MD from Tufts University, and completing a residency in Emergency Medicine and a fellowship in Medical Toxicology. She has spent the last 20 years working in inner city emergency departments, mostly in the Camden area. She helped build and now staffs the Cooper Center for Healing in Camden, New Jersey, an addiction medicine specialty Center dedicated to treating patients with substance use disorders. In 2016, she helped create and implement BupeFirst ED, an initiative to prescribe buprenorphine from the Emergency Department and bridge patients to treatment with various community partners, and in 2019, she helped launch BupeFirst EMS, an innovative program aimed at initiating buprenorphine via paramedics in the field. She is also heavily involved in education as well as various NJ state initiatives to better serve patients struggling with substance use disorders. Expert Bill E. Soares III, MD, MS Dr. William (Bill) Soares is the Director of Harm Reduction Services in the Department of Emergency Medicine at Baystate Medical Center in Springfield, MA, and an Assistant Professor of Emergency Medicine at the University of Massachusetts Chan Medical School-Baystate. He is a practicing emergency and addiction medicine physician researcher who has spent the past 10 years focused on expanding medication treatments and harm reduction services for emergency department patients with opioid use disorder. In his role as Director of Harm Reduction Services, Dr. Soares oversees take-home Narcan, harm reduction safer supply distribution, buprenorphine, and methadone induction programs throughout the four emergency departments in the Baystate Health System. Dr. Soares’s research focuses on clinical decision-making in the emergency department. He has completed a NIDA K08 (1K08DA045933-01) project evaluating provider decisions to prescribe discharge opioid medications to patients presenting with an acutely painful condition. He currently has federal grants from NIDA, AHRQ, and SAMHSA focused on expanding medication treatment and harm reduction for people with substance use disorders. Recently, he led efforts to create a comprehensive inpatient addiction consultation service for the three Baystate community hospitals through a state-level opioid settlement fund grant administered through the Massachusetts Bureau of Substance Use and Addiction Services (BSAS). Expert Ryan McCormack, MD, MS Dr. Ryan McCormack is an Associate Professor of Emergency Medicine at the NYU Grossman School of Medicine and practices clinically in the Bellevue Hospital Emergency Department (ED). He is an NIH-funded clinical investigator who has led several multicenter trials with a history of funding from the National Institute on Drug Abuse (NIDA) and its Clinical Trials Network (CTN) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA). His research employs mixed quantitative and qualitative methods and implementation science approaches to translate efficacious behavioral treatments (e.g., motivational interviewing, case management) and pharmacotherapy (buprenorphine, methadone, naltrexone) for substance use disorders into ED settings with a particular focus on highly marginalized patient populations. 📖 Show Segments 00:05 – Introduction 01:16 – The Evolution of Addiction Treatment in Emergency Departments 04:19 – Implementing Methadone Protocols: Steps and Best Practices 09:40 – Building Relationships and Finding Partners 14:32 – Navigating Federal and State Regulations 20:23 – The Importance of Multiple Treatment Options 23:39 – Policy Changes and the Future of Methadone Access 27:18 – Conclusion and Additional Learning Opportunities 📋 Key Takeaways Promote Multidisciplinary Support: Engage various stakeholders within the hospital, including clinical champions, nurses, residents, and administrative staff, to support methadone initiation. Partner with OTPs: Establish strong relationships with local Opioid Treatment Programs (OTPs) to ensure continuity of care for patients once they leave the emergency department. Implement Flexible Protocols: Develop clear, adaptable protocols for methadone initiation that can be tailored to your institution’s specific needs and resources. Offer Education and Training: Provide education and training to emergency department staff about methadone, including its benefits, dosing, and risk management. Familiarize Yourself with Policy and Regulations: Understand and navigate federal, state, and local regulations related to methadone. For guidance, use resources such as the State Opioid Treatment Authorities (SOTA).  Support Future Policy Shifts: Advocate for policy initiatives and legislative changes that could make methadone prescribing more flexible and accessible, potentially decentralizing it from tightly regulated OTPs.  Identify a Clinical Champion: Addiction pathways are organized, multidisciplinary care plans to support clinical guidelines and protocols. Identifying a clinical champion to help implement these addiction pathways is important for improving patient care. Consider Methadone for OUD Treatment in the ED: Methadone is a valuable, life-saving option for treating opioid use disorder. Don’t be afraid to use it.  🔗 Resources ASAM’s 56th Annual Conference Session: Methadone Initiation for Opioid Use Disorder in the Emergency Department Register HERE Bridge Treatment: A program of the Public Health Institute that bridges emergency care and community health to create an integrated system that improves health and equity.  Clinical Toolkit - This toolkit provides referral algorithms, dosing strategies, risk stratification, literature/references, a guide to stakeholder recruitment and relationships, and tips of the trade.   Overview of Opioid Treatment Program Regulations by State – The Pew Charitable Trusts examines OTP regulations regarding access to care and patient experience across all 50 states and the District of Columbia as of June 2021.  State Opioid Treatment Authorities (SOTA) – SAMHSA provided list of SOTAs by state.  Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings: Geneva: World Health Organization; 2009.   Emergency Department Utilization of the Methadone "72-Hour Rule" to Bridge or Initiate and Link to Outpatient Treatment: Huo S, Heil J, Salzman MS, et al. Am J Emerg Med. 2025;89:209-215. doi:10.1016/j.ajem.2024.12.059  Emergency Department-Initiated Buprenorphine/Naloxone Treatment for Opioid Dependence: A Randomized Clinical Trial: D'Onofrio G, O'Connor PG, Pantalon MV, et al. JAMA. 2015;313(16):1636-1644. doi:10.1001/jama.2015.3474  📢 Join the Discussion Share your thoughts using #ASAMPracticePearls — we’d love to hear from you!       

EP 02 🎙 Special Series: ASAM's 56th Annual Conference This episode is part of a special four-part series spotlighting key sessions from ASAM’s 56th Annual Conference.   In this episode of ASAM Practice Pearls, In this episode of ASAM Practice Pearls, Dr. Stephen Taylor is joined by Drs. Jeanmarie Perrone and Alaina Steck to explore key insights from their session, Emerging Illicit Substances: What Clinicians Need to Know. The conversation covers emerging drugs of concern, clinical challenges, and practical strategies for clinicians navigating this rapidly evolving field. ----more---- Looking for this episode's transcript? Download it HERE Have an idea for a future episode? Share it with us at education@asam.org. Host Stephen M. Taylor, MD, MPH, DFAPA, DFASAM Dr. Stephen M. Taylor is ASAM's President and is board-certified in general psychiatry, child and adolescent psychiatry, addiction psychiatry, and addiction medicine. With over 30 years of practice experience, Dr. Taylor is dedicated to helping adolescents and adults overcome addiction and co-occurring psychiatric disorders. He has served as the Medical Director of the NBA and NBPA Player Assistance and Anti-Drug Program for 16 years and is the Chief Medical Officer of Pathway Healthcare, which operates multiple outpatient addiction and mental health treatment offices across six states. Expert Jeanmarie Perrone, MD Dr. Jeanmarie Perrone is a Professor in the Department of Emergency Medicine and the founding Director of the Center for Addiction Medicine and Policy at the University of Pennsylvania. Dr. Perrone leads programs for the treatment of Opioid and Alcohol Use Disorders in the emergency department (ED) and a virtual telehealth bridge clinic (CareConnect). Her work has been funded by city health departments and by NIDA, PCORI, CDC, and SAMHSA. She has advocated at the state and national levels and contributed to working groups to enhance low-barrier treatment access for substance use disorders. She has been recognized with awards for leadership, education and mentorship and her initiatives have been featured in the media including National Public Radio, the New York Times and USA Today. Expert Alaina Steck, MD Dr. Alaina R. Steck is an Associate Professor in the Emory Department of Emergency Medicine. She completed her residency training in Emergency Medicine at Boston Medical Center in Boston, MA, and her fellowship in Medical Toxicology at the Emory / Centers for Disease Control and Prevention Combined Fellowship in Medical Toxicology, followed by board certification in Addiction Medicine. She currently serves as the Medical Director of the Grady Medication for Alcohol and Opioid Use Disorder Treatment clinic, the Addiction Medicine Clerkship Director, Assistant Medical Director at the Georgia Poison Center, and Pharmacology Thread Director at the Emory School of Medicine. 📖 Show Segments 00:05 – Introduction 00:59 – An Overview of the Emerging Illicit Substances Session 02:08 – What Practitioners Should Know about Emerging Illicit Substances 03:36 – Specific Substances of Growing Concern 04:35 – Challenges in Clinical Practice 05:33 – Surprising Insights and Discussion from the Session 06:40 – Resources for Recent Data Trends 07:19 – Key Lessons for Practitioners to Implement Now 08:56 – Unique Withdrawal Syndromes  11:27 – Anecdotal Examples of Rising Illicit Substances 14:06 – Communicating with Colleagues 16:14 – Conclusion and Additional Learning Opportunities 📋 Key Takeaways Emerging Illicit Substances: The landscape of psychoactive substances is evolving rapidly, with new agents continually appearing on the market. The Rise of Medetomidine as an Illicit Drug Adulterant: Medetomidine, a veterinary anesthetic, is an emerging concern as it seeps into the fentanyl drug supply as a replacement for xylazine in some parts of the country. New Withdrawal Syndromes: Medetomidine has led to a unique withdrawal syndrome that requires high-dose opioids and other sedative agents for management. Importance of Naloxone: Despite the emergence of new substances, fentanyl remains a major driver of opioid fatalities, and naloxone is still effective for these overdoses. Communicate with Colleagues: Regional variations can significantly impact the local drug supply, making communication and information sharing between different parts of the country critical to identifying trends and preparing effective responses. Utilize Available Resources: Important resources, such as the National Drug Early Warning System and local drug checking services, can inform clinicians about local and national trends. 🔗 Resources ASAM’s 56th Annual Conference Sessions: Emerging Illicit Substances: What Clinicians Need to Know Register HERE Opioid Withdrawal and Autonomic Complications Associated with Medetomidine Adulteration: Access Poster HERE CAMP Webinar Recording: An Emerging Adulterant in Philadelphia: Medetomidine Withdrawal in People Who Use Fentanyl - Discusses the latest findings on medetomidine. CDC SUDORS Dashboard - National Drug Overdose Fatality Data Source. CSFRE NPS Discovery - The Center for Forensic Science Research and Education provides drug and forensic toxicology testing results, trend reports, and emerging new substances data. Drug Overdose Toxico-Surveillance (DOT) Reporting Program - The Emergency Department Overdose Biosurveillance Project, conducted by the American College of Medical Toxicology in collaboration with CSFRE, assesses the sociodemographic characteristics, clinical information, and contextual data on opioid and/or stimulant overdoses. National Drug Early Warning System (NDEWS) - Provides real-time surveillance and research on emerging drug trends in the U.S., offering tools like machine learning analyses, online monitoring, and community-based reporting to inform public health responses. National Forensic Laboratory Information System (NFLIS) - A DEA program that collects and analyzes forensic drug chemistry laboratory data, medical examiner and coroner data, and toxicology laboratory data across the U.S., providing data resources, publications, and a public data query system to support drug enforcement and public health initiatives. PENN CAMP: Center for Addiction Medicine and Policy – Offers information and resources related to addiction medicine in clinical services, educational programs, community engagement, harm reduction strategies, research initiatives, and policy and advocacy. StreetCheck: Community Drug Checking – A community-partnered platform that streamlines the collection, analysis, and reporting of drug samples for harm reduction programs, offering tools such as a web-based app, training resources, and real-time drug trend data to help communities respond to the evolving illicit drug supply. Notes from the Field: Suspected Medetomidine Withdrawal Syndrome Among Fentanyl-Exposed Patients — Philadelphia, Pennsylvania, September 2024–January 2025: Huo S, London K, Murphy L, et al. MMWR Morb Mortal Wkly Rep 2025;74:266–268. 📢 Join the Discussion Share your thoughts using #ASAMPracticePearls — we’d love to hear from you!  

EP 01 🎙 Special Series: ASAM's 56th Annual Conference This episode is part of a special four-part series spotlighting key sessions from ASAM’s 56th Annual Conference.   In this episode of ASAM Practice Pearls, Dr. Elizabeth Salisbury-Afshar welcomes Dr. Itai Danovitch to explore highlights from his session, Hospitals as a Frontline for Addiction: Lessons from the START Study. They’ll discuss the pivotal role hospitals play in identifying and treating substance use disorders, drawing on insights and outcomes from the START (Substance Use Treatment and Recovery Team) Study.  ----more---- Looking for this episode's transcript? Download it HERE Have an idea for a future episode? Share it with us at education@asam.org . Host Elizabeth Salisbury-Afshar, MD, MPH, FAAFP, FACPM, DFASAM Dr. Elizabeth Salisbury-Afshar is a family medicine, preventive medicine/public health, and addiction medicine physician. She is an Associate Professor at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin. She is a core faculty member for the Addiction Medicine Fellowship at the University of Wisconsin, and her clinical roles include addiction medicine consult service and serving as medical director of a low-barrier walk-in clinic serving people who use substances. She is also the Program Director of the Preventive Medicine Residency at UW-Madison and Medical Director of Harm Reduction Services at the Wisconsin Division of Public Health. Dr. Salisbury-Afshar's work focuses on expanding access to evidence-based addiction treatment and harm reduction services. She has over 14 years of experience practicing in medically underserved settings. Dr. Salisbury-Afshar lectures nationally on addiction medicine topics, including the treatment of opioid use disorder, harm reduction, the intersection of addiction and the criminal legal system, and public health approaches to reduce overdose mortality. Dr. Salisbury-Afshar is actively involved in ASAM, where she currently serves as the Vice Chair of the Medical Education Council, Course Director of the ASAM-All Rise treatment courts courses, a member of the ASAM Conference Planning Committee, and the Chair of Harm Reduction Special Interest Group. Expert Itai Danovitch, MD, MBA, DFAPA, DFASAM Dr. Itai Danovitch is Professor and Chair of the Department of Psychiatry and Behavioral Neurosciences at Cedars-Sinai Medical Center in Los Angeles. He earned his bachelor's degree from UC Berkeley and his medical doctorate from the UCLA School of Medicine. He completed a psychiatry residency at Columbia University, an addiction psychiatry fellowship at Cedars-Sinai Medical Center, and a Master of Business Administration at the UCLA Anderson School of Management. Dr. Danovitch’s clinical practice and research are focused on the treatment of substance use disorders and the integration of medical and mental health services. His current research is funded by the National Center for Advancing Translational Sciences (NCATS), the National Institute on Drug Abuse (NIDA), and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). He is the author of over 100 articles and book chapters and co-editor of two books on substance use disorders. Dr. Danovitch served as a Governor-appointed state Commissioner to the California Mental Health Services Commission. He is a Distinguished Fellow of the American Society of Addiction Medicine, a Distinguished Fellow of the American Psychiatric Association, and past president of the California Society of Addiction Medicine. 📖 Show Segments 00:05 – Introduction 00:52 – Why the START Study 02:32 – Study Methodology and Key Findings 05:08 – Key Findings 06:46 – Impact and Practical Applications 12:28 – Challenges in expanding access to Addiction Consultation Services 14:35 – Suggestions for Starting Addiction Consultation Services 17:23 – Benefits of having Addiction Consultation Services 19:03 – Expanding Addiction Consultation Services 23:39 – Proactive Approaches and AI Tools 25:02 – Final Thoughts 26:11 – Conclusion and Additional Learning Opportunities 📋 Key Takeaways START Study: The START study was a randomized trial conducted at three different sites, focusing on initiating medication for opioid use disorder and connecting patients to aftercare. Addiction Consultation Services: Addiction consultation services can play an important role in hospitals providing better care for patients with substance use disorders. Effective Interventions: The study found that addiction consultation services significantly increased the likelihood of patients starting medication for opioid use disorder and being linked to follow-up care. Importance of Care Managers: Care managers play a significant role in the success of patient treatment. Those who followed up with patients for a month after discharge and addressed any issues that arose were most impactful. Utilize Available Resources: Initiating addiction consultation services can be effective if you start with available resources and progressively build on them. Financial Constraints: Financing remains the biggest challenge for expanding access to addiction consultation services despite their proven effectiveness. Engagement and Early Identification: Identifying and engaging patients early in their hospitalization can prevent delays and improve outcomes. Interdisciplinary Support: Support from the entire care team, including nurses, social workers, clinical partners, and others, can improve patient care and outcomes. Educational Component: Training and educational interventions for hospital staff can help increase the adoption and effectiveness of addiction services. Provide Comprehensive Care: Addiction consultation services can help provide comprehensive care in hospitals for patients with substance use disorders, similar to how other chronic health conditions are managed. 🔗 Resources ASAM’s 56th Annual Conference Sessions: Hospitals as a Frontline for Addiction: Lessons from the START Study Register HERE Hospital Addiction Consultation Service and Opioid Use Disorder Treatment: The START Randomized Clinical Trial: Ober AJ, Murray-Krezan C, Page K, et al. JAMA Intern Med. doi:10.1001/jamainternmed.2024.8586 Pilot randomized controlled trial of a hospital-based substance use treatment and recovery team (START) to improve initiation of medication for alcohol or opioid use disorder and linkage to follow-up care: Ober AJ, Osilla KC, Klein DJ, et al. J Subst Use Addict Treat. 2023;150:209063. doi:10.1016/j.josat.2023.209063 The Substance Use Treatment and Recovery Team (START) study: protocol for a multi-site randomized controlled trial evaluating an intervention to improve initiation of medication and linkage to post-discharge care for hospitalized patients with opioid use disorder: Ober AJ, Murray-Krezan C, Page K, et al. Addict Sci Clin Pract. 2022;17(1):39. Published 2022 Jul 28. doi:10.1186/s13722-022-00320-7 A Taxonomy of Hospital-Based Addiction Care Models: a Scoping Review and Key Informant Interviews: Englander H, Jones A, Krawczyk N, et al. J Gen Intern Med. 2022;37(11):2821-2833. doi:10.1007/s11606-022-07618-x. Clinical implementation of AI-based screening for risk for opioid use disorder in hospitalized adults: Afshar, M., et al. Nature Medicine. 2025. DOI: 10.1038/s41591-025-03603-z Contextual barriers and enablers to establishing an addiction-focused consultation team for hospitalized adults with opioid use disorder: Evans SK, Ober AJ, Korn AR, et al. Addict Sci Clin Pract. 2024;19(1):31. doi:10.1186/s13722-024-00461-x Post-hospitalization Care Transition Strategies for Patients with Substance Use Disorders: A Narrative Review and Taxonomy: Incze MA, Kelley AT, James H, et al. J Gen Intern Med. 2024;39(5):837-846. doi:10.1007/s11606-024-08670-5 The addiction consultation service for hospitalized patients with substance use disorder: An integrative review of the evidence: Danovitch I, Korouri S, Kaur H, et al. J Subst Use Addict Treat. 2024;163:209377. doi:10.1016/j.josat.2024.209377 Bridge Treatment: A program of the Public Health Institute that bridges emergency care and community health to create an integrated system that improves health and equity. 📢 Join the Discussion Share your thoughts using #ASAMPracticePearls — we’d love to hear from you!  

In this episode of ASAM Practice Pearls, Dr. Stephen Taylor and Dr. Tessa Steel explore the management of alcohol withdrawal in ambulatory, hospital-based, and ED-initiated care settings. They discuss best practices, risk stratification, medication strategies, and emerging approaches to support effective withdrawal management. ----more---- Looking for this episode's transcript? Download it HERE Have an idea for a future episode? Share it with us at education@asam.org. Host Stephen M. Taylor, MD, MPH, DFAPA, DFASAM Dr. Stephen M. Taylor is ASAM’s President-Elect and is board-certified in general psychiatry, child and adolescent psychiatry, addiction psychiatry, and addiction medicine. With over 30 years of practice experience, Dr. Taylor is dedicated to helping adolescents and adults overcome addiction and co-occurring psychiatric disorders. He has served as the Medical Director of the NBA and NBPA Player Assistance and Anti-Drug Program for 16 years and is the Chief Medical Officer of Pathway Healthcare, which operates multiple outpatient addiction and mental health treatment offices across six states. Expert Tessa Steel, MD, MPH Dr. Tessa Steel is an Assistant Professor, physician-scientist, and Pulmonary Critical Care Medicine doctor at Harborview Medical Center, a county safety-net hospital operated by the University of Washington in Seattle. She is board-certified in Internal Medicine, Pulmonary Medicine, and Critical Care Medicine. Her clinical and research interests include improving hospital-based treatments for alcohol withdrawal syndrome and using hospitalizations to help people with addiction launch their process of recovery.  📖 Show Segments 00:05 – Introduction 00:16 – Common Alcohol Withdrawal Scenarios  01:53 – Assessing Alcohol Withdrawal Severity  09:24 – The Emergency Department's Role  12:28 – Inpatient Alcohol Withdrawal Management  19:28 – Outpatient Alcohol Withdrawal Management  21:02 – Challenges and Future Directions  27:44 – Conclusion and Additional Learning Opportunities 📋 Key Takeaways Patient Risk Stratification: Understanding patient history, especially previous alcohol withdrawals, is crucial for predicting the severity of withdrawal symptoms and determining appropriate care settings (home vs. inpatient).  Role of Emergency Departments: Emergency departments are critical access points for initiating alcohol withdrawal management and facilitating the transition to ongoing care for alcohol use disorder (AUD).  Medication Strategies: Consider the various medications beyond benzodiazepines that can treat alcohol withdrawal, such as phenobarbital or gabapentin,  to align medication selection with the individual’s needs and the underlying neuropathology of alcohol withdrawal.  Outpatient vs Inpatient Care: Consider a patient’s history and current symptoms to determine whether they can safely undergo withdrawal in an outpatient setting or if they require inpatient care.  Monitoring and Safety: Carefully monitor patients when using sedating agents for alcohol withdrawal management, as they may cause respiratory suppression.  Holistic and Individualized Treatment: Address the AUD in addition to the withdrawal symptoms. Stay open-minded and familiarize yourself with various medication options. Treating alcohol withdrawal requires an individualized, patient-centered approach.  Team-Based Support and Ongoing Education: Interdisciplinary support and continuous education are important in advancing successful system-wide care. Share success stories to engage healthcare providers in AUD care.  Call for Research and Funding: Additional research, including comparative effectiveness research on medications, and funding are needed to improve the quality of alcohol withdrawal care and to further promote transitions from withdrawal management to long-term AUD treatment.  🔗 Resources PCSS-MAUD Education: Free, comprehensive training, guidance, resources, and mentoring on the prevention, diagnosis, and treatment of AUD.   Assessment and Management of Alcohol Withdrawal – Online Course Alcohol Withdrawal Syndrome in the Emergency Department – Mini Video  The ASAM Clinical Practice Guideline on Alcohol Withdrawal Management: Access HERE Emergency Department Screening and Interventions for Substance Use Disorders: Hawk K, D'Onofrio G. Addict Sci Clin Pract. 2018;13(1):18. Emergency Department Peer Support Program and Patient Outcomes After Opioid Overdose: Treitler P, Crystal S, Cantor J, et al. JAMA Netw Open. 2024;7(3):e243614. Executive Summary of the American Society of Addiction Medicine (ASAM) Clinical Practice Guideline on Alcohol Withdrawal Management: Lindsay DL, Freedman K, Jarvis M, et al. J Addict Med. 2020;14(5):376-392. Inpatient Addiction Medicine Consultation and Post-Hospital Substance Use Disorder Treatment Engagement: A Propensity-Matched Analysis: Englander H, Dobbertin K, Lind BK, et al. J Gen Intern Med. 2019;34(12):2796-2803. Inpatient Addiction Consultation for Hospitalized Patients Increases Post-Discharge Abstinence and Reduces Addiction Severity: Wakeman SE, Metlay JP, Chang Y, Herman GE, Rigotti NA. J Gen Intern Med. 2017;32(8):909-916. Research Needs for Inpatient Management of Severe Alcohol Withdrawal Syndrome: An Official American Thoracic Society Research Statement: Steel TL, Afshar M, Edwards S, et al. Am J Respir Crit Care Med. 2021;204(7):e61-e87. The ASAM Criteria: The most widely used and comprehensive set of standards for placement, continued service, and transfer of patients with addiction and co-occurring conditions. ASAM Criteria Curriculum: Explore the different trainings ASAM offers on both the 3rd and 4th Edition ASAM Criteria. 📢 Join the Discussion Share your thoughts using #ASAMPracticePearls — we’d love to hear from you!  

In this episode of ASAM Practice Pearls, Dr. Stephen Taylor and Dr. Melissa Weimer revisit the fundamentals of alcohol use disorder (AUD), discussing medications like acamprosate, disulfiram, naltrexone, topiramate, and others and how to support various treatment goals, whether that means reducing use or achieving abstinence.  ----more---- Looking for this episode's transcript? Download it HERE Have an idea for a future episode? Share it with us at education@asam.org. Host Stephen M. Taylor, MD, MPH, DFAPA, DFASAM Dr. Stephen M. Taylor is ASAM’s President-Elect and is board-certified in general psychiatry, child and adolescent psychiatry, addiction psychiatry, and addiction medicine. With over 30 years of practice experience, Dr. Taylor is dedicated to helping adolescents and adults overcome addiction and co-occurring psychiatric disorders. He has served as the Medical Director of the NBA and NBPA Player Assistance and Anti-Drug Program for 16 years and is the Chief Medical Officer of Pathway Healthcare, which operates multiple outpatient addiction and mental health treatment offices across six states. Expert Melissa Weimer, DO, MCR, DFASAM Dr. Melissa Weimer is board-certified in Internal Medicine and Addiction Medicine, focusing on substance use disorders in hospital settings.  She is an Associate Professor of Medicine at Yale School of Medicine and currently the Medical Director of the Yale Addiction Medicine Consult Service (YAMCS) at Yale New Haven Hospital. Dr. Weimer has worked on local, state, and national levels to enhance access to evidence-based treatments for substance use disorders.  As an educator, she teaches healthcare students and professionals about substance use disorders and serves as the Associate Program Director of the Yale Addiction Medicine Fellowship program. She is also the Medical Director/Lead Trainer for the SAMHSA-funded Providers Clinical Support System-Medications for Alcohol Use Disorder.  📖 Show Segments 00:05 - Introduction  00:27 - Alcohol Awareness Month and AUD Statistics  01:42 - FDA-Approved Medications for AUD  05:35 - Topiramate and Other Treatment Options  08:21 - Choosing the Right Medication for Patients  14:27 - Barriers to Medication Use and Overcoming Them  17:32 - Telehealth and Network Therapy  19:44 - Integrating Psychosocial Treatments with Medication  26:20 - Patient-Centered Goals and Risk Mitigation  35:06 - Key Takeaways   36:36 - Conclusion and Additional Learning Opportunities 📋 Key Takeaways Medications for AUD: Medications for AUD are safe and effective and should be offered to more individuals diagnosed with the disorder.   Setting Goals: Abstinence is not always the required or primary goal. Reducing alcohol use is a valid and beneficial goal that can also be supported with medications.  Comprehensive Approach: Treating AUD requires a multifaceted approach, combining medication with psychosocial interventions.  MAUD and Liver Disease: Medications for alcohol use disorder (MAUD) can be used safely in hospital settings and in patients with liver disease and have been shown to reduce all-cause mortality in individuals with alcohol-related cirrhosis.  Choosing the Right Medication: Tailoring the medication choice to fit the patient's overall profile and preferences can significantly enhance adherence and treatment outcomes.  Addressing Barriers: Institutional barriers and cultural resistance within clinics and recovery spaces must be addressed to normalize and support the use of medication in treating substance use disorders.  🔗 Resources PCSS-MAUD Education: Free, comprehensive training, guidance, recourses, and mentoring on the prevention, diagnosis, and treatment of AUD.  Integrating Medications for Alcohol Use Disorder and Alcohol Use Services into Primary Care - Online Course  Pharmacotherapy for Alcohol Use Disorder: Best Practices and Clinical Strategies - Online Course   Establishing Goals for Treatment and Recovery - Mini Video   Optimizing Outcomes for Treatment with Medications for Alcohol Use Disorder -  Mini Video  Systematic Review of Medications for Alcohol Use Disorder - Webinar  Network Therapy - Resource  The Sinclair Method: An evidence-based treatment for AUD that allows continued alcohol use at the beginning of treatment.  Alcoholics Anonymous (A.A.): An information hub to learn more about A.A., find support, and access resources.  SMART Recovery: An information hub to learn more about SMART Recovery, find support, and access resources.  Medications for alcohol use disorder improve survival in patients with hazardous drinking and alcohol-associated cirrhosis: Rabiee A, Mahmud N, Falker C, Garcia-Tsao G, Taddei T, Kaplan DE. Hepatol Commun. 2023;7(4):e0093.   Network therapy for addiction: a model for office practice: Galanter M. Am J Psychiatry. 1993;150(1):28-36.  Pharmacotherapy for Alcohol Use Disorder: A Systematic Review and Meta-Analysis: McPheeters M, O'Connor EA, Riley S, et al., JAMA. 2023;330(17):1653-1665.  Promoting alcohol treatment engagement post-hospitalization with brief intervention, medications and CBT4CBT: protocol for a randomized clinical trial in a diverse patient population: Edelman EJ, Rojas-Perez OF, Nich C, et al. Addict Sci Clin Pract. 2025; 20(1):29.  Topiramate Versus Naltrexone for Alcohol Use Disorder: A Genotype-Stratified Double-Blind Randomized Controlled Trial: Morley KC, Kranzler HR, Luquin N, et al. Am J Psychiatry. 2024;181(5):403-411.   📢 Join the Discussion Share your thoughts using #ASAMPracticePearls — we’d love to hear from you!  

In this episode of ASAM Practice Pearls, Dr. Peter Selby and Dr. Emily Brunner explore The Joint Clinical Practice Guideline on Benzodiazepine Tapering: Considerations When Benzodiazepine Risks Outweigh Benefits. They discuss key recommendations and best practices for tapering benzodiazepines safely and effectively. Additional topics include the risks and benefits of tapering, common withdrawal symptoms, strategies to support patients while minimizing new dependencies, and navigating patient resistance and fear. ----more---- Looking for this episode's transcript? Download it HERE Have an idea for a future episode? Share it with us at education@asam.org. Host Peter Selby, MBBS, CCFP(AM), FCFP, FASAM  Dr. Peter Selby is a Senior Scientist and Senior Medical Consultant at the Centre for Addiction and Mental Health (CAMH) and Vice-Chair, Research, and Giblon Professor in Family Medicine at the University of Toronto. His research focuses on innovative methods to understand and treat addictive behaviors and their comorbidities. He utilizes technology to scale and test health interventions, with his cohort of over 400,000 treated smokers in Ontario serving as an example. Dr. Selby has received over $100 million in grant funding from CIHR, NIH, and the Ministry of Health and has published more than 200 peer-reviewed articles. His most recent research program utilizes a Learning Health Systems approach to investigate how technology-equitable, collaborative care can enhance the delivery of evidence-based interventions to the patient while providing a more satisfying care experience for patients and providers across systems. Expert Emily Brunner, MD, DFASAM  Dr. Emily Brunner is board-certified in family medicine and a distinguished fellow in addiction medicine. She has experience treating addiction in both inpatient and outpatient settings. She specializes in trauma-informed clinical treatment of substance use disorders with a comprehensive and compassionate approach. Dr. Brunner has been involved in leadership of the Minnesota Society of Addiction Medicine and is now on the national board of the American Society of Addiction. She is a passionate advocate for improving the care of patients with substance use disorder across the healthcare system, specifically in advocating for increased utilization of medications for opioid use disorder across all levels of care. Minnesota Magazine recognized her as a Top Doctor for Addiction Medicine in 2020 and 2021. She is the medical director of Gateway Recovery and Recovering Hope and does training on behalf of the Hazelden Betty Ford Foundation.  📖 Show Segments 00:05 - Introduction  00:37 - History and Concerns of Benzodiazepine Use 01:59 - Clinical Scenario 03:46 - The Joint Clinical Practice Guideline on Benzodiazepine Tapering 08:15 - Considerations of Risks and Benefits 10:46 - Tapering in Different Settings 12:06 - Monitoring and Managing Symptoms: Underlying Issues vs Withdrawal 15:08 - Synthetic and Illicit Use 17:43 - Managing Side Effects 20:42 - Addressing Patient Fears 22:53 - Differential Diagnosis 24:51 - Final Thoughts and Key Takeaways 27:17 - Conclusion and Additional Learning Opportunities 📋 Key Takeaways Guideline Implementation with Clinical Judgment: Implement best practices outlined in The Joint Clinical Practice Guideline on Benzodiazepine Tapering but recognize that it is not a one-size-fits-all instruction manual for conducting tapers.  Physical Dependence vs Addiction: Most patients on long-term benzodiazepines have physical dependence, not addiction. Clinicians should understand the differences to ensure appropriate treatment.  Slow and Flexible Tapering: The tapering process should be slow, and adjustments should be made based on a patient's response to the taper. Temporary dose increases may sometimes be necessary.  Individualized, Patient-Centered Care: Engage patients in treatment decisions, prioritize their comfort and safety, and individualize tapering plans based on medical history, unique needs, and responses to treatment for a more patient-centered treatment approach.  Compassionate Approach: Treat patients with empathy, acknowledge their experiences, and avoid punitive measures. When your patients tell you something or share their experiences, believe them.  Use of Urine Toxicology: Exercise caution when using urine toxicology tests. While they can be a supportive screening tool, many benzodiazepines may not appear, and false negatives are common. These tests should never be used punitively but rather as part of a patient-centered, supportive approach.  Multidisciplinary Support: Utilize a team-based approach with frequent follow-ups, including possible nurse visits, to monitor and support patients through the tapering process.  Risk-Benefit Considerations: Benzodiazepines should never be abruptly discontinued. Clinicians must assess the risks and benefits with each patient before making changes.  Awareness of Withdrawal Risks: Understand the potential dangers of withdrawal, including seizures and increased potential for mortality, and adjust tapering accordingly.  🔗 Resources Benzodiazepine Tapering Webinar Series: A four-part series designed to provide clinicians with the knowledge and tools necessary to implement evidence-based benzodiazepine tapering strategies across diverse patient populations and practice settings. Register HERE   The Joint Clinical Practice Guideline on Benzodiazepine Tapering: Considerations When Benzodiazepine Risks Outweigh Benefits and other resources such as quick-reference tables, charts, and handouts: Access HERE   Provider Pocket Guide: A free, quick-reference digital tool to provide healthcare providers with access to current guidelines in a clear, concise format. Access HERE  How to Help Your Patients Taper from Benzodiazepines: A concise six-page guide that provides evidence-based strategies for safely tapering patients from benzodiazepines. Download HERE   Dr. Heather Ashton’s Benzodiazepine Guide (Ashton Manual): Download HERE   Benzodiazepine Discontinuation and Mortality Among Patients Receiving Long-Term Benzodiazepine Therapy: Maust DT, Petzold K, Strominger J, Kim HM, Bohnert ASB. JAMA Netw Open. 2023;6(12):e2348557   Outpatient Treatment of Chronic Designer Benzodiazepine Use: A Case Report: Hauck, Rochon, Bahra, Selby. J Addict Med. 2022;16(2):e137-e139.  Appropriate Use of Drug Testing in Clinical Addiction Medicine Consensus Document: Intended to guide provider decisions about drug testing to improve the quality of care for patients with addiction. Access HERE  📢 Join the Discussion Share your thoughts using #ASAMPracticePearls — we’d love to hear from you!  

In this episode of ASAM Practice Pearls, Dr. Stephen Taylor and Dr. Brent Boyett explore the potential of ketamine in addiction treatment. They discuss its history, mechanism of action, current research, clinical applications, risks, and future outlook. The episode offers valuable insights into ketamine’s role in addiction treatment while considering safety and its impact within the biopsychosocial-spiritual model.  ----more---- Looking for this episode's transcript? Download it HERE Have an idea for a future episode? Share it with us at education@asam.org. Host Stephen M. Taylor, MD, MPH, DFAPA, DFASAM Dr. Stephen M. Taylor is ASAM’s President-Elect and is board-certified in general psychiatry, child and adolescent psychiatry, addiction psychiatry, and addiction medicine. With over 30 years of practice experience, Dr. Taylor is dedicated to helping adolescents and adults overcome addiction and co-occurring psychiatric disorders. He has served as the Medical Director of the NBA and NBPA Player Assistance and Anti-Drug Program for 16 years and is the Chief Medical Officer of Pathway Healthcare, which operates multiple outpatient addiction and mental health treatment offices across six states. Expert Brent Boyett, DMD, DO, DFASAM Dr. Brent Boyett is a board-certified specialist in family medicine, addiction medicine, preventive medicine, and dental anesthesiology. He is a Distinguished Diplomat of the American Society of Addiction Medicine and a Diplomat of the American Academy of Family Practice and the American Dental Society of Anesthesiology. With extensive training in addiction disorders, Dr. Boyett travels nationwide to educate others on the effects of opioids, cannabis, and psychedelics on the brain, with a particular focus on the future of psychedelics, especially ketamine. He earned his DMD. from the University of Alabama at Birmingham (1994) and his medical degree from the University of Health Sciences (1998). He then completed a Family Medicine Residency at the University of Mississippi (2001), specializing in internal medicine, anesthesia, and oral surgery. After years in private practice, Dr. Boyett transitioned to addiction treatment and research. He now practices at the North Mississippi Hospital System’s Neuroscience Institute, specializing in pain and addiction treatment. Additionally, he is a certified Ketamine Medical Provider.  📖 Show Segments 00:05 - Introduction 00:14 - Celebrity Encounters with Ketamine 01:58 - History and Medical Use of Ketamine 04:03 - Neuroplasticity and Ketamine 08:17 - Ketamine’s Potential in Treating Addiction 10:57 - Research and FDA-Approval Potential 17:27 - Clinical Procedures for Ketamine Infusion 24:58 - Risks and Concerns with Ketamine Use 28:31 – Accessibility of Ketamine 29:13 - Future of Ketamine 30:29 - Key Takeaways 33:12 – Conclusion and Additional Learning Opportunities 📋 Key Takeaways Ketamine’s Evolution & Uses: Originally developed as an anesthetic in the 1960s, ketamine is now being explored for its potential in treating substance use disorders, depression, PTSD, OCD, chronic pain, and various other maladaptive conditions. Neuroplasticity & Addiction: Ketamine enhances neuroplasticity by helping to rewire the brain and restore prefrontal control, which can disrupt addictive patterns.  Clinical Use & Safety: Proper screening, preparation, and professional supervision are essential for the safe and effective administration of ketamine therapy.  Set, Setting & Integration: A supportive treatment environment—including calming music and minimal distractions—combined with post-treatment activities like journaling, cognitive strategies, and lifestyle changes, helps reinforce long-term benefits.  Challenges & Accessibility: Traditional ketamine lacks patent protection, limiting financial incentives for clinical trials. However, newer forms like esketamine offer commercial viability. Treatment remains costly and is often not covered by insurance.  Potential for Misuse: Ketamine should only be administered professionally. Unsupervised and at-home treatments pose risks and should be avoided.  Holistic Treatment Approach: Ketamine is a tool and should be used in conjunction with a comprehensive treatment plan, combined with other therapies (e.g., contingency management and behavioral strategies) to achieve lasting change.  🔗 Resources Become an ASAM Member today! Join HERE   Psychedelic Medicine Special Interest Group: Educates members on the current best evidence in the field of psychedelic medicine used in the treatment of addictive disorders and mental illness. ASAM Members can log in to ASAM Connect to join the community.  American Society of Ketamine Physicians, Psychotherapists & Practitioners (ASKP3): A non-profit organization dedicated to the safe clinical use of ketamine for mental health and pain conditions.  Boyett Health Services, Inc. The Neuroscience of Pain and Pleasure: Contact Dr. Brent Boyett or explore his insights on ketamine and addiction treatment.  Mendel Kaelen Psychedelic Therapy Spotify Playlist: Curated music designed for psychedelic therapy.  Negative Consequences Inventory (NCI-8): A tool for assessing potential negative outcomes associated with psychedelic use.  Psychedelic Change Questionnaire (PCQ-26): Evaluates emotional and psychological changes experienced during and after psychedelic treatment.  Psychedelic Medicine Podcast: by Lynn Marie Morski, MD, JD   📢 Join the Discussion Share your thoughts using #ASAMPracticePearls — we’d love to hear from you!  

EP 04 🎙 Special Series: Advances in Buprenorphine Education This episode is part of a special series on improving hospital and clinic-based buprenorphine treatment for opioid use disorder.   In this episode of ASAM Practice Pearls, Dr. Carolyn Chan and Dr. Shawn Cohen welcome addiction medicine expert Dr. Marlene Martin. With extensive experience in helping care teams navigate the complexities of in-hospital substance use, Dr. Martin provides insights on how hospital-based providers can effectively address these challenges with confidence and compassion. ----more---- Looking for this episode's transcript? Download it HERE Have an idea for a future episode? Share it with us at education@asam.org . Host Carolyn Chan, MD MHS Dr. Carolyn Chan is board-certified in both internal and addiction medicine. She completed her IM residency at UH Hospitals Cleveland Medical Center, followed by an addiction medicine and medical education fellowship at Yale. She provides care in both inpatient and outpatient addiction medicine settings. Currently, she is the Program Director of the University of Cincinnati Addiction Medicine Fellowship and is committed to educating all health professionals on how to provide evidence-based care to individuals with substance use disorders. Co-Host Shawn Cohen, MD Dr. Shawn Cohen is an addiction medicine doctor at Yale New Haven Hospital. He provides care on a hospital-based addiction consult service and is interested in lowering barriers to MOUD, improving the care of patients experiencing alcohol withdrawal, and making the hospital a more person-centered and less stigmatizing place for people who use substances. Expert Marlene Martin, MD Dr. Marlene Martin is an Associate Professor at UCSF and hospitalist at San Francisco General Hospital. She is the founding director of the Addiction Care Team, which provides compassionate, evidence-based care for hospitalized people with substance use disorders. As Director of Addiction Initiatives for the Latinx Center of Excellence, she coleads PEDAL, a Spanish-language addiction training program for community health workers, aiming to improve care for Latine individuals with substance use disorders. Her work focuses on health equity, harm reduction, and innovative care models. 📖 Show Segments 00:05 – Introduction 02:20 – Case Scenario: Managing In-Hospital Substance Use 03:26 – Approaching In-Hospital Substance Use 07:16 – Best Practices for Hospital Policies 12:55 – Handling Substances and Paraphernalia in Hospitals 16:15 – Engaging Stakeholders in Policy Development 17:59 – Navigating Policy Concerns 21:47 – Managing Adverse Outcomes 23:35 – Mitigating Patient Discomfort When a Search Occurs 26:15 – Engaging Nurses in Substance Use Management 28:15 – Revisiting the Case Scenario 30:00 – Conclusion and Additional Learning Opportunities 📋 Key Takeaways Prioritize compassionate care. Approach in-hospital substance use with empathy, understanding, and kindness to foster trust and better outcomes for both patients and healthcare workers. Avoid punitive measures. Minimize the involvement of security or law enforcement unless there is an imminent safety threat. Maintain open communication. Be transparent with patients about hospital policies, concerns, and available support resources. Follow evidence-based treatment. Provide medications and interventions aligned with best practices for managing substance use disorders. Incorporate harm reduction strategies. Integrate harm reduction principles into hospital care plans to support patient safety and recovery. Address root causes. Identify and manage underlying issues such as untreated pain or withdrawal symptoms that may contribute to substance use. Engage a multidisciplinary team. Involve nursing staff, regulatory teams, and hospital leadership to develop and implement effective partnerships and policies. Continuously review policies. Regularly update hospital guidelines to reflect evolving best practices and improve outcomes for both patients and staff. Empower nursing teams. Provide training and resources to help nurses lead addiction care efforts within hospital settings. Consider patient agreements. Use collaborative agreements with patients as a proactive step before resorting to stricter measures. 🔗 Resources ASAM’s Advanced Buprenorphine Education Series: Explore here. Martin M, Snyder HR, Otway G, Holpit L, Day LW, Seidman D. In-hospital Substance Use Policies: An Opportunity to Advance Equity, Reduce Stigma, and Offer Evidence-based Addiction Care. J Addict Med. 2023;17(1):10-12. doi:10.1097/ADM.0000000000001046. Calcaterra SL, Martin M, Bottner R, Englander H, Weinstein Z, Weimer MB, Lambert E, Herzig SJ. Management of opioid use disorder and associated conditions among hospitalized adults: A Consensus Statement from the Society of Hospital Medicine. J Hosp Med. 2022 Sep;17(9):744-756. doi: 10.1002/jhm.12893. Epub 2022 Jul 26; PMID: 35880813; PMCID: PMC9474708. Read more. 📢 Join the Discussion Share your thoughts using #ASAMPracticePearls — we’d love to hear from you!  

EP 03 🎙 Special Series: Advances in Buprenorphine Education This episode is part of a special series on improving hospital and clinic-based buprenorphine treatment for opioid use disorder.   In this episode of ASAM Practice Pearls, Dr. Stephen Holt and Dr. Shawn Cohen welcome addiction medicine expert Dr. Catherine Trimbur. They explore the delicate balance between protecting patient confidentiality and fulfilling legal responsibilities when responding to requests from parole officers, child welfare agencies, and other external entities. ----more---- Looking for this episode's transcript? Download it HERE Have an idea for a future episode? Share it with us at education@asam.org . Host Stephen Holt, MD, MS, FACP, FASAM Dr. Stephen Holt has been an attending physician at Yale-New Haven Hospital since 2008 and is an Associate Professor of Medicine at Yale School of Medicine. He is the Director of the Yale Addiction Recovery Clinic and the Associate Program Director for Yale's Primary Care Internal Medicine Residency Program. He is board-certified in Addiction Medicine and Internal Medicine. He has published and lectures frequently on a variety of addiction medicine topics and has won numerous teaching awards at the local, regional, and national levels. Co-Host Shawn Cohen, MD Dr. Shawn Cohen is an addiction medicine doctor at Yale New Haven Hospital. He provides care on a hospital-based addiction consult service and is interested in lowering barriers to MOUD, improving the care of patients experiencing alcohol withdrawal, and making the hospital a more person-centered and less stigmatizing place for people who use substances. Expert Catherine Trimbur, MD, MPH Dr. Catherine Trimbur, triple board-certified in internal medicine, addiction medicine, and palliative care, is an assistant professor at Brown University’s Warren Alpert Medical School. She leads Brown’s Transitions Clinic, providing comprehensive care for formerly incarcerated individuals with serious illnesses and substance use disorders. Dr. Trimbur also offers pain management and palliative care at the Rhode Island Adult Correctional Institute. Committed to medical education, she has developed a curriculum to help residents enhance empathy and reduce stigma in marginalized patient care. She serves on several university and hospital committees related to primary care and health equity. 📖 Show Segments 00:03 – Introduction 02:15 – Case Scenario: Navigating Parole and Child Welfare Requests 03:45 – Differences Between Parole and Probation 06:33 – Navigating Parole and Probation in Patient Care 09:51 – Advocating for Patients: Effective Communication Strategies 13:25 – Advocacy and Education in Interactions with Parole Officers 24:09 – Interacting with Child Welfare Systems 30:00 – Success Stories and Legislative Impact 34:28 – Revisiting the Case Scenario 35:56 – Conclusion and Additional Learning Opportunities 📋 Key Takeaways Prioritize patient autonomy. Engage patients in decisions regarding information sharing and advocate for their strengths and progress. Educate stakeholders. Help parole officers, judges, and other officials understand the medical and psychosocial aspects of addiction treatment to foster more recovery-focused decisions. Clarify legal terminology. Understanding distinctions—such as parole (post‑incarceration supervision) versus probation (prison alternative)—helps providers navigate legal complexities more effectively. Advocate through documentation. Writing letters to judges and parole officers highlighting patients' progress and health needs can influence decisions, such as waiving fees or avoiding re‑incarceration. Leverage patient‑controlled testing. Offering urine toxicology screens under patient control can reduce stress and promote adherence with legal requirements. Foster a supportive approach. Encourage family involvement with a focus on support rather than punishment to achieve better long‑term outcomes. Address stigma head‑on. Recognize patients' strengths and build trust to improve healthcare experiences and overall engagement. Use strategic communication. Employ clear, empathetic, and informed communication with legal and welfare authorities to achieve the best patient outcomes. Be persistent in advocacy. Continuous efforts can drive systemic improvements and enhance support structures for justice‑involved patients. Push for policy change. Educate legal personnel and support legislative reforms to create a more supportive system for individuals with substance use disorders. 🔗 Resources ASAM’s Advanced Buprenorphine Education Series: Explore here. Docs for Health: Find additional resources for healthcare providers working with justice-involved patients including letter templates. Transitions Clinics: The Transitions Clinic Network is building an innovative healthcare model for individuals returning to the community from incarceration. 📢 Join the Discussion Share your thoughts using #ASAMPracticePearls — we’d love to hear from you!  

EP 02 🎙 Special Series: Advances in Buprenorphine Education This episode is part of a special series on improving hospital and clinic-based buprenorphine treatment for opioid use disorder.   In this episode of ASAM Practice Pearls, Dr. Shawn Cohen is joined by addiction medicine experts Dr. Carolyn Chan and Dr. Stephen Holt. Together, they explore effective strategies for managing unstable patients and creating realistic follow-up plans that prioritize patient engagement and continuity of care. ----more---- Looking for this episode's transcript? Download it HERE Have an idea for a future episode? Share it with us at education@asam.org . Host Shawn Cohen, MD Dr. Shawn Cohen is an addiction medicine doctor at Yale New Haven Hospital. He provides care on a hospital-based addiction consult service and is interested in lowering barriers to MOUD, improving the care of patients experiencing alcohol withdrawal, and making the hospital a more person-centered and less stigmatizing place for people who use substances. Experts Carolyn Chan, MD MHS Dr. Carolyn Chan is board-certified in both internal and addiction medicine. She completed her IM residency at UH Hospitals Cleveland Medical Center, followed by an addiction medicine and medical education fellowship at Yale. She provides care in both inpatient and outpatient addiction medicine settings. Currently, she is the Program Director of the University of Cincinnati Addiction Medicine Fellowship and is committed to educating all health professionals on how to provide evidence-based care to individuals with substance use disorders. Stephen Holt, MD, MS, FACP, FASAM Dr. Stephen Holt has been an attending physician at Yale-New Haven Hospital since 2008 and is an Associate Professor of Medicine at Yale School of Medicine. He is the Director of the Yale Addiction Recovery Clinic and the Associate Program Director for Yale's Primary Care Internal Medicine Residency Program. He is board-certified in Addiction Medicine and Internal Medicine. He has published and lectures frequently on a variety of addiction medicine topics and has won numerous teaching awards at the local, regional, and national levels. 📖 Show Segments 00:04 – Introduction 00:50 – Case Scenario: Unstable Patient Follow-up 02:17 – Building Low-Barrier Clinics 06:15 – Building Partnerships with Community Resources 09:26 – Troubleshooting Patient Engagement 16:11 – Navigating Complex Patient Scenarios 19:54 – Strategies for Reengaging Patients in Care 23:50 – Reducing Barriers and Integrating Harm-Reduction in Clinics 25:25 – Revisit Case Scenario 27:20 – Conclusion and Additional Learning Opportunities 📋 Key Takeaways Build strong relationships. Foster connections with patients and providers across inpatient, outpatient, and community settings to ensure seamless transitions. Prioritize warm handoffs. Maintain continuity of care through compassionate, consistent communication. Stay proactive. Reach out to patients who miss appointments via phone calls or secure messaging to encourage reconnection and demonstrate support. Align care with patient goals. Tailor treatment plans to individual needs, acknowledging their personal circumstances and preferences. Minimize barriers to care. Offer flexible scheduling, telehealth options, and accommodating policies, such as walk-in availability and relaxed late arrival rules. Emphasize harm reduction. Incorporate approaches like long-acting buprenorphine and methadone when appropriate. Use monitoring tools thoughtfully. Leverage urine toxicology as a supportive tool rather than a punitive measure. Adapt treatment plans as needed. Avoid punitive measures and modify strategies when current approaches are ineffective. Engage community resources. Collaborate with local organizations to support patient re-engagement. Leverage peer support. Utilize peer recovery coaches or case managers to provide continuous patient support. Support prescriber confidence. Offer training and resources to address concerns about managing substance use treatment. Develop sustainable follow-up plans. Implement practical, actionable steps to create personalized follow-up plans that meet patient needs. Maximize telehealth benefits. Ensure compliance with local and federal regulations while expanding access to care. 🔗 Resources ASAM’s Advanced Buprenorphine Education Series: Explore here. American Society of Addiction Medicine. Engagement and Retention of Nonabstinent Patients in Substance Use Treatment: Clinical Consideration for Addiction Treatment Providers. October 2024. Read more. Henssler J, Müller M, Carreira H, Bschor T, Heinz A, Baethge C. Controlled drinking–non-abstinent versus abstinent treatment goals in alcohol use disorder: a systematic review, meta‐analysis and meta‐regression. Addiction. 2021 Aug;116(8):1973–1987. doi: 10.1111/add.15329. Additional information on SUD privacy 42 CFR part 2: View here. 📢 Join the Discussion Share your thoughts using #ASAMPracticePearls — we’d love to hear from you!  

EP 01 🎙 Special Series: Advances in Buprenorphine Education This episode is part of a special series on improving hospital and clinic-based buprenorphine treatment for opioid use disorder.   In this episode of ASAM Practice Pearls, Dr. Stephen Holt is joined by addiction medicine experts Dr. Carolyn Chan and Dr. Shawn Cohen. They explore key challenges and solutions in ensuring continuity of care for patients receiving medication for opioid use disorder (MOUD) during discharge from skilled nursing facilities. ----more---- Looking for this episode's transcript? Download it HERE Have an idea for a future episode? Share it with us at  education@asam.org. Host Stephen Holt, MD, MS, FACP, FASAM Dr. Stephen Holt has been an attending physician at Yale-New Haven Hospital since 2008 and is an Associate Professor of Medicine at Yale School of Medicine. He is the Director of the Yale Addiction Recovery Clinic and the Associate Program Director for Yale's Primary Care Internal Medicine Residency Program. He is board-certified in Addiction Medicine and Internal Medicine. He has published and lectures frequently on a variety of addiction medicine topics and has won numerous teaching awards at the local, regional, and national levels. Experts Carolyn Chan, MD, MHS Dr. Carolyn Chan is board-certified in both internal and addiction medicine. She completed her IM residency at UH Hospitals Cleveland Medical Center, followed by an addiction medicine and medical education fellowship at Yale. She provides care in both inpatient and outpatient addiction medicine settings. Currently, she is the Program Director of the University of Cincinnati Addiction Medicine Fellowship and is committed to educating all health professionals on how to provide evidence-based care to individuals with substance use disorders. Shawn Cohen, MD Dr. Shawn Cohen is an addiction medicine doctor at Yale New Haven Hospital. He provides care on a hospital-based addiction consult service and is interested in lowering barriers to MOUD, improving the care of patients experiencing alcohol withdrawal, and making the hospital a more person-centered and less stigmatizing place for people who use substances. 📖 Show Segments 00:03 - Introduction 02:35 - Barriers to Continuity of Care 07:43 - Navigating Prior Authorizations 10:24 - Methadone Discharge Planning 14:19 - Extended-release Buprenorphine at Discharge 17:44 - Engaging Family and Caregivers 19:23 - Staff Education and Advocacy 22:14 - Discharge Planning Example Scenarios 25:11 - Revisit Case Scenario 25:50 - Conclusion and Additional Learning Opportunities 📋 Key Takeaways Build relationships with local stakeholders. Collaborate with nursing facility administrators, intake personnel, and buprenorphine clinics to facilitate smoother transitions for patients. Address stigma and education gaps. Work closely with facilities to improve their understanding of MOUD and the importance of comprehensive addiction treatment. Be proactive in discharge planning. Arrange follow-up appointments and maintain open communication with all relevant parties to prevent care gaps. Anticipate common barriers. Stay ahead of issues like prior authorizations by verifying medication access before discharge. Strive for incremental improvements. Small changes can lead to significant advancements in patient care over time. Emphasize clear communication. Ensure nursing homes and facilities fully understand discharge plans and patient needs. Encourage patient engagement. Motivate patients to involve their support systems in their recovery journey. 🔗 Resources ASAM’s Advanced Buprenorphine Education Series: Explore here. Skilled Nursing Facility SUD Toolkit (Massachusetts): Access here. Methadone 72-Hour Rule in Hospitals: Read more. Methadone 72-Hour Rule in Bridge Clinics: Read more. DOJ Guidance: ADA & Opioid Treatment Discrimination: View PDF. Legal Action Center Toolkit on Healthcare Discrimination: Access here. Grand Rounds on MOUD in Skilled Nursing Facilities: Watch here. 📢 Join the Discussion Share your thoughts using #ASAMPracticePearls — we’d love to hear from you!  

In this episode of ASAM Practice Pearls, Dr. Peter Selby and Dr. Nancy Rigotti explore current and emerging strategies for treating tobacco use disorder (TUD). They discuss the latest pharmacological interventions, behavioral approaches, harm reduction strategies, and the evolving role of e-cigarettes in smoking cessation.  ----more---- Looking for this episode's transcript? Download it HERE Have an idea for a future episode? Share it with us at education@asam.org. Host Peter Selby, MBBS, CCFP(AM), FCFP, FASAM  Dr. Peter Selby is a Senior Scientist and Senior Medical Consultant at the Centre for Addiction and Mental Health (CAMH) and Vice-Chair, Research, and Giblon Professor in Family Medicine at the University of Toronto. His research focuses on innovative methods to understand and treat addictive behaviors and their comorbidities. He utilizes technology to scale and test health interventions, with his cohort of over 400,000 treated smokers in Ontario serving as an example. Dr. Selby has received over $100 million in grant funding from CIHR, NIH, and the Ministry of Health and has published more than 200 peer-reviewed articles. His most recent research program utilizes a Learning Health Systems approach to investigate how technology-equitable, collaborative care can enhance the delivery of evidence-based interventions to the patient while providing a more satisfying care experience for patients and providers across systems. Expert Nancy Rigotti, MD  Dr. Rigotti is a general internist and Professor of Medicine, Harvard Medical School. Her research aims to reduce tobacco-related diseases by improving the range and delivery of tobacco use treatments, especially in health care systems. She founded the Massachusetts General Hospital's Tobacco Research and Treatment Center, which evaluates tobacco treatment interventions in outpatient and inpatient health care settings in the U.S. and beyond (i.e., India, South Africa).  Additionally, she evaluates the risks and benefits of electronic cigarettes and has evaluated safety and efficacy of cytisine/cytisinicline, a new pharmacotherapy, with the goal of gaining its approval for use in the U.S. 📖 Show Segments 00:04 - Introduction  00:18 - Case Scenario: Challenges in Treating TUD 01:50 - Exploring First-Line and Second-Line Treatments 03:17 - Combining Treatments for Better Outcomes 05:13 - Motivating Patients and Harm Reduction Strategies 08:43 - Controversies and Considerations with E-Cigarettes 18:16 - Future Directions in Tobacco Addiction Treatment 21:55 - Key Takeaways 23:20 - Conclusion and Additional Learning Opportunities 📋 Key Takeaways First-line treatments include varenicline and combination nicotine replacement therapy (NRT), while bupropion and single NRT serve as second-line options. Combining medication with behavioral support improves effectiveness.  For those unable to quit completely, harm reduction is essential. E-cigarettes, though not risk-free, are less harmful than traditional cigarettes and may assist with smoking cessation. However, their long-term safety remains uncertain, and FDA-approved treatments should be prioritized.  Educate patients on the risks and benefits of e-cigarettes and favor FDA-authorized options when considering alternatives to smoking.  Tobacco use disorder should be treated as a chronic disease, with treatment plans tailored to patient preferences and tolerability. Motivational interviewing may enhance adherence and engagement.  Quitting is a process that often requires multiple attempts. Encourage progress, learn from setbacks, and celebrate small successes.  New therapies like cytisinicline show promise as effective and potentially safer options for smoking cessation.  Policy measures such as age restrictions for use, taxation, and marketing controls are critical in reducing smoking and vaping, especially among youth.  Free behavioral support programs are available and should be actively recommended to patients during office visits.  🔗 Resources ASAM’s State of the Art On-Demand Session: Nicotine   Cytisinicline for Smoking Cessation: A Randomized Clinical Trial: Rigotti NA, Benowitz NL, Prochaska J, et al., JAMA. 2023;330(2):152-160.  Electronic Cigarettes for Smoking Cessation - Have We Reached a Tipping Point?: Rigotti NA. N Engl J Med. 2024;390(7):664-665.  Treatment of Tobacco Smoking: A Review: Rigotti NA, Kruse GR, Livingstone-Banks J, Hartmann-Boyce J. JAMA. 2022;327(6):566-577.   FDA Authorized E-Cigarettes: FDA Authorized Products  Web Resource: Smokefree.gov  Quitline: 1-800-QUIT-NOW  Text Message Program: SmokefreeTXT  Youth/Young Adults Text Program: Text DITCHVAPE to 88709   📢 Join the Discussion Share your thoughts using #ASAMPracticePearls — we’d love to hear from you!