#73: Opioid Addiction, Chronic Pain, and Abstinence

Take the pain out of pain management with clinical pearls from addiction medicine specialists Dr. Stefan Kertesz at the University of Alabama at Birmingham School of Medicine and Dr. Ajay Manhapra from the VA Hampton Medical Center in Hampton, Virginia. They walk us through an approach to pain management in persons with a history of opioid use disorder (OUD), discuss treatment options for OUD, plus hot tips on how to interpret guidelines surrounding opioids, and more! What are you waiting for? Hit the play button! Special thanks to Elena Gibson, MD and Carolyn Chan, MD Episodes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | [email protected] | Free CME! Credits Producer: Elena Gibson and Carolyn Chan Writer: Carolyn Chan Infographic: Elena Gibson Cover Art: Elena Gibson Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP  Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com Guest:  Dr. Stefan Kertez and Dr. Ajay Manhapra Time Stamps 00:00 Intro 01:58 Host picks of the week 04:10: Intro to the episode 04:35: Guest Bios 12:32: Case from Kashlak Memorial 13:40 Define substance dependence, substance use, unhealthy use 17:42 Where to go next conversation about pain control 17:54: Assessing risk of relapse 19:35 Screening Tools 20:10 Risk factors for developing OUD when initiating opioids. 25:10: CDC Guidelines length of prescription and risk of substance use disorder (7) 27:00: Defining optimal length of opioid after common surgical procedures (6) 30:30: Long term use of opioids 33:50: OUD treatment options 37:30: Duration of buprenorphine/naloxone treatment, tapering risks (8) 38:50: POATs: Prescription opioids (9) 40:05 Social support and mental health services for SUD treatment 41:10 Risk of abstinence and adverse outcomes 42:35 Protracted withdrawal 43:35: Editorial BMJ Golden Month of Opioid use disorder (10) 44:00 Overdose risk in patients on long term opioids 44:40 Op-Ed on the Hill (11) 45:40 Example of protracted withdrawal syndrome 47:40 Reducing Harms: Naloxone, who to prescribe to? 50:30 Take home points 53:40 Outro