We need more Addiction Medicine physicians, both here in the United States and all over the world. In the United States, board certification in Addiction Medicine is supervised by the American Board of Preventative Medicine (ABPM). In this episode we review the process for how to obtain board certification in Addiction Medicine in the US. It turns out that the ABPM has a practice pathway that allows for board certification in Addiction Medicine without having to do a fellowship for those who alr...
Nov 01, 2022•11 min
I don't know about you but I was taught stimulants didn't have a withdrawal syndrome, and yet many of my patients - after a post methamphetamine crash - will complain of being in withdrawal. So...how much do you know about stimulant withdrawal? In this episode we review stimulant withdrawal - how to diagnose it, how to treat it, and how it feels to patients.
Oct 13, 2022•19 min
A follow up to Episode #27 on labs and alcohol use disorder. So you're at work and you have a patient who you're pretty convinced has an alcohol use disorder, but you're not sure which test you should order to assess their alcohol use. LFTs? Carbohydrate deficient transferrin? Ethyl glucuronide? Phosphatidylethanol? In this episode we take another look at lab tests that can help you with your assessment of patients who use alcohol...including some lab tests that you probably have never heard of ...
Sep 30, 2022•24 min
A bonus episode! This isn't really on the topic of addiction...but it does involve opioid sparing and alternative to opioid treatment protocols (and avoiding a new start of opioids may prevent someone from developing opioid dependence or opioid use disorder). I put together a lecture on the non-opioid management of renal colic a few months back. I thought the topic was really useful, so I presented it to the docs that I work with where I practice as a part of our monthly physician education. I l...
Sep 13, 2022•18 min
How much do you know about hallucinogens? Do you know the differences between LSD, psilocybin, and MDMA? In this episode we review hallucinogens as a general class of drugs, specific hallucinogenic drugs, and how to manage the acutely intoxicated in the ED and acute care setting.
Sep 08, 2022•25 min
Given how prevalent methamphetamine use is, this topic is WAY overdue. In this episode we take a broad look at methamphetamine use disorder - how methamphetamine affects the brain, the clinical features of methamphetamine use disorder, and how to treat methamphetamine use disorder.
Aug 25, 2022•22 min
You just had a patient arrive via ambulance on an involuntary hold who is clearly psychotic. As the paramedics are giving report, you hear that the patient was found using methamphetamine on scene. So...is this schizophrenia? Or is it meth psychosis? Can you tell the difference? In this episode, we do a deep dive into methamphetamine psychosis, to review the clinical features, prognosis, risk factors, and treatment - including a discussion of the differences between primary psychotic disorders a...
Aug 09, 2022•34 min
This episode is on the topic of the label "drug-seeking" that is often given to patients. Dr. Grover reviews a clinical case and reviews a perspective piece written on this topic. How would you handle a patient in pain who has an allergy to multiple medications, is refusing non-opioid options, and is asking for morphine? Is it addiction? Severe pain? Or is the patient in withdrawal? In this episode we delve into the complex and nuanced topic of the so-called "Drug-Seeking" patient.
Jul 26, 2022•22 min
You've probably heard patients talking about going to AA (Alcoholics Anonymous), but how much do you actually know about what AA does? In this episode we review mutual support groups and 12 step programs (such as AA) - what they are and how they work.
Jul 11, 2022•27 min
We all know that buprenorphine is an effective medication to treat opiate withdrawal, yet most of us only use buprenorphine to treat opiate withdrawal from abstinence from opioids. It turns out that buprenorphine can also treat the opiate withdrawal that patients experience when they are given naloxone after an opioid overdose. In this episode we review the literature on using buprenorphine after naloxone rescue, and how to actually do it in your practice. We also take on a few other topics arou...
Jun 28, 2022•30 min
Wait, what??? Drinking Alcohol + Naltrexone = Cure for Alcohol Use Disorder??? In this episode we do a detailed review of a different way to use naltrexone for alcohol use disorder, which is to continue drinking while using naltrexone. This method is often referred to as the Sinclair Method, and may be effective in up to 80% of patients to reduce alcohol consumption or stop drinking entirely. This episode is based on the book "The Cure for Alcoholism" by Roy Eskapa, PhD
Jun 04, 2022•23 min
Have you ever had this case in your ED? A patient purchases a cannabis edible candy bar or pastry. She or he eats a small amount and waits 30-60 minutes. Feeling nothing, the patient proceeds to eat the whole bar and then comes to the ED via ambulance or with a friend about an hour later completely panicked and hallucinating. In this episode we dig in to Cannabis Induced Psychosis - why it happens, how THC content contributes to the development of psychosis, how common it may be, and how to trea...
May 25, 2022•22 min
We all have had this scenario...a patient comes to the ED or is getting admitted for a medical complaint...and you notice a few findings on their lab tests that make you wonder if they have an alcohol use disorder. An elevated MCV. An elevated AST. Have you ever asked yourself - how accurate are these tests are detecting and diagnosing an alcohol use disorder? Or on the flip side - how often do we see a patient presents to the ED requesting help with alcohol after years of heavy drinking and has...
May 07, 2022•27 min
Methamphetamine use disorder...we see it every day in the Emergency Department, and yet it feels like we have nothing to offer as far as treatment. Could there be some hope that we finally have some medications for methamphetamine use disorder? In this episode we review a recent study on the use of Bupropion and Naltrexone for the treatment of methamphetamine use disorder.
Apr 29, 2022•19 min
Have you heard of the kindling phenomenon? Have you ever wondered why alcohol withdrawal seems to get worse the longer people drink? In this episode we review kindling in alcohol withdrawal - what it is, why it happens, and why it matters clinically.
Apr 15, 2022•17 min
Ok. So you've induced your patient with opiate use disorder successfully on to buprenorphine. Nice work! But what happens if they need surgery? Should they still get treated with full agonist opioids after surgery? Will full agonist opioids even work given buprenorphine's pharmacology? In this episode we dig into how to handle pain control and medication management for patients with buprenorphine in the preoperative setting.
Mar 30, 2022•25 min
Sure...you ask your patients if they vape, but how much do you know about the world of vaping? Are they using a cigalike, a vape pen, or a JUUL? And are they using standard cartridges or have they bought a custom vape juice? What types of vape juice are most associated with EVALI? In this episode we review vaping - the history of the industry, the health effects, and the societal trends.
Mar 15, 2022•29 min
In this episode we take a very deep dive into the topic of illicit fentanyl. We review the history of the opiate epidemic in the United States that has led us to our current time where 100,000 Americans have died of a drug overdose in the past year. And more importantly, we discuss what we as healthcare providers can do to fight back against this crisis of illicit fentanyl (and worse) in our drug supply causing so many fatal overdoses.
Mar 11, 2022•37 min
When was the last time you used phenobarbital for alcohol withdrawal? How familiar are you with how to dose it and when to give it? It turns out that phenobarbital is as effective as benzodiazepines for alcohol withdrawal, and might be a medication that you want to consider using in your practice for alcohol withdrawal. In this episode we dive into the topic of phenobarbital for alcohol withdrawal and try to figure out what's the best way to use phenobarbital when treating patients with alcohol ...
Feb 25, 2022•27 min
What does it mean to be well? In this episode we dig into the perspective of a person living with an opiate use disorder. Dr. Grover reads a piece on opiate addiction that he wrote with a patient who has lived experience with an opiate use disorder. The original article can be found here https://www.kevinmd.com/blog/2017/03/mean-well-ask-opiate-addict.html
Feb 12, 2022•11 min
Has this ever happened to you at 11 pm on a Saturday Night..."Hey doc, I'm on 85 mg of methadone and I missed my daily dose yesterday. Can you give me a dose?" In Episode 19 we discuss methadone, how methadone is regulated, and what to do when a patient on methadone for OUD presents to the ED asking for a missed dose or needs inpatient admission.
Feb 03, 2022•25 min
In this episode, we review Post Acute Withdrawal Syndrome (PAWS). Haven't heard of it? You're not alone. It's a common, yet understudied syndrome experienced by people in early recovery. Unfortunately the data is limited, but Dr. Grover summarizes the best information we have on PAWS including pathophysiology, naming, symptoms, and treatment.
Jan 19, 2022•22 min
Buprenorphine precipitated opiate withdrawal is the worst! Patients feel awful, and we as healthcare providers feel awful for making them feel awful. In this episode we review the literature on and discuss some local expert opinion on buprenorphine precipitated opiate withdrawal, including the best way to treat it if it happens.
Jan 03, 2022•23 min
How much do you know about stigma? Would you believe experiencing stigma can shorten a person's lifespan by 12 years? In this episode we review stigma - what it is, how it affects patients with stigmatizing conditions, and how to reduce how much stigma there is in health care. Dr. Grover just did a Grand Rounds presentation on Stigma - and this episode is a rapid review of all the material covered in the Grand Rounds presentation.
Dec 07, 2021•33 min
In this episode we do a review of a recent paper on the safety and efficacy of using high dose (up to 32 mg) buprenorphine in the emergency department. The title of the article is "High Dose Buprenorphine in the Emergency Department for Treatment of Opioid Use Disorder" by Dr. Andrew Herring and his colleagues.
Dec 03, 2021•20 min
This episode has been on the to-do list for quite a while. In Episode 15, Dr. Grover tackles the huge topic of alcohol withdrawal - from definitions, to pathophysiology, to diagnosis, to management.
Nov 20, 2021•36 min
Have you had patients ask you about information on cannabis that they received from a cannabis dispensary? Perhaps they have been told that they need a certain THC:CBD ratio to treat their condition. How good is that information? In this episode we’re going to be talking about Cannabis Dispensaries. Most specifically, who works there, what do they tell people about cannabis, and how good is the information that they give out.
Nov 08, 2021•24 min
How much do you remember from your training on alcoholic ketoacidosis? Do you remember which IV fluids need to be given? In Episode 13, we review the topic of alcoholic ketoacidosis - from a brief history of the condition, to pathophysiology, to making the diagnosis, and how to treat it.
Oct 26, 2021•18 min
In this episode Dr. Grover tackles medications for alcohol use disorder. These are medications to prevent a relapse on alcohol and to reduce the desire for drinking. You may not have used these medications much in your practice, but after listening to this episode hopefully you'll start using them. Episode 12 reviews two papers on medications for alcohol use disorder, reviewing their indications, dosing, side effects, efficacy, contraindications, and cost.
Oct 18, 2021•26 min
Do you have any idea what is truly in the street drugs your patients are buying and using? No? Turns out your patients probably don't either. And worse yet, your hospital doesn't have ready access to testing to find out. Is that really heroin your patient is using or is it quinine? In this episode we review a few papers on how street drugs are cut and adulterated. From quinidine, to acetaminophen, to baking soda, to levamisole - you'll be amazed what ends up in our street drug supply....
Sep 26, 2021•21 min
