Addiction in Emergency Medicine and Acute Care: Recent Episodes
Casey Grover, MD, FACEP
A practical and evidence-based podcast on how to think about, diagnose, and treat substance use disorders in the Emergency Department and Acute Care. Why? One American dies every 6 minutes from a drug overdose, and one American dies every 5 minutes from excessive alcohol use. As many as 64% of adult Emergency Department (ED) patients meet criteria for problematic substance use. Patients with untreated substance use are 81% more likely to require admission when they come to the ED. We need to learn more and do better in treating substance use in the acute care setting.
Can smart people really be immune to addiction? On this special bonus episode of the Addiction Medicine Made Easy podcast, Dr. Casey Grover uncovers the truths behind common myths about addiction, drugs, and overdoses. Designed for students from grades 6 through 12, this episode is both engaging and educational, challenging misconceptions such as the addictive potential of cannabis and the dangers of merely touching fentanyl. You'll gain a deeper understanding of how addiction affects decision-making in the brain, making complex medical science both accessible and compelling.
Additionally, we shed light on how a meal can influence alcohol absorption and reduce intoxication risks. Plus, hear a real-life ER story that underscores the life-saving power of Narcan, a medication that can reverse opioid overdoses in minutes. Dr. Grover also highlights the staggering statistics surrounding addiction in America, driving home the importance of carrying Narcan in schools and public spaces. This episode is not only informative but also a call to action to help save lives by better understanding and treating addiction.
Curious about the mysterious herb that's causing a stir in both traditional medicine and recreational circles? Join Dr. Casey Grover as we uncover the fascinating details about kratom, a plant from Southeast Asia with unique stimulant and opioid-like properties. You'll learn about its historical uses for pain relief and energy, as well as its modern-day appeal for euphoria. We break down the science behind kratom, from opioid receptor agonism to COX-2 inhibition, and even explore how an overdose mirrors that of opioids.
Dr. Grover shares insights from a visit to a local smoke shop, revealing how different strains—green, white, and red vein—are marketed and sold, each promising effects like relaxation, energy, and mood enhancement. However, the lack of consumer information about risks such as dependence and withdrawal will leave you questioning just how safe this herb really is.
Dr. Grover also challenges the regulatory frameworks surrounding kratom, juxtaposing it against well-known supplements like St. John's wort and echinacea. You'll discover the startling gaps in labeling and disclosure, particularly concerning its opioid nature and potential for tolerance and dependence. We also dive into why patients might be hesitant to discuss their kratom use with healthcare providers, shedding light on the stigma and misconceptions that contribute to this silence. This episode underscores the urgent need for better regulations and transparent labeling to ensure consumer safety. Thank you for tuning in and prioritizing your health and well-being with us.
Have you ever wondered how early childhood traumas can shape our mental and physical health, leading to conditions like PTSD, anxiety, and addiction? Join us as Dr. Casey Grover and Dr. Reb Close unravel these complexities with compelling real-life examples from their extensive careers in addiction medicine and emergency care. Hear a poignant story that underscores the importance of understanding a patient's history and using empathetic, non-stigmatizing language. This discussion promises not just insights but practical tools for healthcare providers to foster trust and compassion in their practice.
Discover how community support and harm reduction strategies are pivotal in battling addiction. We highlight the necessity of Narcan, drawing parallels with everyday safety items such as fire extinguishers and seatbelts. Listen to inspiring stories of community initiatives like fitness programs for recovery and essential item distribution, demonstrating how these efforts build trust and support recovery. Dr. Grover and Dr. Close shed light on the success of these programs, emphasizing the human connection and practical assistance in reducing harm.
Finally, we delve into the critical topic of safe and effective pain management, focusing on the use of buprenorphine. Dr. Close shares a real-life scenario of collaborating with a surgeon to manage a patient's post-operative pain using buprenorphine, highlighting the importance of interdisciplinary communication and mutual understanding in patient care. This episode is packed with invaluable insights and compassionate approaches, aiming to equip healthcare providers and anyone interested in addiction medicine with the knowledge to make a significant difference in the lives of those struggling with addiction.
Curious about how to effectively talk to your kids about the perils of drugs and alcohol? Join me, Dr. Casey Grover, as I share my personal experiences and practical strategies for starting these critical conversations. Reflecting on a talk I gave at a local school, I unravel the complexities of parenting in the face of substance use, emphasizing the importance of early and regular communication. Through heartfelt anecdotes, including one particular impactful story, we explore best practices for parenting and the necessity of understanding the underlying reasons for substance use among teens.
Discover the transformative power of family and community in preventing addiction. We highlight the significance of strong parental bonds, family meals, and knowing your child's friends and whereabouts. From the success story of Iceland’s national strategy to local initiatives like CrossFit classes and the Reps for Recovery gym, learn how community connections can act as a robust shield against addiction. We also delve into the mental health aspects and the role of resilience and coping strategies in addiction prevention, offering insights into building a supportive environment for your children.
Unearth powerful strategies for recognizing and addressing signs of substance use and managing challenging conversations about addiction. We discuss the warning signs parents should watch for and the risk factors that might lead teens to substance use. Explore approaches for externalizing the problem, using news stories as conversation starters, and engaging young people as experts. Finally, we shine a light on community-based drug prevention organizations and their vital role in combating overdose deaths among young people.
Discover the life-saving potential of buprenorphine in the fight against opioid overdoses with Dr. Casey Grover on the latest episode of Addiction Medicine Made Easy. We start with a poignant patient story that showcases the remarkable impact of addiction medicine using Topamax for alcohol use disorder. From there, we shift our focus to the powerful effects of buprenorphine in reducing fatal opioid overdoses, especially in the context of acute fentanyl exposures. Drawing on a pivotal 2020 study from the Journal of Substance Use and Addiction Treatment, we unpack the pharmacological magic behind buprenorphine’s ability to block full agonist opioids and explore its potential to protect during the fentanyl crisis.
Effective communication with patients about buprenorphine is key, and Dr. Grover emphasizes the importance of this in reducing overdose risks. Reflecting on his own practice, he shares how he now approaches conversations about the medication, underlining that while buprenorphine substantially lowers the risk of fatal overdoses, it doesn’t offer complete protection, particularly if not taken regularly. Tune in for actionable advice and insightful discussions designed to elevate your approach to addiction medicine.
Can cannabis put your heart at risk? Join me, Dr. Casey Grover, as we unpack groundbreaking research that challenges the widespread perception of cannabis as a harmless, natural remedy. We'll kick off by discussing a revealing study from the Journal of Pain, which found that CBD products may be ineffective for pain relief and even potentially harmful. Then, we delve into a critical study from the Journal of the American Heart Association, shedding light on the alarming rise in cannabis use and cannabis use disorder, and the often-overlooked cardiovascular risks associated with it, such as syncope, stroke, and myocardial infarction.
In this episode, we'll explore the association between cannabis use and cardiovascular disease, presenting it as a likely independent risk factor. You'll discover why it's crucial to counsel patients, especially those already at risk for heart disease, about the potential dangers of cannabis use. This conversation emphasizes the vital role healthcare professionals play in treating substance use disorders and ultimately saving lives. Tune in to equip yourself with the knowledge needed to provide better care and protect your patients' hearts.
How does a drug deal work? How do people with addiction find out what their drugs are cut with? Can you ask your dealer if your drugs are cut with fentanyl? In this episode, Dr. Grover interviews Jeremy, who is a former injection drug user about what it's like buying drugs in the illicit market.
This is a rebroadcast of Episode 64, with improved audio quality
Traditional medicine involves going to the doctor. How is medicine different when we bring the doctor to you? Could we do a better job treating addiction if we brought the doctor to the patient? Better yet - for our unhoused patients - shouldn't we be bringing the doctor to the patient given all the barriers they face? In this episode Dr. Grover interviews Dominique McDowell, who is an experienced healthcare provider – who has worked in a variety of clinic settings – but has done great work with his team using street medicine to treat patients with substance use disorders.
Episode 78. Traditional teaching to medical students about pain management was to give Tylenol, then Advil, then opioids in ever increasing doses without any maximum dose! Turns out that wasn't quite right. In this episode, Dr. Grover and his colleague Dr. Reb Close share their expertise on best practices in pain management, including how to maximize non-opioid and opioid-sparing medication regimens.
Naltrexone - a medication used to reduce alcohol consumption - is usually prescribed on a scheduled basis when treating alcohol use disorder. Could prescribing it to be taken only on drinking days work too?? In this episode Dr. Grover reviews a recent study on how "targeted" naltrexone can be used to reduce alcohol use.
We all know that options to treat stimulant use disorder are limited. In this episode Dr. Grover interviews Dr. Michael Miller, an Addiction Medicine doctor in Indiana who has developed a novel approach to treating stimulant use disorder. In this interview, Dr. Miller describes his novel approach and his outstanding results (Spoiler Alert! - he is seeing an 86% reduction in methamphetamine use in his patients!!!)
In this episode we tackle opioid use disorder during pregnancy with OB-GYN Dr. Kenneth Spielvogel. Dr. Grover and Dr. Spielvogel discuss multiple topics including the use of methadone and buprenorphine during pregnancy, overdoses during pregnancy, fentanyl exposure during pregnancy, and breastfeeding while taking buprenorphine.
Dr. Grover was asked to speak at a high school on the topic of food, nutrition, eating disorders, and how ultra processed food can be addictive. He recorded the lecture while giving it - so here it is as a bonus episode.
We tried to cover counseling and talk therapy as a part of treatment for addiction in a single episode - but it was too big of a topic! This episode is part 2 of Dr. Grover's interview with Andrew Finley, LMFT on the topic of counseling and talk therapy as a part of treatment for addiction.
Ok...so you have a patient using nicotine, cannabis, alcohol, and methamphetamine. What substance should you focus on helping the patient stop first? Or should the patient stop everything at once? In this episode Dr. Grover interviews Addiction Medicine physician Dr. Lee Goldman on the topic of how to treat patients who use multiple substances.
In this episode, we take a second look at cannabis withdrawal. Dr. Grover covered this topic on a previous episode, but as cannabis use is very common, and many people don't realize that cannabis has a withdrawal syndrome - it needed another look. This episode is an up to date review of cannabis withdrawal, including options for treatment.
How much do you know about talk therapy and counseling? How does it work? How does a therapist decide what to talk about? How does one define a successful therapy session? In this episode, Dr. Grover interviews Andrew Finley, LMFT, about how counseling and talk therapy work for patients with addiction. And since it's such a big topic, it will take several episodes to cover.
Are you familiar with Bromazolam? Carfentanil? Isotonitazene? Flualprazolam? What do all these substances have in common? They are showing up in the illicit drug market, and we'll likely be seeing more of them in the future. Dr. Grover gives an update on what's coming next in the illicit drug supply
Dr. Grover was asked to speak at a high school to parents on how to talk to kids about drugs and alcohol - and this episode is a recording of that lecture. Dr. Grover reviews how to talk to kids about substance use in general, as well as how to talk to kids who are actively using substances. Pardon the raspy voice - Dr. Grover is getting over pneumonia :)
We finally came up with a new and better name for the podcast! Addiction in Emergency Medicine and Acute Care is now Addiction Medicine Made Easy. Dr. Grover shares his thoughts on the why behind the name change.
We all know that the illicit drug supply is full of contaminants, some more dangerous than others. I am seeing, in my practice, more of my patients who use stimulants test positive for fentanyl. In this episode, we review a study that analyzes specimens of meth and cocaine to see how often they are laced with fentanyl. Spoiler alert...it's pretty common :(
Do your patients use whippets? Have they ever mentioned that they use nitrous? Not quite sure what we're talking about? In this episode we look at recreational use of nitrous oxide, also known as laughing gas or whippets.
Have you heard of the drug Iso? Is it isofentanyl? Or maybe it's isotonitazene? Or is it just fentanyl cut with who knows what? In this episode we discuss the drug being sold as "Iso" - and try to figure out what's in it.
Have you heard that giving teenagers alcohol in the home under parental supervision can teach them to use alcohol safely and reduce the risk of addiction to alcohol? Many parents believe this to be true. In this episode, we review the evidence in the literature to find out if this is true or not.
How does a drug deal work? How do people with addiction find out what their drugs are cut with? Can you ask your dealer if your drugs have fentanyl in them? In this episode Dr. Grover interviews Jeremy, who is a former injection drug user about what it's like buying drugs in the illicit market.
In this episode we speak with Araceli, a Substance Use Navigator in California, about her work taking care of substance use patients in her Emergency Department. We talk about how to connect with patients with substance use - both in terms of building trust and how to work with patients who do not speak English as their first language.
Have you heard of P2P methamphetamine? It has turned out to be a major destructive force in the world of addiction and in society in general. In this article we tell the story of how P2P meth came to be the dominant stimulant in the US, and how it has produced devastating mental health effects in those who use it.
Have you heard of peer support? It's AWESOME! Such a huge help for patients with mental health conditions and substance use disorders. In this episode Dr. Grover provides an overview of peer support for the treatment of substance use, and we hear from Ceil - a woman in recovery who is providing peer support.
How often have you seen a patient you think has cannabinoid hyperemesis syndrome - and when you tell them you think they need to stop using cannabis they tell you..."it's not the weed". In this episode we review what patients with suspected cannabinoid hyperemesis syndrome think about the condition and how you can help them to stop using cannabis
If you don't have a Substance Use Navigator (SUN) at your hospital, you need one! They are awesome! In this episode Dr. Grover speaks with Austin, a Substance Use Navigator, who shares his experience taking care of patients with substance use. Spoiler alert! Substance Use Navigators do incredible work!
Naloxone saves lives! In this episode, Addiction Medicine and Emergency Medicine physician Dr. Reb Close joins Dr. Grover to discuss naloxone - how to use it, how to get it into the hands of patients, and how to distribute it in the community.
Have you heard of Phenibut? Did you know that it can be bought online as an unregulated supplement and yet regular use causes dependence? Any idea how to manage Phenibut withdrawal? In this episode we review the literature on Phenibut, including Phenibut toxicity and withdrawal.
In this episode we review the risk of having opioids in the home. As in – when you prescribe an opioid to a patient – what is the risk to the other people and family members in that patient’s home?
Have you heard about using baclofen for alcohol use disorder? Does it work? How do you dose it? What are the contraindications? In this episode we do an evidence based review of the use of baclofen to treat alcohol use disorder
So...how much do you know about urine drug screens? Can selegiline cause a false + for meth? Can quinolones cause a false + for opioids? Can putting visine in urine cause a false negative? What should you do if you think you've gotten a false positive result on a urine drug screen. In this episode - we tackle all these questions and more
A really quick bonus episode! Dr. Grover shares a poem written about addiction that reminds us why treating patients with substance use disorders matters so much.
Have you ever been worried that when you prescribe a controlled substance that your patient might sell it on the street or to a friend? Of course you have. What about when you prescribe buprenorphine? In this episode we review the topic of buprenorphine diversion - how common is it, and what actually happens when patients use diverted buprenorphine?
In this episode Dr. Casey Grover and child psychiatrist Dr. Susan Swick discuss the topic of talking to kids about drug use. They discuss how health care providers can connect with kids who are using substances, how to work with the parents of a child who is using substances, and when parents should start discussing substance use with their kids before substance use starts.
Have you ever wondered what it's like growing up with parents who have addiction? Have you ever talked to patients about what it's like parenting while in recovery? How often have you seen one generation with addiction lead to the next generation having addiction too? In this episode Dr. Grover interviews a colleague who discusses her strong family history of addiction, her own addiction, and how she is raising her kids in a healthy drug/alcohol free home.
In this episode Dr. Grover does a follow up interview with Aiden, a young man in recovery. Aiden shares more of his recovery story, including how music keeps him focused on recovery, what it was like to be incarcerated, how being incarcerated has affected his recovery, how he deals with regret looking back on his time with active addiction, and what his goals are for the future.
As we've discussed many times on this podcast there is a lot of concern - from both patients and medical providers - that patients with opioid use disorder using fentanyl will have an increased risk of precipitated opioid withdrawal when they start buprenorphine. And finally, we have a study looking directly at this topic!! In this episode we review a recent paper from JAMA Network Open that looks at the rate of precipitated opioid withdrawal during buprenorphine inductions in patients with opioid use disorder using fentanyl.
In this episode Dr. Grover interviews Aiden, a young man in recovery. Aiden shares his story of how his addiction developed, what it's like living with addiction, how his recovery started, and what life is like as a young man in recovery.
How much do you know about Kratom? Who takes it and why? How does Kratom withdrawal present and how do you treat it? And what do you do in the case of a Kratom overdose? In this episode we do an evidence based review on Kratom to answer all of these questions and more.
Have you had a patient ask you about using Topiramate to treat their alcohol use disorder? Or maybe you've heard a colleague talk about it, but don't know much about it? In this episode we review the use of the medication topiramate in treating alcohol use disorder. Spoiler alert! This may be practice changing!
How often do you see patients who regularly use cannabis who get recurrent abdominal pain, nausea, and vomiting? It seems like this comes up at least every other shift in the Emergency Department. In this episode we review all aspects of Cannabinoid Hyperemesis Syndrome, from pathophysiology, to diagnosis, to treatment.
Have you heard reports of first responders having overdoses on fentanyl after just touching it? Do you actually know how well fentanyl is absorbed through the skin? What PPE should first responders use if they know they are going to be exposed to fentanyl? In this episode we do a mega deep dive to find out what is the risk of fentanyl exposure to first responders and what can we do to mitigate that risk?
How familiar are you with cannabis toxicity? Do you know the symptoms of a cannabis overdose? If your patient told you that she "greened out" last night, would you know what she was talking about? In this episode we do an evidence-based review of cannabis toxicity, including what it means to "green out"
Pink Elephants anyone? In this episode we review Delirium Tremens, also know as alcohol withdrawal delirium. It's not too common, but it makes people impressively sick when it develops. Listen in for an evidence based review of the diagnosis and treatment of delirium tremens.
Have you heard about microdosing buprenorphine? Have your patients asked you if it's an option for them? In this episode we do a deep dive on the topic of microdosing buprenorphine...including how it might be the best option for patients using illicit fentanyl to start bupe without experiencing precipitated withdrawal.
Have you heard of Xylazine? I sure don't remember it from pharmacology in medical school. It turns out Xylazine is a veterinary medicine that is being increasingly cut into the illicit drug supply in the US. Why is it being cut into drugs, what does it do, and how is a Xylazine overdose treated? We cover everything you need to know about Xylazine in this episode.
Have you found all the different formulations of buprenorphine confusing? What is Zubsolv and how is it different from regular sublingual buprenorphine? And what about Belbuca? Or BuTrans? When can you use injectable Buprenex? What about Sublocade? In this episode we do a deep dive into all the different formulations of buprenorphine, including what they are used for and how to dose them. We also discuss how challenging it can be to convert between different formulations.
Another bonus episode! I was asked to give a lecture on medications for alcohol use disorder to some of my colleagues in my area. We have made such incredible improvements in how we treat opiate use disorder with medication...it's time to do the same with alcohol use disorder. So...in this lecture I tried to convince my colleagues that we need to start routinely treating patients with alcohol use disorder with medication for alcohol use disorder. Take a listen...hopefully I can convince you too.
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 already are doing addiction medicine in their current practice. Could you be eligible to apply for board certification in Addiction Medicine? Listen in and find out!
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.
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 (but might find useful)
A bonus episode! This isn't really on the topic of addiction...but it does involve opioid sparing and alternative to opioid treatment protocols (and avoiding a new start of opioids may prevent someone from developing opioid dependence or opioid use disorder).
I put together a lecture on the non-opioid management of renal colic a few months back. I thought the topic was really useful, so I presented it to the docs that I work with where I practice as a part of our monthly physician education. I literally just recorded my presentation with my iPad while I was giving the lecture to my group (thus the lousy audio...my apologies). In any case - I hope you find this lecture helpful. I review non opioid pain management of renal colic in detail, including NSAIDs, lidocaine infusions, antispasmodics, and tamsulosin.
How much do you know about hallucinogens? Do you know the differences between LSD, psilocybin, and MDMA? In this episode we review hallucinogens as a general class of drugs, specific hallucinogenic drugs, and how to manage the acutely intoxicated in the ED and acute care setting.
Given how prevalent methamphetamine use is, this topic is WAY overdue. In this episode we take a broad look at methamphetamine use disorder - how methamphetamine affects the brain, the clinical features of methamphetamine use disorder, and how to treat methamphetamine use disorder.
You just had a patient arrive via ambulance on an involuntary hold who is clearly psychotic. As the paramedics are giving report, you hear that the patient was found using methamphetamine on scene. So...is this schizophrenia? Or is it meth psychosis? Can you tell the difference? In this episode, we do a deep dive into methamphetamine psychosis, to review the clinical features, prognosis, risk factors, and treatment - including a discussion of the differences between primary psychotic disorders and methamphetamine induced psychosis.
This episode is on the topic of the label "drug-seeking" that is often given to patients. Dr. Grover reviews a clinical case and reviews a perspective piece written on this topic. How would you handle a patient in pain who has an allergy to multiple medications, is refusing non-opioid options, and is asking for morphine? Is it addiction? Severe pain? Or is the patient in withdrawal? In this episode we delve into the complex and nuanced topic of the so-called "Drug-Seeking" patient.
You've probably heard patients talking about going to AA (Alcoholics Anonymous), but how much do you actually know about what AA does? In this episode we review mutual support groups and 12 step programs (such as AA) - what they are and how they work.
We all know that buprenorphine is an effective medication to treat opiate withdrawal, yet most of us only use buprenorphine to treat opiate withdrawal from abstinence from opioids. It turns out that buprenorphine can also treat the opiate withdrawal that patients experience when they are given naloxone after an opioid overdose. In this episode we review the literature on using buprenorphine after naloxone rescue, and how to actually do it in your practice. We also take on a few other topics around this issue, including whether or not naloxone can be given electively to induce withdrawal to facilitate a rapid buprenorphine induction.
Wait, what??? Drinking Alcohol + Naltrexone = Cure for Alcohol Use Disorder??? In this episode we do a detailed review of a different way to use naltrexone for alcohol use disorder, which is to continue drinking while using naltrexone. This method is often referred to as the Sinclair Method, and may be effective in up to 80% of patients to reduce alcohol consumption or stop drinking entirely. This episode is based on the book "The Cure for Alcoholism" by Roy Eskapa, PhD
Have you ever had this case in your ED? A patient purchases a cannabis edible candy bar or pastry. She or he eats a small amount and waits 30-60 minutes. Feeling nothing, the patient proceeds to eat the whole bar and then comes to the ED via ambulance or with a friend about an hour later completely panicked and hallucinating.
In this episode we dig in to Cannabis Induced Psychosis - why it happens, how THC content contributes to the development of psychosis, how common it may be, and how to treat it.
We all have had this scenario...a patient comes to the ED or is getting admitted for a medical complaint...and you notice a few findings on their lab tests that make you wonder if they have an alcohol use disorder. An elevated MCV. An elevated AST. Have you ever asked yourself - how accurate are these tests are detecting and diagnosing an alcohol use disorder? Or on the flip side - how often do we see a patient presents to the ED requesting help with alcohol after years of heavy drinking and has essentially normal labs? In this episode we dig into the limited literature on this topic and try to answer the question - how accurate are lab tests in determining if a person is consuming alcohol, and if so how much?
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.
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.
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.
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.
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.
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 withdrawal.
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
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Finally! A medication option for the treatment of Cannabis Dependence and Cannabis Withdrawal. Dr. Grover shares a case from his practice in the Emergency Department and does a deep dive into the literature supporting gabapentin as a treatment for Cannabis Dependence and Cannabis Withdrawal.
On this episode we'll be covering the topic of harm reduction. Most people know a little bit about it, but in this episode we dive deep into harm reduction, and why it is extremely important for patients with an active substance use disorder. Dr. Grover reviews a brief history of harm reduction, how it helps people get into long term recovery, key concepts of harm reduction, how to incorporate it into your practice, and why it can be controversial - including a discussion of syringe exchange programs.
We all know how devastating opioid overdose deaths are in the United States and around the world. However we don't know as much about non-fatal opioid overdoses, including how likely they are to lead to fatal opioid overdoses. In this episode we review the 2020 Annals of Emergency Medicine paper "One Year Mortality of Patients After Emergency Department Treatment for Nonfatal Opioid Overdose".
Have you ever taken care of a patient with a substance use disorder and wondered "what made you think THAT was a good idea??!?!". In Episode 8 - we go through the neurobiology of how substance use affects the brain and how disordered brain function in patients with substance use disorder leads to erratic behavior and an inability to weigh the risks and benefits when making decisions about substance use. Spoiler alert - it's all about dopamine!
Dr. Grover reviews 2 papers on carisoprodol - looking at abuse of, dependence on, and withdrawal from carisoprodol. From Brave New World to treating carisoprodol dependence with a taper, this episode is a deep dive into the sparse literature on the topic of carisoprodol - aka Soma.
If you've ever wondered how we can prevent our youth from developing substance use disorders, Iceland already figured this out in the 1990s. Iceland dropped alcohol use in teens by 90% between 1998 and 2016. How did they do it? We review a magazine article that covers this incredibly effective effort in Iceland to reduce substance use in teens, and how Iceland accomplished it.
Do you know how to determine if an alcohol use disorder is mild, moderate, or severe? Does your patient who is using cocaine have a mild cocaine use disorder, a moderate cocaine use disorder, or a severe cocaine use disorder? In this episode we walk through the DSM-V criteria for substance use disorder and how to assess if your patient has a mild, moderate, or severe substance use disorder
How familiar are you with pharmacotherapy for smoking cessation? Turns out medications for smoking cessation are relatively simple, and easy to prescribe. Dr. Grover gives a concise review of medications for smoking cessation. Considering that cigarette smoking causes about 1 out of every 5 deaths in America - we as acute care providers can make a big different for our patients by helping them quit smoking with medications.
Have you ever sat down with someone after an opioid overdose? Ever wondered what people are worried about after they have an overdose and end up in an Emergency Department? In this episode, we review this paper from Academic Emergency Medicine in 2021: "A qualitative study of Emergency Department patients who survived an opioid overdose: Perspectives on treatment and unmet needs." The authors interviewed patients in the ED after an opioid overdose to hear their perspectives. You'll may be surprised by what patients identify as the most important issues after an overdose.
Benzodiazepines are often mis-managed by physicians. Benzodiazepine dependence develops within weeks of use, with 50% of people using them for > 1 month becoming dependent. 5% of patients with new benzodiazepine prescriptions will continue to use it after 8 years. So what do we do with these patients in the acute care setting when they want to taper off of them? Dr. Grover provides an evidence-based overview of benzodiazepine dependence, how to start people on benzodiazepine tapers, and what to do with patients that are on extremely high doses of benzodiazepines.
How much do you know about Cannabis Withdrawal Syndrome? I didn't know anything until I researched and recorded this episode. Turns out it's way more common than you think, and may be the cause of your patients' worsening anxiety and depression. This episode is an evidence based review of Cannabis Withdrawal Syndrome: What is it? How common is it? And what symptoms does it present with?
Taking on a huge topic in Emergency Medicine and Acute Care - Buprenorphine! A medication that saves lives but can be very intimidating when you first start using it due to how it works in the body. Dr. Casey Grover breaks down the basics so that you can be ready to use buprenorphine successfully on your next shift.
A review of the paper by Evan Wood et al in JAMA 2018: "Will this hospitalized patient develop severe alcohol withdrawal"
We discuss a brief overview of alcohol withdrawal, and what a JAMA Rational Clinical Examination Systematic Review says on which hospitalized patients will develop severe alcohol withdrawal. We also talk about trying to predict which patients who present to the hospital in alcohol withdrawal will go on to develop severe alcohol withdrawal vs mild or moderate withdrawal.
How big of a problem is substance use? Is substance use a problem for patients in the acute care setting? Is treatment for substance use effective in the acute care setting, particularly the Emergency Department?
Dr. Casey Grover provides an evidence-based overview of why we should - as healthcare providers - all care about substance use disorders.
An introduction to the Addiction in Emergency Medicine and Acute Care Podcast
Who am I? Why does this topic matter? How is this podcast going to work?