#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

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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