ASAM Practice Pearls

ASAM Education
  • 0.0 (0)
  • Medizin
  • Zweiwöchentlich

Season 1 | Season 2 Join ASAM Practice Pearls for in-depth discussions on addiction prevention, treatment, and recovery. Geared toward healthcare professionals and individuals seeking knowledge, this series explores the latest evidence-based approaches to addiction medicine. Listen to interviews with leading experts as they delve into critical topics and share practical tools you can use to improve patient care and promote public health.

  1. vor 4 Tagen

    Individualizing Buprenorphine: Low-dose Induction to Long-acting Injectables

    In this episode of ASAM Practice Pearls, Dr. Stephen Taylor hosts Dr. Stephen Holt in a discussion about practical strategies for initiating and managing patients receiving low-dose buprenorphine and long-acting injectable (LAI) formulations. The conversation explores how to match induction approaches to individual patient needs, guidance on dosing, and ways to support ongoing use, cravings, or withdrawal symptoms. This episode offers listeners practical insights for implementing buprenorphine treatment strategies and expanding access to evidence-based care. ----more---- Looking for this episode's transcript? Download it HERE Get credit for listening! Claim your 0.5 CEs 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 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 00:05 - Introduction  00:45 - Patient Case: Erratic use of Buprenorphine 02:23 - Deciding Between Traditional and Low-Dose Induction 05:27 - Direct-to-Inject Approach and Access Logistics 09:23 - Low-dose Induction Approach 10:38 - Considerations for Tailoring Buprenorphine Doses 12:37 - Candidates for LAI Formulations 14:16 - Initiating LAI Treatment 17:56 - Managing Ongoing Use and Breakthrough Symptoms on LAI 21:02 - Addressing Co-occurring Substance Use Disorders 23:05 - Practice Pearls 25:31 - Conclusion and Additional Learning Opportunity  📋 Key Takeaways Match your induction strategy to the patient: Patients using short-acting or predictable opioids can follow a traditional induction. For those taking predictable long-acting opioids or methadone, consider a low-dose induction. For patients with erratic use of buprenorphine or fentanyl, consider a direct-to-inject or high-dose induction approach. Low-dose induction reduces the risk of precipitated withdrawal: Start a patient with very small amounts of buprenorphine (e.g., 0.5 mg) while the patient continues using their opioid, then gradually increase their buprenorphine dose over approximately 6 days in the outpatient setting. Consider direct-to-inject LAI buprenorphine for patients with unstable use: LAI buprenorphine (especially 7-day formulations) allows a gradual receptor transition, reducing withdrawal risk and simplifying care for patients with unstable opioid use patterns. Proactively address logistical barriers to offering LAIs: Establish feasible workflows (e.g., specialty pharmacy or buy-and-bill) to reduce access barriers. Another option is to plan follow-up visits a few days later to administer the injection and use sublingual buprenorphine as a bridge, rather than trying to secure LAI same-day access upfront. Individualize LAI dosing based on patient use patterns and context: There's no perfect conversion from fentanyl to buprenorphine. Dosing decisions depend on opioid type, level of cravings, and environment. Patients using more than 2-3 bags of fentanyl per day may require the maximum dose of LAI buprenorphine, whereas lighter users may not. Offer LAI buprenorphine as a routine option to all patients: No patient is "too stable" or "too unstable" for LAI buprenorphine. While it is especially helpful for patients with erratic adherence, housing instability, or a preference for injections, any patient can benefit. LAI buprenorphine should be offered as a standard option for everyone. Breakthrough symptoms on LAIs can be managed with flexible strategies: Options include increasing LAI dose, switching formulations, adding short-term sublingual buprenorphine, and addressing underlying causes of symptoms, such as psychosocial factors. Pair medication treatment with additional supports: Even with LAIs, providing behavioral support, psychosocial interventions, and treating co-occurring substance use disorders remain essential for long-term recovery. Schedule frequent visits and encourage behavioral support, group therapy, and psychosocial interventions. Start with just one patient: Clinicians hesitant about LAI buprenorphine should start with a single patient. Find a specialty pharmacy in your area and make the connection. The learning curve is manageable, and the impact is often transformative. 🔗 Resources ASAM 57th Annual Conference Sessions: Enhancing Access with Direct-to-Inject Buprenorphine: Evidence and Implementation Long-Acting Injectable Buprenorphine for Birthing and Parenting People with OUD LAI Buprenorphine in Criminal Justice Settings: Strategies and Tools for Implementation ASAM Clinical Tips Advanced Buprenorphine Video Series: Explore HERE Extended-Release (XR) Buprenorphine Formulations Resource Guide - This resource guide compares two formulations of extended-release (XR) buprenorphine, a long-acting treatment for opioid use disorder (OUD). It highlights differences in dosing, administration, and logistics to support informed clinical decision-making. ASAM Clinical Considerations: Buprenorphine Treatment of Opioid Use Disorder for Individuals Using High-potency Synthetic Opioids - Weimer MB, Herring AA, Kawasaki SS, Meyer M, Kleykamp BA, Ramsey KS. J Addict Med. 2023;17(6):632-639. doi:10.1097/ADM.0000000000001202 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. Published 2024 Jul 1. doi:10.1001/jamanetworkopen.2024.20702 📢 Join the Discussion Share your thoughts using #ASAMPracticePearls — we’d love to hear from you! In support of improving patient care, the American Society of Addiction Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

  2. 29. Juni

    Enhancing Addiction Care Through Care Touchpoints

    In this episode of ASAM Practice Pearls, Dr. Stephen Taylor and Dr. Mike Fingerhood discuss the importance of enhancing addiction care through community support and compassionate touch points. They explore how providing access to basic needs can serve as entry points into treatment for individuals struggling with addiction, the effect of compassionate interventions on clinical outcomes, and the challenges related to funding and community acceptance for addiction services. ----more---- Looking for this episode's transcript? Download it HERE Get credit for listening! Claim your 0.5 CEs 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 Michael I. Fingerhood, MD, FACP, DFASAM Dr. Michael I. Fingerhood is a Professor of Medicine and Public Health at Johns Hopkins University and Chief of the Division of Addiction Medicine at Johns Hopkins Bayview Medical Center. Dr. Fingerhood created The Comprehensive Care Practice in 1994, a primary care practice largely devoted to providing care to individuals with substance use disorder. The practice has been innovative in integrating buprenorphine treatment into the primary care setting for over 650 individuals. He has also co-created novel buprenorphine treatment programs for a community center, church, and a mobile van outside the Baltimore Detention Center. Dr. Fingerhood received the Health Equity Leadership Award from the Baltimore City Health Department. He is the co-author of the ASAM Handbook of Addiction Medicine. Dr. Fingerhood serves on the ASAM Board of Directors as Ex-Officio, Chair of the Medical Education Council. In addition, he has co-authored over 80 research papers and received NIH research funding continuously over the past 30 years. 📖 Show Segments 00:05 - Introduction  01:48 - Patient Letter  04:13 - Redefining Harm Reduction 06:26 - Low-threshold, High-impact Intervention 09:30 - Translating Interventions into Clinical Outcomes 11:14 - Community Engagement and Overcoming Resistance 13:21 - Funding and Support of Care Touchpoint Programs 15:05 - Changing Mindsets and Moving Towards Acceptance 20:59 - Use of Test Strips 22:46 - Practice Pearls 23:51 - Conclusion and Additional Learning Opportunity  📋 Key Takeaways Every interaction matters: A single compassionate encounter can plant the seed for change, reinforcing that every person is worth the effort and the investment. Stigma is a barrier to treatment: Reducing stigma through peers, integrated care environments, and direct patient relationships is essential to change how clinicians and communities approach addiction. Low-threshold services are high-impact entry points to care: Access to showers, laundry, naloxone, HIV and hepatitis C testing, and safe spaces restores dignity, builds trust, and often serves as the first step toward recovery and ongoing engagement in healthcare. Recovery starts before substance use stops: Labeling someone as "not ready" puts the burden on the individual; instead, clinicians should ask, "What can I do?" Progress should be defined by making today better than yesterday, recognizing that meaningful change can begin at any touchpoint. Peers are essential to engagement and trust: Peer support provides a nonjudgmental connection, helping individuals feel understood and empowering them to engage in care on their own terms. Compassionate care drives measurable clinical outcomes: Integrated, compassionate care models improve engagement, increase hepatitis C cure rates, support HIV treatment, and reduce overall healthcare costs. Community buy-in is critical for success: Engaging law enforcement, local leaders, and community associations, while actively supporting community needs, turns potential opposition into a partnership. Syringe services and naloxone distribution save lives: These evidence-based interventions reduce infectious disease transmission and overdose risk while creating opportunities to connect individuals to broader care. Make test strips available: Providing tools to detect unwanted contaminants such as xylazine or medetomidine helps individuals make informed decisions and reduce harm in an ever-evolving drug supply. 🔗 Resources The American Society of Addiction Medicine Handbook of Addiction Medicine, Third Edition Charm City Care Connection Impact Report  Integration of Buprenorphine Treatment with Primary Care: Comparative Effectiveness on Retention, Utilization, and Cost - Hsu YJ, Marsteller JA, Kachur SG, Fingerhood MI. Popul Health Manag. 2019;22(4):292-299. doi:10.1089/pop.2018.0163 Targeting Community-Based Naloxone Distribution Using Opioid Overdose Death Rates: A Descriptive Analysis of Naloxone Rescue Kits and Opioid Overdose Deaths in Massachusetts and Rhode Island - Zang X, Macmadu A, Krieger MS, et al. Int J Drug Policy. 2021;98:103435. doi:10.1016/j.drugpo.2021.103435  📢 Join the Discussion Share your thoughts using #ASAMPracticePearls — we’d love to hear from you! In support of improving patient care, the American Society of Addiction Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

  3. 15. Juni

    Implementing Substance Use Care Across Care Settings: ED to Ongoing Care

    In this episode of ASAM Practice Pearls, Dr. Stephen Taylor hosts Dr. Sarah Wakeman to discuss substance use care in the emergency department, sharing highlights from ASAM's new implementation guide for hospital and emergency department (ED) substance use disorder (SUD) care. Together, they explore the gap between evidence-based addiction treatment and current hospital/ED practice, how frontline non-specialist clinicians can provide effective SUD care, practical implementation models, and how to build seamless care transitions from the ED to ongoing treatment. ----more---- Looking for this episode's transcript? Download it HERE Get credit for listening! Claim your 0.5 CEs 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 Sarah Wakeman, MD, FASAM Dr. Sarah Wakeman is the Senior Medical Director for Substance Use Disorder at Mass General Brigham, Director of the Mass General Brigham Program for Substance Use and Addiction Services, 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 of the American Board of Addiction Medicine and board certified in Addiction Medicine. 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 focuses on the integration of addiction care into general medical settings and opioid use disorder treatment. 📖 Show Segments 00:05 - Introduction  02:57 - The Gap in ED and Hospital Addiction Care  05:50 - Setting Realistic Expectations for Frontline Clinicians 08:19 - Critical Elements of Care for Non-specialists 12:07 - Implementation Systems 17:15 - Effective Transitions of Care 21:48 - Closing the Feedback Loop: Sharing Success Stories 24:37 - Practice Pearls 26:23 - Conclusion and Additional Learning Opportunity  📋 Key Takeaways Treat the underlying disorder, not just the acute presentation: While effective treatments for SUDs have existed for decades, many emergency departments and hospitals still don’t consistently deliver evidence-based addiction care during admission, often only treating the complications without addressing the underlying condition. Addiction care should be the standard, not the exception: Initiating medications (e.g., buprenorphine, methadone, naltrexone), managing withdrawal, and linking patients to care should be an expectation for all frontline clinicians. Consider the seven core competencies as your quality checklist for SUD care: Screening, withdrawal management, overdose response, medication initiation, co-occurring conditions, linkage to care, and risk reduction should all be addressed for every SUD patient. Systems change can start small and scale: Even without large resources, hospitals can enhance care through clinical pathways, order sets, education, and peer champions, making best practices easier to implement in everyday workflows. Having a peer champion can help implement these practices by normalizing the behavior, providing real-time support, and making the change feel achievable. Think of system change like motivational interviewing: Approaching the system and framing addiction care in terms the institution already cares about and is familiar with can help make change. Provide warm handoffs and follow-up: The highest-risk period is the first week post-discharge. Effective models, like Bridge Clinics and low-barrier care connections, can ensure a timely, essential transition to ongoing treatment. Bring success stories back to the ED: Community partners and clinicians should share success stories with ED clinicians to reinforce the impact of their interventions and motivate continued engagement. 🔗 Resources Implementation Guide for Hospital and Emergency Department Substance Use Disorder Care ASAM’s 57th Annual Conference Session: Implementing Hospital and ED SUD Care: Translating ASAM Guidance into Action  📢 Join the Discussion Share your thoughts using #ASAMPracticePearls — we’d love to hear from you! In support of improving patient care, the American Society of Addiction Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

  4. 1. Juni

    Methadone: The Right Dose, Every Day

    EP 03 🎙 Special Series: ASAM's 57th Annual Conference This episode is part of a special three-part series spotlighting key sessions from ASAM’s 57th Annual Conference.   In this episode of ASAM Practice Pearls, In this episode of ASAM Practice Pearls, Dr. Elizabeth Salisbury-Afshar is joined by Drs. Ruth Potee and Ari Kriegsman to explore highlights from their session, The Right Dose, Every Day. Together, they challenge the algorithmic, punitive approaches to methadone treatment, instead promoting individualized, patient-centered care. They share their clinical and philosophical approaches to methadone treatment, including split dosing, missed-dosing protocols, and expanded take-home medications, offering practical insights to help you advocate for your patients and collaborate across care settings. ----more---- Looking for this episode's transcript? Download it HERE Get credit for listening! Claim your 0.5 CEs 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, public health and general preventive medicine, and addiction medicine physician. Her work focuses on expanding access to evidence-based addiction treatment and harm reduction services, and she has over 14 years of experience practicing in medically underserved settings. Dr. Salisbury-Afshar is a Professor at the University of Wisconsin-Madison where she works clinically on an inpatient addiction consult team and is the Medical Director of a low-barrier walk-in clinic for people who use substances. Dr. Salisbury-Afshar is the Vice Chair of ASAM’s Medical Education Council and the Vice Chair of the Conference Program Planning Committee. Expert Ruth Potee, MD, DFASAM, FAAFP Dr. Ruth Potee is a board-certified Family Physician and Addiction Medicine physician who works across Massachusetts. She attended Wellesley College, Yale University School of Medicine, and did her residency at Boston University, where she remained an assistant professor of Family Medicine for eight years. She is currently the Medical Director for Behavioral Health Network and the Franklin County House of Corrections. She oversees 10 methadone clinics, including the first county jail-based methadone clinic in the United States. She was named Franklin County Doctor of the Year by the Massachusetts Medical Society in 2015 and has won multiple teaching awards from medical students and residents.  Expert Ari Kriegsman, MD, FASAM Dr. Ari Kreigsman is the Medical Director of the Carlson Recovery Center, an ASAM 3.7 Level Facility in Springfield, MA. He is also the Medical Director of the BHN Springfield OTP. He is board-certified in Internal Medicine and Addiction Medicine. He is a graduate of Weill Cornell Medical College, and completed his residency in Social Internal Medicine at Montefiore/Albert Einstein College of Medicine.  📖 Show Segments 00:05 - Introduction  02:30 - Philosophy of Methadone Treatment  06:42 - Training Gaps & Need for Individualized Clinical Decision-Making 08:29 - Caring for Patients with Unique Clinical Needs 10:13 - Rethinking Missed Dose Protocols 14:58 - Split Dosing Considerations 17:04 - Take-Home Medications 22:21 - Practice Pearls 25:36 - Conclusion and Additional Learning Opportunity  📋 Key Takeaways Patients choosing methadone choose life: Orient care around the patient's own goals, which is often staying alive and getting their life back. Clinical decisions should align with the patient’s goals and be tailored to each individual. Promote individualized dosing over rigid protocols: Clinicians should feel empowered to use clinical judgment for methadone dosing. There is no single protocol, and each patient's history, comorbidities, pain, and life circumstances should guide the dosing plan. Non-punitive missed dose approaches are safe and evidence-based: In most cases, patients who miss doses and continue using opioids can safely resume their previous (or nearly previous) methadone dose. Steep dose reductions can increase the patient's risk of overdose or worsen their substance use disorder. Split dosing is underused and often essential: Pregnant patients, those with chronic pain, shift workers, and anyone experiencing side effects at peak dosing are strong candidates for split doses. Take-home medications should be the default, not the reward: No other medication requires a patient to travel daily just to receive it. Methadone take-home medication should be treated as a right unless there's a specific safety concern that outweighs the benefits. Break down the silos between OTPs and the broader healthcare system: All providers, including hospital and ER clinicians, should familiarize themselves with their local OTP medical directors, establish warm handoff relationships, and feel confident advocating for patients, including requesting that aggressive induction doses or split doses be continued upon transfer to an OTP. 🔗 Resources The Right Dose Every Time Annual Conference Session: Register HERE ASAM 55th Annual Conference Session: Clinicians Advocating for Methadone Reform: Community Engagement and Empowerment 8.12 Federal Opioid Use Disorder Treatment Standards: 42 CFR 8.12 Association Between Increased Dispensing of Opioid Agonist Therapy Take-Home Doses and Opioid Overdose and Treatment Interruption and Discontinuation - Gomes T, Campbell TJ, Kitchen SA, et al. JAMA. 2022;327(9):846-855. doi:10.1001/jama.2022.1271 Evaluation of a Novel Patient-Centered Methadone Restart Protocol - Christine PJ, Blum J, Tillman AR, et al. JAMA Netw Open. 2025;8(8):e2529393. Published 2025 Aug 1. doi:10.1001/jamanetworkopen.2025.29393 Individualizing Methadone Treatment with Split Dosing: An Underutilized Tool - Braun HM, Potee RA. J Subst Use Addict Treat. 2023;152:209096. doi:10.1016/j.josat.2023.209096 Treatment Retention, Return to Use, and Recovery Support Following COVID-19 Relaxation of Methadone Take-Home Dosing in Two Rural Opioid Treatment Programs: A Mixed Methods Analysis - Hoffman KA, Foot C, Levander XA, et al. J Subst Abuse Treat. 2022;141:108801. doi:10.1016/j.jsat.2022.108801 📢 Join the Discussion Share your thoughts using #ASAMPracticePearls — we’d love to hear from you! In support of improving patient care, the American Society of Addiction Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

  5. 18. Mai

    Advanced Management of Alcohol Withdrawal

    EP 02 🎙 Special Series: ASAM's 57th Annual Conference This episode is part of a special three-part series spotlighting key sessions from ASAM’s 57th Annual Conference.   In this episode of ASAM Practice Pearls, In this episode of ASAM Practice Pearls, Dr. Stephen Taylor is joined by Drs. Tessa Steel and Melissa Weimer to discuss highlights from their Annual Conference session, Advanced Management of Alcohol Withdrawal: Case-Based, Evidence-Informed Solutions. Together, they explore the challenges of managing severe and resistant alcohol withdrawal syndrome (AWS), effective assessment tools, escalation strategies, and care considerations for high-risk or medically complex patients. ----more---- Looking for this episode's transcript? Download it HERE Get credit for listening! Claim your 0.5 CEs 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 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. 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  01:39  - Prevalence and Risk 02:54 - Assessment Tools and Common Pitfalls 08:41 - Escalating Pharmacological Strategy 17:02 - Intubation Decisions and ICU Considerations 21:57 - Key Takeaways 25:37 - Conclusion and Additional Learning Opportunity  📋 Key Takeaways Use the right tools to assess alcohol withdrawal: There are several tools that can be used to monitor alcohol withdrawal symptoms and severity, including CIWA-Ar, mMINDS, and RASS; however, it's important to note that CIWA-Ar is not appropriate for patients with altered mental status or inability to self-report. Instead, use mMINDS, RASS, or other objective tools. Treating alcohol withdrawal is about preventing brain injury, not just controlling agitation: Each withdrawal episode progressively upregulates NMDA receptors and worsens the risk of future brain hyperexcitation through a process called “kindling”. Inadequately treated brain hyperexcitation leads to neuron cell death, resulting in permanent brain damage. Therefore, effective management of alcohol withdrawal presents an opportunity to limit and prevent brain injury. Match your pharmacology to the physiology and know what each drug is actually doing: Benzodiazepines give you GABA agonism only. Phenobarbital addresses the GABA agonism and glutamate antagonism and is much longer acting, hitting both sides of the main imbalance in the brain caused by alcohol. Dexmedetomidine helps control autonomic instability related to norepinephrine signaling but won't prevent seizures. Ketamine can directly antagonize NMDA-driven hyperexcitation when GABA-directed therapy isn't enough. Propofol gives you titratable cortical suppression once a patient requires intubation. Front-load benzodiazepines early and monitor closely: When using benzodiazepines for severe alcohol withdrawal, give enough of the medication up-front. Falling behind is very hard to recover from; do not give a dose and walk away for hours without re-evaluation. Always broaden your differential diagnosis: Severe alcohol withdrawal rarely occurs in isolation. Comorbid illnesses, such as infection, sepsis, trauma, or hepatitis, amplify the neurobiologic stress response and can make withdrawal look refractory when the real driver is something else. Intubation is a high-stakes decision in this population: Intubation is a trade-off. In complex patients, such as those with advanced liver disease, active infection, or malnutrition, mechanical ventilation risks include secondary ventilator-associated pneumonia and prolonged sedation due to impaired drug clearance. The decision to ventilate should be deliberate, but once made, it should utilize titratable continuous sedation to reliably quiet brain excitation. Hospitalization is an opportunity for engagement: AWS stabilization is not alcohol use disorder (AUD) treatment, and getting a patient safely through withdrawal is necessary but not sufficient. Withdrawal management should be a bridge to longitudinal AUD care, including shared decision-making, addiction consultation, and medications for AUD. 🔗 Resources  Advanced Management of Alcohol Withdrawal: Case-Based, Evidence-Informed Solutions Annual Conference Session: Register HERE Handouts from session: Yale New Haven Health System Phenobarbital Guidance Supplemental Content from Wolpaw et al, 2025 PCSS MAUD Education: Free, comprehensive training, guidance, resources, and mentoringon the prevention, diagnosis, and treatment of AUD. Assessment and Management of Alcohol Withdrawal – Online Course Medication Matters: Selecting the Right MAUD and Optimizing Outpatient Medically Managed Withdrawal – Online Course Who is at Risk of Alcohol Withdrawal? Management in Ambulatory Care – Online Course Medications for Alcohol Use Disorder: Considerations for Patients with Comorbid Conditions – Digital Resource Outpatient Management of Alcohol Withdrawal – Digital Resource Treatment of Severe and Complicated Alcohol Withdrawal Syndrome – Digital Resource Alcohol Withdrawal Syndrome in the Emergency Department – Mini Video Hospital-wide Implementation, Clinical Outcomes, and Safety of Phenobarbital for Alcohol Withdrawal. Wolpaw BJ, Oren HO, Quinnan-Hostein et al. JAMA Netw Open. 2025;8(8):e2528694. doi:10.1001/jamanetworkopen.2025.28694 2025 Phenobarbital for Alcohol Withdrawal Syndrome Dosing Guidelines - Yale New Haven Health; 2020. Accessed April 28, 2026. PDF The ASAM Clinical Practice Guideline on Alcohol Withdrawal Management - American Society of Addiction Medicine. J Addict Med. 2020;14(3S Suppl 1):1-72. doi:10.1097/ADM.0000000000000668 CIWA-Ar – The Clinical Institute Withdrawal Assessment for Alcohol-Revised (CIWA-Ar) is a validated, 10-question tool used to objectify the severity of alcohol withdrawal. mMINDS - The Modified Minnesota Detoxification Scale (mMINDS) is a 9-item tool to objectively score symptoms for patients with alcohol withdrawal. RASS - The Richmond Agitation-Sedation Scale (RASS) is a 10-point scale used to objectively assess agitation and sedation levels in patients who cannot communicate. 📢 Join the Discussion Share your thoughts using #ASAMPracticePearls — we’d love to hear from you! In support of improving patient care, the American Society of Addiction Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

  6. 4. Mai

    Artificial Intelligence and the Future of Addiction Medicine

    EP 01 🎙 Special Series: ASAM's 57th Annual Conference This episode is part of a special three-part series spotlighting key sessions from ASAM’s 57th Annual Conference.   In this episode of ASAM Practice Pearls, Dr. Elizabeth Salisbury-Afshar is joined by Drs. Sara Polley and Daniel Kaufman to explore highlights from their Annual Conference session, Artificial Intelligence and the Future of Addiction Medicine. Together, they discuss how artificial intelligence is reshaping addiction medicine, including the many ways AI is already being used in clinical care. The conversation focuses on informed consent, maintaining clinical judgment, and ethical considerations. ----more---- Looking for this episode's transcript? Download it HERE Get credit for listening! Claim your 0.5 CEs 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, public health and general preventive medicine, and addiction medicine physician. Her work focuses on expanding access to evidence-based addiction treatment and harm reduction services, and she has over 14 years of experience practicing in medically underserved settings. Dr. Salisbury-Afshar is a Professor at the University of Wisconsin-Madison where she works clinically on an inpatient addiction consult team and is the Medical Director of a low-barrier walk-in clinic for people who use substances. Dr. Salisbury-Afshar is the Vice Chair of ASAM’s Medical Education Council and the Vice Chair of the Conference Program Planning Committee. Expert Sara Polley, MD, FAPA, FASAM Dr. Polley is a triple board-certified psychiatrist in adult, child, and adolescent psychiatry and addiction medicine. She provides integrated psychiatric care for youth and families at Vantage Mental Health, a nonprofit clinic serving both Minnesota and Wisconsin. In addition to her clinical work, Dr. Polley is a national consultant, speaker, and educator with the University of Minnesota Medical School. She serves on Minnesota’s Cannabis Advisory Council and holds committee appointments with the American Society of Addiction Medicine (ASAM) and the American Association of Child and Adolescent Psychiatry (AACAP). Dr. Polley is a passionate advocate for outpatient trauma-informed, developmentally appropriate, and family-centered co-occurring care, drawing on both her clinical experience and personal story as the child of a parent lost to addiction.  Expert Daniel Kaufmann, PhD, LPC, LMHC Dr. Kaufmann is an Associate Professor at Grand Canyon University as well as the Director of Gaming Services at Kindbridge Behavioral Health. He is the author of The Gamer’s Journey (2024), a book focused on explaining the presence of video games in society as a form of mythological storytelling and how these characters and settings can be used therapeutically for every gamer to complete each phase of the hero’s journey in their own lives. Dr. Kaufmann is currently serving as the co-chair of the APA research task force on video game issues and is working on several nationwide training programs to help mental health professionals understand video games in innovative ways. Dr. Kaufmann's publications cover the areas of video games, personality theory, online education, and counselor development. He offers supervision to an international list of clinicians to help bridge the gap in learning about technological impact on society and specific insights related to effective treatment for clients experiencing games-related issues.  📖 Show Segments 00:05 - Introduction  01:19 - Expert Introduction and Initial Start with AI  04:40 - The Landscape of AI in Addiction Care 06:41 - AI Assists Clinicians Might Not Realize They Are Using 08:13 - AI for Search Tools and Scribes 09:29 - Informed Consent for AI Tools 14:02 - Patient's Reception of AI in Care Conversations 15:41 - AI for Progress Notes and Documentation 19:49 - AI for Patient Advocacy Letters 22:04  - Guidance for Adopting AI Tools 25:35 - Advice for Early-Career Health Care Providers 26:21 - Approaching AI with Curiosity 29:00 - Words of Advice 32:50 - Conclusion and Additional Learning Opportunity  📋 Key Takeaways AI is already embedded throughout addiction care: Clinicians are integrating AI into their daily practice, including ambient scribes, literature search tools, helping write progress notes, billing systems, and EMR-driven risk alerts. Informed consent for AI use requires careful consideration: Clinicians should consider the risk to the patient and the potential impact if the tool were to fail to help determine the appropriate level of AI-informed consent. Consider the risks of the tool failing, the likelihood of catching errors, and whether the patient has the ability to opt out before deciding whether to notify, obtain consent, or determine if consent is even needed. AI scribes can free up significant time: Using ambient scribes can allow clinicians to focus more on the patient and the therapeutic relationship and less on documentation; however, clinicians must still review all AI-generated content carefully, never treating it as a finished, accurate product. AI should support, not replace, clinical judgment: AI can be used as a resource to aid clinical administrative work, but it is not a substitute for diagnosis, treatment planning, or medical decision-making. The clinician remains responsible for all care decisions. Early-career clinicians face a unique risk: Relying on AI before developing foundational clinical skills could lead to long-term competency gaps. Instead, use AI-generated content as a learning tool to develop necessary skills rather than as a shortcut. Data privacy and HIPAA compliance are non-negotiable: Before adopting any AI tool, clinicians must verify where patient data is sent, who has access, and whether it is protected from being fed into wider internet systems. Approach AI with curiosity and keep an open mind: AI isn’t going away. Learn how to work with it to help enhance your clinical practice. Educate yourself and use your own judgment on what may or may not be relevant for your own practice. 🔗 Resources Artificial Intelligence and the Future of Addiction Medicine Annual Conference Session: Register HERE 2 in 3 physicians are using health AI-up 78% from 2023 - Henry TA. American Medical Association. February 26, 2025. Accessed April 25, 2026 77% of Americans Embrace AI in Behavioral Health, but Only with Transparency and Strong Safeguards - GlobeNewswire Qualifacts. February 18, 2026. Accessed April 25, 2026 A Scoping Review of AI-Driven Digital Interventions in Mental Health Care: Mapping Applications Across Screening, Support, Monitoring, Prevention, and Clinical Education - Ni Y, Jia F. Healthcare (Basel). 2025;13(10):1205. Published 2025 May 21. doi:10.3390/healthcare13101205 Clinician Experiences With Ambient Scribe Technology to Assist With Documentation Burden and Efficiency - Duggan MJ, Gervase J, Schoenbaum A, et al. JAMA Netw Open. 2025;8(2):e2460637. Published 2025 Feb 3. doi:10.1001/jamanetworkopen.2024.60637 Commercial Products Using Generative Artificial Intelligence Include Ambient Scribes, Automated Documentation and Scheduling, Revenue Cycle Management, Patient Engagement and Education, and Prior Authorization Platforms - Kunze KN, Bepple J, Bedi A, Ramkumar PN, Pean CA. Arthroscopy. 2025;41(11):4950-4955. doi:10.1016/j.arthro.2025.05.021 Ethical Considerations for Clinical Adoption of Ambient Digital Scribe Technology - Anderson TN, Mohan V, Gold JA. J Am Med Inform Assoc. 2026;33(3):770-775. doi:10.1093/jamia/ocaf227 Ethical Obligations to Inform Patients About Use of AI Tools - Mello MM, Char D, Xu SH. JAMA. 2025;334(9):767-770. doi:10.1001/jama.2025.11417 New Doc on the Block: Scoping Review of AI Systems Delivering Motivational Interviewing for Health Behavior Change - Karve Z, Calpey J, Machado C, Knecht M, Mejia MC. J Med Internet Res. 2025;27:e78417. Published 2025 Sep 16. doi:10.2196/78417 Patient Attitudes Toward Ambient Artificial Intelligence Scribes in Clinical Care: Insights From a Cross-Sectional Study - Chandrasekaran R, Moustakas E. J Am Med Inform Assoc. 2026;33(2):263-272. doi:10.1093/jamia/ocaf218 Role of the States in the Future of AI Regulation - Mello MM, Childs PB, Roberts JL. JAMA Health Forum. 2025;6(9):e255020. Published 2025 Sep 5. doi:10.1001/jamahealthforum.2025.5020 Teen and Young Adult Perspectives on Generative AI: Patterns of Use, Excitements, and Concerns - Hopelab, Common Sense Media, Center for Digital Thriving at Harvard Graduate School of Education. Published 2024. Accessed February 2026 📢 Join the Discussion Share your thoughts using #ASAMPracticePearls — we’d love to hear from you! In support of improving patient care, the American Society of Addiction Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

  7. 20. Apr.

    Navigating Cannabis and Cannabinoid Use in Today’s Clinical Practice

    In this episode of ASAM Practice Pearls, Drs. Stephen Taylor and Takeo Toyoshima address the misconception that cannabis is not addictive. They discuss how clinicians can better understand the cannabis products their patients are using, navigate the changing legal landscape, and assess for cannabis use disorder using the “Three Cs” framework. The conversation highlights treatment strategies like motivational interviewing and harm reduction, managing cannabis withdrawal, the risk of psychosis from high-potency products, and emerging pharmacotherapy options. Throughout the episode, they offer practical strategies for keeping patients engaged in care.   ----more---- Looking for this episode's transcript? Download it HERE Get credit for listening! Claim your 0.5 CEs 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 Takeo Toyoshima, MD Dr. Takeo Toyoshima is the interim program director for the UCSF Addiction Psychiatry Fellowship. He completed medical school at UCLA, then psychiatry residency, addiction psychiatry fellowship, and forensic psychiatry fellowship at UCSF. His main clinical duties are at the San Francisco VA Health Care System, both in the Addiction Recovery Treatment Services' outpatient and intensive outpatient programs and in the Veterans Justice Outreach Clinic, which treats patients who are criminal justice-involved. In these settings, Dr. Toyoshima supervises UCSF medical students, psychiatry residents, addiction psychiatry fellows, and forensic psychiatry fellows, in addition to other allied health profession trainees. He concurrently serves as the VA site director for the UCSF Psychiatry and the Law Program. Outside of UCSF, Dr. Toyoshima also works in clinical and forensic private practice and serves in various roles in organized medicine (American Psychiatric Association, Northern California Psychiatric Society, California Society of Addiction Medicine, American Academy of Addiction Psychiatry, etc.). His clinical interests are in the intersection of psychiatry, addiction, and forensic matters.  📖 Show Segments 00:05 - Introduction  01:13 - How to Approach the Conversation with Patients  03:51 - Clarifying Terms and Product Use with Patients 05:52 - Legal and Regional Differences 08:45 - Addressing Patient’s Perceived Pros and Cons of Cannabis 11:19 - Assessing for Cannabis Use Disorder 13:53 - What if a Patient Doesn’t Want to Stop? 15:49 - Approaching Drug Testing with Patients 17:43 - Recommended Treatment Options 20:02  - Cannabis Withdrawal Symptoms 22:08 - Considerations for Adolescents 23:21 - The Risk of Psychosis 24:46 - Harm Reduction 27:22 - Signs of Cannabis Toxicity  31:46 - Key Takeaways 33:20 - Conclusion and Additional Learning Opportunity  📋 Key Takeaways Cannabis addiction is real and common: Around 10% of people who start using become addicted, and around 30% of current users meet criteria for cannabis use disorder (CUD).  Ask about products, routes, and potency: Flower, concentrates, edibles, and vapes carry very different risk profiles. Higher potency can lead to faster tolerance and withdrawal.   Work collaboratively with your patients: Let patients educate you about their use, be curious, and use motivational interviewing techniques in conversation.  Use the three Cs to assess CUD: Screen for issues with Control, Consequences, and Cravings, then map findings to the DSM-5 criteria together with the patient.  Recognize cannabis withdrawal: Withdrawal symptoms affect 20–50% of daily users and can include both psychiatric and physical symptoms, such as appetite changes, nausea and vomiting, mild tremors, temperature dysregulation, irritability, anxiety, and mood changes. Sometimes, what patients attribute to anxiety or poor appetite may actually be withdrawal.  Psychosis is a serious risk: Studies show around a 40% conversion to a schizophrenia diagnosis after a cannabis-induced psychotic episode, especially with high-potency products.  No FDA-approved medications exist: Gabapentin and N-Acetylcysteine (NAC) are off-label pharmacotherapy options that show evidence for treating CUD, but treating co-occurring psychiatric disorders is equally important.  Harm reduction is a valid goal: Reducing potency, spacing out use, switching routes, and building in breaks are practical steps when a patient isn't ready for abstinence.  Keep patients coming back: The therapeutic relationship is the most powerful tool, so focus on patient goals and follow-up.   Know your legal landscape and testing limitations: Laws vary by state. Standard urine screens will not detect synthetic cannabinoids, and THC metabolites can persist for weeks.  🔗 Resources ASAM’s 57th Annual Conference: Register HERE Focus Session: High Risk at Every Stage: Cannabis Exposure During Critical Periods of Development    ASAM 2025 Review Course: Psychiatric Co-morbidities: Complexities of Diagnosis and Care: Register HERE   ASAM 56th Annual Conference:  Cannabinoids and Pregnancy: ASAM Members, Patients and the Public - A Vital Discourse/Debate: Register HERE  Anyone Can Treat!: Master Youth Cannabis Use Treatment for Your Practice Setting: Register HERE  A Simple Guide to Pot, THC and How Much is Too Much: Ramos Barreda A, De Leon K, Urmas S. Los Angeles Times. April 20, 2018. Accessed March 24, 2026.   Cannabis/Marijuana Use Disorder: Yale Medicine. July 24, 2024. Accessed March 30, 2026.   Rates and Predictors of Conversion to Schizophrenia or Bipolar Disorder Following Substance-Induced Psychosis: Starzer MSK, Nordentoft M, Hjorthøj C. Am J Psychiatry. 2018;175(4):343-350. doi:10.1176/appi.ajp.2017.17020223 The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research: National Academies of Sciences, Engineering, and Medicine. 2017. Washington, DC: The National Academies Press. Transition From Substance-Induced Psychosis to Schizophrenia Spectrum Disorder or Bipolar Disorder: Rognli EB, Heiberg IH, Jacobsen BK, Høye A, Bramness JG. Am J Psychiatry. 2023;180(6):437-444. doi:10.1176/appi.ajp.22010076 Understanding Your Risk for Cannabis Use Disorder: Centers for Disease Control and Prevention. December 5, 2024. Accessed March 30, 2026.  📢 Join the Discussion Share your thoughts using #ASAMPracticePearls — we’d love to hear from you! In support of improving patient care, the American Society of Addiction Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

  8. 6. Apr.

    Kratom and 7-OH: What Clinicians Need to Know

    In this episode of ASAM Practice Pearls, Dr. Stephen Taylor hosts researchers Dr. Kirsten Smith and Katie Hill to explore the rapidly evolving landscape of kratom and 7-hydroxymitragynine (7-OH). They examine kratom’s complex pharmacology, review current research on kratom and 7-OH, discuss kratom’s addiction potential, withdrawal patterns, and the challenges of kratom in the clinical setting. The episode provides listeners with a basic understanding of kratom and 7-OH products, helping clinicians better understand where to begin when treating patients who use kratom and kratom-derived products. ----more---- Looking for this episode's transcript? Download it HERE Get credit for listening! Claim your 0.5 CEs 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 Kirsten Smith, PhD, LMSW   Dr. Kirsten Smith is a leading expert on kratom, with over 90 peer-reviewed publications on kratom and related topics like kava and tianeptine. From 2023-2025, she was an Assistant Professor at Johns Hopkins University School of Medicine’s Department of Psychiatry. She joined Hopkins after earning her Master’s from the University of Kentucky, PhD from the University of Louisville, and completing a 4-year postdoctoral fellowship at the National Institute on Drug Abuse Intramural Research Program (NIDA IRP). At NIDA IRP, she completed her K99-funded project that involved a national ecological momentary assessment of daily kratom use and a controlled drug administration sub-study that investigated the acute effects of commercial kratom products. Her R00-funded study at Johns Hopkins examined kratom pharmacokinetics/pharmacodynamics of kratom and assessed spontaneous kratom withdrawal among chronic consumers. She also received an R01 to study the safety, tolerability, and abuse potential of kratom in healthy adults, which is ongoing. She has conducted surveys and qualitative research on kratom and 7-hydroxymitragynine (7-OH). Dr. Smith is currently transitioning from academia to clinical practice but consults on kratom regularly and welcomes opportunities for collaboration. Disclosure: There are no relevant financial relationships.  Expert Katherine Hill, MPH   Katherine (Katie) Hill is a PhD candidate in Epidemiology of Microbial Diseases at Yale School of Public Health. Her research interests include substance use and harm reduction. Her doctoral research employs mixed methods to evaluate the impact of emerging substances, such as xylazine and kratom, on people who use drugs.  Disclosure: There are no relevant financial relationships.  📖 Show Segments 00:05 - Introduction  01:49 - Defining Kratom  04:42 - Consumers of Kratom 05:48 - Is Kratom an Opioid 07:29 - Differences Between Kratom and 7-OH 11:39 - Addiction Potential 16:50 - Toxicity, Acute Intoxication, and Toxidrome 18:55 - 7-OH Withdrawal and Overdose 24:16 -  Patient History and Assessment  26:25 - Practice Pearls for Clinicians 30:48 - Patient Motivations and Harm Reduction 33:03 - Conclusion and Additional Learning Opportunity  📋 Key Takeaways “Kratom” is often used as a broad term for kratom-derived products: Kratom can refer to powdered leaves, capsules, teas, concentrated extracts, or semi-synthetic 7-OH products, many of which may also contain caffeine, kava, CBD, or other additives. When a patient says they use "kratom," it provides little clinical clarity. Clinicians need to ask which product, form, and brand the patient is using to better understand their usage patterns.  Understand the product your patient is using: Product composition, potency, and co-ingredients of kratom are variable. Clinicians need to gather information on formulation, dosing, frequency, route, motivations, and co-use to gain a clear history. Self-report gives far more insight than current toxicology assays.   Kratom’s pharmacology is complex: Kratom can produce pain relief via the serotonin and opioid system. Effects from kratom also include increases in energy and mood elevation. Some kratom alkaloids and metabolites have atypical mu-opioid receptor activity as well as non-opioid activity, making kratom’s pharmacology complex. Kratom can lead to physical dependence symptoms when consumed regularly.  7-OH is different from natural kratom: 7-hydroxymitragynine is found only in trace amounts in kratom leaves, but exists in much higher levels in commercial semi-synthetic products. These formulations behave differently and have low bioavailability, making their clinical effects distinct.  Mild to moderate dependence and withdrawal are possible: Daily, repeated kratom use commonly leads to tolerance and withdrawal symptoms such as restlessness, irritability, fatigue, and cravings. Severe withdrawal appears uncommon in current data, though more evidence is needed, especially for 7-OH products.   People can develop a kratom use disorder: About 25% of people using kratom meet criteria for kratom use disorder based on modified DSM-5 Criteria, though most presentations appear to be mild to moderate.  Standard drug testing has limitations: Urine assays detect mitragynine, but a positive result can't distinguish between kratom leaf products and 7-OH products containing residual mitragynine. 7-OH is unstable in blood and rapidly metabolized, making detection challenging. Rely on self-report and consider asking patients to bring in their products for better clarity.  Understand motivations for use: Many people who use kratom and 7-OH are not seeking intoxication. They're trying to manage pain or mood, function at work, self-treat withdrawal, etc. Treatment planning should account for these functional goals and incorporate motivational interviewing and shared decision-making. Help is needed to move the field forward: Researchers are behind front-line clinicians in understanding these substances. There is still a lot that is unknown about kratom and kratom-derived products. Clinicians are encouraged to publish case reports, develop internal protocols, describe withdrawal symptoms, and refine assessments to better guide emerging best practices.  🔗 Resources ASAM’s 57th Annual Conference - Register HERE General Session: Understanding the Evolving Drug Landscape: From Epidemiology to Clinical Practice  Focus Session: Beyond Kratom: Novel Products Containing 7-OH, Pseudo, MGM, and Kava  Chapter 5: Kratom-related Physical Dependence and Addiction - Smith KE, Singh D, Grundmann O. In: Kratom History, Science and Therapeutic Potential. Academic Press; 2026:59-78. https://doi.org/10.1016/B978-0-443-27412-1.00005-5   Clinically Characterizing Adults Who Use Kava or Kratom: Substance Use Disorder Assessment Challenges for Increasingly Popular Botanical Products - Hill K, Boyer EW, Smith KE. Drug Alcohol Depend Rep. 2025;17:100394. Published 2025 Nov 9. doi:10.1016/j.dadr.2025.100394  Controversies in Assessment, Diagnosis, and Treatment of Kratom Use Disorder - Smith KE, Epstein DH, Weiss ST. Curr Psychiatry Rep. 2024 Sep;26(9):487-496. doi: 10.1007/s11920-024-01524-1. Epub 2024 Aug 13. PMID: 39134892; PMCID: PMC11344726 The Rise of Novel, Semi-synthetic 7-hydroxymitragynine Products - Smith KE, Boyer EW, Grundmann O, McCurdy CR, Sharma A. Addiction. 2024;120(2):387-388. doi:10.1111/add.16728   National Institute on Drug Abuse (NIDA): Kratom - Learn more about kratom, ongoing research, and additional resources.   📢 Join the Discussion Share your thoughts using #ASAMPracticePearls — we’d love to hear from you! In support of improving patient care, the American Society of Addiction Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Alle anzeigen (34)

Info

Season 1 | Season 2 Join ASAM Practice Pearls for in-depth discussions on addiction prevention, treatment, and recovery. Geared toward healthcare professionals and individuals seeking knowledge, this series explores the latest evidence-based approaches to addiction medicine. Listen to interviews with leading experts as they delve into critical topics and share practical tools you can use to improve patient care and promote public health.

Informationen

  • Erstellt von
    ASAM Education
  • Jahre aktiv
    2025 - 2026
  • Folgen
    34
  • Bewertung
    Unbedenklich
  • Copyright
    © Copyright 2025 All rights reserved.
  • Sendungswebsite
    ASAM Practice Pearls

Das gefällt dir vielleicht auch