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Addiction Medicine Made Easy
Addiction Medicine Made Easy Podcast
Welcome back to Addiction Medicine Made Easy! Our podcast is designed for everyone, whether you're a healthcare provider or someone with no experience in the field. We offer concise, relevant, and practical information on addiction medicine to help anyone understand and address common addiction-related issues. Featuring guest experts from various backgrounds, including healthcare professionals, addiction medicine specialists, and patients in recovery, we cover a wide array of pertinent topics. Each episode is crafted to provide valuable insights within a 20-60 minute timeframe, making it accessible for busy schedules. Join us in the fight against addiction by tuning in to our episodes directly on our website or through your preferred podcast platform.
Check back periodically for updated episodes.
Latest Episode
#78: Managing Pain Safely
June 16, 2024
GUEST: Dr. Reb Close, Addiction & Emergency Medicine
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-sharing medication regimens.
#77: Using "Targeted" Naltrexone to Reduce Alcohol Use
June 3, 2024
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.
#76: A Treatment That Reduces Meth Use by 86% !!!
May 13, 2024
Guest: Dr. Michael Miller, Addiction Medicine
We all know that options to treat stimulant use disorder are limited. In this episode, Dr. Grover interviews Dr. Michael Miller, an Addiction Medicine physician 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 !!!)
#75: Opioid Use Disorder during Pregnancy
May 1, 2024
Guest: Dr. Kenneth Spielvogel, OB-GYN
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.
Bonus Episode - Food, Eating Disorders, and Addictive Food
April 20, 2024
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.
#74: How Does Counseling and Talk Therapy Help Patients with Addiction (Part 2)
April 13, 2024
Guest: Andrew Finley, LMFT
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.
#73: How to Handle The Polysubstance Use Patient
April 1, 2024
Guest: Dr. Lee Goldman, Addiction Medicine
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.
#72: Cannabis Withdrawal Revisited
March 18, 2024
In this episode, we take a second look at cannabis withdrawal. Dr. Grover covered this topics 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.
#71: How does counseling and talk therapy help patients with addiction? (Part I)
March 4, 2024
Guest: Andrew Finley, LMFT
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.
#70: What drug is coming next in the illicit drug supply?
February 25, 2024
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.
#69: Parent Education on How to Talk to Kids About Drugs and Alcohol
February 12, 2024
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 abuse in gneeral, as well as how to talk to kids who are actively using substances. Pardon the raspy voice -Dr. Grover is getting over pneumonia.
#68: Fentanyl-laced Stimulants
January 29, 2024
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.
#67: Recreational Nitrous Oxide Use
January 18, 2024
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.
#66: Have you heard of Iso?
December 26, 2023
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.
#65: Can parents prevent alcohol use disorder by allowing teens to drink at home?
December 9, 2023
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.
#64: The Art of the (Drug) Deal
November 20, 2023
How does a drug deal work? How doe 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.
#63: Building Trust with Substance Use Patients
November 3, 2023
Guest: Araceli, Substance Use Navigator
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.
#62: How P2P Meth Changed Everything
October 19, 2023
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.
#61: Have you heard of peer support? It's awesome!
October 4, 2023
Guest: Ceil, Provider of Peer Support
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.
#60: How to actually help patients with Cannabinoid Hyperemesis Syndrome
September 25, 2023
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.
#59: Why Substance Use Navigators are awesome!
September 13, 2023
Guest: Austin, Substance Use Navigator
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!
#58: How to Use Naloxone like a Pro
August 30, 2023
Guest: Dr. Reb Close, Emergency Medicine
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.
#57: Have you heard of Phenibut?
August 24, 2023
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.
#56: When you prescribe an opioid, who else besides your patient might have an overdose?
July 24, 2023
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?
#55: Can you use baclofen to treat alcohol use disorder?
July 10, 2023
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.
#54: Do you know enough about urine drug screens to use them effectively?
June 26, 2023
So... how much do you know about urine drug screens? Can selegiline cause a false positive for meth? Can quinolones cause a false positive 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.
Bonus Episode - A Little Inspiration
June 14, 2023
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.
#53: Is the buprenorphine you prescribe going to end up on the street?
June 1, 2023
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?
#52: Talking to Kids About Drug Use
May 15, 2023
Guest: Dr. Susan Swick, Child Psychiatrist
In this episode, Dr. 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.
#51: What's it like having a family history of addiction?
May 4, 2023
Guest: Cassandra, Mother with Drug/Alcohol Free Home
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.
#50: A Recovery Story, Part 2
April 26, 2023
Guest: Aiden
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.
#49: Buprenorphine vs Fentanyl
April 19, 2023
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.
#48: A Recovery Story
April 5, 2023
Guest: Aiden
In this episode, Dr. Grover interviews Aiden, a young man in recovery. Aiden shares his story of how this addiction developed, what it's like living with addiction, how this recovery started, and what life is like as a young man in recovery.
#47: What is Kratom?
March 22, 2023
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.
#46: Treating Alcohol Use Disorder with Topiramate
March 9, 2023
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!
#45: Cannabinoid Hyperemesis Syndrome
February 27, 2023
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.
#44: What is the risk of fentanyl exposure to first responders and what do we do about it?
February 10, 2023
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?
#43: Cannabis Toxicity and "Greening Out"
January 19, 2023
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."
#42: Delirium Tremens
January 6, 2023
Pink Elephants anyone? In this episode, we review Delirium Tremens, also known 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.
#41: How does micro-dosing buprenorphine work?
December 28, 2022
Have you heard about micro-dosing 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 micro-dosing buprenorphine... including how it might be the best option for patients using illicit fentanyl to start buprenorphine without experiencing precipitated withdrawal.
#40: What the heck is Xylazine and how do you treat a Xylazine overdose?
December 1, 2022
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.
#39: Are you confused by all the different formulations of buprenorphine? Me too.
November 17, 2022
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.
Bonus Episode - A Plea to Treat Alcohol Use Disorder as well as we do Opiate Use Disorder
November 7, 2022
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.
#38: Could you be eligible to be board certified in Addiction Medicine?
October 31, 2022
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!
#37: Stimulant Withdrawal
October 13, 2022
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.
#36: What labs can you use to assess alcohol use? (Follow-up to Episode #27)
September 29, 2022
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).
Bonus Episode - The Non-Opioid Management of Renal Colic
September 13, 2022
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.
#35: Hallucinogen Intoxication
September 7, 2022
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.
#34: An Overview of Methamphetamine Use Disorder
August 25, 2022
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.
#33: Methamphetamine Psychosis
August 8, 2022
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.
#32: The "Drug-Seeking" Patient and why it's time to retire the term "Drug-Seeking"
July 26, 2022
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.
#31: How do mutual support groups and 12 step programs like Alcoholics Anonymous work?
July 10, 2022
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.
#30: Buprenorphine After Naloxone Rescue
June 27, 2022
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.
#29: Drinking Alcohol + Naltrexone = Cure for Alcohol Use Disorder
June 4, 2022
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.
#28: Cannabis Induced Psychosis
May 25, 2022
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.
#27: Can you diagnose an alcohol use disorder based on lab tests?
May 6, 2022
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 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 topics and try to answer the question - how accurate are lab tests in determining if a person is consuming alcohol, and if so how much?
#26: Can Bupropion and Naltrexone help treat methamphetamine use disorder?
April 29, 2022
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 as 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.
#25: What is kindling in alcohol withdrawal?
April 15, 2022
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.
#24: How to Handle Buprenorphine in the Perioperative Setting
March 30, 2022
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.
#23: How much do you know about vaping?
March 14, 2022
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.
#22: Illicit Fentanyl
March 10, 2022
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.
#21: What's the deal with phenobarbital for alcohol withdrawal?
February 24, 2022
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.
#20: A Patient Story - Getting "Well" with Opiate Use Disorder
February 12, 2022
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.
#19: The Patient on Methadone for Opiate Use Disorder
February 3, 2022
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.
#18: What is Post Acute Withdrawal Syndrome?
January 19, 2022
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.
#17: Buprenorphine Precipitated Opiate Withdrawal
January 3, 2022
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.
#16: How does stigma hurt patients? What can we do about it?
December 6, 2021
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.
#15.5: Lit Review - Using High Dose Buprenorphine in the Emergency Department
December 3, 2021
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.
#15: An Overview of Alcohol Withdrawal
November 20, 2021
This episode has been on the to-do list for quite a while. In this Episode 15, Dr. Grover tackles the huge topic of alcohol withdrawal - from definitions, to pathophysiology, to diagnosis, to management.
#14: Cannabis Dispensaries - Who works there and what do they tell patients about cannabis?
November 8, 2021
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.
#13: Alcoholic Ketoacidosis
October 26, 2021
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.
#12: Medications to prevent relapses on alcohol and reduce alcohol intake (aka Medications for Alcohol Use Disorder)
October 17, 2021
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.
#11: Adulterants in Street Drugs: Does anyone actually know what's in the drugs they use?
September 26, 2021
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.
#10: Gabapentin as a Treatment for Cannabis Dependence and Withdrawal
September 8, 2021
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.
#9: Harm Reduction and How Using it in your Practice Improves your Patient Care
August 24, 2021
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.
#8.5: Lit Review - What is the 1 year mortality for patients after an ED visit for a non-fatal opioid overdose?
August 9, 2021
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."
#8: The Neurobiology of the "Addict Brain" (aka why addiction makes people do crazy things)
July 25, 2021
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!
#7: Carisoprodol (Soma) Abuse and Withdrawal
July 12, 2021
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.
#6.5: Lit Review - How Iceland Got Teens to Say No to Drugs
July 5, 2021
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
#6: How to Assess the Severity of a Substance Use Disorder
June 22, 2021
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.
#5: Medications for Smoking Cessation 101
June 8, 2021
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.
#4.5: Lit Review - What are patients thinking about after an opioid overdose?
June 2, 2021
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.
#4: How to Handle Benzodiazepine Dependence
May 25, 2021
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.
#3: What is Cannabis Withdrawal Syndrome?
May 22, 2021
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?
#2: Buprenorphine Basics
May 17, 2021
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.
#1.5: Lit-Review - Will this hospitalized patient develop severe alcohol withdrawal?
May 10, 2021
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.
#1: Why Care About Addiction?
May 3, 2021
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.
#0: Introduction
May 3, 2021
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?
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