2024 Fellow Lightning Round Presentations

2024 Fellow Lightning Round Presentations

ACAAM is committed to fostering connection among members of the academic addiction medicine community by advocating for our patients and our learners, as well as promoting belonging. By leveraging our common purpose and focusing on the mission of promoting academic excellence and leadership in addiction medicine, we will develop the next generation of academic addiction leaders to be true change agents to create a more just system to care for our patients.


On Wednesday, May 15, 2-4 pm ET, 19 addiction medicine fellows presented 5-minute/5-slide oral presentations on a topic of their choice. 

If you were unable to join us or wish to view the session again, head on over to the ACAAM Addiction Medicine Education Portal and access the recording. You can also view the PowerPoint Presentations and chat file. As a reminder, you must have an active ACAAM membership and be logged into the portal to access the recording. 

Presentation Summaries

Lit Review: Race and Cultural Differences in Substance Use Disorders
Discussion on the racial and ethnic differences in substance use disorders and now they pertain to treatment of patients, treatment options and perceived myths.
Janice Chuang, DO, Wake Forest University, School of Medicine, Winston-Salem, NC
Blood Transfusion as a Contributor to False Positive Phosphatidylethanol Testing
In this presentation, we delve into the critical implications of false positive PEth (phosphatidylethanol) testing, particularly concerning severely ill patients awaiting liver transplantation. The presentation highlights the potential for false positive PEth levels post-allogeneic packed RBC transfusions, shedding light on the transfer of PEth from alcohol-consuming donors to recipients at concentrations detectable in the recipient's bloodstream. With a mandatory six-month abstinence criterion for most liver transplant centers, the presentation emphasizes the need for clinicians to consider red blood cell transfusions as a potential cause for false positive PEth results, especially in patients reporting sobriety.
Giovani V. Cruz Cruz, MD, University of California, Los Angeles, Los Angeles, CA
Prevalence of Problematic Alcohol Use in Patients with Opioid Use Disorder Receiving Opioid Maintenance Treatment Using Urine Metabolites
Alcohol use disorder (AUD) and opioid use disorder (OUD) are two significant public health issues worldwide. Problematic alcohol use is associated with adverse health and economic outcomes, especially among people in opioid agonist treatment. The co-occurrence of these disorders is estimated at 14% nationally. Most patients who present for opioid use disorder treatment abstain from problematic drinking. However, a proportion of individuals continue to drink despite denying the use of alcohol. As many drink alcohol excessively, there is a need to address alcohol use to improve health outcomes for these individuals. Urine metabolite testing has emerged as a promising tool to identify alcohol use in patients, but its utility in detecting problematic alcohol use prevalence in OUD patients remains understudied. This research outlines a study aimed at investigating the prevalence of problematic alcohol use in patients with OUD by employing urine metabolite testing.
Nadia Feroz, MD, Geisinger Health System, Wilkes Barre, PA
Investigating the Prevalence of Gambling Use Disorder Among Patients with Substance Use Disorder at Geisinger South Wilkes-Barre MAT Clinic
This is a quality improvement project that was done in the MAT clinic I am doing fellowship in. We wanted to see the prevalence of gambling disorder among patients with substance use disorder. I had patients fill out annomous questionnaire regarding their gambling habit in addition to answering question based on DSMV criteria for GUD. I just finished data collection, I would like to share my findings in the presentation.
Asmita Gautam, MD, Geisinger Health System, Wilkes Barre, PA
“Gas Station Heroin”: Tianeptine, a unique Tricyclic Antidepressant with Addictive Properties
This is a case presentation series on Tianeptine which is turning out to be a drug with highly addictive properties. It is readily available over gas stations which makes it easily accessible to patients. Often it is substituted for opioids as it has unique effects through opioid receptors. I present here two unique cases of Tianeptine misuse with withdrawal and overdose and subsequently their management in hospital and clinic settings.
Alman Bin Khalid, MD, HMH Jersey Shore University Medical Center, Neptune, NJ
Unintended Consequences of Phenobarbital?
Penn State Milton S. Hershey Medical Center has moved away from the use of symptom-triggered benzodiazepines for the medical management of alcohol withdrawal. Phenobarbital has become the default option for patients admitted, and options include an intravenous or oral load with oral taper, or just an oral taper. Patients are often reflexively started on phenobarbital if they have previous admissions using this treatment. While research has shown positive trends in length-of-stay, there is the possibility for the development of sedative use disorder in some patients who are placed on phenobarbital protocols without more consideration.
Stuart MacKay, DO, Penn State Milton S. Hershey Medical Center, Hershey, PA
A Case of Phencyclidine-Induced Catatonia
This case report presents a 23-year-old male with a history of phencyclidine and opioid use disorder who had two emergency department visits within 24 hours due to intoxication from PCP and fentanyl. The patient exhibited symptoms of catatonia, which improved with treatment using intravenous lorazepam and intramuscular haloperidol. Despite elevated liver enzymes and creatinine phosphokinase levels, the patient showed improvement in renal function and liver enzymes after treatment. He was discharged on sublingual buprenorphine to manage his opioid use disorder and connected to a residential treatment facility. At a one-week follow-up, the patient denied any substance use since discharge.
Samuel Ogechukwuka Nwaobi, MD MPH, Massachusetts General Hospital, Boston, MA
Rates of Hepatitis B Screening and Vaccination in a Rapid Access Substance Use Disorder Clinic: Opportunities for Improved Screening and Primary Prevention ​
Hepatitis B virus (HBV) is a DNA virus transmitted via infected bodily fluids and can cause significant morbidity and mortality including acute fulminate liver failure, cirrhosis and hepatocellular carcinoma. Vaccination is highly effective at preventing HBV infection. Despite widespread national vaccination efforts, the prevalence of hepatitis B has been increasing for US born individuals with history of substance use and limited data exist regarding hepatitis B vaccination rates in individuals accessing substance use treatment programs. This current retrospective chart review study analyzes the rates of hepatitis B screening and vaccination in a rapid access substance use clinic located in Cleveland, Ohio.
Lindsay A. Perusek, DO, The MetroHealth System / Case Western Reserve University, Cleveland, OH
Co-prescription Rates of Naloxone with Chronic Opioids
Over the last two decades the number of deaths due to opioid overdose has continued to increase. One goal of the United States Department of Health and Human Services to combat opioid overdose is to expand use and distribution of naloxone. This presentation will present a study that investigates the prevalence of naloxone co-prescription with chronic opioid prescriptions (>= 3mo in 12-month period) by non-specialist in the Geisinger Health Network. The goal of the study is to identify a potential healthcare gap and to make changes to improve patient outcomes.
Tommy D. Pham, MD, Geisinger Health System, Wilkes Barre, PA
From Crisis to Triumph: A Case of Inpatient Ketamine Supported High-dose Buprenorphine Initiation
I will present a case of ketamine supported high dose buprenorphine initiation in an inpatient setting for a patient who has had several unsuccessful treatment attempts in the past. Our team utilized treatment strategies as discussed during recent CSAM conference, utilizing ketamine for treatment of withdrawal and subsequently as pre-dose strategy to prevent additional withdrawal episodes.
Parmis Y. Rad, MD, Kaiser Permanente Northern California, San Leandro, CA

More Than Just a Hit: Recent Traumatic Brain Injury and Subsequent Nonfatal Overdose
Traumatic brain injury (TBI) is common among people who use drugs and may increase the risk of overdose via behavioral and neurocognitive mechanisms. In this presentation, I will describe original research using data from ongoing prospective cohort studies of people who use drugs in Vancouver. We aimed to examine the relationship between TBI in the prior six months and subsequent nonfatal overdose. Individuals who reported preceding TBI had significantly higher odds of subsequent nonfatal overdose in this analysis. Further research on the interaction between TBI and overdose, including efforts to prevent recurrent TBI and overdose, is warranted.
Gabriela E. Reed, MD, Boston Medical Center, Boston, MA
A Nauseating Buprenorphine Induction in a Patient with Acute Hepatitis A
This is a case of a buprenorphine induction in a patient with acute Hepatitis A. Learning objectives include considering high dose buprenorphine when a low dose buprenorphine protocol results in precipitated withdrawal and modifying existing buprenorphine protocols in cases of transient, acute hepatic injury. In this case, I switched to Subutex (buprenorphine monoproduct) after learning that Suboxone (buprenophine/naloxone combination) triggers precipitated withdrawal as naloxone plasma concentrations and half-life are 2-3x longer in cases of hepatic impairment. There is very limited literature on buprenorphine inductions in cases of hepatic injury and none since fentanyl has been introduced into the drug supply.
Ruchi Shah, DO, Boston Medical Center, Boston, MA
Buprenorphine as an Alternative Therapy for Alcohol Use Disorder: A Case Series
This case series aims to present two cases of patients treated with buprenorphine for alcohol use disorder: one with a history of significant liver disease and another with a history of opioid use disorder. Both patients exhibited decreased alcohol cravings and sustained abstinence after stabilization on buprenorphine.
James F. Simons, MD, Geisinger Health System, Danville, PA
Accelerated Inpatient Transition from Methadone to Long-Acting Injectable Buprenorphine
While methadone is an effective and evidence-based Food and Drug Administration-approved treatment for opioid use disorder, some patients experience barriers to treatment adherence such as difficulty with daily to weekly clinic attendance, limits to clinic hours, transportation, limits to dose titration, and stigma and may benefit from transitioning from methadone to buprenorphine. Long-acting injectable buprenorphine (LAIB) also represents an opportunity to address patient barriers to treatment adherence. Methadone’s long half-life creates challenges for transitions to buprenorphine while avoiding precipitated withdrawal and there are few studies that described the “optimal” treatment strategy, however, hospitalization may present an opportunity to transition patients in a controlled setting. This presentation includes the case of a patient who transitioned from methadone to LAIB during his hospitalization at the West Suburban Medical Center (WSMC) in Chicago, Illinois using an accelerated approach. This patient is part of the Project LIFE program (Long-Acting Injectable Buprenorphine to End Overdose), which is a hospital-based LAIB program that was started at the WSMC in August 2022 that allows patients to initiate LAIB in the emergency room and inpatient setting.
Tiffany G. Tahata, DO, Rush University Medical Center, Chicago, IL
Implementation of Addiction/Cardiology Co-Management Clinic to Promote Engagement in Addiction Medicine/Psychiatry Care for Patients with Stimulant and Alcohol Related Heart Failure
A multidisciplinary team of social workers, nurses and clinicians from Cardiology, General Internal Medicine, Addiction Medicine and Addiction Psychiatry at Harborview Medical Center started a QI project to increase access to and engagement in substance use disorder care for patients with stimulant and alcohol related heart failure. The second PDSA cycle involves a pilot Cardiology/Addiction co-management clinic. This presentation describes the clinic protocol, aims and future directions.
Ngoc K. Tran, MD, University of Washington, Seattle, WA
A Complicated Case of Fentanyl and Butalbital Withdrawal Management
This is a case report on a 50 year old female with history of chronic migraines and cervical disc disease on 350 mcg of fentanyl patches/day and 8 Fioricet (50mg butalbital/325mg acetaminophen/40mg caffeine) tablets/day presenting with intractable vomiting and altered mental status from acute opioid and barbiturate withdrawal and bowel obstruction from a new duodenal mass. It will highlight the challenges of managing a combined withdrawal syndrome in the setting of an acute organic pathologic process. Due to her history of colon resection and bowel obstruction, other routes of methadone administration were considered which will be discussed. I will also go over the less prevalent butalbital withdrawal process and its management.
Kim H. Tran, MD, Ventura County Medical Center, Ventura, CA
Low Dose Initiation of Buprenorphine using a Methadone Cross-Tapering Strategy: A Case Series
There is growing evidence showing that a low-dose buprenorphine initiation (i.e. Bernese Method) can be implemented successfully. Patients with opioid use disorder continue to express interest in avoiding treatment due to severe withdrawal symptoms required prior to initiation. This presentation will summarize the case series of two patients, prior using only illicit opioids, were started on low-dose initiation (LDI) of buprenorphine while simultaneously started on tapering doses of methadone. Both patients successfully tolerated a methadone taper with buprenorphine initiation without complications including precipitated withdrawal.
Aditya Varambally, DO, University at Buffalo, Buffalo, NY
Starting Treatment for Hepatitis C in Patients with Addiction Consults while Hospitalized
With the start of our Addiction Medicine outpatient Bridge Program 4 weeks ago, our inpatient Addiction Medicine consult service started recommending a panel of infectious disease screening labs into every new consult. Many of these patients had the labs completed during their hospitalization and were approached about interest in following up in the Bridge Clinic for medications for opioid use disorder (MOUD) or other services such as hepatitis C treatment and pre-exposure prophylaxis (PrEP). If interested in starting hepatitis C treatment, the medications were ordered and started during the hospitalization so that treatment could continue while at other facilities such as substance rehab, skilled nursing facility, or acute physical rehab. We are excited to continue to engage these patients with tele-health and in-person visits to support their successful treatment of hepatitis C, and hopefully provide evidence that treatment can be successfully started in the hospital and should not be deferred to outpatient follow-up.
TaReva L. Warrick-Stone, DO, Thomas Jefferson University Hospital, Philadelphia, PA
Capacity Assessment – Any Physician Can Do It
It has been estimated that up to 25% of patients on adult medicine units lack medical decision-making capacity. In patients with substance use disorder, assessing medical decision-making capacity is essential, especially in light of the severe co-morbidities that may occur in this population. This presentation aims to review the basics of assessing medical decision-making capacity.
Qais Zalim, MD, Penn State College of Medicine, Harrisburg, PA