2024 Fellow Lightning Round PresentationsACAAM 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 SummariesLit Review: Race and Cultural Differences in Substance Use Disorders 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 |