Substance use disorder

So kind of average complex patient with BPD, you have to put them into a BPD treatment that takes 12 to 18 months.

Then is SUD treatment or an anorexia treatment or a OCD treatment.

And it really kind of sets forth a pathway that, first of all, is expensive and unavailable.

But also, it doesn't work in sequence because these patients who have substance use disorder and BPD get kicked out of the BPD treatments for their substance use disorder.

Live from our studios in Midtown Manhattan, here is today's program.

Hello everyone, this is your host Emily and I'm speaking with Lindsay Peck and she is in Reiki as well as being an SUD counselor and the owner of Recover Reiki in Portland, Oregon.

Lindsay, how are you doing today?

I'm good, thank you.

For anesthetists in particular, it is a deadly intersection of high-stress, high-acuity work coupled with immediate, unhindered access to highly lethal, fast-acting intravenous drugs.

That intersection of stress and access brings us to substance use disorder, or SUD.

The textbook notes a terrifying statistic regarding prescription drug misuse.

Physicians misuse opioids and benzodiazepines at five times the rate of the general population.

Why does that happen?

It is a combination of physiological differences, such as how enzymes in the liver process alcohol or drugs, and psychological factors.

Women with SUD are much more likely to have comorbid, untreated psychiatric conditions like severe depression or trauma histories.

And that ties back to the work-life conflicts we discussed earlier.

Part 1.

What defines a substance use disorder? Substance use disorder, or SUD, refers to a pattern of substance use, be it nicotine, cannabis, cocaine, opioids, or something else, that causes significant impairment or distress to the user.

SUD is prevalent and growing in the United States and around the world.

People of any age may be at risk for developing SUD.

But exposure to and experimentation with alcohol and drugs usually begins in adolescence.

Substance abuse has been recognized as a mental health disorder for many years.

But instead of separating substance use from abuse, we now use the term substance use disorder, SUD, with specifiers to describe the severity of the use.

As with all types of substance abuse, a person needs to exhibit two of the 11 diagnostic criteria over a 12-month period of time to fulfill the definition of SUD.

What about the issue? What about the impact of drug use on this issue? Your thoughts, since weed is legal, it seems to be overused in our community.

I definitely do hear, I do see your point when it comes to substance use disorder in our communities.

And when I talk about depression, I can definitely answer that question because with the legalization of marijuana, it has become a coping mechanism.

And unfortunately, a lot of our youth have undiagnosed mental health disorders.

it.

No, it's definitely social.

And I didn't really talk about substance use disorder, but I'm grateful that you're here and that you introduced it to the conversation because that is true.

A lot of social learning, there is drug use is in every video now.

Today is Tuesday, October 27th, and I'm Zach Caruso.

Our lead story this week is in the Journal of Attention Disorders and is titled The Effect of Stimulant Medications on Symptom and Treatment Outcomes in Adults with Comorbid Attention Deficit Slash Hyperactivity and Substance Use Disorder, a Systematic Review and Meta-Analysis.

ADHD and SUDs have shared genetic vulnerability, and 20% of people with an SUD have co-occurring ADHD.

This study assessed the risks and benefits of stimulant treatment in patients with both diagnoses.

Researchers found seven studies that met inclusion criteria, of which six were randomized controlled trials.

And today we're really excited to welcome Karen Haessler.

She is an addiction medicine PA. Karen has been working in inpatient addiction consult service, primarily providing treatment for patients who are experiencing substance use disorders, and that includes alcohol withdrawal, opioid disorders.

She also helps to initiate medication-assisted therapy, such as buprenorphine, methadone, She is also a PCSS MOUD mentor.

That stands for Providers Clinical Support System Medications for Opioid Use Disorders mentor.

And what that means is that you essentially help to mentor other clinicians with the use of buprenorphine, methadone, naltrexone.

So we're going to get a little bit of that today.

In addition, because you do so many things, I've had the privilege of working with you as your capacity as an adjunct instructor, working over at the Mass General Brigham University of Health Professions, doing psychiatric content, substance use disorders, doing small case groups with students, as well as precepting both students from my program as well as other students in the area.

I've known you since 2022 now.

Patients might take extra doses, report lost or stolen prescriptions, hoard pills, or seek prescriptions from multiple providers.

And the clinician's instinct is to label this as a severe SUD and abruptly terminate the relationship.

Which is often a tragic misinterpretation of the behavior, isn't it?

It is.

This is why stigmatization must be stringently avoided.

Labeling a terrified patient as an addict destroys a therapeutic alliance.

Conversely, patients who do have a legitimate history of SUD are at a significantly higher risk of developing chronic pain.

And ironically, their pain is frequently severely undertreated due to physician stigma and fear of regulatory scrutiny.

Among its aims, make high alcohol content beverages more expensive, as some provinces have done; review the number and location of liquor outlets and how many hours they're open; and to pass legislation that provincial outlets must allocate at least 3% of net profits for local harm reduction initiatives.

The health prevention angle is a big part of the strategy, which relies on Canada's Guidance on Alcohol and Health, released by the Canadian Centre on Substance Use and Addiction.

It's no accident that PEI's Chief Public Health Officer, Dr. Heather Morrison, is the point person on the new strategy.

Did you ever, uh, worry that you wouldn't get this over the finish line?