Cracking Addiction

In this episode of Cracking Addiction I speak with Associate Professor Suzanne Nielsen about the opioid epidemic and what we can do about it.In the USA there seems to be more a problem with heroin whereas in Australia we are struggling with prescription opioid dependence. Even though a doctor may be prescribing your pain killers, it is still possible to become addicted to pain killers. The traditional treatments we have for opioid dependence in general include methadone and buprenorphine based opioid replacement therapy. A recent addition to the family includes the Long -Acting Injectable Buprenorphine therapies, commonly referred to as “the Injection”. Patients who struggle with prescription opioid use disorder (which has been referred to as “pain killer addiction”) also benefit from opioid replacement therapy. Suzanne’s research over the last ten years has proven that the same therapies that work for heroin dependency, also work for prescription opioid dependency.Discussions and comments in our videos are for informational purposes only and should not replace the advice of your medical professional. Please consult with your doctor before making any changes to your medical treatment or lifestyle.Latest Blogshttps://www.meducate.com.au/blogAbout Meducate ®Meducate provides online education for doctors, clinicians, health professionals and the public.See the website to browse the many different talks and courses available https://www.meducate.com.au

In episode 69 of Cracking Addiction we discuss the difference and similarities between general practice and Addiction Medicine. We discuss Addiction Medicine consultation liaison services in hospital, inpatient and community management options with regards to Addiction Medicine. Lastly we discuss the role general practitioners play in managing patients with substance use disorders within the community and the breadth of community presentations and continuity of care that they provide their patients.Discussions and comments in our videos are for informational purposes only and should not replace the advice of your medical professional. Please consult with your doctor before making any changes to your medical treatment or lifestyle.Latest Blogshttps://www.meducate.com.au/blogAbout Meducate ®Meducate provides online education for doctors, clinicians, health professionals and the public.See the website to browse the many different talks and courses available https://www.meducate.com.au

In this episode of Cracking Addiction we discuss the class of drugs known as gabapentinoids, a group of GABA analogues. In this episode we discuss the clinical uses of gabapentinoids and also the increasing rates of prescription of gabapentinoids in recent years and the resultant harms associated with gabapentinoids including the risks of dependence/addiction as well as increased rates of overdose and polypharmacy harms.Discussions and comments in our videos are for informational purposes only and should not replace the advice of your medical professional. Please consult with your doctor before making any changes to your medical treatment or lifestyle.Latest Blogshttps://www.meducate.com.au/blogAbout Meducate ®Meducate provides online education for doctors, clinicians, health professionals and the public.See the website to browse the many different talks and courses available https://www.meducate.com.au

In episode 67 of Cracking Addiction we discuss the management of acute intoxication of MDMA and discuss the principles of both MDMA and stimulant withdrawal including supportive management options as well as the importance of psychosocial interventions in particular contingency management and CBT based interventions.Discussions and comments in our videos are for informational purposes only and should not replace the advice of your medical professional. Please consult with your doctor before making any changes to your medical treatment or lifestyle.Latest Blogshttps://www.meducate.com.au/blogAbout Meducate ®Meducate provides online education for doctors, clinicians, health professionals and the public.See the website to browse the many different talks and courses available https://www.meducate.com.au

In episode 66 of Cracking Addiction we discuss MDMA or ecstacy and discuss its analogues PMA and PMMA and discuss the pharmacokinetics of these drugs, the unique properties of MDMA as both an atypical amphetamine-type substance and its effects as an empathogen. We also discuss the usage as both a recreational drug but also the new and emerging evidence of the clinical effects and benefits of MDMA and its increased usage in medical practice. MDMA has many effects on the body and we discuss the effects of MDMA on the brain, heart and liver in particular as well as some of the side effects of MDMA.Discussions and comments in our videos are for informational purposes only and should not replace the advice of your medical professional. Please consult with your doctor before making any changes to your medical treatment or lifestyle.Latest Blogshttps://www.meducate.com.au/blogAbout Meducate ®Meducate provides online education for doctors, clinicians, health professionals and the public.See the website to browse the many different talks and courses available https://www.meducate.com.au

In this episode of Cracking Addiction we discuss the timeframe of GHB withdrawal, the severe and significant symptoms of GHB withdrawal and the potential life threatening sequelae of GHB withdrawal. We explore the approach to GHB withdrawal management including medications that can assist to manage these symptoms and the need to speak specialist help promptly given the potential for significant deterioration.Discussions and comments in our videos are for informational purposes only and should not replace the advice of your medical professional. Please consult with your doctor before making any changes to your medical treatment or lifestyle.Latest Blogshttps://www.meducate.com.au/blogAbout Meducate ®Meducate provides online education for doctors, clinicians, health professionals and the public.See the website to browse the many different talks and courses available https://www.meducate.com.au

In this episode of Cracking Addiction we discuss GHB and its analogs GBL and 1,4-butanediol and the differences between these drugs. We explore the clinical indications for GHB as well as the pharmacology and pharmacokinetics of this drug. We discuss the side effects of GHB and some of the symptoms of GHB withdrawal.Discussions and comments in our videos are for informational purposes only and should not replace the advice of your medical professional. Please consult with your doctor before making any changes to your medical treatment or lifestyle.Latest Blogshttps://www.meducate.com.au/blogAbout Meducate ®Meducate provides online education for doctors, clinicians, health professionals and the public.See the website to browse the many different talks and courses available https://www.meducate.com.au

In this episode of Cracking Addiction we speak to Professor Peg O'Connor, a professor of moral philosophy who is in recovery from alcohol use disorder and who addresses an audience much like herself: those in recovery who have struggled with the Christian-centric God at the heart of Alcoholics Anonymous. She brings our attention to a little-known fact: the term “higher power,” a touchstone in the twelve steps of Alcoholics Anonymous, was coined by William James, philosopher, psychologist, and intellectual giant of the early 20th century. In this book Professor O'Connor addresses concepts such as:Understanding the Concept of “Higher Power” at the Heart of the 12-Step Program Why There Must Be Multiple Paths out of Addiction and No One is the Best or RightWhy Needs in Recovery Change over TimeUndertaking Spiritual Recovery in AA without a Religious DenominationProfessor O'Connor's book 'Higher and Friendly Powers: Transforming Addiction and Suffering' can be ordered from her website: https://pegoconnorauthor.com/ as well as Amazon, Barnes and Noble and Wildhouse Publications.

In this episode of Cracking Addiction we discuss people who use drugs whilst in hospital and discuss the ethics of treating people who use drugs, harm reduction measures that can assist with patient engagement, the stigma and marginalisation people who use drugs experience and the evidence and ethics around behaviour contracts.Discussions and comments in our videos are for informational purposes only and should not replace the advice of your medical professional. Please consult with your doctor before making any changes to your medical treatment or lifestyle.Latest Blogshttps://www.meducate.com.au/blogAbout Meducate ®Meducate provides online education for doctors, clinicians, health professionals and the public.See the website to browse the many different talks and courses available https://www.meducate.com.au

Kamini an Ayurvedic opiate-Kamini or Kamini Vidrawan Ras is an Ayurvedic medicine containing opiates as well as some heavy metals. It is a medicine marketed for a variety of indications ranging from premature ejaculation and impotence to increased stamina. There is increased recognition and awareness of patients presenting to specialist Addiction Medicine services with opioid dependence secondary to Kamini Vidrawan Ras often requiring treatment with opioid substitution therapy.Discussions and comments in our videos are for informational purposes only and should not replace the advice of your medical professional. Please consult with your doctor before making any changes to your medical treatment or lifestyle.Latest Blogshttps://www.meducate.com.au/blogAbout Meducate ®Meducate provides online education for doctors, clinicians, health professionals and the public.See the website to browse the many different talks and courses available https://www.meducate.com.au

In this episode of Cracking Addiction we discuss the timeframe and symptoms of benzodiazepine withdrawal, how to stabilise a patient on benzodiazepines and weaning and tapering of benzodiazepines within a community setting. We also discuss and highlight the importance of psychosocial support and lifestyle interventions in managing benzodiazepine dependence and withdrawal.Discussions and comments in our videos are for informational purposes only and should not replace the advice of your medical professional. Please consult with your doctor before making any changes to your medical treatment or lifestyle.Latest Blogshttps://www.meducate.com.au/blogAbout Meducate ®Meducate provides online education for doctors, clinicians, health professionals and the public.See the website to browse the many different talks and courses available https://www.meducate.com.au

In this episode  of Cracking Addiction we discuss the effects of chronic benzodiazepine usage and the mechanisms of which tolerance and dependence to benzodiazepines develops and discuss the time course in which these syndromes can occur as well as discuss the diagnostic criteria for a benzodiazepine use disorder.Discussions and comments in our videos are for informational purposes only and should not replace the advice of your medical professional. Please consult with your doctor before making any changes to your medical treatment or lifestyle.Latest Blogshttps://www.meducate.com.au/blogAbout Meducate ®Meducate provides online education for doctors, clinicians, health professionals and the public.See the website to browse the many different talks and courses available https://www.meducate.com.au

In episode 58 of Cracking Addiction we discuss the pharmacology of benzodiazepines and their interaction with the GABA-A receptor, the different types of benzodiazepines and their different half lives and effects, discuss how to calculator benzodiazepine dose equivalence, the increased risks of benzodiazepine overdose when compared with other medications especially with opioid medications and the pharmacokinetics and metabolism of benzodiazepines.Discussions and comments in our videos are for informational purposes only and should not replace the advice of your medical professional. Please consult with your doctor before making any changes to your medical treatment or lifestyle.Latest Blogshttps://www.meducate.com.au/blogAbout Meducate ®Meducate provides online education for doctors, clinicians, health professionals and the public.See the website to browse the many different talks and courses available https://www.meducate.com.au

In today's episode of Cracking Addiction we are joined by Dr Sam Manger the President of the Australasian Society of Lifestyle Medicine and host of the GP Show podcast who discusses lifestyle interventions in substance use disorders. Lifestyle interventions can be safe and efficacious interventions and there is a growing evidence base for certain lifestyle interventions in some substance use disorders. For further information on lifestyle interventions in substance use disorders please read our journal article on this topic at: https://www1.racgp.org.au/ajgp/2022/august/lifestyle-interventions-for-substance-use-disorderThe GP Show podcast and other lifestyle medicine resources: https://thegpshow.comDiscussions and comments in our videos are for informational purposes only and should not replace the advice of your medical professional. Please consult with your doctor before making any changes to your medical treatment or lifestyle.Latest Blogshttps://www.meducate.com.au/blogAbout Meducate ®Meducate provides online education for doctors, clinicians, health professionals and the public.See the website to browse the many different talks and courses available https://www.meducate.com.au

In this episode of Cracking Addiction we discuss relapse prevention strategies with regards to methamphetamine use and discuss harm reduction strategies, how to avoid a lapse becoming a relapse, the Matrix Model, motivational intervention and contingency management. We also discuss the importance of peer support programs in aiding people on their path to recovery from substance use disorder and discuss the evidence surrounding pharmacotherapy interventions for methamphetamine use disorder.Discussions and comments in our videos are for informational purposes only and should not replace the advice of your medical professional. Please consult with your doctor before making any changes to your medical treatment or lifestyle.Latest Blogshttps://www.meducate.com.au/blogAbout Meducate ®Meducate provides online education for doctors, clinicians, health professionals and the public.See the website to browse the many different talks and courses available https://www.meducate.com.au

In this Episode of Cracking Addiction we discuss the three phases of methamphetamine withdrawal, strategies to manage the methamphetamine withdrawal including possible medication options and the ongoing psychosocial support required to support patients during methamphetamine withdrawal.Discussions and comments in our videos are for informational purposes only and should not replace the advice of your medical professional. Please consult with your doctor before making any changes to your medical treatment or lifestyle.Latest Blogshttps://www.meducate.com.au/blogAbout Meducate ®Meducate provides online education for doctors, clinicians, health professionals and the public.See the website to browse the many different talks and courses available https://www.meducate.com.au

In this episode of Cracking Addiction we mainly speak about methamphetamines but also amphetamines and discuss the amphetamine class of drugs and their physiological effects, the different types of methamphetamines, symptoms of intoxication with amphetamines, side effects of methamphetamine and amphetamines including the various organ systems they impact and in particular the potential psychological and psychiatric harms and focus on drug induced psychosis. Discussions and comments in our videos are for informational purposes only and should not replace the advice of your medical professional. Please consult with your doctor before making any changes to your medical treatment or lifestyle.Latest Blogshttps://www.meducate.com.au/blogAbout Meducate ®Meducate provides online education for doctors, clinicians, health professionals and the public.See the website to browse the many different talks and courses available https://www.meducate.com.au

In this episode of Cracking Addiction we are privileged to have Steven McDonald who discusses his lived experience with addiction and his path towards recovery. Steven speaks openly and honestly about his past history and his experiences. Steven has written a book 'Thanks for Letting Me Share' which is a book of 368 quotes that have helped him along his journey. The book is available on Amazon https://www.amazon.com/dp/B09BCG67JK/ and Facebook https://www.facebook.com/Thanks-for-Letting-Me-Share-book-102078078856382Discussions and comments in our videos are for informational purposes only and should not replace the advice of your medical professional. Please consult with your doctor before making any changes to your medical treatment or lifestyle.Latest Blogshttps://www.meducate.com.au/blogAbout Meducate ®Meducate provides online education for doctors, clinicians, health professionals and the public.See the website to browse the many different talks and courses available https://www.meducate.com.au

In this episode of Cracking Addiction we discuss cannabis hyperemesis syndrome, the various theories surrounding the pathophysiology of cannabis hyperemesis, treatment of cannabis hyperemesis syndrome, diagnostic criteria for cannabis hyperemesis syndrome and discuss the other potential differential diagnoses of cyclic vomiting symptoms and how cannabis hyperemesis syndrome is often a diagnosis of exclusion.Discussions and comments in our videos are for informational purposes only and should not replace the advice of your medical professional. Please consult with your doctor before making any changes to your medical treatment or lifestyle.Latest Blogshttps://www.meducate.com.au/blogAbout Meducate ®Meducate provides online education for doctors, clinicians, health professionals and the public.See the website to browse the many different talks and courses available https://www.meducate.com.au

In this episode of Cracking Addiction we discuss the variety within the class of synthetic cannabinoids, symptoms of synthetic cannabis intoxications, side effects and complication of synthetic cannabis usage and specific considerations in withdrawal management.Discussions and comments in our videos are for informational purposes only and should not replace the advice of your medical professional. Please consult with your doctor before making any changes to your medical treatment or lifestyle.Latest Blogshttps://www.meducate.com.au/blogAbout Meducate ®Meducate provides online education for doctors, clinicians, health professionals and the public.See the website to browse the many different talks and courses available https://www.meducate.com.au

In the latest episode of Cracking Addiction we discuss the symptoms of cannabis withdrawal syndrome and the duration that can be expected for these symptoms, the common reasons that people use cannabis and how to manage these symptoms post cannabis withdrawal, the pharmacological management options for cannabis withdrawal which is largely symptomatic management and also the the common clinical scenarios of comorbid dependency with cannabis and other substances such as tobacco and caffeine and the need to often manage withdrawal of other substances whilst managing cannabis withdrawal.Discussions and comments in our videos are for informational purposes only and should not replace the advice of your medical professional. Please consult with your doctor before making any changes to your medical treatment or lifestyle.Latest Blogshttps://www.meducate.com.au/blogAbout Meducate ®Meducate provides online education for doctors, clinicians, health professionals and the public.See the website to browse the many different talks and courses available https://www.meducate.com.au

In this episode of Cracking Addiction we discuss the symptoms of cannabis use disorder and cannabis intoxication, the different preparations of cannabis and the THC contents of these various preparations, the harms associated with cannabis use, the harms of cannabis when compared with tobacco and alcohol usage, the risk factors for developing cannabis use disorder, how to identify a person with cannabis use disorder, the social determinants impacting substance use and the classifications systems for cannabis use disorder mainly DSM 5 and ICD 11.Discussions and comments in our videos are for informational purposes only and should not replace the advice of your medical professional. Please consult with your doctor before making any changes to your medical treatment or lifestyle.Latest Blogshttps://www.meducate.com.au/blogAbout Meducate ®Meducate provides online education for doctors, clinicians, health professionals and the public.See the website to browse the many different talks and courses available https://www.meducate.com.au

In this episode of Cracking Addiction we discuss cannabidiol (CBD) and discuss the clinical effects of CBD, how CBD acts on the cannabinoid receptors, the clinical indications for CBD products, the potential areas where CBD may have the most clinical benefit and discuss the lack of psychoactive properties of CBD. We also discuss the risks associated with CBD and how to counsel patients on these risks. Finally we discuss the potential future role of CBD in the management of chronic pain and people on high dose opioids and also in the treatment of cannabis use disorder.Discussions and comments in our videos are for informational purposes only and should not replace the advice of your medical professional. Please consult with your doctor before making any changes to your medical treatment or lifestyle.Latest Blogshttps://www.meducate.com.au/blogAbout Meducate ®Meducate provides online education for doctors, clinicians, health professionals and the public.See the website to browse the many different talks and courses available https://www.meducate.com.au

In this episode of Cracking Addiction we discuss delta 9 tetrahydrocannabinol (THC) and how it interacts with the cannabinoid receptors and how this interaction with the receptors causes its effects on the body. We also explore the clinical effects of THC, side effects of THC and the clinical indications for THC products.Discussions and comments in our videos are for informational purposes only and should not replace the advice of your medical professional. Please consult with your doctor before making any changes to your medical treatment or lifestyle.Latest Blogshttps://www.meducate.com.au/blogAbout Meducate ®Meducate provides online education for doctors, clinicians, health professionals and the public.See the website to browse the many different talks and courses available https://www.meducate.com.au

In this episode of Cracking Addiction we discuss the endocannabinoid system, the different types of endocannabinoid receptors CB1 and CB2, the location of the different receptors, the endogenous ligands of cannabinoid receptors and their synthesis and breakdown and briefly touch on the two best known cannabinoids THC and cannabidiol. Discussions and comments in our videos are for informational purposes only and should not replace the advice of your medical professional. Please consult with your doctor before making any changes to your medical treatment or lifestyle.Latest Blogshttps://www.meducate.com.au/blogAbout Meducate ®Meducate provides online education for doctors, clinicians, health professionals and the public.See the website to browse the many different talks and courses available https://www.meducate.com.au

In this episode of Cracking Addiction, Scot Aitken and Dr Ferghal Armstrong chat about Johan Hari’s book, Chasing The Scream. We explore some of themes of the book including the motivations that underpin the war on drugs, the economic factors that affect the war on drugs and the role of decriminalization of drug use.Discussions and comments in our videos are for informational purposes only and should not replace the advice of your medical professional. Please consult with your doctor before making any changes to your medical treatment or lifestyle.Latest Blogshttps://www.meducate.com.au/blogAbout Meducate ®Meducate provides online education for doctors, clinicians, health professionals and the public.See the website to browse the many different talks and courses available https://www.meducate.com.au

In this episode of Cracking Addiction we are again joined by Dr Colin Mendelsohn to discuss the controversies around vaping including the risks around vaping, the thoughts of vaping being a gateway to smoking cigarettes, the risks of EVALI, the role of 'Big Tobacco' in vaping, looking at the evidence around vaping and challenging some of the latest reviews around vapingDiscussions and comments in our videos are for informational purposes only and should not replace the advice of your medical professional. Please consult with your doctor before making any changes to your medical treatment or lifestyle.Latest Blogshttps://www.meducate.com.au/blogAbout Meducate ®Meducate provides online education for doctors, clinicians, health professionals and the public.See the website to browse the many different talks and courses available https://www.meducate.com.au

In part 2 of 3 episodes. In this episode of Cracking Addiction we are again joined by Dr Colin Mendelsohn to discuss the different types of vaping products on the market, the different types of nicotine e-liquids available, how to source vaping products, how to prescribe nicotine and how to vape safely.Discussions and comments in our videos are for informational purposes only and should not replace the advice of your medical professional. Please consult with your doctor before making any changes to your medical treatment or lifestyle.Latest Blogshttps://www.meducate.com.au/blogAbout Meducate ®Meducate provides online education for doctors, clinicians, health professionals and the public.See the website to browse the many different talks and courses available https://www.meducate.com.au

In this 1st of three episodes of Cracking Addiction we are joined by Dr Colin Mendelsohn to discuss the harms of tobacco usage, what vaping is and how vaping can be useful to aid smoking cessation, the myths and benefits surrounding nicotine and the efficacy of vaping in smoking cessation. Nicotine vaping is surrounded in mystery with a lot of myths and misinformation abounding and in this episode we try and dispel some of this misinformation.Discussions and comments in our videos are for informational purposes only and should not replace the advice of your medical professional. Please consult with your doctor before making any changes to your medical treatment or lifestyle.Latest Blogshttps://www.meducate.com.au/blogAbout Meducate ®Meducate provides online education for doctors, clinicians, health professionals and the public.See the website to browse the many different talks and courses available https://www.meducate.com.au

In this episode of Cracking Addiction we discuss tobacco use in pregnancy and the those with mental health disorders and the evidence around smoking cessation in these special population groups.Discussions and comments in our videos are for informational purposes only and should not replace the advice of your medical professional. Please consult with your doctor before making any changes to your medical treatment or lifestyle.Latest Blogshttps://www.meducate.com.au/blogAbout Meducate ®Meducate provides online education for doctors, clinicians, health professionals and the public.See the website to browse the many different talks and courses available https://www.meducate.com.au

In this episode of Cracking Addiction we discuss various smoking cessation interventions including behavioural interventions, nicotine replacement therapy, varenicline, bupropion and nortriptyline to aid patients in stopping smoking.Discussions and comments in our videos are for informational purposes only and should not replace the advice of your medical professional. Please consult with your doctor before making any changes to your medical treatment or lifestyle.Latest Blogshttps://www.meducate.com.au/blogAbout Meducate ®Meducate provides online education for doctors, clinicians, health professionals and the public.See the website to browse the many different talks and courses available https://www.meducate.com.au

In this episode of Cracking Addiction we discuss the harms associated with tobacco use, the health benefits of tobacco cessation, briefly discuss smoking cessation interventions and highlight the importance of brief interventions in eliciting behaviour change.Discussions and comments in our videos are for informational purposes only and should not replace the advice of your medical professional. Please consult with your doctor before making any changes to your medical treatment or lifestyle.Latest Blogshttps://www.meducate.com.au/blogAbout Meducate ®Meducate provides online education for doctors, clinicians, health professionals and the public.See the website to browse the many different talks and courses available https://www.meducate.com.au

In Episode 38 of Cracking Addiction we summarise the previous episodes regarding opioid use disorder and discuss a framework on the safe management of patients with opioid use disorder.Discussions and comments in our videos are for informational purposes only and should not replace the advice of your medical professional. Please consult with your doctor before making any changes to your medical treatment or lifestyle.Latest Blogshttps://www.meducate.com.au/blogAbout Meducate ®Meducate provides online education for doctors, clinicians, health professionals and the public.See the website to browse the many different talks and courses available https://www.meducate.com.au

In episode 37 of Cracking Addiction we discuss in detail some of the social comorbidities associated with substance use disorders and what to screen for, be aware of and some management strategies to tackle these social comorbidities.Social isolation and alienation are some of the unfortunate hallmarks of substance use disorder. Some of the biggest social harms that occur to the patient are the harms that can occur with increased rates of unemployment, homelessness, broken relationships and social isolation. Loneliness appears to be a significant product and by-product of substance use disorder and can lead to worsening outcomes.Some of the social harms to society include the role of acquisitive crime to fund drug usage in some circumstances, increased rates of violence and domestic violence in particular as well as potential risks of child endangerment and child welfare concerns. It is important that we focus on safety with the above concerns, and that in the case of domestic violence and child abuse that medical practitioners are aware of their mandatory reporting requirements and also how to support women and children in particular who are at risk of violence or other harms and which supports and services one can refer them to. The role of incarceration in the management of substance use disorder is controversial. History has provided numerous examples of where prohibition of drugs was ineffective and incarceration for substance use disorder (which is a medical condition) does not appear to be effective in reducing drug usage or it’s associated harms. Effective treatment of substance use disorder and consideration of decriminalisation of drugs and managing patients through diversion and rehabilitation programs would likely be of more benefit for the individual and society as a whole. Furthermore, by marginalising people with substance use disorder and treating people like criminals and incarcerating people we risk alienating and further stigmatising people. From a governmental perspective this could include less people participating in the workforce and a loss of tax revenue, the costs of incarcerating people and the costs of the criminal justice system to process people through this system.In summary there are significant social comorbidities associated with substance use disorder. Treating people with substance use disorders holistically, understanding the potential struggles which they might encounter and providing appropriate assistance might help decrease the social harms associated with substance use disorder for both the individual but society as a whole.Discussions and comments in our videos are for informational purposes only and should not replace the advice of your medical professional. Please consult with your doctor before making any changes to your medical treatment or lifestyle.Latest Blogshttps://www.meducate.com.au/blogAbout Meducate ®Meducate provides online education for doctors, clinicians, health professionals and the public.See the website to browse the many different talks and courses available https://www.meducate.com.au

In episode 36 of Cracking Addiction we discuss in detail some of the physical comorbidities associated with substance use disorders and what to screen for, be aware of and some management techniques.People with substance use disorders often deal with many medical and physical issues that can impact both their quality of life but also increase the risks of morbidity and mortality. There are a number of medical and physical conditions that could be discussed but for the sake brevity this blog post will detail the following:• Chronic pain• Tobacco use• Infectious diseases• Chronic NSAID toxicityChronic painChronic pain alters brain’s stress and reward systems and increases the risk for developing an opioid use disorder. It is thought that up to 30% of chronic pain patients misuse prescription opioids and this is becoming an increasingly problematic matter within society. Recent data and statistics reveal that prescription drug deaths in Victoria now exceed the road toll. The treatment and management of chronic non-cancer related pain is now moving away from a medication centred approach and indeed chronic opioid medication usage are associated with long-term harms within this group including increased risks of opioid induced hyperalgaesia, osteoporosis and hypothalamic pituitary gonadal axis dysfunction. The management of chronic non-cancer related pain now increasingly centres around active pain management strategies, physical therapy, allied health input and rehabilitation activities.Tobacco useMany patients with substance use disorders smoke tobacco and broaching smoking and tobacco cessation is important to improving the overall health and wellbeing of the patient. Oftentimes it appears other drugs and substances take priority of tobacco usage but tobacco usage is also associated with significant harms to the patient. It is important to discuss the harms of smoking with patients with substance use disorders and offer smoking cessation interventions. Tobacco usage is responsible for the majority of lung cancer and approximately one-third of all cancer related deaths. Tobacco use is also directly responsible for: cardiovascular disease, reduced immunity, poor wound healing, age related macular degeneration and worsening chronic pain.Infectious diseasesPatients with substance use disorder are at increased risk of some infectious diseases and it is important to screen people appropriately. In particular people who inject drugs and share needles or who engage in commercial sex work to pay for drugs require screening for blood borne viruses and the latter group in particular will require a thorough sexually transmitted infection screen. Blood borne virus screening includes screening for Hepatitis B, C and HIV and STI screening includes screening for chlamydia, gonorrhoea and syphilis in the first instance.People who inject drugs are also at risk of skin infections and abscesses as a result of injecting drug use and skin examination should be carried out periodically to exclude thrombophlebitis in veins, cellulitis and one should always consider the risks of infective endocarditis in the appropriate clinical scenario. It is important to be thorough and systematic in our physical examination of our patients and when ordering tests so as not to miss an important medical diagnosis.Chronic NSAID toxicityCodeine misuse and dependency associated with chronic non-steroidal anti-inflammatory drug (NSAID) toxicity. NSAIDS can ulceration of the gastrointestinal tract which can lead to bleeding and even perforation of the gastrointestinal tract in severe circumstances. Chronic NSAIDs usage can lead to iron deficiency with or without anaemia due to bleeding from the gastrointestinal tract. Chronic NSAID usage can also lead to recurrent metabolic acidosis and also cause significant renal impairment and lead to NSAID nephropathy...

In episode 35 of Cracking Addiction we discuss in detail some of the psychiatric comorbidities associated with substance use disorders and what to screen for, be aware of and some management techniques.Discussions and comments in our videos are for informational purposes only and should not replace the advice of your medical professional. Please consult with your doctor before making any changes to your medical treatment or lifestyle.Latest Blogshttps://www.meducate.com.au/blogAbout Meducate ®Meducate provides online education for doctors, clinicians, health professionals and the public.See the website to browse the many different talks and courses available https://www.meducate.com.au

In episode 34 of Cracking Addiction we discuss how to manage some of the special circumstances in opioid substation therapy including OST in renal and hepatic impairment, managing polypharmacy complications with OST and managing acute pain whilst a patient is on OST.Discussions and comments in our videos are for informational purposes only and should not replace the advice of your medical professional. Please consult with your doctor before making any changes to your medical treatment or lifestyle.Latest Blogshttps://www.meducate.com.au/blogAbout Meducate ®Meducate provides online education for doctors, clinicians, health professionals and the public.See the website to browse the many different talks and courses available https://www.meducate.com.au

In episode 33 of Cracking Addiction we discuss how to manage some of the special circumstances in opioid substation therapy including vomiting of doses of OST, dealing with intoxicated patients, overdoses of OST and transitioning between Methadone and Suboxone and vice versa.Discussions and comments in our videos are for informational purposes only and should not replace the advice of your medical professional. Please consult with your doctor before making any changes to your medical treatment or lifestyle.Latest Blogshttps://www.meducate.com.au/blogAbout Meducate ®Meducate provides online education for doctors, clinicians, health professionals and the public.See the website to browse the many different talks and courses available https://www.meducate.com.au

In episode 32 of Cracking Addiction we discuss the harm reduction intervention of Naloxone and when to consider prescribing this medication, the benefits of take home naloxone and how it saves lives!Discussions and comments in our videos are for informational purposes only and should not replace the advice of your medical professional. Please consult with your doctor before making any changes to your medical treatment or lifestyle.Latest Blogshttps://www.meducate.com.au/blogAbout Meducate ®Meducate provides online education for doctors, clinicians, health professionals and the public.See the website to browse the many different talks and courses available https://www.meducate.com.au

In episode 31 of Cracking Addiction we discuss the harm reduction interventions that we can implement for people who inject drugs to decrease the risks of morbidity and mortality.Discussions and comments in our videos are for informational purposes only and should not replace the advice of your medical professional. Please consult with your doctor before making any changes to your medical treatment or lifestyle.Latest Blogshttps://www.meducate.com.au/blogAbout Meducate ®Meducate provides online education for doctors, clinicians, health professionals and the public.See the website to browse the many different talks and courses available https://www.meducate.com.au

In episode 30 of Cracking Addiction we discuss the different opioid receptors buprenorphine acts upon and the nature of these effects, the difference between agonists and antagonists, how to start a patient on Suboxone and how to monitor patients on Suboxone and adjust doses.Discussions and comments in our videos are for informational purposes only and should not replace the advice of your medical professional. Please consult with your doctor before making any changes to your medical treatment or lifestyle.Latest Blogshttps://www.meducate.com.au/blogAbout Meducate ®Meducate provides online education for doctors, clinicians, health professionals and the public.See the website to browse the many different talks and courses available https://www.meducate.com.au

In episode 29 of Cracking Addiction we discuss Suboxone and talk about the components of Suboxone as well as the pharmacology and pharmacokinetics of Suboxone.Discussions and comments in our videos are for informational purposes only and should not replace the advice of your medical professional. Please consult with your doctor before making any changes to your medical treatment or lifestyle.Latest Blogshttps://www.meducate.com.au/blogAbout Meducate ®Meducate provides online education for doctors, clinicians, health professionals and the public.See the website to browse the many different talks and courses available https://www.meducate.com.au

In episode 28 of Cracking Addiction we discuss our practical tips, advice and experience in managing patients on LAIB and share what we have learned.Discussions and comments in our videos are for informational purposes only and should not replace the advice of your medical professional. Please consult with your doctor before making any changes to your medical treatment or lifestyle.Latest Blogshttps://www.meducate.com.au/blogAbout Meducate ®Meducate provides online education for doctors, clinicians, health professionals and the public.See the website to browse the many different talks and courses available https://www.meducate.com.au

Episode 27 of Cracking Addiction discusses the patient journey on LAIB and how to adequately deal with and manage adjusting doses of LAIB, commencing and ceasing LAIB and ensuring that patients are maintained on LAIB therapyDiscussions and comments in our videos are for informational purposes only and should not replace the advice of your medical professional. Please consult with your doctor before making any changes to your medical treatment or lifestyle.Latest Blogshttps://www.meducate.com.au/blogAbout Meducate ®Meducate provides online education for doctors, clinicians, health professionals and the public.See the website to browse the many different talks and courses available https://www.meducate.com.au

Cracking Addiction discusses Sublocade one of the LAIB preparations available and how to commence, maintain and manage any dose changes or complications associated with Sublocade.Sublocade is a long acting injectable buprenorphine (LAIB) manufactured by Invidior that uses the “Atrigel” system to provide for a sustained and prolonged delivery of buprenorphine into the systemic circulation after subcutaneous injection.Discussions and comments in our videos are for informational purposes only and should not replace the advice of your medical professional. Please consult with your doctor before making any changes to your medical treatment or lifestyle.Latest Blogshttps://www.meducate.com.au/blogAbout Meducate ®Meducate provides online education for doctors, clinicians, health professionals and the public.See the website to browse the many different talks and courses available https://www.meducate.com.au

Cracking Addiction discusses Buvidal one of the LAIB preparations available and how to commence, maintain and manage any dose changes or complications associated with Buvidal.Buvidal is a long acting injectable buprenorphine (LAIB) preparation manufactured by Camurus and uses “FluidCrystal” technology to provide for a sustained and prolonged delivery of buprenorphine into the systemic circulation after subcutaneous injection.

Cracking Addiction discusses some of the special or difficult circumstances of prescribing LAIBs including intoxicated patients, pregnant patients, patients with chronic disease, patients with acute pain and our management strategies in these situations.

Episode 23 of Cracking Addiction explores commencement of patients on LAIB, side effects and risks of LAIB, discussion about precipitated withdrawal and when and how to review patients

An Introduction to Long Acting Injectable Buprenorphine (LAIB)Long acting injectable buprenorphine (LAIB) are long acting buprenorphine depot preparations that are injected subcutaneously and provide patients with a sustained release of buprenorphine for the duration of the depot preparation. Currently, two LAIB products are available for the Australian market. They differ in their formulations, administration and pharmacology.See blog for further informationhttps://www.meducate.com.au/blogAbout Meducate ®Meducate provides online education for doctors, clinicians, health professionals and the public.See the website to browse the many different talks and courses availablehttps://www.meducate.com.au

Episode 21 of Cracking Addiction explores methadone pharmacokinetics, breakdown and interactions within the body and interactions with other drugs.Methadone is a drug with a wide variability in its absorption with oral bio-availability ranges from 35% to 100%. This is a significant amount of variability and explains why the same dose of Methadone can impact different patients differently. Methadone is metabolised within the liver by the cytochrome P450 enzymes but mainly 3A4. There is a 17-fold inter-individual variation of methadone blood concentration for a given dosage and variations in metabolism account for a large part of this variation. Kinetic interactions influenced by the CYP 450 enzyme can affect plasma methadone levels.• Inducers of CYP450 can• Accelerate the metabolism of methadone• lower methadone plasma levels• Precipitate opioid withdrawal • Inhibitors of CYP450 can • Slow the metabolism of methadone• Increase plasma levels• Produce opioid toxicity (sedation, overdose)Methadone is excreted renally with approximately 10% of drug renally eliminated unchanged. Renal excretion of methadone urinary pH dependent with increased Methadone excretion noted at pH less than 6 and decreased Methadone excretion at higher pH levels.About Meducate ®Meducate provides online education for doctors, clinicians, health professionals and the public.See the website to browse the many different talks and courses availablehttps://www.meducate.com.au