2025 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 28, 2-4 pm ET, 20 addiction medicine fellows will present 5-minute/5-slide oral presentations on a topic of their choice. Save-the-date and plan to join us! A Zoom link will be included in ACAAM Bi-weekly Digests, as well as targeted communication. Be on the lookout!
Presentation SummariesPoint of Care Fentanyl Testing vs. Standard Testing in a CDUWe would like to share our study on point of care testing (POCT) for fentanyl, which is often not available. Fentanyl testing is imperative to guide further management of our OUD patients. Our POCT study shows great promise. We tested 41 consecutive patients presenting to our CDU seeking OUD detox, comparing standard UDS with send out fentanyl testing to POCT fentanyl. Our results showed perfect correlation. Brooke Balchan, DO FAAP, George John, DO, Jamaica/Flushing Hospital Medical Center, Flushing, NY Opioid Overdose in Patients Presenting to Hospital Settings Effective management of opioid overdose in hospital settings is critical for those using unregulated substances in the community and events of in-hospital unregulated substance use. Hospital settings are opportunities to provide patient-centered care for those who overdose with opioids as they are capable of close patient monitoring and rapid intervention. Addiction medicine providers skilled in careful administration of naloxone and continuous naloxone infusions can keep those affected by overdose safe while limiting precipitated withdrawal, patient directed discharges, and other adverse outcomes. Elliott D. Brady, MD MPH, Montefiore Einstein Addiction Medicine Fellowship Program, Bronx, NY Transition from High Dose Methadone to Buprenorphine in a 36-year-old Presenting in Alcohol Withdrawal This is the case of a 36-year-old female who presented to the hospital after her boyfriend witnessed her having convulsions and an unresponsive episode at home, in the setting of a 2-month relapse on alcohol. She had severe opioid use disorder in sustained remission, on maintenance methadone therapy, and had been taking 255mg methadone daily. Upon presentation to the hospital, she had intermittent episodes of ventricular tachycardia, with a severely prolonged QTc of up to 710ms, even after correction of hypokalemia and hypomagnesemia. Over her 8-day hospital course, the addiction medicine consult service was able to transition the patient from 255mg of methadone daily onto Suboxone 8-2mg TID using a microinduction protocol and PRN full opioid agonists for symptomatic management during the induction. Zachary J. Brown, DO, University of Colorado, Aurora, CO Getting to the Heart of It: Methadone and QTc Prolongation This presentation explores the relationship between methadone and QTc prolongation. It begins by reviewing the definition and potential causes of QT prolongation, followed by an examination of the mechanisms by which methadone may contribute to QTc prolongation. Next, the connection between methadone, QTc prolongation, and Torsades de Pointes is analyzed. Finally, a checklist is provided to guide the evaluation of patients with QTc prolongation who are on methadone. Alyssa Cheng, DO, Yale Program in Addiction Medicine, New Haven, CT kRatom for pain in Patient with history of AUD 53 yo M with pmh Anxiety, AUD in remission presents to outpatient clinic with request detox from Kratom. Pt had shoulder injury 2020 and was prescribed Oxycodone. Introduced to kratom for pain relief. Pt admitted pain was managed as well as anxiety but began using 40-50 mg Daily and on attempts to stop would experience withdrawal sx similar to opioid withdrawal. Claudia Ferguson, MD, South Brooklyn Health (NYCHHC), Brooklyn, NY Thyroid Storm Precipitated by Polysubstance Withdrawal : A Comprehensive Approach This case involves a 38-year-old female with a history of methamphetamine, fentanyl, and alcohol use disorder, as well as hyperthyroidism, who presented with severe tachycardia (170s) after being incarcerated. Initially presumed to be in withdrawal, she was unresponsive to adenosine and diltiazem but improved with IV labetalol. Further evaluation revealed thyroid storm, triggered by medication non-compliance and polysubstance withdrawal. She required intubation for airway protection but improved with thyroid storm treatment (esmolol, PTU, iodide, hydrocortisone) and withdrawal management (propofol, midazolam). She was extubated in two days and discharged within four days, highlighting the importance of a comprehensive approach beyond withdrawal management in incarcerated patients. Hrant Gevorgian, MD MPH, Loma Linda University Health, Loma Linda, CA Getting to the Point: Creation of a Syringe Prescribing Tool for Prescribers and Patients Who Inject Drugs Prescribing syringes for people who inject drugs (PWID) reduces the risks of HIV, Hepatitis B and C, infective endocarditis and skin and soft tissue infections. Despite evidence supporting its effectiveness in healthcare engagement, it remains underutilized. Through collaboration with addiction medicine providers, pharmacists, and local syringe service programs, we focused on building a provider and patient facing syringe prescribing guide with an accompanying EPIC Electronic Medical Record (EMR) order set. Creating a syringe prescribing tool that physicians are able to integrate into their clinical care practices makes healthcare providers’ encounters another venue where patients can obtain syringes, in addition to local SSP’s, taking a critical step toward increasing health equity, fostering trust and increasing access to safe supplies. Christina M. Joy, MD, Grayken Fellowship at Boston Medical Center, Boston, MA Management of "Fenty-Tranq" Withdrawal Case presentation on management of 34-year-old identical twin brothers presenting for "fenty tranq" withdrawal leading to a discussion of the Hershey Medical Center protocol on xylazine/fentanyl withdrawal. Rusina Karia, MD, Hershey S. Milton Medical Center, Hershey, PA Apples to Oranges: Converting from Methadone to Dose Equivalents of Morphine This is case of a 37-year-old male with a past medical history of opioid use disorder (OUD) in sustained remission who presented to the emergency room with multiple syncopal episodes, found to have recurrent episodes of polymorphic VT secondary to QTc prolongation (QTc 637) from methadone (dose 155 mg). This patient was agreeable to switching from methadone to buprenorphine, however during this process there was uncertainty on how to convert the patients home methadone dose to milligrams of morphine equivalents (MMEs). Although there is some guidance on the conversion from morphine to methadone for pain in the palliative care literature, there is little guidance on the conversion from methadone to morphine as this conversion is not necessarily bidirectional nor addresses nuances of managing OUD vs pain. Using some existing models in palliative care medicine and limited case report data, we converted the patient’s high dose methadone for OUD to the equivalent dose in morphine through a unique stepwise process and successfully implemented a low dose buprenorphine induction. This case highlights a rare but fatal adverse effect of methadone, the importance of a smooth transition to morphine equivalents to prevent destabilization of patients with OUD, and the challenges of converting between methadone and milligrams of morphine equivalents due to gaps in the literature especially when pertaining to OUD. Bella G. Kalayilparampil, MD MPH, Yale School of Medicine, New Haven, CT Glucagon-LikePeptides-1 Receptor Agonist and there role as Antabuse with mortality benefit in alcohol use disorder; A Recovery Center perspective Alcohol use disorder is a well-known chronic relapsing addiction condition affecting approximately 14%-30% of the global population. A comparative population study. Ifeoma P. Kwentoh, MD, NYITCOM Addiction Fellowship at Highwatch Recovery Center, Kent, CT Sustained Positive Buprenorphine after LAIs and Naltrexone Micro-Dosing in Treating OUD A case report of an 18-year-old female with opioid use disorder (OUD) who transitioned from long-acting injectable (LAI) buprenorphine to naltrexone using a novel micro-dosing regimen. I will discuss the challenges posed by the prolonged presence of LAI buprenorphine in the system, the complexities of interpreting urine drug screens (UDS) after fluid resuscitation, and the successful implementation of a compounded naltrexone micro-dosing protocol to minimize withdrawal symptoms. This case highlights the importance of tailored treatment approaches in OUD management and the need for careful consideration of medication transitions. Anyun Ma, MD, University of Nebraska Medical Center, Omaha, NE A quality improvement initiative to quantify and compare retention rates for patients with Alcohol Use Disorder (AUD) on Medication-assisted treatment (MAT) receiving counseling The goal of this quality improvement initiative is to improve enrollment in counseling or group therapy/12 steps (which was found to be effective in comparison to no counseling), enhance patient engagement in counseling and MAT treatment for AUD. Documentation, progress reporting, and maintaining detailed records of interventions, patient responses, and outcomes regularly to necessary supervisors and stakeholders (5,6) have also been shown to improve outcomes. Linda N. Okoro, MD, Geisinger Health System, Abington, PA Developing a Unified Hospital Policy to Address Inpatient Substance Use Individuals who use drugs may face sudden regulation over their use when hospitalized in acute care settings. Health care professionals and hospitals commonly enforce drug-free environments to reduce safety risks and ensure legal compliance, while patients often disregard these behavioral expectations for various reasons, including inadequate pain control, fear of stigma, unaddressed cravings or withdrawal symptoms, and untreated or under-treated substance use disorders. The medical team’s response to inpatient substance use is crucial as poor management can contribute to stigma, jeopardize therapeutic patient relationships, and lead to patient-directed discharges. Our hospital’s inpatient addiction medicine consultation service developed and proposed a patient-centered, non-punitive, and non-stigmatizing hospital policy to address substance use during inpatient admissions with aims to connect patients with substance use disorder treatment and engage patients in their acute care. Ultimately, the success of this policy depends on the strong support from hospital leadership, key frontline personnel, and patients alike, and hinges on its ability to educate our healthcare force on substance use disorders. Veronica A. Pace, MD, The University of New Mexico, Albuquerque, NM Fast-tracking recovery:A literature review of rapid methadone titration protocols With current methadone initiation protocols, it can take patients as long as a month to reach a therapeutic methadone dose for the treatment of opioid use disorder. As fentanyl replaces heroin in the drug supply, people who use drugs have a higher opioid tolerance than before and every day of sub-therapeutic methadone dosing increases their risk of mortality from continued fentanyl use. In this presentation, we will review the current literature of rapid methadone initiation protocols in both the inpatient and outpatient setting. We will also evaluate the safety of these protocols by reporting adverse events across the studies reviewed. We use this review to propose next steps for improving the methadone initiation process for our patients. Molly M. Perri, MD, Yale Program in Addiction Medicine, New Haven, CT The Bitter Aftertaste: A Unique Case of Alcohol Withdrawals Alcohol use disorder (AUD) is commonly linked to traditional alcoholic beverages, but the misuse of non-beverage alcohol products, such as vanilla extract and mouthwash, is an underrecognized risk. This case report describes a 48-year-old woman with AUD and psychiatric comorbidities who presented with acute intoxication and metabolic acidosis after ingesting large amounts of vanilla extract and mouthwash. She turned to these alternatives due to financial constraints and required medical stabilization, including treatment for alcohol withdrawal and intramuscular naltrexone. This case highlights the dangers of non-beverage alcohol products, which often contain high alcohol content but lack clear labeling and regulation. Increased clinical awareness and regulatory measures are needed to mitigate the risks these products pose to vulnerable populations. Axel Rodriguez Rosa, MD, Interdisciplinary Addiction Medicine Fellowship at Penn State College of Medicine, Hershey, PA Attitudes of those with substance use disorders towards hospital use prevention policies In hospitals around the country, use of substances and/or medications not prescribed by the inpatient medical team can and has resulted in complications of care and patient-care team relationships. In an effort to address this and inform policy for prevention and response to such events, we conducted 25 interviews to ascertain the patient perspective around such policies. Our findings uncovered 4 central themes as well as unexpected heterogeneity among respondents in endorsed prevention and response strategies. Spencer M. Schell, MD, OhioHealth Grant Medical Center Addiction Medicine, Columbus, OH An Innovative Low-Dose Buprenorphine Initiation Strategy: Transitioning from methadone to buprenorphine with COWS <4 Recent data has shown that Brixadi 24mg may be used to initiate buprenorphine for patients with COWS 4-7. The slope of buprenorphine onset for Brixadi 8mg is substantially lower, which may allow for its usage as a low-dose buprenorphine initiation for patients with COWS <4, alongside an opioid agonist bridge. In this presentation we discuss a patient case that successfully implemented this innovative strategy to initiate buprenorphine. Ram Sundaresh, MD MS, Massachusetts General Hospital, Boston, MA Need for Integration Between Schools and Substance Use Treatment Programs: a case series United States national survey data shows that approximately 4 out of every 100 adolescents ages 12 to 17 years received substance use treatment in the past year. Returning to baseline after managing a substance use disorder (SUD) can be difficult for adolescents, as the disorder itself and treatment process may cause a disruption in their daily schedule. This may lead to school avoidance, which has been defined as a student having difficulty in attending or remaining in school for the entirety of the day, primarily fueled by anxiety of one’s ability to cope at school. There is a scarcity of research on how schools and SUD treatment programs play a role in a young person’s recovery from SUD. This case series explored the complexity of this topic, and offers suggestions for future practice. Aishwarya Thakur, MD, Boston Children's Hospital, Boston, MA Bringing Treatment for Substance Use Disorder Back Home: A Process for Transferring Stable Patients from MAT Clinic to Primary Care There is a significant unmet need for addiction treatment and providers. However, despite the discontinuation of X-waiver requirements, many primary care physicians are not prescribing buprenorphine. The goal of this project was to create a process to identify stable patients with substance use disorder and transfer these patients to primary care providers who are willing and interested in caring for this population. Ultimately this will improve access to addiction specialist care by increasing the capacity of MAT clinics to care for new patients and patients with complex addiction care needs. Alyssa J. Thomas, MD, Loma Linda University Health, Loma Linda, CA |
