2026 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.

Presentation Summaries

Methadone Maintenance Treatment and Hypoglycemia: What is the Connection?
This case involves a 44-year-old female with a history of OUD on Methadone Maintenance Treatment, Renal Amyloidosis with End Stage Renal Disease on Hemodialysis, Lower extremity amputation, Atrial fibrillation, Congestive Heart Failure, enterocutaneous fistula/ostomy, with intermittent hypoglycemia since June 2025 increasing in frequency, during which time methadone dose has increased from 110-150mg.  Patient is in sustained OUD remission and glucose recorded as low as 12 mg/dL in February 2026 and split dosing has not resolved hypoglycemia and the patient does not agree to dose reduction. Work-up noted minimally elevated insulin with elevated cortisol and c-peptide levels, imaging of pancreas has been negative to date. Literature review revealed case studies with methadone associated hypoglycemia with proposed etiologies to include promotion of pancreatic insulin release, suppression of counter-regulatory mechanisms such as glucagon, epinephrine and sympathoadrenal responses to hypoglycemia, as well as impairment of glycogenolysis and gluconeogenesis.
Heather Alker, MD MPH, Thomas Jefferson University, Philadelphia, PA

The Significance of Time-Sensitive Patient Education in the Prevention of Fetal Alcohol Spectrum Disorder (FASD)
The leading preventable cause of cognitive disability in the United States is prenatal alcohol exposure. Maternal alcohol consumption usually occurs before most patients are aware of their pregnancy and receive prenatal care. The objective of this study was to explore provider practice patterns regarding education on prenatal alcohol exposure at routine well visits. We found the majority of providers agree that prenatal alcohol exposure education should be provided to all patient of reproductive age, even if they are not planning pregnancy.  Nevertheless, a major barrier to doing this routinely was time management.
Brian Beard, MD MBA, Southern Illinois University School of Medicine, Springfield, IL
 
A proposed framework for understanding drug-related stigma
Drug-related stigma is a pervasive phenomenon that creates trauma, health disparities and significant barriers to recovery for people who use drugs. This framework describes different facets of drug-related stigma (person, substance, and disorder) and how they manifest at the systemic and personal/interpersonal level to create barriers to addiction care. This framework can also be applied to discuss how drug-related stigma & racism are intertwined, and how to create interventions to combat stigma. While this framework cannot fully capture the complexity of drug related stigma and its interactions with other systems of discrimination, it can be used as a tool for learners to recognize and process stigma they encounter in clinical care.
Shraddha  Damaraju, MD MPH, Massachusetts General Hospital, Boston, MA

A Case of Adolescent Polysubstance Use: Dangers of the Dark Web
This case describes a 17-year-old male admitted from a dual-diagnosis treatment facility after ingesting Lysol, which he reported using to achieve alcohol intoxication. Addiction Medicine was consulted due to polysubstance use, and the patient was subsequently diagnosed with diphenhydramine, inhalant, alcohol, cannabis, tobacco, and opioid use disorders as well as stimulant misuse and other exposures. Detailed social history revealed that much of his substance use knowledge and experimentation was influenced by exposure to content on the dark web. In addition to initiating oral naltrexone, his treatment plan incorporated safer internet practices, highlighting the importance of assessing online influences and providing harm-reduction education when treating adolescents with substance use disorders.
Natalie P. deQuillfeldt, MD MA, Yale Program in Addiction Medicine, New Haven, CT
 
Screening for Liver Fibrosis in Patients with Alcohol Use Disorder in Outpatient Addiction Medicine
In this ongoing quality improvement project, we identified a care gap in liver fibrosis screening in patients with alcohol use disorder in our outpatient addiction medicine clinics. By educating providers on the significance and rationale for utilizing the FIB-4 index, a non-invasive scoring tool based on routine laboratory results, we aimed to achieve a 10% increase in fibrosis screening following our initial intervention. This project attempts to improve health outcomes in an at-risk population by decreasing barriers to routine liver fibrosis testing and bridging the gap between patients with alcohol use disorder and primary care/hepatology.
Amanda Frondella, MD, Geisinger Health System, Waverly, PA
 
Phenobarbital Taper for Severe Gabapentin Use Disorder and Withdrawal: A Case Report
This is a case study of a 46-year-old woman with a history of opioid use disorder in remission who presented to acute detox with severe gabapentin use disorder. She was treated with a 3-day inpatient phenobarbital taper, which was well tolerated. Withdrawal symptoms were tracked using the MINDS protocol, with scores remaining low (2–6) throughout. This case highlights phenobarbital as a potentially safe and effective option for high-dose gabapentin withdrawal when outpatient management is not ideal.
Alyssa N. Hill, MD, University of Colorado, Aurora, CO
 
Successful Transition to Buprenorphine in a Case of Methadone-Associated Torsades de Pointes
Torsades de pointes is a rare but serious complication of QTc prolongation associated with methadone, with risk increasing at higher methadone doses that are increasingly used in the fentanyl era. This is a case report of a 48-year-old male on high-dose methadone who developed torsades de pointes with a markedly prolonged QTc and was successfully transitioned to buprenorphine using a low-dose induction protocol during critical illness. This case highlights the dose-dependent risk and reinforces that methadone should be discontinued once torsades de pointes occurs. It also demonstrates the feasibility of initiating buprenorphine in medically complex patients, ensuring continuity of evidence-based treatment for opioid use disorder.
Ashley Iannantone, MD, Alison Vasa, MD, Rush University Medical Center, Chicago, IL
 
The Changing Face of Withdrawal: Rise of Xylazine
A 53-year-old male was admitted to inpatient detox unit for detoxification from opioids, benzodiazepines, alcohol, and cocaine. He noted that opioids mixed with xylazine differed from pure opioids in both taste and intoxication effects. Given that xylazine is an alpha-2 agonist, his withdrawal symptoms varied in intensity and character from typical opioid withdrawal. Treatment included scheduled methadone, clonidine, gabapentin, clonazepam, with frequent as needed use of ibuprofen, methocarbamol, diphenhydramine, zolpidem, and lorazepam. He successfully completed detox and transitioned to a residential rehabilitation program.
Hemangkumar Javaiya, MD, Jamaica Hospital Medical Center, Richmond Hill, NY

Suspected Fentanyl and Medetomidine Withdrawal Refractory to Aggressive Opioid Agonist Therapy, Managed Without ICU Escalation, Complicated by Benzodiazepine-Responsive Catatonia: A Case Report
A young adult male patient with severe OUD and daily illicit fentanyl use was hospitalized with severe withdrawal signs and symptoms, including refractory nausea & vomiting, diaphoresis, piloerection, profound mydriasis, and hypertension, despite aggressive buprenorphine treatment. Because withdrawal severity peaked early and COWS  remained elevated (22) despite aggressive opioid agonist therapy,  significant medetomidine withdrawal was suspected. After escalation of oral clonidine and initiation of adjunct tizanidine, his withdrawal severity progressively improved and ICU transfer and/or initiation of dexmedetomidine infusion were avoided. Later, after substantial improvement in withdrawal severity, he developed a distinct syndrome of mutism, staring, posturing, catalepsy, and minimal responsiveness, concerning for catatonia. His catatonia responded rapidly to benzodiazepines, with BFCRS improving from approximately 9 to 3 to 1 to 0, suggesting that severe suspected medetomidine withdrawal may have contributed to the later emergence of catatonia.
Michael Ross Lawson, MD, University of Cincinnati, Cincinnati, OH

Methadone-induced Secondary Adrenal Insufficiency: A case report
This is a case report of a 34 year-old woman with history of opioid use disorder in remission on methadone 150mg, who presented with hypotension, bradycardia, and refractory hypoglycemia. Ultimately she was diagnosed with secondary adrenal insufficiency which was thought to be induced by methadone. Opioid receptor activation on the pituitary and hypothalamus can lead to downstream endocrine suppression including secondary adrenal insufficiency, and the risk of this is increased for people on higher doses of opioids over longer durations. Prevalence of adrenal insufficiency in patients with opioid use disorder is not well known, but this diagnosis should be considered in patients presenting with characteristic symptoms and lab findings. Treatment of opioid-induced adrenal insufficiency consists of either weaning opioid doses and/or supplementing with hydrocortisone, and should involve detailed risk-benefit conversations with patients.
Delia Motavalli, MD, Boston Medical Center, Boston, MA
 
Reproductive Health for People Who Use Substances: Case and Literature Review
This is a review of the factors that result in reproductive health inequities amongst people who use substances. We will discuss an illustrative case of a patient who uses substances and how this influences their reproductive life story and review the surrounding literature to contextualize outcomes. We will also review suggestions for practice moving forward to enhance reproductive justice and equity.
Martha Renn, MD, Institute for Family Health, New York City, NY
 
Buprenorphine Prescribing from a Street Medicine Program
Buprenorphine is a partial opioid agonist FDA approved for the treatment of opioid use disorder. Despite being a life-saving medication, several barriers in access to care remain, particularly in unhoused and under- or un-insured populations. This presentation provides a framework for providing buprenorphine treatment from a Street Medicine Program, increasing access to care in concordance with American Society of Addiction Medicine guidelines.
Bryn Thatcher, MD, Wright State University, Dayton, OH
 
Expect the Unexpected: Severe Dystonic Reaction Induced by Opioid Withdrawal
This presentation describes a patient with opioid use disorder who experiences complicated and atypical opioid withdrawal characterized by severe dystonic reaction resulting in rhabdomyolysis, intensive care unit admissions, and multiple prior intubations. We will discuss the management of atypical opioid withdrawal including differential diagnosis, appropriate treatment, and surveillance for potential complications that may arise. This case reinforces the significant morbidity that can be associated with opioid withdrawal, often thought of as an uncomfortable but non-life threatening condition.
Nicole Turturro, MD MPH, Yale Program in Addiction Medicine, New Haven, CT
 
Case Report: Management of Opioid and Medetomidine withdrawal in pregnancy
This is a case report of a 38-year-old G3P1011 at 26 weeks gestational age who presents to a hospital to initiate methadone and is found to be in active opioid and medetomidine (an alpha2 agonist) withdrawal. She is initially very ill, and her withdrawal is aggressively treated with alpha 2 agonists, high doses of short acting opioids, and a dexmedetomidine infusion in the ICU. She leaves her first hospitalization after going into precipitated withdrawal during a buprenorphine micro-induction but later comes back and is started on sublingual buprenorphine (Subutex) and later delivers a healthy baby while in in recovery. We go over the pathophysiology of medetomidine withdrawal and effective treatment regimens for pregnant and non-pregnant patients.
Jonathan Weinhold, MD, University of Pittsburg Medical Center, Pittsburgh, PA
 
Management of Concurrent Phenibut and Alcohol Withdrawal Symptoms in a Level 3.7 Residential Facility
This is a case report of a 55-year-old male who presented to our residential facility reporting  daily use of alcohol and Phenibut. It describes the management of concurrent phenibut and alcohol withdrawal in an inpatient detoxification setting. A multimodal pharmacologic approach targeting both GABA-A and GABA-B pathways ultimately resulted in clinical stabilization. This case highlights the challenges of phenibut withdrawal and the importance of individualized treatment strategies in patients with co-occurring substance use disorders.
Banya Win, MD, High Watch Recovery Center, NYITCOM, Kent, CT

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