The Addiction Connection

Drs. Bell and DeVine are again joined by their Augsburg University Physician Assistant student, Mika. This discussion will dive into the concept of ‘compassion fatigue’. Is it truly a ‘thing?’ Who is at highest risk of developing compassion fatigue and what does the data say? To learn more about the doctors as well as keep up with current happenings follow on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com Part of the Ars Longa Media Productions.

Drs. Bell and DeVine are joined by their Augsburg University Physician Assistant student, Mika, to start the discussion on substance use disorders in transgender and gender non-conforming populations. This segment, the first of two, will give background information and lay out the basics to better help listeners understand this patient population. To learn more about the doctors as well as keep up with current happenings follow on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com Part of the Ars Longa Media Productions.

Drs. Bell and DeVine, thank you to Ruth Merick from the American Farm Bureau Federation, return for part 2 of our rural America and Opioids two part series. This episode will delve into the bias and perceptions of opioids and opioid use disorder(s) felt by adults in rural MN. It will also highlight some of the ideas that these same rural adults have in terms of solutions to the epidemic. To learn more about the doctors as well as keep up with current happenings follow on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com Part of the Ars Longa Media Productions.

Drs. Bell and DeVine, thank you to Ruth Merick from the American Farm Bureau Federation, will discuss the data on mental health access and opioid use in rural America. This will be followed next week by the perceptions of opioid use in rural America as well as possible solutions to the opioid epidemic in this particular niche. To learn more about the doctors as well as keep up with current happenings follow on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com Part of the Ars Longa Media Productions.

Drs. Bell and DeVine return to the topic of suicide. Previously we discussed suicide risk in relation to opioids, this episode will discuss suicide risk with individuals with nicotine, stimulant and/or cannabis use disorder. The statistics and data are quite alarming, again showing the importance of screening for and assessing for use disorders and mental health. To learn more about the doctors as well as keep up with current happenings follow on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com Part of the Ars Longa Media Productions.

Drs. Bell and DeVine follow up with even more information about the harms of Kratom outside of the substance itself. Where it is grown and how it is processed can lead to many additional health complications, some of which will surprise you. We will finish with a discussion on harm reduction as well in relation to Kratom. To learn more about the doctors as well as keep up with current happenings follow on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com Part of the Ars Longa Media Productions.

Drs. Bell and DeVine return with Kratom 2.0. With what seems like an increase in the amount of Kratom that is being seen in the clinic and healthcare setting, this will review what Kratom is as well as take a deeper dive into the effects and withdrawal states. To learn more about the doctors as well as keep up with current happenings follow on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com Part of the Ars Longa Media Productions.

Drs. Bell and DeVine came across, initially, one article alluding to an association between eye color and the risk for alcohol use disorder, interestingly finding that they both would be considered “higher risk” (listen to hear our eye color disclosure!) Upon further research, there does seem to be a genetic linkage and association between the two. To learn more about the doctors as well as keep up with current happenings follow on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com Part of the Ars Longa Media Productions.

Drs. Bell and DeVine will discuss another system in the body that is not typically thought of in relation to alcohol consumption. Interestingly enough, alcohol consumption can and does have a significant impact on the eyes, and the “optic” system, in several different ways. To learn more about the doctors as well as keep up with current happenings follow on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com Part of the Ars Longa Media Productions.

Drs. DeVine and Bell will discuss a theme in medical practice, shared-decision making, that continues to grow in its practice in medicine. This idea incorporates and includes the patient in their own medical decisions. This episode will explore the shared decision making concept in relation to non-cancer pain chronic opioid therapy and how health and safety outcomes are improved when it’s utilized. To learn more about the doctors as well as keep up with current happenings follow on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com Part of the Ars Longa Media Productions.

Drs. Bell and DeVine, this week, will take a dive into prazosin, a medication FDA approved only for the treatment of hypertension, and how it may actually aid in the treatment of alcohol use disorder. Although this medication is approved only for hypertension, it is often used off label for things like PTSD and Benign Prostatic Hypertrophy (BPH). We will review recent studies that look at the efficacy, however, of its use for the treatment of AUD both with and without co-occurring PTSD. To learn more about the doctors as well as keep up with current happenings follow on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com Part of the Ars Longa Media Productions.

Drs. Bell and DeVine discuss “Dry January.” Is this just a fad or does it actually have merit? We will discuss how it started, the data behind who ‘typically’ does it, and what health, and life, benefits are realized. Hint: the concept behind ‘dry January’ is somewhat of a ‘self-reflection’ but we will discuss the hows and the whys! We also have a bit of a challenge for the listeners at the end! To learn more about the doctors as well as keep up with current happenings follow on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com Part of the Ars Longa Media Productions.

Drs. Bell and DeVine will start a review of some new research being done for different use disorder treatments. This episode will review a journal article recently released on how Ketamine, currently being done for depression and chronic pain, may potentially help or aid in the treatment of alcohol use disorder. To learn more about the doctors as well as keep up with current happenings follow on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com Part of the Ars Longa Media Productions. All referenced articles will be listed in the show notes of Part 4 of the Perioperative Series.

Drs. Bell and DeVine bring you part 2 of gambling disorders. We describe who is at [higher] risk for developing gambling disorder. Also, is there tolerance and what does withdrawal actually looks like? Finally, we will review the best treatments for this addiction. To learn more about the doctors as well as keep up with current happenings follow on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com Part of the Ars Longa Media Productions. All referenced articles will be listed in the show notes of Part 4 of the Perioperative Series. https://www.ncpgambling.org/help-treatment/help-by-state/ Source: Korman, Collins, et al., (2008) www.icrg.org Www.divisionaddiction.org www.mnapg.org MN Helpline: 1800-333-HOPE

Drs. Bell and DeVine come back after a bit of a hiatus and bring you Gambling Disorder Part 1: The Facts and Consequences. Information courtesy of Ted Hartwell from the Nevada Counsel on Problem Gambling. Why is Gambling Disorder the only behavioral addiction in the DSM-V? We will discuss the facts of gambling including the prevalence and negative consequences data. To learn more about the doctors as well as keep up with current happenings follow on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com. Part of the Ars Longa Media Productions. All referenced articles will be listed in the show notes of Part 4 of the Perioperative Series.

Drs. Bell and DeVine return for Part 4 of Perioperative Considerations, Management, and Process for patients on buprenorphine. This final (for now) episode discusses the ‘other’ patient situations concerning perioperative times. How do you manage patients who have an undiagnosed opioid use disorder or are on very high doses of chronic opioids? What about patients who are opioid naive but who are high-risk for development of an OUD? These patients may be those who, personally, do not want opioids for any reason either due to a history of another substance use disorder or those who just do not want opioid exposure. Teaser- there will likely be a part 5 of this series of Perioperative Considerations… Below you will find the resources used for the development of this series. To learn more about the doctors as well as keep up with current happenings follow on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com Part of the Ars Longa Media Productions. Articles for Perioperative Series: •Bentzley BS et al. Discontinuation of buprenorphine maintenance therapy: perspectives and outcomes. J Subst Abuse Treat 2015;52:48-57. •Buresh M, et al. Treatment perioperative and acute pain in patients on buprenorphine: narrative literature review and practice recommendations. J Gen Intern Med 2020;35(12):3635-3643. •Champagne K, et al. Patients on buprenorphine formulations undergoing surgery. Current Pain and Headache Reports 2022;26:459-468. •Engle AL, et al. The divided dose approach to perioperative buprenorphine management in patients with opioid use disorder. Journal of Opioid Management 2021;17(7):101-107. •Evans E, et al. Mortality among individuals accessing pharmacological treatment for opioid dependence in California, 2006-10. Addiction 2015;110:996. Goel A et al. The perioperative patient on buprenorphine: a systematic review of perioperative management strategies and patient outcomes. Can J Anaest 2019;66:201-17 •Greenwald M et al. Buprenorphine duration of action: mu-opioid receptor availability and pharmacokinetic and behavioral indices. Biol Psychiatry. 2007 Jan1;61(1):101-10. •Katz A, et al. Tobacco, alcohol, and drug use and willingness to change. J Hosp Med 2008;3:369-75. •Kubalanza K et al. Sublingual buprenorphine vs. morphine for acute pain. Am Fam Physician. 2012;86(7):682. •Liebschutz JM, et al. Buprenorphine treatment for hospitalized, opioid-dependent patients: a randomized clinical trial. JAMA Intern Med 2014;174:369-76. •Machado FC et al. Transdermal buprenorphine for acute postoperative pain: a systematic review. Braz J Anesthesiol. Jul-Aug 2020;70(4):419-428. Pergolizzi J et al. Current knowledge of buprenorphine and its unique pharmacological profile. Pain Pract. Sep-Oct 2010;10(5):428-50.

Drs. Bell and DeVine return for Part 3 of Perioperative Considerations, Management, and Process for patients on buprenorphine. So now that the question and the science have been discussed, what do we do? As previously stated, there isn’t a set guideline, just expert recommendations. Over time we have developed protocols and resources to help navigate the maintenance of buprenorphine through the perioperative and postoperative period. Please email us if you would like any protocols or forms we have developed! To learn more about the doctors as well as keep up with current happenings follow on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com Part of the Ars Longa Media Productions. All referenced articles will be listed in the show notes of Part 4 of the Perioperative Series.

Drs. Bell and DeVine return for Part 2 of Perioperative Considerations, Management, and Process for patients on buprenorphine. We continue the “what does it mean” from the previous episode which focused on the science of buprenorphine. What happens if buprenorphine is continued in terms of pain mitigation and what happens if buprenorphine is discontinued, both in terms of analgesia but also in terms of relapse potential. To learn more about the doctors as well as keep up with current happenings follow on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com. Part of Ars Longa Media Productions. All referenced articles will be listed in the show notes of Part 4 of the Perioperative Series.

Drs. Bell and DeVine start another series, Perioperative Considerations, Management, and Process for patients on buprenorphine. This episode reviews the science, particularly the buprenorphine and mu receptor neurobiology, of analgesia management post-op for patients going into, or coming out of, surgery. What has historically been done, and what do articles say? To learn more about the doctors as well as keep up with current happenings follow on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com Part of the Ars Longa Media Productions. All referenced articles will be listed in the show notes of Part 4 of the Perioperative Series.

Drs. Bell and DeVine sadly bring you the last installment of “Sugar Addiction!” Part 5 attempts to make the information more applicable to humans, with a few touches of the rats as well! How and why can and should sugar be an addiction? What does it mean in terms of food addiction and eating disorders? To learn more about the doctors as well as keep up with current happenings follow on twitter: @echocsct or email us with questions or feedback: theaddictionconnectionpodcast@gmail.com Part of the Ars Longa Media Productions