Treating Opioid Use Disorder with Dr. Evan Schwarz

Recorded live at Michigan ACEP at Mackinac, Dr. Ryan Stanton talks with Dr. Evan Schwarz, a UCLA emergency physician, medical toxicologist, and addiction medicine specialist, about the evolving landscape of substance use disorder in the ED. Dr. Schwarz explains why opioid overdose deaths are trending down despite what emergency physicians see day to day, and how the drug supply has shifted from prescription opioids and heroin to fentanyl, kratom, xylazine, and medetomidine adulterants. The conversation covers practical buprenorphine dosing, including why higher doses are often needed and safe, how to use the COW score to assess readiness, microdosing for patients not yet ready to start, and the role of harm reduction and peer recovery coaches in getting patients into treatment. Dr. Schwarz will present this topic again at ACEP26 in Chicago.