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ASAM Practice Pearls: Daily Summaries Delivered
by ASAM Education
Join ASAM Practice Pearls for in-depth discussions on addiction prevention, treatment, and recovery. Geared toward healthcare professionals and individuals seeking knowledge, this series explores the latest evidence-based approaches to addiction medicine. Listen to interviews with leading experts as they delve into critical topics and share practical tools you can use to improve patient care and promote public health.
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- 2 weeks ago28 min
Gambling and Sports Betting Addiction: Screening and Interventions
In this season 2 finale of ASAM Practice Pearls, Dr. Stephen Taylor sits down with Dr. Timothy Fong to discuss one of the fastest-growing and most overlooked concerns in addiction medicine: gambling disorder. With sports betting now legal in over 40 states and digital gambling accessible on every smartphone, gambling and sports betting are rapidly expanding. This episode breaks down the prevalence, consequences, and unique aspects of gambling disorder and offers practical, actionable guidance on screening, brief intervention, and treatment. ----more---- Looking for this episode's transcript? Download it HERE Get credit for listening! Claim your 0.5 CEs HERE Have an idea for a future episode? Share it with us at education@asam.org. Host Stephen M. Taylor, MD, MPH, DFAPA, DFASAM Dr. Stephen M. Taylor is ASAM's President and is board certified in general psychiatry, child and adolescent psychiatry, addiction psychiatry, and addiction medicine. With over 30 years of practice experience, Dr. Taylor is dedicated to helping adolescents and adults overcome addiction and co-occurring psychiatric disorders. He has served as the Medical Director of the NBA and NBPA Player Assistance and Anti-Drug Program for 16 years and is the Chief Medical Officer of Pathway Healthcare, which operates multiple outpatient addiction and mental health treatment offices across six states. Expert Timothy Fong, MD Dr. Timothy Fong is the President of the American Academy of Addiction Psychiatry (AAAP) and a clinical professor of psychiatry at the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA. He is board certified in adult and addiction psychiatry. He is the co-director of the UCLA Gambling Studies Program, a program that examines the clinical characteristics of gambling disorder in order to develop effective, evidence-based prevention and treatment strategies. Dr. Fong is also a member of the Steering Committee of the UCLA Center for Cannabis and Cannabinoids, whose mission is to address the most pressing questions about the impact of cannabis legalization through rigorous scientific study and interdisciplinary discourse. He is a member of the UCLA Sports Psychiatry Service and the UCLA Sports Medicine Mental Health Team. 📖 Show Segments 00:05 - Introduction 02:38 - Modern Day Gambling: Investing vs Gambling vs Betting 04:38 - Prevalence and Public Health Impact 08:21 - Consequences of Gambling Disorder 14:30 - Screen and Clinical Assessment 20:03 - Interventions and Treatment Options 23:59 - Practice Pearls 27:40 - Conclusion 📋 Key Takeaways Recognize that we are practicing in a gambling-centered environment: The rapid expansion of mobile sports betting, online wagering, and prediction markets has normalized gambling and lowered perceptions of risk. Clinicians should expect to encounter gambling-related harms more frequently across patient populations. Recognize gambling disorder as a serious and potentially life-threatening condition: Gambling disorder is associated with high rates of suicidality, co-occurring substance use disorders, mental health disorders, financial strain, relationship problems, and intimate partner violence. Clinicians should approach it with the same level of concern as substance use disorders. Remember that gambling disorder is often a hidden addiction: Patients may appear highly functional, professionally successful, and psychologically intact while experiencing severe financial losses, emotional distress, and compulsive gambling behaviors. Do not rely on appearance or external functioning to assess risk. Screen routinely and ask the right questions: Gambling should be assessed alongside substance use during intakes, annual assessments, and follow-up visits. Because many patients do not view sports betting, poker, online wagering, or prediction markets as "gambling," ask specifically about betting behaviors. Consider questions such as: Have you ever lied to anybody about spending money on gambling or betting? Have you ever increased your bet, wager, or gambling amount to get the same thrill or rush? How much time, energy, and money do you spend online trying to make more money? Assess financial heal
- 4 weeks ago33 min
GLP-1s in Addiction Medicine: An Update Since Our Last Conversation
In this episode of ASAM Practice Pearls, Dr. Stephen Taylor welcomes back Dr. Stephanie Weiss and is joined by Dr. Anna Lembke to explore an update on GLP-1 receptor agonists for alcohol use disorder (AUD), discussing current research, how things have evolved since the last discussion, and the challenges and implications of integrating these innovative treatments into addiction care. ----more---- Looking for this episode's transcript? Download it HERE Get credit for listening! Claim your 0.5 CEs HERE Have an idea for a future episode? Share it with us at education@asam.org. Host Stephen M. Taylor, MD, MPH, DFAPA, DFASAM Dr. Stephen M. Taylor is ASAM's President and is board certified in general psychiatry, child and adolescent psychiatry, addiction psychiatry, and addiction medicine. With over 30 years of practice experience, Dr. Taylor is dedicated to helping adolescents and adults overcome addiction and co-occurring psychiatric disorders. He has served as the Medical Director of the NBA and NBPA Player Assistance and Anti-Drug Program for 16 years and is the Chief Medical Officer of Pathway Healthcare, which operates multiple outpatient addiction and mental health treatment offices across six states. Expert Stephanie Weiss, MD, PhD Dr. Stephanie Weiss is a Research Physician with the Translational Addiction Medicine Branch (TAMB) of the NIDA Intramural Research Program. She holds a PhD in pharmaceutical chemistry and a medical degree from the Cleveland Clinic Lerner College of Medicine. Board-certified in emergency medicine, addiction medicine, and medical toxicology, Dr. Weiss focuses on caring for patients with poisonings, overdoses, and medication misuse. Her research interests include novel psychoactive substances, medication misuse, and improving urine drug testing interpretation. Expert Anna Lembke, MD, FASAM Dr. Anna Lembke received her undergraduate degree in Humanities from Yale University and her medical degree from Stanford University. She is currently Professor and Medical Director of Addiction Medicine, Stanford University School of Medicine. She is also Program Director of the Stanford Addiction Medicine Fellowship, Chief of the Stanford Addiction Medicine Dual Diagnosis Clinic, and a diplomate of the American Board of Psychiatry and Neurology and the American Board of Addiction Medicine. 📖 Show Segments 00:05 - Introduction 04:15 - Latest Developments in Research 05:34 - Prescribing GLP-1's Off Label 06:28 - Challenges With Prescribing 07:36 - Who Benefits From GLP-1's and Who Doesn't 09:52 - Potential for Other SUD Treatment Beyond AUD 11:18 - Side Effects, Tolerability Concerns, and Adherence Challenges 15:11 - Where GLP-1's Fit into the Treatment Toolbox 16:19 - Unanswered Questions about GLP-1 Treatment 19:14 - GLP-1's Possible Impact on Mood 25:11 - Dosing Strategy and Titration Approach 26:36 - Life After GLP-1s: Rebound Risk and "Chipping" 28:52 - Biggest Surprise from the Research So Far 31:05 - Practice Pearls 32:34 - Conclusion and Additional Learning Opportunities 📋 Key Takeaways Emerging evidence continues to build for GLP-1s in AUD: Multiple recent clinical trials of semaglutide for AUD have reported positive findings, with additional studies expected to be published in the coming year. While the evidence base is growing, GLP-1s are not yet FDA-approved for the treatment of substance use disorders. Continue to prioritize FDA-approved medications for AUD first: Clinicians should start with established treatments such as naltrexone, acamprosate, and disulfiram before considering off-label GLP-1 therapy. Consider GLP-1s for patients with AUD and relevant co-occurring conditions: Patients with refractory AUD who have not responded well to evidence-based treatments and also have obesity, diabetes, binge eating disorder, food addiction, or treatment-resistant depression may be good candidates for a GLP-1 trial. Start low and titrate based on efficacy and tolerability: There is currently no established optimal GLP-1 dose for AUD. Clinicians prescribing GLP-1s off-label should begin with low doses and gradually titrate while monitoring symptom improvement and adverse effects
- Aug 10, 202630 min
Addiction Care in Custody: Trust, Treatment, and Advocacy
In this episode of ASAM Practice Pearls, Dr. Stephen Taylor hosts Dr. Justin Berk to discuss addiction care for individuals involved in the criminal justice system, including patients in custody and those transitioning back to the community. The conversation explores practical strategies for building therapeutic alliances with incarcerated patients, advocating for evidence-based treatment in correctional settings, and navigating common barriers to care. The episode covers opportunities for clinicians to provide compassionate, patient-centered care that improves outcomes for this high-risk population. ----more---- Looking for this episode's transcript? Download it HERE Get credit for listening! Claim your 0.5 CEs HERE Have an idea for a future episode? Share it with us at education@asam.org. Host Stephen M. Taylor, MD, MPH, DFAPA, DFASAM Dr. Stephen M. Taylor is ASAM's President and is board certified in general psychiatry, child and adolescent psychiatry, addiction psychiatry, and addiction medicine. With over 30 years of practice experience, Dr. Taylor is dedicated to helping adolescents and adults overcome addiction and co-occurring psychiatric disorders. He has served as the Medical Director of the NBA and NBPA Player Assistance and Anti-Drug Program for 16 years and is the Chief Medical Officer of Pathway Healthcare, which operates multiple outpatient addiction and mental health treatment offices across six states. Expert Justin Berk, MD, MPH, MBA, FASAM Dr. Justin Berk is an addiction medicine physician-researcher and the former Medical Director of the Rhode Island Department of Corrections. He is an Associate Professor in the Departments of Medicine and Pediatrics at the Alpert Medical School at Brown University and the Director for the Center of Health and Justice Transformation at Brown University Health. He completed residency at the Urban Health Combined Internal Medicine – Pediatrics Residency Program at Johns Hopkins Hospital and is Board Certified in Internal Medicine, Pediatrics, and Addiction Medicine. His research and advocacy focus on the intersection of addiction medicine, correctional health, and health equity. 📖 Show Segments 00:05 - Introduction 03:09 - Building Rapport with Patients in Custody 08:23 - Evidence for MOUD in Jails and Prisons 11:05 - Overcoming Implementation Barriers for Evidence-based Treatment 13:11 - Advocating for Patients in Custody 17:25 - Reentry and Continuity of Care 19:44 - Addressing Diversion Concerns 23:22 - Privacy, Autonomy, and Care Coordination 24:50 - Lightning Round Q&A 28:05 - Practice Pearls 29:58 - Conclusion and Additional Learning Opportunity 📋 Key Takeaways Recognize the justice system as a critical treatment touchpoint: Approximately 58% of individuals in state prisons and 63% of individuals in jails meet criteria for substance use disorder, making correctional settings an important, and often underutilized, opportunity to initiate evidence-based addiction care. Tailor clinical management to the correctional setting: Jails and prisons present distinct clinical challenges, with jails more commonly managing acute intoxication, withdrawal, and trauma, while prisons often focus on chronic disease management and long-term care. Use humanistic, patient-centered care to improve engagement and outcomes: Small actions, such as requesting the removal of handcuffs during clinical encounters, advocating for privacy, facilitating necessary evaluations, and coordinating directly with correctional facilities during transitions of care, can build trust and strengthen therapeutic relationships. Use hospitalization to close care gaps for patients in custody: When feasible, initiate evidence-based treatments during hospitalization rather than deferring care. Consider starting HCV treatment, optimizing medication for opioid use disorder (MOUD), addressing rehabilitation needs, completing necessary diagnostic workups, and documenting ongoing care requirements. Support access to MOUD in correctional settings: Evidence demonstrates that methadone and buprenorphine save lives, reduce overdose risk, improve treatment retention, and improve outcomes, yet many of these treatments remain unavailable in many cor
- Jul 27, 202628 min
Polysubstance Intoxication: Managing the Unknown
In this episode of ASAM Practice Pearls, Dr. Stephen Taylor welcomes Dr. Itai Danovitch to discuss the descriptive term polysubstance use and methods for evaluating and managing patients with polysubstance intoxication and unknown toxidromes. The conversation covers strategies for assessing altered mental status, maintaining a broad differential diagnosis, safely managing agitation, and providing supportive care while avoiding common cognitive biases. This episode offers listeners practical insights for navigating clinical uncertainty and supporting patients from stabilization to treatment engagement. ----more---- Looking for this episode's transcript? Download it HERE Get credit for listening! Claim your 0.5 CEs HERE Have an idea for a future episode? Share it with us at education@asam.org. Host Stephen M. Taylor, MD, MPH, DFAPA, DFASAM Dr. Stephen M. Taylor is ASAM's President and is board certified in general psychiatry, child and adolescent psychiatry, addiction psychiatry, and addiction medicine. With over 30 years of practice experience, Dr. Taylor is dedicated to helping adolescents and adults overcome addiction and co-occurring psychiatric disorders. He has served as the Medical Director of the NBA and NBPA Player Assistance and Anti-Drug Program for 16 years and is the Chief Medical Officer of Pathway Healthcare, which operates multiple outpatient addiction and mental health treatment offices across six states. Expert Itai Danovitch, MD, MBA, DFAPA, DFASAM Dr. Itai Danovitch is Professor and Chair of the Department of Psychiatry and Behavioral Neurosciences at Cedars-Sinai Medical Center in Los Angeles. He earned his bachelor's degree from UC Berkeley and his medical doctorate from the UCLA School of Medicine. He completed a psychiatry residency at Columbia University, an addiction psychiatry fellowship at Cedars-Sinai Medical Center, and a Master of Business Administration at the UCLA Anderson School of Management. Dr. Danovitch’s clinical practice and research are focused on the treatment of substance use disorders and the integration of medical and mental health services. His research is funded by the National Center for Advancing Translational Sciences (NCATS), the National Institute on Drug Abuse (NIDA), and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). He is the author of over 100 articles and book chapters and co-editor of two books on substance use disorders. Dr. Danovitch served as a Governor-appointed state Commissioner to the California Mental Health Services Commission. He is a Distinguished Fellow of the American Society of Addiction Medicine, a Distinguished Fellow of the American Psychiatric Association, and past president of the California Society of Addiction Medicine. 📖 Show Segments 00:05 - Introduction 02:28 - Chapter 59 in The ASAM Principles of Addiction Medicine 03:45 - Patient Case: Altered Mental Status 06:01 - Polysubstance Use as a Descriptive Term 07:53 - Approaching Unclear or Mixed Toxidromes 11:36 - Completing a Differential Diagnosis Workup 14:54 - Responding When There Is a Lack of Clear Protocols 18:39 - Contaminants and the Changing Drug Supply 20:39 - Practice Pearls 23:33 - Lightning Round Q&A 27:35 - Conclusion and Additional Learning Opportunity 📋 Key Takeaways Conduct empirical evaluations and avoid confirmation bias: Polysubstance presentations often involve incomplete histories, unexpected substances, or contaminants. Remain comfortable with uncertainty, continually reassess the patient, and adapt management as new information emerges rather than becoming committed to an early diagnosis. Keep the differential diagnosis broad when evaluating altered mental status: Do not assume that all episodes of agitation, confusion, or delirium are caused solely by substance use. Consider intoxication, withdrawal, infection, trauma, metabolic disorders, neurologic conditions, and other medical causes. Supportive care is the foundation of managing most toxidromes: For many unknown or mixed toxidromes, treatment focuses on maintaining airway, breathing, circulation, temperature regulation, and patient safety while the body metabolizes and clears substances. Match agitation management to the
- Jul 13, 202626 min
Individualizing Buprenorphine: Low-dose Induction to Long-acting Injectables
In this episode of ASAM Practice Pearls, Dr. Stephen Taylor hosts Dr. Stephen Holt in a discussion about practical strategies for initiating and managing patients receiving low-dose buprenorphine and long-acting injectable (LAI) formulations. The conversation explores how to match induction approaches to individual patient needs, guidance on dosing, and ways to support ongoing use, cravings, or withdrawal symptoms. This episode offers listeners practical insights for implementing buprenorphine treatment strategies and expanding access to evidence-based care. ----more---- Looking for this episode's transcript? Download it HERE Get credit for listening! Claim your 0.5 CEs HERE Have an idea for a future episode? Share it with us at education@asam.org. Host Stephen M. Taylor, MD, MPH, DFAPA, DFASAM Dr. Stephen M. Taylor is ASAM's President and is board certified in general psychiatry, child and adolescent psychiatry, addiction psychiatry, and addiction medicine. With over 30 years of practice experience, Dr. Taylor is dedicated to helping adolescents and adults overcome addiction and co-occurring psychiatric disorders. He has served as the Medical Director of the NBA and NBPA Player Assistance and Anti-Drug Program for 16 years and is the Chief Medical Officer of Pathway Healthcare, which operates multiple outpatient addiction and mental health treatment offices across six states. Expert Stephen Holt, MD, MS, FACP, FASAM Dr. Stephen Holt has been an attending physician at Yale-New Haven Hospital since 2008 and is an Associate Professor of Medicine at Yale School of Medicine. He is the Director of the Yale Addiction Recovery Clinic and the Associate Program Director for Yale's Primary Care Internal Medicine Residency Program. He is board-certified in Addiction Medicine and Internal Medicine. He has published and lectures frequently on a variety of addiction medicine topics, and has won numerous teaching awards at the local, regional, and national levels. 📖 Show Segments 00:05 - Introduction 00:45 - Patient Case: Erratic use of Buprenorphine 02:23 - Deciding Between Traditional and Low-Dose Induction 05:27 - Direct-to-Inject Approach and Access Logistics 09:23 - Low-dose Induction Approach 10:38 - Considerations for Tailoring Buprenorphine Doses 12:37 - Candidates for LAI Formulations 14:16 - Initiating LAI Treatment 17:56 - Managing Ongoing Use and Breakthrough Symptoms on LAI 21:02 - Addressing Co-occurring Substance Use Disorders 23:05 - Practice Pearls 25:31 - Conclusion and Additional Learning Opportunity 📋 Key Takeaways Match your induction strategy to the patient: Patients using short-acting or predictable opioids can follow a traditional induction. For those taking predictable long-acting opioids or methadone, consider a low-dose induction. For patients with erratic use of buprenorphine or fentanyl, consider a direct-to-inject or high-dose induction approach. Low-dose induction reduces the risk of precipitated withdrawal: Start a patient with very small amounts of buprenorphine (e.g., 0.5 mg) while the patient continues using their opioid, then gradually increase their buprenorphine dose over approximately 6 days in the outpatient setting. Consider direct-to-inject LAI buprenorphine for patients with unstable use: LAI buprenorphine (especially 7-day formulations) allows a gradual receptor transition, reducing withdrawal risk and simplifying care for patients with unstable opioid use patterns. Proactively address logistical barriers to offering LAIs: Establish feasible workflows (e.g., specialty pharmacy or buy-and-bill) to reduce access barriers. Another option is to plan follow-up visits a few days later to administer the injection and use sublingual buprenorphine as a bridge, rather than trying to secure LAI same-day access upfront. Individualize LAI dosing based on patient use patterns and context: There's no perfect conversion from fentanyl to buprenorphine. Dosing decisions depend on opioid type, level of cravings, and environment. Patients using more than 2-3 bags of fentanyl per day may require the maximum dose of LAI buprenorphine, whereas lighter users may not. Offer LAI buprenorphine as a routine op
- Jun 29, 202625 min
Enhancing Addiction Care Through Care Touchpoints
In this episode of ASAM Practice Pearls, Dr. Stephen Taylor and Dr. Mike Fingerhood discuss the importance of enhancing addiction care through community support and compassionate touch points. They explore how providing access to basic needs can serve as entry points into treatment for individuals struggling with addiction, the effect of compassionate interventions on clinical outcomes, and the challenges related to funding and community acceptance for addiction services. ----more---- Looking for this episode's transcript? Download it HERE Get credit for listening! Claim your 0.5 CEs HERE Have an idea for a future episode? Share it with us at education@asam.org. Host Stephen M. Taylor, MD, MPH, DFAPA, DFASAM Dr. Stephen M. Taylor is ASAM's President and is board certified in general psychiatry, child and adolescent psychiatry, addiction psychiatry, and addiction medicine. With over 30 years of practice experience, Dr. Taylor is dedicated to helping adolescents and adults overcome addiction and co-occurring psychiatric disorders. He has served as the Medical Director of the NBA and NBPA Player Assistance and Anti-Drug Program for 16 years and is the Chief Medical Officer of Pathway Healthcare, which operates multiple outpatient addiction and mental health treatment offices across six states. Expert Michael I. Fingerhood, MD, FACP, DFASAM Dr. Michael I. Fingerhood is a Professor of Medicine and Public Health at Johns Hopkins University and Chief of the Division of Addiction Medicine at Johns Hopkins Bayview Medical Center. Dr. Fingerhood created The Comprehensive Care Practice in 1994, a primary care practice largely devoted to providing care to individuals with substance use disorder. The practice has been innovative in integrating buprenorphine treatment into the primary care setting for over 650 individuals. He has also co-created novel buprenorphine treatment programs for a community center, church, and a mobile van outside the Baltimore Detention Center. Dr. Fingerhood received the Health Equity Leadership Award from the Baltimore City Health Department. He is the co-author of the ASAM Handbook of Addiction Medicine. Dr. Fingerhood serves on the ASAM Board of Directors as Ex-Officio, Chair of the Medical Education Council. In addition, he has co-authored over 80 research papers and received NIH research funding continuously over the past 30 years. 📖 Show Segments 00:05 - Introduction 01:48 - Patient Letter 04:13 - Redefining Harm Reduction 06:26 - Low-threshold, High-impact Intervention 09:30 - Translating Interventions into Clinical Outcomes 11:14 - Community Engagement and Overcoming Resistance 13:21 - Funding and Support of Care Touchpoint Programs 15:05 - Changing Mindsets and Moving Towards Acceptance 20:59 - Use of Test Strips 22:46 - Practice Pearls 23:51 - Conclusion and Additional Learning Opportunity 📋 Key Takeaways Every interaction matters: A single compassionate encounter can plant the seed for change, reinforcing that every person is worth the effort and the investment. Stigma is a barrier to treatment: Reducing stigma through peers, integrated care environments, and direct patient relationships is essential to change how clinicians and communities approach addiction. Low-threshold services are high-impact entry points to care: Access to showers, laundry, naloxone, HIV and hepatitis C testing, and safe spaces restores dignity, builds trust, and often serves as the first step toward recovery and ongoing engagement in healthcare. Recovery starts before substance use stops: Labeling someone as "not ready" puts the burden on the individual; instead, clinicians should ask, "What can I do?" Progress should be defined by making today better than yesterday, recognizing that meaningful change can begin at any touchpoint. Peers are essential to engagement and trust: Peer support provides a nonjudgmental connection, helping individuals feel understood and empowering them to engage in care on their own terms. Compassionate care drives measurable clinical outcomes: Integrated, compassionate care models improve engagement, increase hepatitis C cure rates, support HIV treatment, and reduce overall healthcare costs. Community buy-in
- Jun 15, 202627 min
Implementing Substance Use Care Across Care Settings: ED to Ongoing Care
In this episode of ASAM Practice Pearls, Dr. Stephen Taylor hosts Dr. Sarah Wakeman to discuss substance use care in the emergency department, sharing highlights from ASAM's new implementation guide for hospital and emergency department (ED) substance use disorder (SUD) care. Together, they explore the gap between evidence-based addiction treatment and current hospital/ED practice, how frontline non-specialist clinicians can provide effective SUD care, practical implementation models, and how to build seamless care transitions from the ED to ongoing treatment. ----more---- Looking for this episode's transcript? Download it HERE Get credit for listening! Claim your 0.5 CEs HERE Have an idea for a future episode? Share it with us at education@asam.org. Host Stephen M. Taylor, MD, MPH, DFAPA, DFASAM Dr. Stephen M. Taylor is ASAM's President and is board certified in general psychiatry, child and adolescent psychiatry, addiction psychiatry, and addiction medicine. With over 30 years of practice experience, Dr. Taylor is dedicated to helping adolescents and adults overcome addiction and co-occurring psychiatric disorders. He has served as the Medical Director of the NBA and NBPA Player Assistance and Anti-Drug Program for 16 years and is the Chief Medical Officer of Pathway Healthcare, which operates multiple outpatient addiction and mental health treatment offices across six states. Expert Sarah Wakeman, MD, FASAM Dr. Sarah Wakeman is the Senior Medical Director for Substance Use Disorder at Mass General Brigham, Director of the Mass General Brigham Program for Substance Use and Addiction Services, and an Associate Professor of Medicine at Harvard Medical School. She received her AB from Brown University and her MD from Brown Medical School. She completed residency training in internal medicine and served as Chief Medical Resident at Mass General Hospital. She is a diplomate of the American Board of Addiction Medicine and board certified in Addiction Medicine. Clinically, she provides specialty addiction and general medical care in the inpatient and outpatient setting at Mass General Hospital and the Mass General Charlestown Health Center. Her research focuses on the integration of addiction care into general medical settings and opioid use disorder treatment. 📖 Show Segments 00:05 - Introduction 02:57 - The Gap in ED and Hospital Addiction Care 05:50 - Setting Realistic Expectations for Frontline Clinicians 08:19 - Critical Elements of Care for Non-specialists 12:07 - Implementation Systems 17:15 - Effective Transitions of Care 21:48 - Closing the Feedback Loop: Sharing Success Stories 24:37 - Practice Pearls 26:23 - Conclusion and Additional Learning Opportunity 📋 Key Takeaways Treat the underlying disorder, not just the acute presentation: While effective treatments for SUDs have existed for decades, many emergency departments and hospitals still don’t consistently deliver evidence-based addiction care during admission, often only treating the complications without addressing the underlying condition. Addiction care should be the standard, not the exception: Initiating medications (e.g., buprenorphine, methadone, naltrexone), managing withdrawal, and linking patients to care should be an expectation for all frontline clinicians. Consider the seven core competencies as your quality checklist for SUD care: Screening, withdrawal management, overdose response, medication initiation, co-occurring conditions, linkage to care, and risk reduction should all be addressed for every SUD patient. Systems change can start small and scale: Even without large resources, hospitals can enhance care through clinical pathways, order sets, education, and peer champions, making best practices easier to implement in everyday workflows. Having a peer champion can help implement these practices by normalizing the behavior, providing real-time support, and making the change feel achievable. Think of system change like motivational interviewing: Approaching the system and framing addiction care in terms the institution already cares about and is familiar with can help make change. Provide warm handoffs and follow-up: The highest-risk period is the first week post-dis
- Jun 1, 202626 min
Methadone: The Right Dose, Every Day
EP 03 🎙 Special Series: ASAM's 57th Annual Conference This episode is part of a special three-part series spotlighting key sessions from ASAM’s 57th Annual Conference. In this episode of ASAM Practice Pearls, In this episode of ASAM Practice Pearls, Dr. Elizabeth Salisbury-Afshar is joined by Drs. Ruth Potee and Ari Kriegsman to explore highlights from their session, The Right Dose, Every Day. Together, they challenge the algorithmic, punitive approaches to methadone treatment, instead promoting individualized, patient-centered care. They share their clinical and philosophical approaches to methadone treatment, including split dosing, missed-dosing protocols, and expanded take-home medications, offering practical insights to help you advocate for your patients and collaborate across care settings. ----more---- Looking for this episode's transcript? Download it HERE Get credit for listening! Claim your 0.5 CEs HERE Have an idea for a future episode? Share it with us at education@asam.org. Host Elizabeth Salisbury-Afshar, MD, MPH, FAAFP, FACPM, DFASAM Dr. Elizabeth Salisbury-Afshar is a family medicine, public health and general preventive medicine, and addiction medicine physician. Her work focuses on expanding access to evidence-based addiction treatment and harm reduction services, and she has over 14 years of experience practicing in medically underserved settings. Dr. Salisbury-Afshar is a Professor at the University of Wisconsin-Madison where she works clinically on an inpatient addiction consult team and is the Medical Director of a low-barrier walk-in clinic for people who use substances. Dr. Salisbury-Afshar is the Vice Chair of ASAM’s Medical Education Council and the Vice Chair of the Conference Program Planning Committee. Expert Ruth Potee, MD, DFASAM, FAAFP Dr. Ruth Potee is a board-certified Family Physician and Addiction Medicine physician who works across Massachusetts. She attended Wellesley College, Yale University School of Medicine, and did her residency at Boston University, where she remained an assistant professor of Family Medicine for eight years. She is currently the Medical Director for Behavioral Health Network and the Franklin County House of Corrections. She oversees 10 methadone clinics, including the first county jail-based methadone clinic in the United States. She was named Franklin County Doctor of the Year by the Massachusetts Medical Society in 2015 and has won multiple teaching awards from medical students and residents. Expert Ari Kriegsman, MD, FASAM Dr. Ari Kreigsman is the Medical Director of the Carlson Recovery Center, an ASAM 3.7 Level Facility in Springfield, MA. He is also the Medical Director of the BHN Springfield OTP. He is board-certified in Internal Medicine and Addiction Medicine. He is a graduate of Weill Cornell Medical College, and completed his residency in Social Internal Medicine at Montefiore/Albert Einstein College of Medicine. 📖 Show Segments 00:05 - Introduction 02:30 - Philosophy of Methadone Treatment 06:42 - Training Gaps & Need for Individualized Clinical Decision-Making 08:29 - Caring for Patients with Unique Clinical Needs 10:13 - Rethinking Missed Dose Protocols 14:58 - Split Dosing Considerations 17:04 - Take-Home Medications 22:21 - Practice Pearls 25:36 - Conclusion and Additional Learning Opportunity 📋 Key Takeaways Patients choosing methadone choose life: Orient care around the patient's own goals, which is often staying alive and getting their life back. Clinical decisions should align with the patient’s goals and be tailored to each individual. Promote individualized dosing over rigid protocols: Clinicians should feel empowered to use clinical judgment for methadone dosing. There is no single protocol, and each patient's history, comorbidities, pain, and life circumstances should guide the dosing plan. Non-punitive missed dose approaches are safe and evidence-based: In most cases, patients who miss doses and continue using opioids can safely resume their previous (or nearly previous) methadone dose. Steep dose reductions can increase the patient's risk of overdose or wor
About ASAM Practice Pearls
Join ASAM Practice Pearls for in-depth discussions on addiction prevention, treatment, and recovery. Geared toward healthcare professionals and individuals seeking knowledge, this series explores the latest evidence-based approaches to addiction medicine. Listen to interviews with leading experts as they delve into critical topics and share practical tools you can use to improve patient care and promote public health.
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