Withdrawal.
|
|
- Brent Bennett
- 6 years ago
- Views:
Transcription
1 Withdrawal Shamim Nejad, MD Director, Adult Burns & Trauma Psychiatry Division of Psychiatry and Medicine Medical Director, Addiction Consultation Team MGH Center for Addiction Medicine Massachusetts General Hospital Assistant Professor of Psychiatry Harvard Medical School
2 Disclosures: Shamim Nejad, MD Neither I nor my spouse/partner has a relevant financial relationship with a commercial interest to disclose.
3 Withdrawal: Overview Epidemiology Uncomplicated alcohol withdrawal syndrome (AWS) Signs and symptom Management strategies Opioid withdrawal syndrome Signs and symptoms Management strategies
4 Epidemiology of AUD Alcohol use disorder (AUD) in the US: Adults (ages 18+): 16.6 million adults ages 18 and older had an AUD in This includes 10.8 million men and 5.8 million women. About 1.3 million adults received treatment for an AUD at a specialized facility in 2013 (7.8 percent of adults who needed treatment). This included 904,000 million men. Youth (ages 12 17): In 2013 an estimated 697,000 adolescents ages had an AUD. This number includes 385,000 women and 311,000 men. An estimated 73,000 adolescents (44,000 males and 29,000 females) received treatment for an alcohol problem in a specialized facility in
5 Epidemiology: AWS Prevalence of alcohol withdrawal is less than 5% in general population Prevalence of alcohol withdrawal is approximately 86% in detoxification centers and rehab facilities In one study, 94% of patients deemed suitable for outpatient management of AWS successfully completed detoxification in this setting. Caetano R, Clark CL, Greenfield TK. Prevalence, trends, and incidence of alcohol withdrawal symptoms: analysis of general population and clinical samples. Alcohol Health Res World 1998;22:73 9. Soyka M, Horak M. Outpatient alcohol detoxification: implementation efficacy and outcome effectiveness of a model project. Eur Addict Res 2004;10:180 7.
6 DSM-5 Criteria for Alcohol Withdrawal Cessation or reduction in alcohol use, especially after a period of heavy and prolonged drinking, result in alcohol withdrawal. The symptoms of alcohol withdrawal syndrome develop within several hours to a few days after an individual stops drinking. These can include: Insomnia (trouble sleeping) Autonomic symptoms (including, sweating or racing heart) Increased hand tremors (known as the shakes ) Nausea and/or vomiting Psychomotor agitation (feeling physically restless, inability to stop moving) Anxiety Seizures (typically the generalized tonic-clonic type, which is characterized by rhythmic, yet jerking movement, especially of the limbs) Hallucinations, or perceptual disturbances of the auditory, tactile, or visual type (the rarest of alcohol withdrawal symptoms) In order to meet the DSM-5 criteria for alcohol withdrawal syndrome, a person must experience a combination of two of more of these symptoms. Significant distress or impairment in social, occupational, or other important areas of functioning must also be present. These symptoms must be directly caused by stopping or reducing alcohol intake and not attributable to other medical conditions, a primary mental disorder, or the influence of another substance.
7 Clinical States of Alcohol Withdrawal 4 main clinical states: Autonomic hyperactivity Neuronal excitation Hallucinations (+/- paranoid state) Alcohol withdrawal delirium (delirium tremens)
8 Phenotypes of AWS Stages Clinical Findings Onset (Usual * ) Early or Uncomplicated 1) Anxiety, fine tremor (anxiety), tachycardia (anxiety); headache; palpitations; anorexia; GI upset; general malaise 2) May have elements of catacholamine excess (coarse tremor, elevated BP, elevated HR, diaphoresis, slight fever) 6-36 hrs Phenotype of AWS Uncomplicated Complicated Seizure Generalized, tonic-clonic seizures, status epilepticus (rare) 6-48 hrs Alcoholic Hallucinosis Visual, auditory, and/or tactile hallucinations hrs Delirium Tremens Delirium, tachycardia, hypertension, agitation, fever, diaphoresis, coarse tremor hrs
9 Management of Uncomplicated AWS Supportive Care Wernicke s Prophylaxis Risk: thiamine 200mg IV/IM daily Pharmacologic management Benzodiazepines Antiepileptic drugs (AEDs) Ethanol BZD Administration Strategies Prophylaxis Fixed dose Active Symptoms Symptom Triggered Fixed schedule + PRN Front loading
10 Rating Scales in AWS CIWA-Ar (Clinical Institute Withdrawal Assessment for Alcohol Revised) AWS (Alcohol Withdrawal Symptoms rating scale) SAWS (Short Alcohol Withdrawal Scale) SAS (Severity Assessment Scale)
11 CIWA-Ar CIWA-Ar (Clinical Institute Withdrawal Assessment for Alcohol Revised) Used to guide AWS management strategies Relatively easy to use Reliable and validated assessment tool for non-medically/surgically ill Scores correlate with severity of AWS - for non-medically/surgically ill NOT diagnostic ---- it is an ASSESSMENT TOOL Inter-rater reliability only fair to poor CIWA-Ar Nausea and Vomiting Tremor Paroxysmal Sweats Anxiety Agitation Tactile Disturbances Auditory Hallucinations Visual Disturbances Headache, fullness in head Orientation, clouding of sensorium
12 CIWA-Ar Considerations Current severity of alcohol withdrawal History of repeated episodes of complicated alcohol withdrawal Level of medical co-morbidity Mental status Patient Location Back up protocol should be available
13 CIWA-Ar Example
14 Fixed-Dose
15 Opiate Withdrawal
16 Opiate Withdrawal Symptoms Stage Clinical Symptoms Onset Early Mid-Late Late Protracted Craving; anxiety; irritability; dysphoria; diaphoresis Insomnia; restlessness; lacrimation; rhinorrhea; diaphoresis; mydriasis; yawning Vomiting, diarrhea, chills, muscle spasms, tremor, tachycardia, piloerection Sleep disturbance, drug craving anhedonia, emotional lability, altered sexual function 4 to 12 hours 8 to 24 hours Up to 3 days Up to 6 months
17 Opiate Withdrawal Scales Clinical Institute of Narcotic Assessment (CINA) 11-items Score: 1-6= Mild; 7-10 Moderate; 11 Severe Clinical Opioid Withdrawal Scale (COWS) 11 items Score: 5 12=Mild; 13 24=Moderate; 25 36=Moderately severe; >36=Severe withdrawal
18 Opiate Withdrawal Management Agonists Methadone (typically 30-40mg in first 24hrs) Buprenorphine (typically 8-16mg first 24hrs) α-2 adrenergic receptor agonist Clonidine ( mg every 2-4 hours) Symptom specific meds Muscle relaxants, NSAIDs, anti-diarrheals, antiemetics, anti-spasmodics (dicyclomine), anxiolytics
19 Opiate Withdrawal Management
20 Opiate Agonists Methadone Peak effect 2-4 hours; t1/ hours Give 10mg increments based on symptoms or give single dose of 20 40mg Not to exceed 40mg in first 24 hours Sample protocol: taper every 24hours 40mg 30mg 20mg 10mg 5mg discontinue Buprenorphine Peak effect 2-4 hours; t1/2 4-6 hours No opioid use for hours with mild-moderate withdrawal with objective signs prior to initiation First dose should not exceed 4mg Sample protocol: taper every 24 hours 8mg 6mg 4mg 2mg d/c Can give in divided doses (ex. 4mg SL bid)
21 Opiate Agonists Efficacy of symptoms resolution is equivalent Buprenorphine: Patients with QTc prolongation Younger patients and/or with less severe opiate use disorder Seems to be associated with faster resolution of symptoms with buprenorphine Seems to be associated with lower risk for adverse outcomes Methadone may be better option: Patients requiring opiate medications Patients who may need operative interventions in next 7 days Patients already on methadone maintenance
Complicated Withdrawal
Complicated Withdrawal Shamim Nejad, MD Director, Adult Burns & Trauma Psychiatry Division of Psychiatry and Medicine Medical Director, Addiction Consultation Team MGH Center for Addiction Medicine Massachusetts
More informationComplicated Withdrawal
Complicated Withdrawal Shamim Nejad, MD Medical Director, Psycho-Oncology Services Swedish Cancer Institute Swedish Medical Center Seattle, Washington Shamim.Nejad@Swedish.org Disclosures: Shamim Nejad,
More informationComplicated Withdrawal
Complicated Withdrawal Shamim Nejad, MD Medical Director, Division of Psychosocial Oncology Swedish Cancer Institute Swedish Medical Center Seattle, Washington Shamim.Nejad@Swedish.org Disclosures: Shamim
More informationAdmit date: 1-WM 2-WM 3.2-WM 3.7-WM 4-WM DSM-V diagnoses: Please list all diagnoses (psychiatric, chemical dependency and medical)
https://providers.amerigroup.com Substance Use Disorder Withdrawal Management Prior Authorization and Continued Care Request (Use for American Society of Addiction Medicine [ASAM] withdrawal management
More informationPlease review the following slides prior to class. Information from these slides will be used to answer patient cases. Come prepared!
Please review the following slides prior to class Information from these slides will be used to answer patient cases. Come prepared! Alcohol and Opiate Dependence Reference Slides Substances of Abuse A
More informationTreatment of Alcohol and Opiate Withdrawal
Objectives Treatment of Alcohol and Opiate Withdrawal Renee Striker, Pharm.D., BCPS, BCPP Pharmacy Clinical Specialist Huron Hospital East Cleveland, Ohio Outline the diagnostic criteria for substance
More informationAACN PCCN Review. Behavioral
AACN PCCN Review Behavioral Presenter: Carol A. Rauen, RN, MS, CCNS, CCRN, PCCN, CEN Independent Clinical Nurse Specialist & Education Consultant rauen.carol104@gmail.com 0 Behavioral I. INTRODUCTION PCCN
More informationMethodist Hospital Alcohol Withdrawal Suggested Guidelines
Methodist Hospital Alcohol Withdrawal Suggested Guidelines S. Prizada Sattar, MD Teri L Gabel, Pharm.D.,BCPP Sidney Kauzlarich, MD Subhash Bhatia, MD Mitzi Bollinger, RN S. Prizada Sattar, MD 6-20-3 Rationale
More informationProvider Update: Alcohol Withdrawal Order Set Edits
Provider Update: Alcohol Withdrawal Order Set Edits Situation: A revised Alcohol Withdrawal Order Set and new CIWA-Ar scoring tool will go LIVE February 12, 2018. Background: The latest guidelines for
More informationOpioid dependence: Detoxification
Opioid dependence: Detoxification What is detoxification? A. Process of removal of toxins from the body? B. Admitting a drug dependent person in a hospital and giving him nutrition? C. Stopping drug use
More informationDISCLAIMER: ECHO Nevada emphasizes patient privacy and asks participants to not share ANY Protected Health Information during ECHO clinics.
DISCLAIMER: Video will be taken at this clinic and potentially used in Project ECHO promotional materials. By attending this clinic, you consent to have your photo taken and allow Project ECHO to use this
More informationStabilization Algorithm
VA/DoD Clinical Practice Guideline for the Management of Substance Use Disorders Stabilization Algorithm Stabilization Pocket Card 1 Patient and Time Information Clinical Institute Withdrawal Assessment
More informationALCOHOL WITHDRAWAL GUIDELINES
ALCOHOL WITHDRAWAL GUIDELINES Policy author Accountable Executive Lead Approving body Policy reference Dr M Lewis, Gastroenterologist; Professor J A Vale, Clinical Toxicologist; Dr D A Robertson, Alcohol
More informationAlcohol withdrawal. Clinical features
Alcohol withdrawal Clinical features Severity increase with amount consumed; uncommon with < drinks per day. Predictable pattern: patients with previous withdrawal seizures are at high risk for recurrence.
More informationAPPENDIX 7 CLINICAL INSTITUTE NARCOTIC ASSESSMENT (CINA) SCALE FOR WITHDRAWAL SYMPTOMS
APPENDIX 7 CLINICAL INSTITUTE NARCOTIC ASSESSMENT (CINA) SCALE FOR WITHDRAWAL SYMPTOMS The Clinical Institute Narcotic Assessment (CINA) Scale measures 11 signs and symptoms commonly seen in patients during
More informationALCOHOL USE DISORDER WITHDRAWAL MANAGEMENT AND LONG TERM TREATMENT ANA HOLTEY, MD ADDICTION MEDICINE FELLOW UNIVERSITY OF UTAH HEALTH
ALCOHOL USE DISORDER WITHDRAWAL MANAGEMENT AND LONG TERM TREATMENT ANA HOLTEY, MD ADDICTION MEDICINE FELLOW UNIVERSITY OF UTAH HEALTH Prevalence of 12-Month Alcohol Use, High-Risk Drinking, and DSM-IV
More informationCurrent Clinical Patterns in the Management of Alcohol Withdrawal Syndrome (AWS)
1 Current Clinical Patterns in the Management of Alcohol Withdrawal Syndrome (AWS) The goal of the survey is to evaluate current practices for the inpatient management of AWS in adult hospitals located
More informationInterprofessional Trauma Conference September 28th 2018 Montreal
Interprofessional Trauma Conference September 28th 2018 Montreal Marc Perreault & Marc Alexandre Duceppe ICU Pharmacists MGH & RVH-CUSM Faculté de Pharmacie Université de Montréal I have no potential conflict
More informationClinical Policy: Lofexidine (Lucemyra) Reference Number: ERX.NPA.88 Effective Date:
Clinical Policy: (Lucemyra) Reference Number: ERX.NPA.88 Effective Date: 07.31.18 Last Review Date: 08.18 Revision Log See Important Reminder at the end of this policy for important regulatory and legal
More informationPART VI: TAPERING OPIOIDS ROBERT JENKINSON MD MARCH 7, 2018
PART VI: TAPERING OPIOIDS ROBERT JENKINSON MD MARCH 7, 2018 TAPERING OPIOIDS GETTING STARTED ON OPIOIDS IS EASY BUT GETTING PATIENTS OFF IS HARD WE ARE ARE OBLIGED TO TAPER PATIENTS DOWN AND OFF OPIOIDS
More informationMedical Necessity Criteria 2017
Medical Necessity Criteria 2017 The New Directions Medical Necessity Criteria have been revised. The new version will be effective January 1, 2017. See https://www.ndbh.com/providers/behavioralhealthplanproviders.aspx.
More informationDetoxification of Chemically Dependent Inmates Federal Bureau of Prisons Clinical Practice Guidelines August 2009
Detoxification of Chemically Dependent Inmates Federal Bureau of Prisons Clinical Practice Guidelines August 2009 Clinical guidelines are made available to the public for informational purposes only. The
More informationOpioids Research to Practice
Opioids Research to Practice May 2013 Daniel P. Alford, MD, MPH, FACP, FASAM Associate Professor of Medicine Assistant Dean, Continuing Medical Education Case 32 yo female brought in after heroin overdose
More informationAmbulatory Intoxication and Withdrawal Management: A Clinical Monograph
Ambulatory Intoxication and Withdrawal Management: A Clinical Monograph Revised December 2016 1 Table of Contents I. Ambulatory Intoxication and Withdrawal Management... 3 II. Evaluation and Assessment
More informationOpioid Agonists. Natural derivatives of opium poppy - Opium - Morphine - Codeine
Natural derivatives of opium poppy - Opium - Morphine - Codeine Opioid Agonists Semi synthetics: Derived from chemicals in opium -Diacetylmorphine Heroin - Hydromorphone Synthetics - Oxycodone Propoxyphene
More informationOpioids Research to Practice
Opioids Research to Practice CRIT Program May 2009 Daniel P. Alford, MD, MPH Associate Professor of Medicine Boston University School of Medicine Boston Medical Center 32 yo female brought in after heroin
More informationOpioid Use in Youth. Amy Yule M.D. March 2,
Opioid Use in Youth Amy Yule M.D. March 2, 2018 An opioid is a substance that acts on opioid receptors Beta-endorphin Endogenous opioids Dynorphin Opiates Natural products of the poppy plant Morphine Heroin
More informationGuidelines for the In-Patient Management of Alcohol Withdrawal at Frimley Park Hospital NHS Foundation Trust
Guidelines for the In-Patient Management of Alcohol Withdrawal at Frimley Park Hospital NHS Foundation Trust Authors: Dr Aftab Ala, Consultant Gastroenterologist & Hepatologist Dr Tasneem Pirani, ST4 in
More informationSubstance Use Disorders. A Major Problem. Defining Addiction 2/24/2009. Lifetime rates of alcoholism estimated at 13.4 %
Substance Use Disorders A Major Problem Lifetime rates of alcoholism estimated at 13.4 % Rates of drug abuse estimated at 6% Marijuana is most frequent Approximately 600,000 deaths each year from substance
More informationPSYCHIATRIC CO-MORBIDITY STEVE SUGDEN MD MPH
PSYCHIATRIC CO-MORBIDITY STEVE SUGDEN MD MPH OVERVIEW: PSYCHIATRIC DISORDERS Mood Disorders Anxiety Disorders Psychotic Disorders Personality Disorders PTSD Eating Disorders EXAMPLE What is the diagnosis?
More informationLorraine Wilson, 74 years of age, is admitted. Alcohol Withdrawal. During Hospitalization. Early recognition and consistent intervention are critical.
1.9 h o u r s Continuing Education Withdrawal During Hospitalization Early recognition and consistent intervention are critical. Overview: For a chronic drinker, sudden alcohol withdrawal because of an
More informationManagement of Alcohol Dependence
STANDARD TREATMENT GUIDELINES Management of Alcohol Dependence Quick Reference Guide February 2016 Ministry of Health & Family Welfare Government of India 1 Table of Contents Objectives-... 3 Diagnosis...
More informationBehavioral Health Service Request Form Detox and Substance Abuse Rehab
Medicaid Call for Pre-Certification of Admissions: 1-855-620-1861 Kentucky Medicaid Fax: 1-877-338-3686 Standard Request Requests for prior authorization (with supporting clinical information and documentation)
More informationOpioids Research to Practice
Opioids Research to Practice CRIT Program May 2008 Daniel P. Alford, MD, MPH Associate Professor of Medicine Boston University School of Medicine Boston Medical Center 32 yo female brought in after heroin
More informationDrug & Alcohol Detox:
Drug & Alcohol Detox: Beginning Stages of Addiction Treatment If you ve tried to detox on your own and failed, you are not alone. The good news is that research shows those who commit to a rehabilitation
More informationMedications in the Treatment of Opioid Use Disorder: Methadone and Buprenorphine What Really Are They?
Medications in the Treatment of Opioid Use Disorder: Methadone and Buprenorphine What Really Are They? Yngvild Olsen, MD, MPH Cecil County Board of Health Workgroup Meeting Elkton, MD October 8, 2013 Objectives
More informationOpioid Initiative Wave I Treating Opioid-Use Disorder in the ED Part 1
Opioid Initiative Wave I Treating Opioid-Use Disorder in the ED Part 1 Presenter Eric Ketcham, MD, MBA Reuben J. Strayer, MD emergency department management of the patient with opioid withdrawal OD is
More informationTreatment Alternatives for Substance Use Disorders
Treatment Alternatives for Substance Use Disorders Dean Drosnes, MD, FASAM Associate Medical Director Director, Chronic Pain and SUD Program Caron Treatment Centers 1 Disclosure The speaker has no conflict
More informationModule II Opioids 101 Opiate Opioid
BUPRENORPHINE TREATMENT: A TRAINING FOR MULTIDISCIPLINARY ADDICTION PROFESSIONALS Module II Opioids 101 Module II Goals of the Module This module reviews the following:! Opioid addiction and the brain!
More informationDr. (Trish) Patricia Uniac WALTON ON 209
Society of Rural Physicians of Canada 26TH ANNUAL RURAL AND REMOTE MEDICINE COURSE ST. JOHN'S NEWFOUNDLAND AND LABRADOR APRIL 12-14, 2018 Dr. (Trish) Patricia Uniac WALTON ON 209 ADDICTION IN THE OFFICE
More informationDRUGS USED IN THE TREATMENT OF ADDICTION JOSEPH A. TRONCALE, MD FASAM RETREAT PREMIERE ADDICTION TREATMENT CENTERS
DRUGS USED IN THE TREATMENT OF ADDICTION JOSEPH A. TRONCALE, MD FASAM RETREAT PREMIERE ADDICTION TREATMENT CENTERS MAJOR CATEGORIES OF TREATMENTS Detoxification and Post-Acute Withdrawal Maintenance Co-Occurring
More informationBehavioral Health Service Request Form Detox and Substance Abuse Rehab
Arkansas 855-538-0454 Connecticut 855-538-0454 Florida 855-538-0454 Georgia 800-424-5412 Illinois 800-504-2766 Kentucky 855-620-1861 Louisiana 855-538-0454 Arkansas 855-710-0159 Connecticut 888-365-3233
More informationPHARMACOTHERAPY OF SMOKING CESSATION
PHARMACOTHERAPY OF SMOKING CESSATION Domenic A. Ciraulo, MD Director of Alcohol Pharmacotherapy Research Center for Addiction Medicine Department of Psychiatry Massachusetts General Hospital Disclosure
More informationOpioids Research to Practice
Opioids Research to Practice CRIT Program May 2010 Daniel P. Alford, MD, MPH Associate Professor of Medicine Boston University School of Medicine Boston Medical Center 32 yo female brought in after heroin
More informationAlcohol Detoxification (Inpatient) Prescribing Guidelines
Alcohol Detoxification (Inpatient) Prescribing Guidelines Author: Sponsor/Executive: Responsible committee: Consultation & Approval: (Committee/Groups which signed off the procedure, including date) This
More informationMultiple Choice Questions
Multiple Choice Questions 25yo M presents without psychiatric or medical history, with complaint of tremor to the ER. He denies drinking alcohol but his friend at bedside takes you to the side and reports
More informationOpioids Research to Practice
Opioids Research to Practice CRIT/FIT 2016 April 2016 Daniel P. Alford, MD, MPH Associate Professor of Medicine Assistant Dean, Continuing Medical Education Director, Clinical Addiction Research and Education
More informationHow soon does tramadol withdrawal start
Cari untuk: Cari Cari How soon does tramadol withdrawal start How to Stop Restless Legs From Opiate Withdrawal using natural remedies at home. Opiate Withdrawal Restless Legs can be eased using these powerful
More informationPrescription Opioid Addiction
CSAM-SCAM Fundamentals Prescription Opioid Addiction Presentation provided by Meldon Kahan, MD Family & Community Medicine University of Toronto Conflict of interest statement I received funds from Rickett
More informationPrevalence and Correlates of Withdrawal-Related Insomnia among Adults with Alcohol Dependence: Results from a National Survey
The American Journal on Addictions, 19: 238 244, 2010 Copyright C American Academy of Addiction Psychiatry ISSN: 1055-0496 print / 1521-0391 online DOI: 10.1111/j.1521-0391.2010.00035.x Prevalence and
More informationAlcoholism. Social environment, stress, mental health, family history, age, ethnic group, and gender all influence the risk for the condition.
SAY NO TO ALCOHOL Alcoholism Alcoholism is a chronic and often progressive disease that includes problems controlling your drinking, being preoccupied with alcohol, continuing to use alcohol even when
More informationSubstitution Therapy for Opioid Use Disorder The Role of Suboxone
Substitution Therapy for Opioid Use Disorder The Role of Suboxone Methadone/Buprenorphine 101 Workshop, December 10, 2016 Leslie Lappalainen, MD, CCFP, dip ABAM Prepared by Mandy Manak, MD, ABAM, CCSAM
More informationTapering Opioids Best Practices*
Tapering Opioids Best Practices* Chuck Hofmann, MD, MACP 5 th Annual EOCCO Office Staff and Provider Summit September 28, 2017 Disclosure No Conflicts of Interest to report Learning Objectives Understand
More informationBehavioral Health Service Request Form Detox and Substance Abuse Rehab
Please Submit to the Dedicated Fax Line Below Medicaid Call for Pre-Certification of Admissions: 888-453-2534 New Jersey Medicaid Fax: 855-703-8082 Lev el of Care: Place of Serv ice: Detox Substance Abuse
More informationDRAFT FOR CONSULTATION
1) What is the accuracy of a tool and/or clinical judgement for the a) assessment b) monitoring of patients at risk of acute alcohol withdrawal? 2) Does the assessment and monitoring of patients with acute
More informationConsequences and Treatment of Opioid Abuse During Pregnancy. Katie Ellis, PharmD March 12, 2018
Consequences and Treatment of Opioid Abuse During Pregnancy Katie Ellis, PharmD March 12, 2018 Disclosure I have nothing to disclose. Objectives At the completion of this activity, the pharmacist will
More informationControlled Substance and Wellness Agreement
Controlled Substance and Wellness Agreement You and your provider have agreed on the use of controlled substance medications to treat your: We want to make sure you know how to manage your new prescription(s)
More informationSee Important Reminder at the end of this policy for important regulatory and legal information.
Clinical Policy: (Lucemyra) Reference Number: CP.PMN.152 Effective Date: 07.31.18 Last Review Date: 08.18 Line of Business: Commercial, HIM, Medicaid Revision Log See Important Reminder at the end of this
More informationEducation Pack for the Alcohol Liaison Nurse Service
Education Pack for the Alcohol Liaison Nurse Service Welcome to the Alcohol Liaison Nurse Service, this pack is designed to help you get the most out of your time here with us today and set some objectives
More informationAlcohol withdrawal including the Symptom triggered CIWA score Management
Alcohol withdrawal including the Symptom triggered CIWA score Management Classification: Policy Lead Author: Ruth Brown Alcohol specialist Nurse Additional author(s): Hailey Pennington Authors Division:
More informationBehavioral Health Service Request Form Detox and Substance Abuse Rehab
Please Submit to the Dedicated Fax Line Below Medicaid Call for Pre-Certification of Admissions: 888-588-9842 South Carolina Medicaid Fax: 888-339-8293 Lev el of Care: Place of Serv ice: Detox Substance
More informationDISCLOSURES MANAGEMENT OF OPIOID USE DISORDERS LECTURE COVERS. SUDs ARE IMPORTANT. I have nothing to declare
MANAGEMENT OF OPIOID USE DISORDERS DISCLOSURES Marc A Schuckit Distinguished Professor of Psychiatry, UCSD Medical School I have nothing to declare SUDs ARE IMPORTANT Affect > 20% of your patients Are
More informationRisk assessment of moderate to severe alcohol withdrawal Predictors for seizures and delirium tremens
Risk assessment of moderate to severe alcohol withdrawal Predictors for seizures and delirium tremens Results of a retrospective Cohort Study Florian Eyer, MD Toxicological Department Klinikum rechts der
More informationOverview of Psychoactive Drug use
Overview of Psychoactive Drug use By Dr. Oladosu Ahmed Kayode Specialist in mental health Attending physician Dept. of psychiatry, GH Ilorin & Hopeville Psychiatric Hospital, Ilorin. Learning objectives
More informationCMBHS Clinical Management of Behavioral Health Services
Client: CMBHS Clinical Management of Behavioral Health Services Detoxification Assessment Assessment Information (te: All are Required fields) Assessment Number Assessment Date Assessment Type Contact
More informationSession 2: Alcohol and Recovery 2-1
Session 2: Alcohol and Recovery 2-1 Alcohol in the Brain Alcohol upsets a delicate balance between chemical systems that stimulate and chemical systems that inhibit functions of the brain and body. Matrix
More informationCIWA-AR CLINICAL INSTITUTE WITHDRAWAL ASSESSMENT FOR ALCOHOL SCALE
CIWA-AR CLINICAL INSTITUTE WITHDRAWAL ASSESSMENT FOR ALCOHOL SCALE SAM G CAMPBELL MB BCH, FCFP(EM), DIP PEC(SA), FCCHL, FRCP(EDIN) PROFESSOR OF EMERGENCY MEDICINE DALHOUSIE UNIVERSITY, HALIFAX, NOVA SCOTIA.
More information3/27/2013. Objectives. Psychopharmacology at the End of Life Nicole Thurston, MD
Psychopharmacology at the End of Life Nicole Thurston, MD Psychiatrist Mountain States Tumor Institute Objectives Describe 2 common psychiatric symptoms that can present at or near end of life. Review
More informationUnderstanding Mental Illness A Review of the Disorders
Understanding Mental Illness A Review of the Disorders Objectives Define and describe mental illness To be able to recognize signs, symptoms, and behaviors of the major categories of mental illness Recognition
More informationSCID-I Version 2.0 (for DSM-IV) Non-Alcohol Use Disorders
SCID-I Version 2.0 (for DSM-IV) Non-Alcohol Use Disorders *NON-ALCOHOL SUBSTANCE USE DISORDERS* (LIFETIME DEPENDENCE AND ABUSE) Now I am going to ask you about your use of drugs or medicines. SHOW DRUG
More informationOpioid dependence and buprenorphine treatment
Opioid dependence and buprenorphine treatment David Roll, MD Revere Family Health, Cambridge Health Alliance Instructor in Medicine, Harvard Medical School Joji Suzuki MD Medical Director of Addictions
More informationAlternatives to Buprenorphine
Alternatives to Buprenorphine Charles Morgan, MD, FASAM, FAAFP Medical Director Bridgeton, NJ Westfield, PA New York, NY Cherry Hill, NJ Northfield, NJ 1 2 Heroin Purity increasing Pharmaceuticals Expense
More informationMENTAL HEALTH AND MENTAL ILLNESS: OUR JOURNEY ACROSS THE CONTINUUM LLI PROGRAM OCTOBER 5, 2018 VIRGINIA F. RIGGS MS, MSN, RN
MENTAL HEALTH AND MENTAL ILLNESS: OUR JOURNEY ACROSS THE CONTINUUM LLI PROGRAM OCTOBER 5, 2018 VIRGINIA F. RIGGS MS, MSN, RN OBJECTIVES: Focus on a continuum from mental health to mental illness Examine
More informationKurt Haspert, MS, CRNP University of Maryland Baltimore Washington Medical Center
Kurt Haspert, MS, CRNP University of Maryland Baltimore Washington Medical Center Data from the National Vital Statistics System Mortality The age-adjusted rate of drug overdose deaths in the United States
More informationAlcohol Withdrawal: Assessment and Symptom-Triggered Treatment
Alcohol Withdrawal: Assessment and Symptom-Triggered Treatment 2016 Alcohol, or ethanol, is produced by the fermentation of yeast, sugars and starches. Yeast breaks sugar down into ethanol and carbon dioxide.
More informationSubstance Use Disorders: What Can We Do to Help Break the Cycle of Addiction
Handout for the Neuroscience Education Institute (NEI) online activity: Substance Use Disorders: What Can We Do to Help Break the Cycle of Addiction Learning Objectives Identify patients who are dependent
More informationMedical Assisted Treatment. Dr. Michael Baldinger Medical Director Haymarket Center Harborview Recovery Center
Medical Assisted Treatment Dr. Michael Baldinger Medical Director Haymarket Center Harborview Recovery Center Current Trends Prescription Drug Abuse/Addiction Non-medical use of prescription pain killers
More informationChapter 7. Screening and Assessment
Chapter 7 Screening and Assessment Screening And Assessment Starting the dialogue and begin relationship Each are sizing each other up Information gathering Listening to their story Asking the questions
More informationSupplemental Digital Content
1 Clinical Drug Investigation Evaluation of Buprenorphine Dosage Adequacy in Opioid Receptor Agonist Substitution Therapy for Heroin Dependence First Use of the Buprenorphine-Naloxone Dosage Adequacy Evaluation
More informationLONG TERM PHARMACOTHERAPY OF OPIOID DEPENDENCE
LONG TERM PHARMACOTHERAPY OF OPIOID DEPENDENCE DR. SHILPA ADARKAR ASSOCIATE PROFESSOR DEPARTMENT OF PSYCHIATRY & DRUG DEADDICTION CENTRE OF EXCELLENCE SETH GSMC & KEMH LONG TERM OPTIONS FULL AGONIST PARTIAL
More informationPharmacological Therapy Policy Practice Guidance Note Management of Acute Alcohol Withdrawal in Adults (Over 18) - V01. Planned review: December 2017
Pharmacological Therapy Policy Practice Guidance Note Management of Acute Alcohol Withdrawal in Adults (Over 18) - V01 V01 issued: Issue 1- Dec 14 Issue 2 April 17 Planned review: December 2017 PPT-PGN
More informationROSC & MAT II: Opioid Treatment Services
ROSC & MAT II: Opioid Treatment Services September 23, 2015 Stan DeKemper Executive Director Indiana Credentialing Association on Addiction and Drug Abuse 1 GOALS Review medication assisted recovery Identify
More informationMood Disorders.
Mood Disorders Shamim Nejad, MD Medical Director, Psycho-Oncology Services Swedish Cancer Institute Swedish Medical Center Seattle, Washington Shamim.Nejad@swedish.org Disclosures Neither I nor my spouse/partner
More informationGeneral Effects. Special Patient Populations. Alcoholism. Who is an Alcoholic
Alcohol Use & Abuse in Acutely and Critically Ill Patients: Don t Be Fooled General Effects Christine Schulman, RN, MS, CNS, CCRN Clinical Nurse Specialist & Consultant Trauma & Critical Care Nursing Portland,
More informationAssessment Main title and management of alcohol dependence and withdrawal in the acute hospital: concise guidance
CONCISE GUIDANCE Clinical Medicine 01, Vol 1, No : 71 Assessment Main title and management of alcohol dependence and withdrawal in the acute hospital: concise guidance Author head name Stephen Stewart
More informationOpioids. Sergio Hernandez, MD
Opioids Sergio Hernandez, MD Required Slide Disclosures 1. SIGNIFICANT FINANCIAL INTERESTS NO SIGNIFICANT FINANCIAL, GENERAL, OR OBLIGATION INTERESTS TO REPORT 2. GENERAL AND OBLIGATION INTERESTS All general
More informationDRUGS THAT ACT IN THE CNS
DRUGS THAT ACT IN THE CNS Anxiolytic and Hypnotic Drugs Dr Karamallah S. Mahmood PhD Clinical Pharmacology 1 OTHER ANXIOLYTIC AGENTS/ A. Antidepressants Many antidepressants are effective in the treatment
More informationPrepared by: Dr. Elizabeth Woodward, University of Toronto Resident in Psychiatry
Prepared by: Dr. Elizabeth Woodward, University of Toronto Resident in Psychiatry In broad terms, substance use disorders occur when a substance is used in a compulsive manner with a lack of control over
More informationDr. Renner receives honoraria from Reed Medical Education
Substance Use Disorders Symposium on Men s Health Massachusetts Medical Society June 17, 2010 John A. Renner, Jr., M.D. John A. Renner Jr., MD DISCLOSURES Johnson & Johnson Stock Holder Dr. Renner receives
More informationPATHOPHYSIOLOGY AND TREATMENT OF ALCOHOL WITHDRAWAL SYNDROME: A REVIEW
PATHOPHYSIOLOGY AND TREATMENT OF ALCOHOL WITHDRAWAL SYNDROME: A REVIEW Dana Bartlett, BSN, MSN, MA, CSPI Dana Bartlett is a professional nurse and author. His clinical experience includes 16 years of ICU
More informationWithdrawal Why is stopping substance use so difficult?
Withdrawal Why is stopping substance use so difficult? Withdrawal occurs in drug dependant individuals who stop or considerably reduce their drug use. Definitions Dependence syndrome is characterized by
More informationShhh! Let s Talk About Moderation for Mild Alcohol Use Disorders. Cyndi Turner, LCSW, LSATP, MAC Craig James, LCSW, MAC
Shhh! Let s Talk About Moderation for Mild Alcohol Use Disorders Cyndi Turner, LCSW, LSATP, MAC Craig James, LCSW, MAC Shhh! Let s Talk About Moderation for Mild to Moderate Alcohol Use Disorders Insight
More informationThe National Methamphetamine Symposium
The National Methamphetamine Symposium Making Research Work in Practice 12 May 2015 Arts Centre, Melbourne Physical and psychological effects of methamphetamine use Amanda Baker PhD National Centre for
More informationMary Ann Ferguson,Pharmacist St Josephs Health Care Concurrent Disorders Inpatient Unit
Mary Ann Ferguson,Pharmacist St Josephs Health Care Concurrent Disorders Inpatient Unit Fergusom@stjoes.ca Medication should be considered as part of the treatment plan for addictions/substance use disorders:
More informationten questions you might have about tapering (and room for your own) an informational booklet for opioid pain treatment
ten questions you might have about tapering (and room for your own) an informational booklet for opioid pain treatment This booklet was created to help you learn about tapering. You probably have lots
More informationLead for Gastroenterology Lee Dodge Alcohol Liaison 03/03/2015. Clive Gibson Safeguarding Adults Lead Nurse 03/03/2015
Acute Alcohol Withdrawal Management for Adult Inpatients Type: Clinical Guideline Register No: 1409 Status: Public on ratification Developed in response to: Best Practice Contributes to CQC Outcome number:
More informationROLE OF HEALTH CARE PROVIDERS IN THE MANAGEMENT OF ALCOHOL AND DRUG USE RELATED PROBLEMS
ROLE OF HEALTH CARE PROVIDERS IN THE MANAGEMENT OF ALCOHOL AND DRUG USE RELATED PROBLEMS Dr. Anita Rao? ASK SCREEN Refer HELP T T Ranganathan Clinical Research Foundation TTK Hospital IV Main Road, Indira
More informationBasics of Benzodiazepine Use Disorder. DATE: June 12, 2018 PRESENTED BY: Melissa B. Weimer, DO, MCR
Basics of Benzodiazepine Use Disorder DATE: June 12, 2018 PRESENTED BY: Melissa B. Weimer, DO, MCR Disclosures Speaker: Melissa Weimer, DO, MCR, has nothing to disclose. Planning Committee: The members
More informationANTICONVULSANTS IN ALCOHOL WITHDRAWAL TREATMENT: A BETTER WAY?
Psychiatry and Addictions Case Conference Medicine Psychiatry and Behavioral Sciences ANTICONVULSANTS IN ALCOHOL WITHDRAWAL TREATMENT: A BETTER WAY? RICHARD RIES MD PROFESSOR OF PSYCHIATRY AND DIRECTOR
More informationA NEW RATING SCALE FOR THE ASSESSMENT OF THE ALCOHOL-WITHDRAWAL SYNDROME (AWS SCALE)
Alcohol & Alcoholism Vol. 32, No. 6, pp. 753-760, 1997 A NEW RATING SCALE FOR THE ASSESSMENT OF THE ALCOHOL-WITHDRAWAL SYNDROME (AWS SCALE) TILMAN WETTERLING*, ROLF-DETER KANTTZ, BETTINA BESTERS, DOROTHEA
More information