DeepSummary
The episode features a conversation with Dr. Neil Christopher, a physician psychiatrist and addiction specialist, who discusses the recent deregulation of buprenorphine and provides insights into effectively prescribing and managing this medication for opioid use disorder. He explains the drug's mechanism of action as a partial opioid agonist, its safety profile, and the importance of proper dosing and timing to avoid precipitated withdrawal.
Dr. Christopher shares practical strategies for initiating buprenorphine treatment, managing dosages, and supporting patients throughout their recovery journey. He emphasizes the role of psychotherapy, motivational interviewing, and harm reduction approaches in conjunction with medication-assisted treatment. Additionally, he addresses common concerns, such as family pressure to discontinue medication and the risk of relapse after stopping maintenance treatment.
Overall, the episode aims to educate healthcare providers on the effective use of buprenorphine and to highlight the importance of a comprehensive, patient-centered approach to opioid use disorder management, emphasizing the integration of medication, psychosocial interventions, and harm reduction strategies.
Key Episodes Takeaways
- Buprenorphine is a partial opioid agonist that can be effectively used in the treatment of opioid use disorder, offering a safer alternative to full agonists like methadone.
- Proper dosing and timing of buprenorphine initiation are crucial to avoid precipitated withdrawal and ensure patient comfort and adherence to treatment.
- Integrating psychotherapy, motivational interviewing, and harm reduction strategies alongside medication-assisted treatment is essential for a comprehensive, patient-centered approach to opioid use disorder management.
- Relapse is a common part of the recovery journey, and healthcare providers should maintain a non-judgmental, supportive stance while continuing to work with patients through setbacks.
- Long-term maintenance treatment with buprenorphine is often recommended to prevent relapse, but a collaborative approach involving the patient's goals and readiness should guide decisions about discontinuing medication.
- Ongoing education and practical guidance for healthcare providers are crucial to increase access to and effective use of buprenorphine in addressing the opioid epidemic.
- The recent deregulation of buprenorphine prescribing aims to increase access to this life-saving medication and expand treatment options for opioid use disorder.
- Harm reduction strategies, such as safe use education and overdose prevention measures, can be lifesaving for patients not yet ready for treatment, particularly in the context of the highly potent and dangerous fentanyl.
Top Episodes Quotes
- “And so, yes, we know from published studies, and we know you'll know if you do this and treat a number of these patients directly, you will see what works and what doesn't very, very quickly.“ by Neil Christopher
- “I treat a lot of these patients, not as much as some that work full time, only in a specialty treatment center, but based on the inpatient and outpatient settings, I treat a lot, and I'm probably only terminating from my treatment. Probably only about three per year is what I average right now out of all the patients I see.“ by Neil Christopher
- “And so, as much as they may want to not use, their brain is firing in such a way that perhaps we can't understand if we've never had an addiction ourselves. They can't say no yet, but just as much as that, much as that is true, it is that once they're in treatment long enough, that brain will heal itself.“ by Neil Christopher
- “Harm reduction may be the techniques that they need to stay alive long enough to get to treatment.“ by Neil Christopher
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Episode Information
Psychiatry & Psychotherapy Podcast
David Puder, M.D.
9/27/23
We are joined again by Dr. Neal Christopher, who is currently the Vice Chair and Associate Medical Director of Arrowhead Regional Medical Center and the Psychiatry and Addiction Consultant for the San Bernardino County Department of Public Health. Dr. Christopher has previously appeared on the Psychiatry and Psychotherapy Podcast in episode 063, “Interviewing Well For Psychiatry Residency & Beyond,” and episode 103, “Acceptance and Commitment Therapy with Dr. Steven Hayes.”
In this week’s episode, Dr. Puder and Dr. Christopher discuss the recent elimination of the X-Waiver and what it means for providers, the mechanism and efficacy of buprenorphine, and practical tips for prescribing buprenorphine and supporting patients on their road to recovery from opioid use disorder.
This episode continues our podcast series on addiction, designed to meet the one-time, 8-hour training requirement introduced by the Consolidated Appropriations Act of 2023. This mandate applies to all providers registered with the Drug Enforcement Administration (DEA), and our series primarily focuses on the treatment and management of patients with substance use disorders.