Addiction Toxicology Case Conference - December 2020

Case 1: Sleight of Hand During Buprenorphine Administration - Combing Drug Testing, Observed Dosing and Telehealth to Support a Challenging Patient
A 26-year-old F with opioid use disorder ‘reconnects’ with an outpatient treatment program “to get back on Suboxone and then get the shot.” She has a history of fentanyl use disorder with use, despite Rx of buprenorphine/naloxone. Also, UDS showed her to stop taking, or only intermittently take, the buprenorphine around her fentanyl use. At the start of COVID-19, the plan was to have sufficient obs doses and on-site dosing to safely give the SC buprenorphine, but she didn’t follow-up. “Now I’m ready.” This case features discussion of buprenorphine induction and stabilization in order to safely give the SC buprenorphine monthly injection. Drug testing during COVID-19 as well as supporting challenging patients with limited ‘on-site’ resources will be discussed. On the on-site obs dose, the patient was caught taking a piece of buprenorphine/naloxone film pre-wrapped with cellophane, which she reported “was an accident. I had it open and didn’t want to lose it, so I wrapped it up.”

Case 2: Different Results by Matrix - The Oral Fluid Doesn’t Match the Urine!
A 27-year-old F and mother of 3-year-old with Autism has been taking buprenorphine/naloxone but struggles with heavy crack cocaine use. Her partner is also struggling with cocaine and there have been several domestic disturbance calls as well as CPS calls to their residence. Counseling appointments have been challenging to make and, apparently, quite a few of the “early intervention” appointments for her son have been missed. CPS is asking for drug testing results. COVID-19 cases are increasing dramatically in the area.

Series Moderators

• Timothy J. Wiegand, MD, FACMT, DFASAM (ACMT/ASAM Expert), Director of Toxicology and of the Toxicology Consult Service, University of Rochester Medical Center, Rochester, NY  
• Gloria J. Baciewicz, MD (ASAM Expert), Medical Director, Strong Recovery; Professor of Clinical Psychiatry, Department of Psychiatry, University of Rochester Medical Center, Rochester, NY

Panelists

• Lewis S. Nelson, MD, FACMT, FASAM (ACMT/ASAM Expert) Professor and Chair of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ
• Cara Poland, MD, M.Ed, FACP, DFASAM (ASAM Expert) Assistant Professor, College of Human Medicine, Michigan State University, Grand Rapids, MI
• Ross Sullivan, MD (ACMT/ASAM Expert) Director of Medical Toxicology, Upstate University Hospital; Director, Upstate Emergency Medicine Opioid Bridge Clinic; Medical Director, Helio Health, Syracuse, NY

About The Series: The ACMT/ASAM Addiction Toxicology Case Conference webinar series discusses Addiction/Toxicology cases in an interactive fashion featuring experts from Addiction Medicine, Addiction Psychiatry, and Medical Toxicology.

This webinar is open to the public.