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Dr. Wetterau discusses his early experience managing alcohol use disorder, the value of listening with kindness

“People came to me for their alcohol problems because I listened and cared.” Dr Norm Wetterau (NYSAM 2023). One can have all the credentials in the world but there are things much more valuable in addiction treatment. ⁦New York Society of Addiction Medicine⁩ ⁦American College of Medical Toxicology⁩ ⁦ASAM⁩

Dan Ciccarone MD MPH “Goofballs & Speedballs…” fentanyl trends at NYSAM 2023 most recent fatal OD data -Plateauing…? Little lingo around fentanyl “fetty” but not like heroin -lingo around “liked” things fentanyl less liked vs heroin? New York Society of Addiction Medicine⁩ + meth coming your way!

“Pills have lower barrier to use.” Counterfeit opioid pills containing fentanyl widely available -2.5 million pills seized in Q4 2021! Fentanyl via pill form impacts different demographics younger less experienced high risk OD many not aware fentanyl ⁦New York Society of Addiction Medicine⁩

Shannon Smith-Bernadin PhD, RN, CNL, on Managed Alcohol Programs in San Francisco c COVID19 (similar to MAPs in Canada) safe place to help people struggling with AUD - amount alcohol used decreased, LFTs didn’t rise, reduction in hospital & law encounters ⁦New York Society of Addiction Medicine⁩

#acmt2023 Ward Donovan lecture Gut/Brain axis & Psychoneuroendocrinology - translation to addiction med. Dr Lorenzo Leggio (NIDA)- ghrelin increases EtOH CPP & ghrelin receptor antagonism reduces CPP. High blood [ghrelin] Assoc EtOH craving. ⁦American College of Medical Toxicology⁩ ⁦ASAM⁩

Dr Matt Salzman -xylazine & impact on addiction medicine consults at Cooper hospital. Protocol for complicated fentanyl & xylazine dependence—> Bup Microinduction, high dose Clonidine, phenobarbital, dexmedetomidine (JAM paper) #acmt2023 ⁦⁦American College of Medical Toxicology⁩ ⁦ASAM⁩

Dr Craig Smollin presents #acmt2023 on use of the California Poison Control System CASUL (California Substance Use Line) to support front-line providers to treat buprenorphine. ⁦CA Poison Control⁩ ⁦UC San Francisco⁩ ⁦American College of Medical Toxicology⁩

B. Zane Horowitz #2023ACMT Career Achievement Award (congratulations!) B. Is for ? Brooklyn? Bromism/Bromide? Black Tar Heroin? Botulism! (?) congratulations!!! ⁦American College of Medical Toxicology⁩ ⁦Oregon Poison Center⁩

B. Zane Horowitz #ACMT2023 on diagnostic Pentad for botulism in Alaska. Consider if individual has consumed Alaskan native food and has 3 of following: nausea or vomiting, dysphagia, diplopia, dilated fixed pupils, or dry throat. ⁦American College of Medical Toxicology⁩ ⁦Oregon Poison Center⁩

Updating my ‘pruno’ recipe* at #ACME2023 (*note to self this is from botulism outbreak -emphasis on wash the 2 week old potato with soap TWICE!!!) ⁦American College of Medical Toxicology⁩ ⁦Oregon Poison Center⁩ ⁦Ziad Kazzi, MD, FACMT, FAACT, FAAEM, FACEP⁩ ⁦Evan Schwarz⁩

“You sign it you own it!” Words of wisdom on understanding what you sign for (bill) as physician from Kelly Clark MD, MBA, DFASAM, DFAPA #ASAM2023 John P. McGovern awardee. Congratulations Dr Clark! Well deserved. ⁦ASAM⁩ ⁦New York Society of Addiction Medicine⁩ ⁦Kelly J. Clark MD⁩

Xylazine #ASAM2023 all seats taken! Medical/Addiction Toxicologists explain xylazine & impact on heroin markets & users in 2023. >90% of ‘heroin’ supply contaminated/adulterated with xylazine in parts of Northeast. ⁦ASAM⁩ ⁦American College of Medical Toxicology⁩ ⁦New York Society of Addiction Medicine⁩

“Kidney stone to transcendent religious experience-ketamine in the ER.” Dr Andrew Herring @ #ASAM2023 0.5 mg/kg dose over hour =analgesic ‘smooth’ effect. Bup ppt wd start ketamine (CA Bridge guide)15-20 mg over 10-20 min ‘makes Bup stronger” ⁦ASAM⁩ ⁦American College of Medical Toxicology⁩

Much lower rates of psychoses & suicidality for patients treated using psychedelics compared to prescription stimulants #ASAM2023 & psychedelics don’t cause dependence tachyphylaxis occurs rapidly due to internalization of 5HT2A receptor ⁦ASAM⁩ ⁦American College of Medical Toxicology⁩

Most salient part of Psychedelic session #ASAM2023 in final two slides (esketamine illustration) no matter efficacy if CPT codes not developed appropriately covering psychedelic treatment (& therapy) use —> limited to wealthy (self pay). ⁦ASAM⁩ ⁦American College of Medical Toxicology⁩

Drs Laes ⁦⁦Evan Schwarz⁩ Pueringer & Steck ⁦#ASAM2023 ⁦American College of Medical Toxicology⁩ Collaborative Session “ Delta what…?” TCHP/Delta-9-P long side chain ->potent, 11-OH-THC long lasting (more produced with PO cannabis), CBN ? less potent advertised for sleep ⁦ASAM⁩

Dr Alaina Steck on the medical claims for ‘grey market cannabinoids’ at the #ASAM2023 ⁦American College of Medical Toxicology⁩ ⁦ASAM⁩ Session “Delta What..?” So rats don’t eat as much after they are given THCV? 🤔—> Miracle weight loss drug in humans!!! 😃$$$ ⁦Evan Schwarz⁩

Delta-8-THC higher cross reactivity than Delta-9-THC in immunoassay tests for Delta-9-THC. Delta-10-THC & Delta-P-THC less (+/- 25%). So yes these other cannabinoids can cause + THC UDS. To confirm sending GC/MS (expensive send out test) ⁦ASAM⁩ ⁦American College of Medical Toxicology⁩

So proud to have led this edition of NYS clinical guidelines in opioid use disorder treatment, geared toward outpatient clinicians. Here’s to expanding evidence-based and person-centered care for people who use drugs! hivguidelines.org CEI HCV/DUH Center @LorenzTaki Judy Griffin Timothy Wiegand, MD, FACMT, FAACT, DFASAM