Intermediate
Workshop Session
Alaina Steck, MD
Assistant Professor
Emory University / Grady Memorial Hospital
JoAn Laes, MD
Assistant Professor of Medicine
Hennepin Healthcare
Timothy Wiegand, MD, FACMT, FAACT, DFASAM
Director of Medical Toxicology
University of Rochester Medical Center
University of Rochester School of Medicine & Dentistry
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Lewis Nelson, MD
Professor
Rutgers New Jersey Medical School
With changing patterns of opioid use, a growing number of patients are at risk for experiencing opioid withdrawal. Due to convenient access to “pseudo-medical” information via social media and purchasing options on the Internet, patients may be using a variety of substances to “self-detox” or to mitigate withdrawal symptoms at home, such as kratom, ibogaine, and loperamide, all of which have potentially toxic effects. Treatment and recovery providers need to be knowledgeable of how patients self-treat opioid withdrawal, and to understand and manage the complications that arise from such practices.
Additionally, patients may present with precipitated withdrawal from buprenorphine, naltrexone, or well-intended naloxone administration. These periods of intense withdrawal place patients at risk for medical complications and can jeopardize the early stages of recovery. Understanding the risks and optimizing management using opioid and non-opioid strategies can comfort patients and improve treatment engagement.
This session is an interactive case-based workshop in which clinicians will discuss strategies to manage patients with atypical or unusually severe presentations related to opioid self-detoxification and precipitated withdrawal. Cases will illustrate the expected and unintended consequences related to the use of loperamide, kratom, and ibogaine as agents of self-detoxification. Attendees will develop approaches to diagnose and manage the complications of these so-called “alternative” detoxification agents, and learn to identify and treat the withdrawal that develops after regular use of kratom. We will also review the pathophysiology of precipitated withdrawal, discuss strategies to prevent this complication, and examine options to manage severe withdrawal. As there is currently no consensus on the best practices for treating atypical or complex opioid withdrawal, this session will offer an in-depth look at the benefits, risks, and knowledge gaps in rapid buprenorphine induction after naloxone- or naltrexone-precipitated withdrawal, and evaluate the use of other evidence-based agents such as opioid agonists, alpha-2 agonists, gabapentin, and atypical antipsychotics for patients with these multifaceted opioid withdrawal syndromes.