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Alcohol Use Disorder: Emerging Therapies

Michael Baca Atlas, MD and Neda Frayha, MD
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How much do we really know about the pharmacologic treatment of alcohol use disorder? After this segment with Dr. Michael Baca-Atlas and our own Neda Frayha, the answer will be, a whole lot.

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Chris -

Thanks for this segment! Could you elaborate on the "significant reaction" that is possible if a patient used opioids while on naltrexone? Are we not simply talking about opioid withdrawal or is there something more to this?

Neda F., MD -

Hi Chris! Here's Michael's response: "Christopher, thanks for your question, which is an important concept to clarify! If a patient uses an opioid while already maintained on Naltrexone, it is unlikely the individual will feel the effects of that opioid. This is because Naltrexone is blocking the opioid receptor, and it takes considerably larger amounts of an opioid to overcome that blockade (eg pt has trauma/postop pain). This is very different than someone starting Naltrexone after using an opioid. The Naltrexone displaces the opioid from the receptor, causing precipitated withdrawal which is very distressing for patients. The recommendation is to start Naltrexone is a minimum of 7 days after short acting opioids (oxycodone, heroin) and 14 days for long acting opioids (methadone)."

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A World of (Bladder) Hurt Full episode audio for MD edition 186:36 min - 88 MB - M4AHippo Primary Care RAP - March 2019 Written Summary 1 MB - PDF

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