Treating Substance Use Disorder: Stimulants & How to Get Addiction Histories

clinical topics interviews psych Aug 08, 2024

I’m THRILLED to share a second episode from our last guest Shelby Pope, an addiction medicine nurse practitioner who started out in primary care and LOVES her work. First of all, Shelby is brilliantly smart, but second of all, she imparted SO much wisdom in our last episode together, I just knew I needed to bring her back to talk more about addiction medicine essentials.

I wanted to acknowledge how challenging and scary addiction can feel to new nurse practitioners (or even experienced NPs when they don’t feel confident in their knowledge 🙋🏻). So we got into how to talk to patients about addiction in a way that feels accessible and less intimidating.

We also covered the essentials of stimulant use disorders - how to assess them, manage them, and educate & support patients.

This is a must-listen - SO many patients in our practices have addictions, and there’s so much bias against patients who have addictions.

We have so much power to contribute to patients’ lives and reduce morbidity and mortality, and it’s way easier than it seems.

Key Takeaways From This Episode

Open and non-judgmental conversations are essential when discussing substance use with patients.
Screening practices, such as using screeners like PHQ-2, SBIRT, and DAST, can help identify substance misuse or struggles.
Taking a comprehensive history of substance use, including the type, amount, frequency, and motivation, is crucial for providing appropriate care.
Healthcare providers should be aware of the different routes of administration and the potential risks associated with each.
Stimulant use disorder, particularly cocaine and methamphetamine use, can have significant adverse effects and poor outcomes. Cocaine and methamphetamine are both monoamine neurotransmitter reuptake inhibitors, increasing serotonin, norepinephrine, and dopamine levels in the brain.
There is a withdrawal syndrome associated with stimulant use disorder, characterized by depression, fatigue, and sleep disturbances.
In managing patients with stimulant use disorder, primary care providers should consider triage based on severity and acuity, and refer patients to appropriate resources such as rehab or the ER.
Psychosocial interventions, such as cognitive behavioral therapy and contingency management, are the mainstay of treatment for stimulant use disorder.
Off-label pharmacologic treatments for stimulant use disorder include mirtazapine, bupropion, injectable naltrexone, topiramate, and psychostimulants.
It is important for healthcare providers to be aware of state regulations and their own comfort level in prescribing off-label medications for stimulant use disorder.