Emergency Medicine Half and Half MAT Waiver Training-Module 4: Special Populations and Co-Occurring Disorders

Module 4: Special Populations and Co-Occurring Disorders

Pdf Summary

This document discusses the diagnosis and appropriate management of co-occurring substance use and other psychiatric disorders. It emphasizes the importance of treating depressive and anxiety symptoms that persist beyond acute intoxication and withdrawal. Benzodiazepines should be avoided in the treatment of anxiety and depression, and instead, selective serotonin reuptake inhibitors and psychotherapy are recommended.<br /><br />The document also addresses the appropriate management of opioid use disorder (OUD) in different populations. For adolescents, buprenorphine is considered the first-line treatment, while methadone is recommended for pregnant women with OUD. The treatment of OUD in older adults requires considering age-related physiological changes, polypharmacy, and multiple co-morbidities. Buprenorphine is the preferred medication for older patients due to fewer drug-drug interactions.<br /><br />In HIV-positive patients, there are potential interactions between buprenorphine or methadone and antiretroviral medications. Buprenorphine is generally safer in this population compared to methadone. The document suggests considering referral to specialized HIV treatment programs and services.<br /><br />Patients with renal failure can safely use buprenorphine, while those with compromised hepatic function may require lower doses of buprenorphine due to reduced metabolism. Pregnant patients on methadone or buprenorphine can breastfeed their babies as the transferred amounts of medication are insufficient to cause symptoms of neonatal opioid withdrawal syndrome.<br /><br />Overall, the document highlights the importance of individualized treatment plans based on specific populations and their unique needs. It also emphasizes the need for close monitoring and careful consideration of medication interactions in different populations.

Keywords

substance use

psychiatric disorders

depressive symptoms

anxiety symptoms

buprenorphine

methadone

pregnant women

older adults

HIV-positive patients

neonatal opioid withdrawal syndrome