The Curbsiders team serves up random pearls and highlights
Recap of random pearls and highlights from SGIM19 Day 2 including: methadone and buprenorphine, perioperative buprenorphine, medical cannabis, HPV vaccination, young adult medicine, academic promotions, long term sequelae of childhood kidney disease, stage 1 hypertension, some great free resources in addiction medicine, and more! Special thanks to the Society for General Internal Medicine for their hospitality.
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Credits
Written, produced, and cohosted by: Paul Williams MD, Matthew Watto MD, Justin Berk MD, Carolyn Chan MD, Shreya Trivedi MD, Nora Taranto MS4 (soon to be MD!). Edited by: Matthew Watto MD
Young Adult Medicine pearls from SGIM19 Day 2 Recap Show
Recap SGIM19 Day 2
Time Stamps and Links
00:00 Intro and Disclaimer
02:30 Generalists receive the same number of grants, but publish fewer publications and are less likely to achieve professorship versus medical or surgical subspecialists (JGIM 2017)
05:30 GIM division directors differ in their emphasis on peer-reviewed publications for academic promotion (Acad Med 2015)
07:30 Only about 30% of patients are started on MAT after an overdose despite a known mortality benefit and a known mortality rate of 5% twelve month mortality in this population (Larochelle Annals Int Med 2018)
11:00 Stimulant use is not a contraindication to continuing buprenorphine (expert opinion from SGIM session on Addiction Medicine).
11:45 Perioperative buprenorphine: 1) Consider switching to full agonist therapy or 2) Dose buprenorphine 3-4 times daily and continue use during the perioperative period (Expert opinion from SGIM session titled “Buprenorphine 2.0”)
12:40 Options to transition from methadone to buprenorphine: Option 1) Taper methadone to 30-40 mg once daily. Then, hold methadone for 72 hours before starting buprenorphine. Option 2) “Microdosing” with buprenorphine patch while still on methadone and then start oral buprenorphine. Note: This is expert opinion so consult with your local expert before attempting this on your own!
13:46 UCSF has a “Warm Line” for free consultation about substance use https://nccc.ucsf.edu.
Get a free buprenorphine waiver from https://pcss.org
15:10 New joint guidelines on transitions remind providers that young adults need help navigating the healthcare system. Many young adults have never accessed healthcare resources on their own (Pediatrics 2018)
18:50 Childhood kidney disease increases risk for end stage renal disease as an adult (NEJM 2018)
20:35 Two studies concluded that stage 1 hypertension in young adults confers an increased risk for morbidity and treating it confers a benefit (Yano JAMA 2018; Son JAMA 2018)
26:40 Dr Chan offers tips on how to handle resident mistreatment and phrases that you can use to defuse the situation.
31:30 Some broad comments on the use of medical cannabis for pain management (Expert opinion from SGIM session)
36:30 Newer data suggests that even one drink daily might have adverse health outcomes (Lancet 2019).
39:00 Outro
Citation
Paul Williams MD, Matthew Watto MD, Justin Berk MD, Carolyn Chan MD, Shreya Trivedi MD, Nora Taranto MS4. Recap SGIM19 Day 2”. The Curbsiders Internal Medicine Podcast http://thecurbsiders.com. May 17, 2019.
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