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Perinatal Marijuana Use: Neonatal Effects and Best Practices for Screening, Education, and Treatment Program presented by: Nia Bhadra-Heintz, MD, MS, OB/GYN physician and Co-Director of the PROUD program (Perinatal Resources for Opioid Use Disorder) at Penn Family Care Roschanak Mossabeb, MD, Section Chief of Neonatology, Temple University Hospital Objectives: Describe the pediatric impact of perinatal marijuana use. Identify key points to include when educating parents about perinatal marijuana use. Learn More
Case Review: Infectious Disease Vaccinations in People Who Use Drugs There is an increased urgency to provide HAV/HBV vaccination and HIV/HCV screening/treatment for patients who use drugs due to their risk of infection. Nonetheless, patients presenting for care may have other priorities, and providers may not be prepared to offer vaccination. Additionally, other factors complicate screening, vaccination, and treatment, such as difficulty obtaining labs, tracking vaccination records, or contacting patients for follow up. This program sought to describe a patient who presented for treatment of substance use disorder and obtained vaccination for HAV/HBV. Presenter: Jennifer Aldrich, MD Professor, Clinical Medicine, Lewis Katz School of Medicine at Temple University Learning Objective:  Describe a case that illustrates how giving residents experience of providing care to patients with substance use disorders outside of traditional treatment settings benefits learners, patients, and communities. Learn More
OAR Webinar Series #3: Buprenorphine Induction Beyond the Basics Micro-induction and how to prevent precipitated withdrawal in the age of synthetic fentanyl analogs   The Poison Control Center’s Opioid Assistance Resource (OAR) organized a 4-part virtual webinar series focusing on prescribing, family and pediatric approaches to opioid use disorder (OUD) care, and the landscape of substance and opioid treatment in Philadelphia. This series is part of the OAR collection with support from the Health Federation of Philadelphia's Substance Use Response Guidance and Education (SURGE) program In a view of the fact that avoiding precipitated withdrawal is a priority for both the patient and the provider when starting buprenorphine for the treatment of opioid use disorder, this program Led by Dr. Joseph D'Orazio, MD aimed to review practices to prevent precipitated withdrawal. As the drug supply has become more potent, approaches to buprenorphine have needed to adapt.  While still relevant to patients who are dependent on opioid pills obtained from a pharmacy, the standard induction that was taught as the primary means of buprenorphine initiation during the first few years of the opioid crisis can cause precipitated withdrawal for patients who are dependent to fentanyl.  Presenter: Dr. Joseph D'Orazio, MD, FAAEM, FACMT Dr. D'Orazio is a medical toxicologist and serves as the Director of the division of emergency, medical toxicology and addiction medicine at Temple University Hospital, as well as a medical toxicology consultant for Children’s Hospital of Philadelphia. Dr. D'Orazio is active in communicating with other experts in the field about drug supply treating withdrawal with other providers across health systems. The Poison Control Center at CHOP’s Opioid Assistance Resource: The Poison Control Center at CHOP provides Philadelphia’s medical community with Opioid Assistance Resource support via our 24/7 phone line: 800-222-1222. OAR is here to help you with managing opioid toxicity and initiating buprenorphine for Opioid Use Disorder. Learn More
Treating Beyond the Surface: What Providers Need to Know About Treating Wounds Among People Who Inject Drugs Led by Dr. Sara Keely Schultz, who is an Associate Professor of Medicine and the Infectious Diseases Fellowship Program Director at Temple, this program explored the evaluation and treatment of complex wounds and related infections associated with injection behavior. Dr. Schultz shared her perspective as an infectious disease provider at Temple University Hospital and discussed myths and best practices associated with diagnosing complex wound infections, prescribing appropriate antibiotics, escalating care to the hospital, and implementing harm reduction with patient-centered care. Learn More
OAR Webinar Series #2: Adolescent Opioid Use Disorder The Poison Control Center’s Opioid Assistance Resource (OAR) organized a 4-part virtual webinar series focusing on prescribing, family and pediatric approaches to opioid use disorder (OUD) care, and the landscape of substance and opioid treatment in Philadelphia. This series is part of the OAR collection with support from the Health Federation of Philadelphia's Substance Use Response Guidance and Education (SURGE) program This session explored evidence demonstrating how addiction can be considered a pediatric disease as well as treatment currently provided to adolescent patients with Opioid Use Disorder (OUD). Survey data on substance use and overdose death rates among youth was reviewed along with Medications for Opioid Use Disorder (MOUD) for Adolescents, use of telehealth visits, as well as special developmental, ethical, and legal issues. Presenter: Dr. Krishna White, MD, MPH  Dr. White is an Attending Physician of Adolescent & Addiction Medicine, the Interim Medical Director for Adolescent Medicine Outpatient Clinical Operations, and the Medical Director of Substance Abuse Services for the Craig-Dalsimer Division of Adolescent Medicine at Children’s Hospital of Philadelphia. She is also an Associate Professor of Clinical Pediatrics at the Perelman School of Medicine, University of Pennsylvania. The Poison Control Center at CHOP’s Opioid Assistance Resource: The Poison Control Center at CHOP provides Philadelphia’s medical community with Opioid Assistance Resource support via our 24/7 phone line: 800-222-1222. OAR is here to help you with managing opioid toxicity and initiating buprenorphine for Opioid Use Disorder. Learn More
Basics of Wound Care Patients who inject drugs and have injection related wounds often delay or avoid care due to fears of withdrawal or being mistreated in healthcare settings. Unfortunately, this can have devastating results as untreated wounds rarely heal on their own and can lead to amputation or death. This training led by wound care nurses, Sara Wallace-Keeshen, Rachel McFadden & Rebecca Hosey will describe the basics of wound care so providers understand what interventions aid healing and what should be avoided. Learn More
OAR Webinar Series #1: The Pediatric Impact of the Opioid Epidemic The Poison Control Center’s Opioid Assistance Resource (OAR) organized a 4-part virtual webinar series focusing on prescribing, family and pediatric approaches to opioid use disorder (OUD) care, and the landscape of substance and opioid treatment in Philadelphia. This series is part of the OAR collection with support from the Health Federation of Philadelphia's Substance Use Response Guidance and Education (SURGE) program This session explored the many ways in which opioid epidemic affects pediatric medicine, from toddler exploratory poisonings, to young patients’ parental loss, neonatal abstinence syndrome to adolescent opioid use disorder. In addition, this program looked at child injury epidemiology and focus on child injury prevention. Attendees learned how they can reduce the harm of the opioid epidemic by sharing key public health messages with caretakers of pediatric patients.  Presenter: Dr. Kevin Osterhoudt, MD Dr. Kevin Osterhoudt is an attending physician in the Division of Emergency Medicine, and the medical director of the Poison Control Center, at the Children's Hospital of Philadelphia (CHOP) and is Professor of Pediatrics at the University of Pennsylvania School of Medicine. Dr. Osterhoudt is an Associate Fellow for the Center for Injury Prevention and Research at CHOP and is a member of the Executive Committee of the American Academy of Pediatrics’ Council on Injury, Violence and Poisoning Prevention. The Poison Control Center at CHOP’s Opioid Assistance Resource: The Poison Control Center at CHOP provides Philadelphia’s medical community with Opioid Assistance Resource support via our 24/7 phone line: 800-222-1222. OAR is here to help you with managing opioid toxicity and initiating buprenorphine for Opioid Use Disorder. Learn More
Case Review: Medical Cannabis and OUD The use of medical cannabis or marijuana (MMJ) for patients who are living with opioid use disorder (OUD) or are in recovery have not been widely discussed. In this presentation, Dr. Adam Lake, who is the Medical Director of Lancaster General Health Physicians' Comprehensive Care practice, reviews strategies for navigating MMJ and OUD through a substance use disorder lens with a focus on low barrier treatment.  Learn More
Xylazine Withdrawal Management The presence of xylazine in Philadelphia's drug supply has further complicated withdrawal management for patients. In this session, Dr. Rachel Ehrman-Dupre, & Dr. Caroline Kaigh explore a case article they co-authored descrbing withdrawal management for a patient being treated for wounds, who had both xylazine and fentanyl dependence. This presentation was followed by a live Q&A. Learn More
Wound and Skin Changes in Persons who Inject Drugs Dr. Barbara Pieper describes the different wounds and skin changes that can occur as a result of injection drug use. Her presentation is followed by a moderated discussion with local clinicians who treat patients who use drugs. Harm reduction approaches and the need for skilled, compassionate care are discussed. Learn More
Cross Taper: Methadone to Buprenorphine Transitioning from methadone to buprenorphine can be complicated and uncomfortable. This case review session discusses the successful cross-tapering of medications for two hospitalized patients. Pharmokinetics of medications for opioid use disorder (MOUD), microinduction, and the patients' response are described. Learn More
Incorporating Trauma-Informed Approaches in Substance Use Screenings Screening for prior substance use history is essential for identifying risks associated with drug use. Unfortunately, providers may not know how to ask questions that will identify patients at risk for overdose and may avoid screening patients for substance use disorder. This may contribute to loss of care or missed opportunities to discuss harm reduction with patients. Likewise, patients may withhold important information about their drug use. Learn More
Developing Safety in the Patient/Provider Relationship: Integrating Trauma Informed Principles into Sexual Health Assessments Stigma continues to impact provider attitudes and patient retention/engagement. It is important that health providers and members of the integrated care team are educated and informed on how to take a trauma-informed sexual history and its impact on health outcomes. This talk will address how to support sexual assessments and outcomes with trauma-informed approaches. Learn More
Provider Update: Clinical Implications from National and Local Drug User Health Surveys PDPH epidemiologists Tanner Nassau and Jennifer Shinefeld discuss the 2018 National HIV Behavioral Surveillance Survey and current drug user health surveys being conducted in Philadelphia. Learn More
Second Monday Case Review: Skin and soft tissue infections and OUD Patients who use drugs are at risk of developing wounds. Incorporating harm reduction while addressing wounds can decrease ID transmission and improve health outcomes. Rachel McFadden, BSN, RN, CEN uses a case study to describe the treatment of the "Whole" person as opposed to the "hole in the person." Learn More
ID Screenings in People Who Use Drugs: Harm Reductionist Approach in Primary Care Gina Simoncini, MD, MPH discusses a case that describes the screening for infectious disease among people who use drugs. Harm reduction and choosing appropriate testing modalities will be discussed. Learn More
Second Monday Case Review: Perinatal HIV and OUD Navid Roder, MD, AAHIVS discusses lessons learned around providing care for OUD for a pregnant patient. The discussion includes information about screening for HIV and HCV, pearls regarding perinatal OUD, and the implementation of treatment for perinatal patients who have OUD. Learn More
Xylazine in Philly’s Drug Supply: Provider Update and Panel Discussion Xylazine’s role in fatal overdose and adverse health outcomes are raising concerns for health providers who care for people who use drugs. As fentanyl shifted from being an occasional contaminant of heroin to replacing it altogether, drug surveillance shows that as of this program’s date, xylazine is now the primary drug adulterant in Philadelphia. This session describes what is know about xylazine and explore questions related to medical care for patients who have substance use disorder. Learn More
Incorporating Long Acting Injectable Buprenorphine into your MAT Practice Part 2 Kara Cohen, CRNP offers additional practical insights into incorporating Long Acting Injectable buprenorphine into your practice. Learn More
PDPH’s Response to the Illicit Drug Crisis in Philadelphia Kendra Viner, PhD, MPH, former Director of Substance Use Prevention and Harm Reduction (SUPHR) Division of the Philadelphia Department of Public Health (PDPH) describes the city’s substance use and health data collection and response to the drug crisis. Learn More
Second Monday Case Review: Sexual Health and OUD Lara Carson Weinstein, MD, MPH, DrPH describes a patient case in which disclosure of health behaviors impacts provider decision making.  The importance of harm reduction practices is emphasized. Learn More
Incorporating Long Acting Injectable Buprenorphine into your MAT Practice Part 1 Kara Cohen, CRNP describes her experience using Long Acting Injectable (LAI) buprenorphine with patients. This presentation includes practical advice about obtaining successful prior authorization, selecting patient candidates, and administering the medication. Audience questions are included. Learn More