Course Description
Any co-occurring substance use increases the difficulty in determining the best treatment approach, however, AUD and OUD were listed as one of the most common co-occurring SUD that many pharmacists encounter in clinical practice. The target audience for this topic would be those familiar with individual treatment of AUD and OUD who may want to further explore the complications and intricacies of treating these disorders when they are co-occurring.
Both AUD and OUD have FDA approved medications and clear guidelines which guide treatment of these disorders individually. However, when these disorders are co-occurring, treatment can become more complicated. The medical community has largely focused on OUD during the epidemic even though most patients with substance use disorder use multiple substances, and the presence of multiple substance use disorders is associated with worse treatment outcomes. Because problematic alcohol and opioid use are traditionally studied as independent conditions, limited evidence-based strategies exist for mitigation of alcohol-related risk among patients with OUD. Comorbid OUD and AUD are known to interfere with medication adherence and to be associated with increased morbidity and mortality.
The presence of chronic pain is also known to complicate both AUD and OUD and to be associated with poorer outcomes. Recent studies have started to consider the effect of pain on alcohol treatment outcomes. Jakubczyk and colleagues (2016) found reductions in physical pain during alcohol treatment predicted lower risk of alcohol relapse during the 4 weeks following treatment. Similarly, Witkiewitz and colleagues (2015) found pain interference and pain intensity at the end of treatment significantly predicted heavy drinking and time to first heavy drinking day during and following treatment.
Naltrexone is the only medication currently indicated to treat AUD and OUD. In a patient who is not able or not willing to take naltrexone, there may be a need to consider other medications for OUD and AUD as monotherapy or in combination. It can be difficult to determine if one treatment should take precedence or to manage concurrently.
One significant concern is that treatment of OUD with an opioid agonist medication (buprenorphine or methadone) may be dangerous in combination with alcohol. A case-control cohort study found that treatment of OUD with opioid agonists is associated with fewer admissions for alcohol-related acute events in patients with OUD with co-occurring AUD.
Learning Objectives
- Describe the clinical considerations for co-occurring opioid and alcohol use disorders.
- Evaluate the evidence for treatment of co-occurring opioid and alcohol use disorders.
- Develop a treatment plan for a patient scenario with co-occurring opioid and alcohol use disorders.
Target Audience
If you are a pharmacist, nurse practitioner or other healthcare professional involved in the comprehensive medication management of psychiatric patients, we invite you to participate in this online course.
Faculty
View biographical information
Michelle Colvard, PharmD, BCPP
Clinical Pharmacist Practitioner, Substance Use Disorders
Nashville VA Medical Center
Nashville, TN
Dr. Colvard received her Doctor of Pharmacy degree from Samford University in 2011 in her hometown of Birmingham, AL. She completed PGY1 pharmacy residency at VA Tennessee Valley Healthcare System (TVHS) and PGY2 psychiatric pharmacy residency at the Medical University of South Carolina.
Dr. Colvard’s passion for treating patients with substance use disorders began when working to optimize management of alcohol and opioid withdrawal in her previous practice as an inpatient psychiatric pharmacist. She now practices as an outpatient Clinical Pharmacist Practitioner for Substance Use Disorders where she provides substance use disorder pharmacotherapy, ambulatory detoxification, and overdose prevention services. She also supports inpatient addiction consult and transitions of care services at her practice site to ensure SUD pharmacotherapy continuity across care settings.
Course Requirements
To receive ACPE credit for this session, you must:
- Register for this course.
- Review the full content of the activity and reflect upon its teachings.
- Complete the evaluation at the end of the activity.
- Provide the necessary details in your profile to ensure correct reporting by AAPP to CPE Monitor.
Continuing Education Credit and Disclosures
Activity Date: 10/07/2022
ACPE Contact Hours: 1.25
ACPE Number: 0284-0000-22-075-H08-P (Application)
Nursing Credit Reminder: Note that ACPE credit is accepted for ANCC Certification Renewal and AANPCB advanced practice provider content. For specific questions related to your organization's acceptance of ACPE continuing education units, please contact your organization directly.
The College of Psychiatric and Neurologic Pharmacists is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.
AAPP owns the copyright, is licensed or has received permissions for use of, or is otherwise permitted to use copyrighted materials within any CPE activity. Authors and speakers are required to obtain necessary copyright permissions for content in CPE activities. AAPP complies with copyright laws and regulations.
View planning committee disclosures
2022 Planning Committee
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Ericka Crouse, PharmD, BCPP, BCGP, FASHP, FASCP Associate Professor VCU School of Pharmacy Richmond, VA External Consultant Activities, Advisory Panels, Speakers Bureaus, etc.: ASHP - PAM Behavioral Health Committee (volunteer), Editorial Board - The Medical Letter (paid), American Society of Consultant Pharmacists - speak at meetings/webinars on GeroPsych topics (paid), Wolters-Kluwer, paid consultant |
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Cassandra Davis, PharmD, BCPP, BCPS Mental Health Clinical Pharmacy Specialist Orlando VA Medical Center Orlando, FL No Relevant Financial Relationships to Disclose |
 Megan J. Ehret, PharmD, BCPP, MSBCPP Program Director Professor University of Maryland Baltimore, MD External Consultant Activities, Advisory Panels, Speakers Bureaus, etc.: Psych U Section Advisor, Lexi-Comp Consultant/Reviewer, SMI Adviser; Pharmacist Consultant Educational Grants, Research Grants or Contracts: FDA/University of Maryland CERSI, Maryland Behavioral Health Department, NIH |
 Sarah Melton, PharmD, BCPP, BCACP, FASCPChair Professor of Pharmacy Practice Gatton College of Pharmacy Johnson City, TN Non-Financial Interests: One Care of Southwest Virginia, Virginia Board of Pharmacy, Virginia Opioid Abatement Authority, Overmountain Recovery, Virginia Department of Health Professions Board, Virginia Medicaid Pharmacy and Therapeutics Committee |
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Troy Moore, PharmD, MS, BCPP |
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Erika Titus-Lay, PharmD, BCPP, BCPS Assistant Professor California Northstate University College of Pharmacy Elk Grove, CA Educational Grants, Research Grants or Contracts: Sponsor, ASHP Pharmacy Leadership Scholars Research Grant |
2022 Reviewers
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Audrey Abelleira, PharmD, BCPP, BCPS |
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David Dadiomov, PharmD, BCPP |
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James J. Gasper, PharmD, BCPP |
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Cindy A. Gutierrez, PharmD, MS, BCPP |
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Dara L. Johnson, PharmD, BCPP, BCACP |
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Benjamin Miskle, PharmD |
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Marnie Noel, PharmD, BCPP |
All relevant relationships have been mitigated.
All relevant relationships have been mitigated.
View disclaimer and disclosure of off-label use
Off-Label Use: This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA (see faculty information). The opinions expressed in the educational activity do not necessarily represent the views of AAPP and any educational partners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Disclaimer: Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Presentation-Specific Disclosure: My presentation will include discussion of off-label, experimental, and /or investigational use of drugs or devices: off-label use of gabapentin, topiramate for alcohol use disorder
View fair balance and integrity statement
It is the policy of AAPP to ensure independence, balance, objectivity, scientific rigor, and integrity in continuing education activities. Those involved in the development of this continuing education activity have made all reasonable efforts to ensure that information contained herein is accurate in accordance with the latest available scientific knowledge at the time of accreditation of this continuing education activity. Information regarding drugs (e.g., their administration, dosages, contraindications, adverse reactions, interactions, special warnings, and precautions) and drug delivery systems is subject to change, however, and the reader is advised to check the manufacturer’s package insert for information concerning recommended dosage and potential problems or cautions prior to dispensing or administering the drug or using the drug delivery systems.
Fair balance is achieved through ongoing and thorough review of all materials produced by faculty, and all educational and advertising materials produced by supporting organizations, prior to educational offerings. Approval of credit for this continuing education activity does not imply endorsement by AAPP for any product or manufacturer identified.