SBIRT..WHAT SHOULD I KNOW? Michelle Bauer MD Addiction Psychiatry .Addiction Medicine

Medical Director Substance Use Disorder Service VAMC S CREENING,

TREATMENT BRIEF INTERVENTION AND REFERRAL TO Evidence base approach supported by SAMHSA since 2003 for use in primary care setting and some other settings. Goal is to reduce frequency and severity of alcohol

use. Promote early involvement of primary care providers in prevention and treatment of substance use disorder Substance use and related disorders are among the leading causes of preventable injuries and illnesses

21.5million americans 12 or older had substance use disorder in 2014 GO.. WHERE EVER YOU Medicine..liver cirrhosis, HIV

Cardiologymyocardial infarction ,arrhythmia Neurologyneuropathy, Parkinson, Korsakoff Pulmonarysmall cell Ca,pulmonary edema Obstetrics.abruptio placenta Surgery..trauma,fractures Pediatrics..FAS,NAS,asthma ALCOHOL USE

DISORDER Most people drink with moderation . 87.6% adult over 18 reported they drank alcohol at some point in their life Lifetime prevalence Alcohol Use Disorder is 29.1% However of those 176.6 million alcohol users,an estimated 17million have alcohol use disorder 1.5million received treatment for AUD (8.9% of adult

who need treatment) TOBACCO USE DISORDER In 2014, 66.9 million Americans aged 12 or older were current users of a tobacco product. Young adults aged 18 to 25 had the highest rate of current use of a tobacco product (35%), followed by

adults aged 26 or older (25.8%), and by youths aged 12 to 17 (7%). CANNABIS USE DISORDER Marijuana is the most-used drug after alcohol and tobacco in the United States.

In 2014, about 22.2 million people ages 12 and up reported using marijuana during the past month. STIMULANT USE DISORDER In 2014, an estimated 913.000 people ages 12 and older had a stimulant use disorder because of

cocaine use. 476.000 people had a stimulant use disorder as a result of using other stimulants besides methamphetamine. In 2014, almost 569.000 people in the United States ages 12 and up reported using methamphetamine in the past month.

OPIOID USE DISORDER In 2014 an estimated 1,9 million people had an opioid use disorder related to prescription pain relievers and 586 000 had opioid use disorder related to heroin Overdose death from opioids have nearly quadruple since 1999 (increase 265% in man and 400% in women ) 28 000 people died from opioid OD in 2014 (more than 1/2 related to prescription drugs )

Approximately 3 out of 4 new heroin users abused prescription opioids before switching to heroin PERSPECTIVE High blood pressure75 million /410 000 Tobacco use disorder.66.9 million /88 000

Diabetes.29.1 million / 75 578 Cannabis use disorder..22.2 million Asthma.17.7 millions /3630 Alcohol use disorder..17 million /88 000 Opioid use disorder1.9 million +586 K /18 930+10 574 I am right there in the room and no one even


PHARMACOLOGY SUBSTANCE USE DISORDER Alcohol use disorder. Disulfiram 1950. Naltrexone PO and IM Acamprosate

Tobacco use disorder Nicotine gum 1984. Bupropion 1997. Varenicline Opioids use disorder Methadone.

Buprenorphine DIABETES 28 different drugs. 9 insulin ,rapid,short intermediate long acting 14 sulfonylurea-3rd generation, 4 DPP-4 inhibitor

(Sitagliptin ,Alogliptin ), 3 bile sequestrates (Cholestyramine ) 1 biguanide (Metformin), 3 meglitinides(Repaglinide), 2 thiazolidinediones ,( Pioglitazone ) 2 alpha glucosidase inhibitor(Acarbose,Miglitol)

HYPERTENSION 63 FDA approved medication 6 diuretics 3 potassium sparing diuretics 1 loop diuretic 13 beta blockers

10 ACE inhibitors 6ARB 8 calcium channel blocker 3 alpha blockers 1 alpha2 receptor agonist 4 central agonist 3 peripheral adrenergic inhibitor

2 vasodilators 2 combined alpha and beta blockers ASTHMA 23 FDA approved medication . 9 corticosteroids,

5 long acting beta blockers, Cromolyn sodium, 2 leukotriene modifiers (Zabirlukast), 1 5lipoxygenase inhibitor (Zileuton ) Short acting beta 2 agonist PATIENT INTERVIEW

LANGUAGE IS SOURCE OF MISUNDERSTANDINGS Exupery Antoine de Saint Many physicians admit they are not

confident about how to prescribe opioids safely,how to detect abuse or emerging addiction or even how to discuss these issues with their patients Nora Volkow Whoa! way too much information!

You should relax less.. You said you need to relax. Lets talk about it REFERENCES Substance Abuse and Mental Health Administration. National Institute on Drug Abuse.

SBIRT:Public health training for primary care . R.Taylor MD ,American Journal Public Health ,August 2012 ,vol 102,No 8 Neurobiologic advances from the Brain Disease model of Addiction . Nora Volkow MD,George Koob,PHD Thomas McLellanPHD:N England J Medicine 374:4,January 28 2016 The Future of Public Health

Thomas Frieden MD,MPH :N England J Medicine 373;18 ,October 29 2015 Drug dependence,a chronic medical illness . 284,No13;October 4 2016 Thomas McLellan ,JAMA Vol

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