Concurrent Paper Session II

COVID-19 Treatment Outcome in a Cohort of Methamphetamine and Cannabis Users

Summary
Poor outcomes of COVID-19 has been reported in older males with medical comorbidities including substance use disorders 1-3. However, it is not entirely clear whether there is difference in COVID-19 treatment outcomes between patients who actively use a common substance such as cannabis (TCH) with low perceived health risk 4 and those who use a medically hazardous stimulant such as methamphetamine (METH). Electronic medical records (EMR) of COVID-19 patients with active METH (n=56) or cannabis use (n=89) were reviewed. COVID-19 infection was confirmed by positive SARS-CoV-2 PCR test and active drug use was confirmed by history and positive urine drug testing. Both METH (mean age: 39.8±12 (18.2-59.1) years, 80% males) and THC groups (mean age: 35.6±16.6 (14.9-74.6) years, 51% males) with COVID-19 infection had high rates of medical and psychiatric comorbidities. Significantly more METH users, compared to THC users, required hospitalization (73.2% vs 55%, P=0.02), exhibited manifestations of delirium (35.1% vs 19.1%), and received benzodiazepine treatment (49.1% vs 25.8%, P=0.003). Four patients in each group (7% vs. 4.5%, P=0.4) died within 10 months from testing positive for SARS-CoV-2 infection. In conclusion, the results of this small retrospective study lend more evidence to the limited literature about the high morbidity and mortality among METH and THC users and calls for more research in this area.

Methods
Electronic medical records (EMR) of 145 COVID-19 patients with active METH (n=56) or cannabis (n=89) use were reviewed. Patients were included if they had both a positive drug screen and COVID-19 infection with full documentation available about hospital course and medical/psychiatric comorbidities. COVID-19 infection was confirmed by positive SARS-CoV-2 PCR test and active drug use was confirmed by history and positive urine drug testing. Demographic data was collected as well as comorbid medical and psychiatric conditions. COVID-19 symptoms, hospitalization, ICU admission, treatment, and outcome (survival and discharge psychiatric medications) were compared between the two groups using two-tailed student t-test or Chi squared test. Presenting complaint were collected as patients often presented with conditions in addition to their active COVID-19 infection including substance intoxication, complications of pre-existing medical conditions, psychiatric symptoms, or trauma. Information about comorbid medical conditions was collected via the discharge summaries with updated hospital problem lists. If a patient was not admitted to the hospital, a problem list and current medications were taken from the closest visit with complete documentation.

Results
Demographics and comorbid medical and psychiatric conditions
The mean age of the THC group [35.6±16.6 years] was not significantly different from the METH group [39.8±12 years]. No significant demographic differences were found between the two groups. However, unemployed males were more highly represented in the METH group than the THC group. Most patients reported tobacco use with significantly more METH compared to THC users (77.2% vs. 58.4%, P=.01).

Several significant differences were observed in medical comorbidities. METH users had significantly more comorbid GI conditions (40.4% vs 16.9%, P<0.0001),and Hepatitis C affected 14% of the METH group vs 4.5% in the THC group. Comorbid CVS conditions (42.1% vs 25.8%, P=0.03) and cancer (12.3% vs 3.4%, P=0.03) were also more prevalent among METH users, while THC users had more pain disorders including chronic pain and fibromyalgia (30.3% vs 14%, P=0.02).

The two groups matched in past psychiatric history except that the THC group had more anxiety (52.8% vs 35.1%, P=0.04). Among THC users 21.3% and 15.7% reported past METH and Cocaine use while 8.9% of METH users reported cocaine use.

Hospital course

The two most common reasons for hospital visit were COVID-19 related symptoms in 22.8% of METH users and 15.7% of THC users (P=0.2) and psychiatric complaints (21.1% and 21.3% in METH and THC users respectively). The most common psychiatric symptoms were suicidal ideation, poorly controlled psychiatric conditions, toxic encephalopathy, and altered mental status due to substance abuse. Frequently abused substances were heroin, other opiates, alcohol, and methamphetamine. This was common across both THC and METH users. No differences between the two groups in the reasons for hospitalization were noted except that more THC users presented after testing positive at drive through service (38.2% vs 15.8%, P=0.004) and more METH users presented with intoxication (19.3% vs 3.4%, P=0.001).

Significantly more METH users compared to THC users were hospitalized (73.2% vs 55%, P=0.02). The two groups show no differences in the course of hospitalization, ICU admission (21.1% in METH users and 14.6% in THC users), or even mortality (7% in METH users and 4.5% in THC users). However, METH users required more benzodiazepines (49.1% vs 25.8%, P=0.003) and had more delirium than their THC user counterparts (35.1% vs. 19.1%, P=0.02). About half of the patients in each group were prescribed a psychiatric medication at time of discharge (METH vs THC: 47.4% vs 56.2%, P=0.3) mostly antidepressants (26.3% vs 37.1%), or antipsychotics (19.3% vs 18%) No significant differences were found between the two groups in psychiatric medications

Conclusion
Direct comparison between two groups of COVID-19 patients with active THC and METH use reveals high rates of medical and psychiatric comorbidities as well as high rates of severe illness as evident by ICU admission and mortality rates. It is very important to note that 35% of patients with METH abuse and 19% of patients with THC abuse suffered from delirium during their hospitalization. Psychiatric conditions are clearly present at high frequency among both THC and METH users. 54% of METH users and 58.4% of THC users had coexisting mood disorders which underscores the importance of assessing mood symptoms and suicidality in these patient populations. Both THC and METH groups had high frequencies of medical comorbidities that are often associated with worsened COVID-19 outcomes including cardiovascular issues, pulmonary conditions, and endocrine conditions, particularly diabetes.

The use of covid specific medications (remdesivir, steroids, convalescent plasma, or monoclonal antibodies) was required in 33.3% of METH users and 23.6% of THC users. Additionally, an impressive 21.1% of METH users and 14.6% of THC users required ICU level care during their admission. Patients were often hospitalized and provided ICU level care for additional medical conditions presenting in conjunction with active COVID-19 infection. This factor does make it difficult to identify how COVID in isolation affects patients with active substance abuse. However, active substance users are less likely to have reliable access to care and often present with more advanced illnesses. 16 Therefore, our patient presentations likely provide a realistic snapshot of how patients will present with active substance abuse and COVID-19 infection. Another notable finding was the prevalence of tobacco smoking among both groups, especially METH users. 77.2% of METH users and 58.4% of THC users were actively using tobacco at the time of hospitalization. Tobacco smoking has well known adverse pulmonary effects, and therefore can contribute to negative respiratory outcome of COVID-19 in these patient populations. 17

Scientific Significance
The COVID-19 pandemic has caused tremendous morbidity and mortality, dramatically changed how people live their lives, and transformed how healthcare is provided and accessed. It has also changed substance abuse patterns across the US and worldwide. The impact of COVID-19 on drug use patterns is varied with some studies reporting slightly decreased usage and some increased usage with higher incidents of overdose. Limitations in access to drugs also affects overdose patterns. 8,18 Cannabis sales have reportedly increased with the advent of the pandemic in states with legal recreational marijuana, but self-reported use has not. 6,19 The general consensus among addiction specialists is that substance abuse as a whole has increased during the pandemic and is often cited as a coping mechanism for COVID-19 associated anxiety. 5, 20

Given the high proportion of our patients with mood and anxiety disorders it is likely that these conditions feed into substance abuse patterns. It is difficult to predict how trends in substance abuse will change as the pandemic continues to evolve and people return to work. It will benefit any physician working with COVID-19 patients to have an understanding of how both METH and THC abuse affect COVID-19 patients, particularly given the changing landscape of substance abuse patterns and persistent anxiety associated with COVID-19.

Learning Objectives

Learners will recognize how medical and psychiatric comorbidities compare between active marijuana (THC) and methamphetamine (METH) users.
Learners will appreciate the high rates of delirium, ICU hospitalization, and mortality we observed among patients with active METH or THC use and COVID-19 infection.
Learners will place the findings of this cohort into the larger context of increasing substance abuse in the COVID-19 pandemic along with the medical comorbidities that make patients with substance abuse disorders more susceptible to severe COVID-19 infection.

State Requirement Topic Category

Addiction- Substance Use Disorders: Identifying, Diagnosing, Treating, and/or Managing

Keywords

COVID19
Methamphetamine
Cannabis

Presenter
Ann Rydberg, BS

M.D. Candidate, Mayo Clinic Alix School of Medicine-AZ
Class of 2023
She/her/hers
Mayo Clinic Alix School of Medicine Scottsdale, Arizona: 13400 E. Shea Blvd. Scottsdale, AZ 85259
Phone: 507-261-4178 | rydberg.ann@mayo.edu

Ann Rydberg is a third-year medical student at Mayo Clinic Alix School of Medicine in Scottsdale, Arizona. She completed her undergraduate degrees in Biology and History at the College of William & Mary where she graduated Phi Beta Kappa. Following graduating from college, she worked as a foster parent with the Hands of Hope Internship at Casa de Esperanza de los Ninos in Houston, Texas working with children who were victims of abuse, neglect, homelessness, and/or drug exposure. She is currently interested in pursuing a career in Psychiatry and is interested in the intersections between different health domains including physical, mental, and emotional. She is currently pursing research interests including how marijuana and methamphetamine use during COVID-19 affects outcomes both medically and psychologically, incorporating sex and gender specific medicine in medical student education, how immunosuppressive medication for transplant relate to the development of cutaneous complications in pediatric patients, and how social media usage affects contraceptive knowledge in teens.

Co-Authors: Ann Rydberg, Terry Schneekloth, Osama Abulseoud

The Impact of COVID-19 on Overdose Risk and Healthcare-Seeking Behaviors Among Hospitalized Patients With Opioid Use Disorder

Summary
Background: Little research has examined the impact of the COVID-19 pandemic on overdose risk and healthcare-seeking behaviors among hospitalized patients with opioid use disorder (OUD) .

Methods: We surveyed participants enrolled in Project COMMIT, an on-going multi-site randomized controlled trial evaluating extended-release buprenorphine co-managed with infectious disease compared to treatment as usual in persons medically hospitalized with severe OUD-related infections. A COVID-19 survey assessing overdose risk and healthcare-seeking behaviors was administered to all participants at baseline and at 4- and 8-week follow-up visits.

Results: 34% (28/83) rated themselves as more likely to use drugs alone, 27% (22/83) as more likely to purchase drugs, and 14% (12/83) as more likely to overdose in the pandemic vs. pre-pandemic. 18% (15/83) rated themselves as more likely to be on medication for OUD (MOUD) during the pandemic vs. pre-pandemic. Over the course of the trial, more participants rated themselves as more likely to use drugs alone at week 8 (42%; 22/52) vs. baseline (34%; 28/83), and more likely to overdose at week 4 (24%; 15/63) vs. baseline (14%; 12/83). More participants rated themselves as more likely to be on MOUD at week 8 (29%; 15/52) vs. baseline (18%; 15/83).

Conclusion: As compared to pre-pandemic ratings, hospitalized patients with OUD rated themselves at higher risk for using drugs alone, purchasing drugs, and overdose since the onset of the pandemic. Disruptions in addiction services pose unique challenges to already vulnerable populations with OUD, highlighting the need for research to improve treatment access and delivery.

Methods
A COVID-19 survey was administered to all participants enrolled in Project COMMIT at baseline and at 4- and 8-week follow-up visits. Study recruitment began on August 18th, 2020 and is ongoing (clinicaltrials.gov: NCT04180020); data for the present descriptive study was evaluated through May 11th, 2022.

The COVID-19 survey consisted of 9 questions covering the following domains: 1) COVID-19 testing and diagnosis; 2) COVID-19 risk behaviors (e.g., social distancing); 3) overdose risk behaviors (e.g., use drugs alone, seek/purchase drugs); 4) healthcare-seeking behaviors (e.g., seek addiction care, seek infectious disease care, seek/be on medication for opioid use disorder); and 5) overdose risk. COVID-19 testing and diagnosis were assessed with three responses (no, yes, don’t know); survey responses for the other domains were assessed using a 5-point Likert scale (a lot less likely to a lot more likely or very bad to very good).

The sample was described using frequencies and proportions for categorical variables (5-point Likert scale converted to 3 categories: less likely/no change/more likely or bad/neither bad nor good/good) and means and standard deviations for continuous variables. Differences in means and rates with 95% confidence intervals were used to compare survey responses, and univariate plots of selected responses were visualized as a function of time. All analyses were performed using R and RStudio software.

Results
Demographics and clinical characteristics: A total of 83 participants were surveyed at baseline. Participants were average age 38 years old, 53% male, and most were white (77%), not working (77%), and had a high school education or greater (83%). Over half had health insurance (57%), 36% were homeless, and approximately one-fifth were on parole or probation (22%). The majority were intravenous drug users (77%) of heroin (84%) in the past month and just over one-quarter (27%) reported past month fentanyl use. Forty-two percent reported past month methamphetamine use, 29% reported past month cocaine use, and 42% reported past month cannabis use.

COVID-19 survey responses at baseline: Ninety-four percent (78/83) of participants had been tested for COVID-19 and 20% (17/83) reported having had a positive test result. Twenty percent (17/83) indicated that they were “bad” at social distancing. Regarding overdose risk behaviors since the pandemic, 34% (28/83) rated themselves as being more likely to use drugs alone and 27% (22/83) as being more likely to seek/purchase drugs, compared to before the pandemic. Six percent (5/83) rated themselves as being less likely to use drugs alone and 11% (9/83) as being less likely to seek/purchase drugs in the pandemic, compared to before the pandemic. Regarding healthcare-seeking behaviors since the pandemic, 16% (13/83) rated themselves as being less likely to seek addiction care, 11% (9/83) as being less likely to seek infectious disease care, and 13% (11/83) as being less likely to seek/be on medication for opioid use disorder (MOUD), compared to before the pandemic. Twenty percent (17/83) rated themselves as being more likely to seek addiction care, 25% (21/83) as being more likely to seek infectious disease care, and 18% (15/83) as being more likely to seek/be on MOUD during the pandemic, compared to before the pandemic. Fourteen percent (12/83) rated themselves as being more likely to overdose in the pandemic, compared to before the pandemic, and 5% (4/83) rated themselves as being less likely to overdose in the pandemic, compared to before the pandemic.

Select COVID-19 survey responses over time: Over the course of the trial, more participants rated themselves as being more likely to use drugs alone at week 8 (42%; 22/52), compared to week 4 (38%; 24/63) and baseline (34%; 28/83), and as being more likely to seek/purchase drugs at week 4 (28%; 18/64), compared to baseline (27%; 22/83). More participants rated themselves as being more likely to seek/be on MOUD at week 8 (29%; 15/52), compared to week 4 (23%; 15/64) and baseline (18%; 15/83). Finally, more participants rated themselves as being more likely to overdose at week 4 (24%; 15/63), compared to week 8 (21%; 11/52) and baseline (14%; 12/83).

Conclusion
As compared to pre-pandemic ratings, hospitalized patients with opioid use disorder (OUD) rated themselves as being at higher risk for using drugs alone, purchasing drugs, and overdose since the onset of the pandemic. Over the course of the trial, more participants rated themselves as being at higher risk for using drugs alone and overdose, and more likely to be on medication for OUD.

Scientific Significance
These preliminary findings provide new insights into the impact of COVID-19 on overdose risk and healthcare-seeking behaviors among hospitalized patients with opioid use disorder (OUD). Disruptions in addiction services and social distancing measures pose unique challenges to already vulnerable populations with OUD, highlighting the need for research to improve treatment access and delivery.

Learning Objectives

Examine the perceived impact of the COVID-19 pandemic on overdose risk and healthcare-seeking behaviors among hospitalized patients with opioid use disorder.
Assess changes in overdose risk and healthcare-seeking behaviors among persons with opioid use disorder over the course of a clinical trial.
Describe the importance of clinically focused research and treatment delivery for vulnerable populations with opioid use disorder during the COVID-19 pandemic.

State Requirement Topic Category

Addiction- Substance Use Disorders: Identifying, Diagnosing, Treating, and/or Managing
Buprenorphine
Infectious Disease including HIV/AIDS

Keywords

COVID19
Hositalized Patients
Opioid Use Disorder
Infectious Diseases
Injectable Buprenorphine

Presenter
Manesh Gopaldas, MD

Dr. Manesh Gopaldas is a first-year T32 addiction psychiatry fellow at Columbia University. His area of focus is health services research and implementation science. Dr. Gopaldas is interested in treatment engagement among people with opioid use disorder (OUD) and in developing interventions that increase uptake of medications for OUD among hard-to-reach/out-of-treatment populations.

Co-Authors: Manesh Gopaldas, Brent Vander Wyk, Victor Neirinckx, Angela Di Paola, Alain Litwin, Kathleen Brady, Frances Levin, Edward Nunes, Sandra Springer

Inpatient Low Dose Transitions From Full Agonist Opioids Including Methadone Onto Long-Acting Depot Buprenorphine: Case Series From a Multicenter Clinical Trial

Summary
We present a case series of participants from the NIH-sponsored COMMIT multi-site randomized controlled trial who were hospitalized with OUD and concurrent infections and underwent transitions from full opioid agonists, including methadone, to long-acting injectable buprenorphine (LAB) via low dose transition strategies.

Methods
The COMMIT trial is an NIH-funded multisite randomized controlled trial evaluating LAB administered by Infectious Disease physicians and hospitalists compared to treatment as usual for persons with OUD hospitalized with infections. We report a case series of participants on full agonist opioids including methadone who transitioned using low dose synchronous (“microdosing”) buprenorphine strategies onto sublingual buprenorphine then to LAB.

Results
Seven participants met case definition criteria and life-threatening infections requiring surgical intervention were common. Low dose transitions in this high complexity cohort were well tolerated by all participants without adverse events or precipitated withdrawal. Transitions from transmucosal buprenorphine initiation to LAB took an average of 7.5 days and occurred as quickly as 5 days.

Conclusion
Inpatient low dose buprenorphine transition from full agonist opioids including methadone onto LAB is feasible even in those with complex hospitalizations for concurrent infections and/or surgery. Such strategies can facilitate expedited dosing of LAB prior to discharge.

Scientific Significance
Our study shows the feasibility of low dose transitions onto LAB for patients with serious comorbidities in a manner that is safe, well tolerated and expedited such that it complements and does not excessively prolong hospitalization. As OUD treatment options and strategies expand, clinical infrastructure should evolve to meet these growing needs.

Learning Objectives

Participants will be more aware of how to identify persons in medical hospital settings who have OUD with concurrent injections who can initiate Long acting injectable buprenorphine and how to safely.
Participants will be better able to understand how to perform low dose buprenorphine transitions from oral opioids used for pain management as well as from methadone for OUD treatment to long-acting buprenorphine after this session in patients admitted to the hospital with acute co-morbid infections and co-occurring pain syndromes
Participants will know how to monitor patients’ safety and tolerability of transitions from oral opioids to long-acting buprenorphine in the setting of acute illness and surgery in the inpatient setting after this session.

State Requirement Topic Category

Addiction- Substance Use Disorders: Identifying, Diagnosing, Treating, and/or Managing
Buprenorphine
Infectious Disease including HIV/AIDS

Keywords

Buprenorphine Initation
Injectable Buprenorphine
Infectious Diseases
Hospitalized Patients
Low Dose Transitions

Presenter
Sandra Springer, MD

Dr. Sandra Springer is an Associate Professor of Medicine in the Department of Internal Medicine, Section of Infectious Diseases at the Yale School of Medicine. In addition, she is an attending Infectious Disease physician at the VA Connecticut Healthcare System and the Director of the Infectious Disease Clinic at the Newington VA site. She has significant clinical and research experience with persons with HIV and substance use disorders (SUDs) and is Board certified in Internal Medicine, Infectious Disease and Addiction Medicine. She is the Director of her research program InSTRIDE (Integrating Substance Use Treatment Research with Infectious Disease for Everyone) at Yale School of Medicine where she and her team conduct clinical research on the integration of SUDs and Infectious Disease/HIV treatments. In particular, she has focused on evaluating medication treatments for opioid and alcohol use disorders to improve substance use and ID/HIV treatment for persons involved with the criminal justice system. She currently is a Principal Investigator on 6 NIH awards and 1 VA Cooperative Studies award. These awards include research evaluating the: impact of medication treatment for OUD on immunobiological outcomes and HIV latency; as well as randomized controlled trials evaluating the impact of long-acting injectable buprenorphine and naltrexone among persons with OUD released from prison and jail, among hospitalized patients with comorbid infections, and among Veterans with OUD. She has presented her research numerous times both nationally and internationally, and has published over 100 manuscripts and book chapters.

Co-Authors: Nikhil Seval, Jonathan Nunex, Prerana Roth, Meredith Schade, Michelle Strong, Cynthia Frank, Alain Litwin, Frances Levin, Kathleen Brady, Edward Nunes, Sandra Springer

Retrospective Chart Review of Patients Prescribed Benzodiazepines in the Outpatient Psychiatry Resident Clinic: Identifying Those at High Risk of Adverse Effects

Summary
Chronic benzodiazepine prescription use leading to the development of benzodiazepine use disorder is a major public health concern. Increased knowledge of benzodiazepine risk has led investigators to perform targeted studies of benzodiazepine deprescribing in limited patient populations, such as in patients ages 65 and older without specified substance use disorders (SUD) or other mental illness who are prescribed benzodiazepines for insomnia through the primary care setting (1). The presence of a comorbid psychiatric illness, however, complicates deprescribing practices, and recent deprescribing guidelines in such scenarios recommend consultation with a psychiatrist (2). A notable gap in the literature is that there are no studies, guidelines or interventions on benzodiazepine de-prescribing in patients with substance use disorders or mental illness. This is a critical need because these patient populations are prescribed benzodiazepines at relatively high rates and are also at elevated risk of adverse drug and medication interactions, and development of benzodiazepine use disorder (3,4,5).

We completed a retrospective chart review of all patients prescribed benzodiazepines in the outpatient psychiatry resident clinic at Stony Brook University Hospital. We found that a high proportion of included patients had long-term benzodiazepine treatment and one or more additional risk factors for adverse effects, such as older age (>65), history of substance use disorder, and concurrent opioid prescriptions. These findings showing high comorbidity of our patients indicate a need for developing benzodiazepine deprescribing guidelines and interventions adapted for psychiatric care settings.

Methods
We conducted a retrospective chart review of patients prescribed benzodiazepines during the period between July 2020 and June 2021, in the outpatient psychiatry resident clinic at Stony Brook University Hospital. Any patient prescribed benzodiazepines was included for further analysis. Sociodemographic and clinical information was then collected with attention to risk factors for benzodiazepine adverse effects, such as dose/duration of therapy, concurrent prescription opioid use, substance use disorder history and older age.

Results
Of 634 total clinic patients, 125 (19.7%) were prescribed benzodiazepines at the time of study and were analyzed further. Twenty-four patients (19.2%) had a history of one or more substance use disorders. Twenty (16%) had concurrent prescriptions for opioids. Seventeen (13.6%) were ages 65 and older. Twenty-two (17.6%) patients had two or more of these risk factors present. Median and mean duration of benzodiazepine treatment was 24.5 and 36.7 months, but this varied widely (SD = 29.9, range = 1-104). Mean daily benzodiazepine dose in clonazepam equivalents by age ranged from 0.73 mg/day to 1.48 mg/day and was highest for the 60-64 age group generally. Mean daily benzodiazepine dose in clonazepam equivalents over a 12-month period was twice as high for patients concurrently prescribed opioids (P=0.017).

Conclusion
About 35% of patients prescribed benzodiazepines in our outpatient psychiatry resident clinic had at least one risk factor for benzodiazepine adverse effects, including older age, SUD history, and concurrent opioid prescription, and about 18% had two or more of these risk factors. The mean daily benzodiazepine dose was twice as high for patients with concurrent opioid prescriptions, a finding of particular importance considering the known increased risk of overdose when the two are combined. Long-term benzodiazepine use also increases risk of adverse outcomes, and the median duration of use in our clinic was over two years. Given these clinical characteristics of our patient sample, we suggest that future research and clinical efforts should be aimed at establishing evidence-based deprescribing guidelines and interventions for at-risk patients that are specifically adapted to psychiatric care settings.

Scientific Significance
Increasing knowledge of the adverse effects of benzodiazepines has led to deprescribing research and guideline formation in recent years. However, all such prior studies were conducted on limited patient groups that are not generalizable to the broad spectrum of patients seen in outpatient clinics. In particular, prior studies did not examine benzodiazepine deprescribing in patients with substance use disorders and other mental illness. In our study, about 35% of patients prescribed benzodiazepines in our outpatient psychiatry resident clinic had at least one high-risk characteristic, and about 18% had two or more concurrently. We suggest that future development of evidence-based guidelines and interventions for benzodiazepine deprescribing specifically adapted for psychiatric care settings would be beneficial for enhancing outpatient care.

Learning Objectives

To identify that there is a gap in knowledge and a lack of benzodiazepine deprescribing guidelines and interventions specifically for use in psychiatric care settings
To describe the demographic and clinical characteristics of patients prescribed benzodiazepines in the outpatient psychiatry resident clinic at Stony Brook University Hospital
To characterize patients at increased risk of benzodiazepine adverse effects with special attention to substance use disorder history, concurrent treatment with opioid analgesics, and older age

State Requirement Topic Category

Addiction- Substance Use Disorders: Identifying, Diagnosing, Treating, and/or Managing
Opioids and other Controlled Substances: Use and Abuse, Prescribing, Dispensing, and/or Administering

Keywords

Benzodiazepines
Adverse Effects of Benzodiazepines
Benzodiazepine Deprescribing

Presenter
Geoffrey Russell, MD

Geoffrey Russell is a psychiatry resident at Stony Brook University Hospital. His current research interests include benzodiazepine prescription use, especially among patients with substance use disorders.

Co-Authors: Geoffrey Russell, Kathryn Hy, Marina Tsoy-Podosenin

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