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Workshop: Extended-Release Buprenorphine for Vulnerable Populations with Opioid Use Disorder: Clinical Challenges, Pharmacokinetics, and Outcomes
Abstract

This workshop will focus on clinical challenges associated with initiating medication for opioid use disorder (MOUD) in medically complicated patients, such as those with injection-related infections. The utility of extended-release buprenorphine (XR-BUP) and issues with its management in this population will be explored. Several challenges will be discussed, including the impact of fentanyl and other high-potency synthetic opioids, as well as patient concerns regarding XR-BUP effectiveness. Additionally, it will examine the pharmacokinetic and pharmacodynamic properties of XR-BUP and their relationship to high-potency synthetic opioid use and MOUD initiation. Preliminary findings from an ongoing trial [NCT04180020] will be presented, and the workshop will facilitate discussions on lessons learned and the clinical implications for optimizing MOUD delivery.

Learning Objectives
  • Discuss the pharmacokinetic and pharmacodynamic properties of extended-release buprenorphine (XR-BUP), and the impact of high-potency synthetic opioid use on MOUD initiation and treatment response
  • Identify the challenges of initiating XR-BUP in medically complicated patients with OUD, including the impact of fentanyl and other high-potency synthetic opioids, and patient concerns related to XR-BUP effectiveness
  • Recognize the importance of improving MOUD access and treatment delivery for vulnerable populations, including those with co-occurring OUD and severe infections
Keywords / Topics
  • Injectable
  • Buprenorphine
  • Hospitalized Patients
  • Opioid Use Disorder
Presenters
Manesh Gopaldas, MD, Chairperson

 

Manesh Gopaldas, MD is an addiction psychiatrist and NIDA-funded T32 postdoctoral fellow at Columbia University. His primary focus lies in identifying, developing, and implementing best practices to engage and retain individuals with substance use disorders in their care. 

Sandra Springer, MD, Co-Chair

 

Dr. Sandra Springer is a Professor of Medicine in the Department of Internal Medicine, Section of Infectious Diseases at the Yale University School of Medicine. She is also an attending at the Veterans Administration Connecticut Healthcare System and directs the VA Newington, CT Infectious Disease Clinic. She received a BA from Harvard University, an MD from University of Massachusetts Medical School, and completed her Internal Medicine Residency and Infectious Disease Fellowship at Yale. She has significant clinical and research experience with persons with and at risk of HIV and substance use disorders (SUD) including within the criminal justice system. She is the Director of InSTRIDE (Integrating Substance Use Treatment Research with Infectious Disease treatment for Everyone) at the Yale School of Medicine where she and her team conduct clinical research on the integration of SUD and Infectious Disease/HIV prevention and treatments. In particular, she has focused on evaluating medication treatments for opioid and alcohol use disorders to improve substance use and ID/HIV treatment outcomes. She is currently a Principal Investigator of 6 NIH awards and 1 VA Cooperative Studies award. In addition, Dr. Springer was awarded an Avant Garde Award by NIDA in June of 2022 to evaluate a cutting-edge mobile innovative program to provide medication treatment of opioid use disorder integrated with PrEP/ HIV treatment for people who use drugs wherever they live with mobile pharmacies, telehealth, and community health workers. She has presented her research numerous times both nationally and internationally and has published over 100 manuscripts and book chapters. 

Rachel Luba, PhD, Presenter

 

Rachel Luba is a clinical psychologist and post-doctoral research fellow in the division on Substance Use Disorders at Columbia University/NY State Psychiatric Institute. Her research focuses on investigating novel interventions for substance use disorders, with an emphasis on clinical trials for opioid use disorder. 

Michelle Strong, DNP, MSN, FNP- BC, CARN-AP, Presenter

 

Michelle Strong DNP, MSN, FNP- BC, CARN-AP is a Family Nurse Practitioner, certified in Addiction Medicine, at the Prisma Health Addiction Medicine Center in Greenville, SC. She helped build, launch, and currently serves as the Clinical Lead on Prisma Health’s Inpatient Addiction Medicine Consult Team and is the Project Director for the NIH funded COMMIT study. She has a background working in both adult and pediatric ICU and has worked with vulnerable pediatric populations in Alaska. Her research interests include the impact of fitness on mental health and substance use and the exploration of a functional medicine approach on patient’s perceived state of health. Strong is a two-time graduate of Emory University with a BS in biology/sociology and a BSN in nursing. She completed her MSN, graduating with honors in 2019 and finished her Doctorate of Nursing Practice with a concentration in Executive Health Systems Leadership at the University of Arizona in December of 2022. 

Alain Litwin, MD, MPH, Presenter

 

Dr. Alain Litwin is Vice Chair of Academics and Research and Professor of Medicine at Prisma Health, University of South Carolina School of Medicine – Greenville, and Clemson University School of Health Research where he serves as the Executive Director of the Prisma Health Addiction Medicine Center. He is board certified in internal medicine and addiction medicine, and has been providing medical care to people who use drugs with complex social, psychiatric and medical needs within an integrated primary care and substance use treatment program since 2000. Dr. Litwin’s research is focused on developing and studying models of addiction and medical care for people who inject drugs (PWID), and on advocating for increasing access to effective HCV care for all people who inject drugs and other marginalized populations. 

Edward Nunes, MD, Presenter

 

Dr. Nunes is Professor of Psychiatry at Columbia University Medical Center and New York State Psychiatric Institute (NYSPI), Principal Investigator (multiple PI) of the Greater New York node of the NIDA Clinical Trials Network (CTN), and a practicing psychiatrist Board Certified in Addiction Psychiatry and Addiction Medicine. He has devoted his career to research on the treatment of cocaine, opioid and other substance use disorders and is nationally and internationally recognized for his work on the evaluation and treatment of co-occurring depression, alcohol, cocaine and opioid use disorders and the development of pharmacological and behavioral treatments for substance use disorders as well as his work in the Clinical Trials Network testing the effectiveness of behavioral and pharmacological treatments in community-based treatment settings. Dr. Nunes has extensive experience with research on comorbidity of substance and psychiatric disorders, including co-occurring mood, anxiety disorders and ADHD. He also has extensive experience on the effectiveness and implementation portions of the translational spectrum, including leadership of two large multisite clinical trials in the clinical trials network, one of a computer-delivered behavioral therapy for substance use disorders (Campbell, Nunes et al., 2014) which served as the pivotal trial leading to FDA approval as a digital therapeutic, and one on treatment of opioid use disorder with XR-NTX vs buprenorphine (Lee, Nunes et al., 2019). He has extensive experience mentoring fellows and junior faculty, having recently completed two funding periods of a NIDA-funded K24 with emphasis on mentoring at NYSPI/CUMC. 

Frances Levin, MD, Presenter

 

Frances Rudnick Levin, MD is the Kennedy-Leavy Professor of Psychiatry at Columbia University and the Chief of the Division on Substance Use Disorders at NYSPI/CUIMC. Dr. Levin, working with Columbia University faculty, inaugurated the university-wide Center for Healing of Opioid and Other Substance Use Disorders: Enhancing Intervention Development and Implementation (CHOSEN) in 2020 and serves as one of the senior Directors. She is the Principal Investigator of a NIDA-funded T32, a K24 Mid-Career Investigator Award and several NIH grants. She is the Medical Director of two SAMHSA-supported grants, the Providers Clinical Support System and the STR-TA Opioid Response Network. Her current research interests include pharmacologic interventions for opioid, cocaine and marijuana use disorders, and treatments targeting adults with substance use disorders and attention-deficit hyperactivity disorder (ADHD). She was a long-standing member of the NIDA – Initial Review Group: Training and Career Development Subcommittee and the NIDA Interventions to Prevent and Treat Addiction (IPTA). She serves on the Board of Directors for the American Academy of Addiction Psychiatry (AAAP), CPDD, and the American Society of ADHD and Related Disorders (APSARD). She is a past President of the American Academy of Addiction Psychiatry and past Chair of the APA Council on Addiction Psychiatry. 
Summary
Availability:
On-Demand
Cost:
FREE
Credit Offered:
1.5 CME Credits
1.5 Other Professionals Credits
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