Timothy Wiegand, MD, FACMT, FAACT, DFASAM

Trump in Oshkosh, WI today. I’m very proud to tweet photos of my parents protesting at his appearance. I’m from the Fox Valley area in WI -this is a highly contested area. I remember community & neighborhood camaraderie not racism, bias, greed & fear. #TrumpIsACompleteFailure

So proud to have led this edition of NYS clinical guidelines in opioid use disorder treatment, geared toward outpatient clinicians. Here’s to expanding evidence-based and person-centered care for people who use drugs! @hivguidelines @CeiHcv @LorenzTaki @judithlgriffin @twtoxmd

Delta-8-THC higher cross reactivity than Delta-9-THC in immunoassay tests for Delta-9-THC. Delta-10-THC & Delta-P-THC less (+/- 25%). So yes these other cannabinoids can cause + THC UDS. To confirm sending GC/MS (expensive send out test) ⁦@ASAMorg⁩ ⁦@acmtmedtox⁩

Dr Alaina Steck on the medical claims for ‘grey market cannabinoids’ at the #ASAM2023 ⁦@acmtmedtox⁩ ⁦@ASAMorg⁩ Session “Delta What..?” So rats don’t eat as much after they are given THCV? 🤔—> Miracle weight loss drug in humans!!! 😃$$$ ⁦@TheSchwarziee⁩

Drs Laes ⁦⁦@TheSchwarziee⁩ Pueringer & Steck ⁦#ASAM2023 ⁦@acmtmedtox⁩ Collaborative Session “ Delta what…?” TCHP/Delta-9-P long side chain ->potent, 11-OH-THC long lasting (more produced with PO cannabis), CBN ? less potent advertised for sleep ⁦@ASAMorg⁩

Most salient part of Psychedelic session #ASAM2023 in final two slides (esketamine illustration) no matter efficacy if CPT codes not developed appropriately covering psychedelic treatment (& therapy) use —> limited to wealthy (self pay). ⁦@ASAMorg⁩ ⁦@acmtmedtox⁩

Much lower rates of psychoses & suicidality for patients treated using psychedelics compared to prescription stimulants #ASAM2023 & psychedelics don’t cause dependence tachyphylaxis occurs rapidly due to internalization of 5HT2A receptor ⁦@ASAMorg⁩ ⁦@acmtmedtox⁩

“Kidney stone to transcendent religious experience-ketamine in the ER.” Dr Andrew Herring @ #ASAM2023 0.5 mg/kg dose over hour =analgesic ‘smooth’ effect. Bup ppt wd start ketamine (CA Bridge guide)15-20 mg over 10-20 min ‘makes Bup stronger” ⁦@ASAMorg⁩ ⁦@acmtmedtox⁩

Xylazine #ASAM2023 all seats taken! Medical/Addiction Toxicologists explain xylazine & impact on heroin markets & users in 2023. >90% of ‘heroin’ supply contaminated/adulterated with xylazine in parts of Northeast. ⁦@ASAMorg⁩ ⁦@acmtmedtox⁩ ⁦@NYSAM_connect⁩

“You sign it you own it!” Words of wisdom on understanding what you sign for (bill) as physician from Kelly Clark MD, MBA, DFASAM, DFAPA #ASAM2023 John P. McGovern awardee. Congratulations Dr Clark! Well deserved. ⁦@ASAMorg⁩ ⁦@NYSAM_connect⁩ ⁦@kellyclarkmd⁩

Updating my ‘pruno’ recipe* at #ACME2023 (*note to self this is from botulism outbreak -emphasis on wash the 2 week old potato with soap TWICE!!!) ⁦@acmtmedtox⁩ ⁦@ORpoisoncenter⁩ ⁦@ZiadKazzi⁩ ⁦@TheSchwarziee⁩

B. Zane Horowitz #ACMT2023 on diagnostic Pentad for botulism in Alaska. Consider if individual has consumed Alaskan native food and has 3 of following: nausea or vomiting, dysphagia, diplopia, dilated fixed pupils, or dry throat. ⁦@acmtmedtox⁩ ⁦@ORpoisoncenter⁩

B. Zane Horowitz #2023ACMT Career Achievement Award (congratulations!) B. Is for ? Brooklyn? Bromism/Bromide? Black Tar Heroin? Botulism! (?) congratulations!!! ⁦@acmtmedtox⁩ ⁦@ORpoisoncenter⁩

Dr Craig Smollin presents #acmt2023 on use of the California Poison Control System CASUL (California Substance Use Line) to support front-line providers to treat buprenorphine. ⁦@PoisonInfo⁩ ⁦@UCSF⁩ ⁦@acmtmedtox⁩

Dr Matt Salzman -xylazine & impact on addiction medicine consults at Cooper hospital. Protocol for complicated fentanyl & xylazine dependence—> Bup Microinduction, high dose Clonidine, phenobarbital, dexmedetomidine (JAM paper) #acmt2023 ⁦⁦@acmtmedtox⁩ ⁦@ASAMorg⁩

#acmt2023 Ward Donovan lecture Gut/Brain axis & Psychoneuroendocrinology - translation to addiction med. Dr Lorenzo Leggio (NIDA)- ghrelin increases EtOH CPP & ghrelin receptor antagonism reduces CPP. High blood [ghrelin] Assoc EtOH craving. ⁦@acmtmedtox⁩ ⁦@ASAMorg⁩

Shannon Smith-Bernadin PhD, RN, CNL, on Managed Alcohol Programs in San Francisco c COVID19 (similar to MAPs in Canada) safe place to help people struggling with AUD - amount alcohol used decreased, LFTs didn’t rise, reduction in hospital & law encounters ⁦@NYSAM_connect⁩

“Pills have lower barrier to use.” Counterfeit opioid pills containing fentanyl widely available -2.5 million pills seized in Q4 2021! Fentanyl via pill form impacts different demographics younger less experienced high risk OD many not aware fentanyl ⁦@NYSAM_connect⁩

Dan Ciccarone MD MPH “Goofballs & Speedballs…” fentanyl trends at NYSAM 2023 most recent fatal OD data -Plateauing…? Little lingo around fentanyl “fetty” but not like heroin -lingo around “liked” things fentanyl less liked vs heroin? @NYSAM_connect⁩ + meth coming your way!

Dr. Wetterau discusses his early experience managing alcohol use disorder, the value of listening with kindness

“People came to me for their alcohol problems because I listened and cared.” Dr Norm Wetterau (NYSAM 2023). One can have all the credentials in the world but there are things much more valuable in addiction treatment. ⁦@NYSAM_connect⁩ ⁦@acmtmedtox⁩ ⁦@ASAMorg⁩