Arwen Podesta, MD: Best Practices for Treating Patients Addicted to Opioids


Patients struggling with addiction can be difficult to treat. Following best practices can help simplify a complex process.

Arwen Podesta, MD:

Getting a really good family history is one of the most essential things for doing any sort of psychiatric, clinical, pain management workup, or any crossover thereof — so a really good family history [is important] because people who have genetic loading of opiate misuse or opiate use disorders are very likely to have that themselves.

And then also having a very good clinical history, which we all do when time is allowed. But having a great clinical history [is important] to understand what different drugs, what different medicines have done to individuals.

If for example, someone is starting on a pain regimen for true pain after a surgery or after an injury, being able to work with that pain doctor as if you're the psychiatrist — being able to work with that pain doctor, or if you're working as the pain physician, being able to get an incredible clinical history of like, “Okay did you ever take Vicodin for your wisdom teeth removal? And what did that do for you? What did it do to your mind, your energy?”

Because if we know that someone is gonna get kind of spun up and get, like, energy from using opiates, or if they've ever misused opiates before recreationally, even in you know, college, and they're very far out, then they're more likely to become addicted to their pain medications at this time.

Also getting a really good psychiatric history, which all of us psychiatrists think that we do really well. So we're always looking at the biopsychosocial model, but part of that psychiatric history is going to include both drug use history, medication use history, but also a symptom history. And if people have comorbid psychiatric disorders plus pain, or their pain worsens when they are more stressed out, or you know, have more anxiety, or their mood is deeper and darker, then it's very essential to have a good work up and treatment plan for that.

More from the 30th Annual Psych Congress in New Orleans, LA.

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