Substance Use Disorder Treatment Trends and Hurdles

As the opioid crisis worsens—with over 108,000 drug overdoses in 2021—and clinicians continue to help patients overcome substance use disorders, it is imperative to understand what the field is up against during treatment. Following her Psych Congress 2022 session "The State of Substance Use: Current Trends," Arwen Podesta, MD, psychiatrist at Podesta Wellness, discussed the trends 2022 brought on in substance use and which drugs clinicians need to have on their radars for 2023.

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Arwen Podesta, MD, ABPN, FASAM, ABIHM, is a board-certified adult psychiatrist with sub-specializations in addiction medicine, forensic psychiatry, and integrative medicine. A graduate of the University of Southern California Keck School of Medicine, Dr Podesta completed her psychiatry residency in at Louisiana State University before pursuing a fellowship in forensic psychiatry at Tulane University.

In the aftermath of Hurricane Katrina, Dr Podesta became involved in actioning psychiatric care for underserved and disenfranchised populations and was awarded the Gambit’s 40 Under 40 in 2009. Since then she has been an enthusiastic participant in the public sector as medical director of multiple addiction treatment centers, and a consultant for the Orleans Criminal Court, Drug Court and Re-entry Services. Additionally, she maintains status as a consulting addiction medicine specialist and an expert witness. 

Read the Transcript: 

2022 has brought about some new and challenging hurdles in substance disorders. It's been a challenge with the opioid crisis. We've had such an increase in alcohol. And then we have some new smatterings of things that are really challenging for prescribers and treaters in the field. 

Of course, with the opioid crisis, we've had fentanyl added to so many different street drugs. Even non-opiates have fentanyl in it coming from the street in most jurisdictions. And it's really scary because the overdose risk with fentanyl is so high, and we've had so many losses over the years because of it. And it's getting worse, not better right now. Then there's kratom, which is actually over the counter and it's oftentimes purchasable at what used to be called a head shop, but at just a corner dispensary or corner store, and it has properties that are similar to opioids and also similar to speed methamphetamine. And so that's always concerning as well. And patients are coming in with needing treatment for withdrawal from kratom, but it's not similar to opioid withdrawal because it's more complicated because of the other components that are in the drug.

And then we have some newfound drugs that are on the market. And in certain areas around the country, we've seen xylazine which is a tranquilizer, and that plus the opioids can cause more overdoses. But it's also not necessarily trackable as far as a typical urine drug screen. We've also seen tianeptine, a tricyclic antidepressant that's being marketed on the web as a euphorigenic. And that plus the opioids or plus benzodiazepines can be perhaps more euphorigenic, but definitely more at risk of overdose and death.