Treatment and care for stimulant use disorder

Podcast

Season 3: Episode 2 - June 8 2023

Runtime: 30:40

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Summary

Individuals and communities in BC are facing an increased risk of stimulant-related harms. Stimulant use can cause significant harms on its own, including negative cardiac and mental health outcomes. In the context of the unregulated drug supply, toxic drug poisonings can occur due to contamination of stimulants with opioids and other substances.

In this episode of Addiction Practice Pod, Dr. Marcus Greatheart and David P. Ball talk with addiction psychiatrist Dr. Julius Elefante, about harm reduction and treatment for stimulant use disorder. We also hear from the executive director of UNDU, Katt Cadieux, on the importance of trusting your patient and building a care plan based on their lived experience.
 

Learning Objectives

  1. Recognize the increasing risk associated with stimulant use in BC and identify strategies to reduce stimulant-related harms.
  2. Discuss evidence-based psychosocial treatment options for stimulant use disorder and how to apply clinical judgement to determine the best course of treatment.
  3. Describe pharmacological interventions that have been studied in the academic literature, recognizing the limits in currently available evidence to apply these to clinical practice.
  4. Describe the cultural context associated with sexualized stimulant use and harm reduction approaches that may be utilized.

 
Lineup

In this episode, you’ll hear:

  • 3:07 – Dr. Julius Elefante – Staff Psychiatrist, St. Paul’s Hopsital; Clinical Assistant Professor, University of British Columbia
  • 19:20 – Katt Cadieux – Executive Director and Founder, Uniting Northern Drug Users UNDU’ing Stigma

 
Pearls

Here’s what listeners can take away from this episode:

  1. To ensure your approach to screening, treatment, and harm reduction is non-stigmatizing, it is important to consider social contexts that underly stimulant use. For example, factors that contribute to sexualized stimulant use.
  2. Psychosocial treatment is currently the standard of care for stimulant use disorder. Common psychosocial treatment modalities for stimulant use disorder, such as contingency management and community reinforcement, involve reinforcing positive behavioural change and leveraging the support of family and friends during treatment.
  3. Currently, there is a lack of evidence for pharmacological interventions for stimulant use disorder. That said, a small subgroup of patients who have been prescribed stimulants have experienced benefits, including reduced reliance on or use of unregulated street stimulants. Clear communication with patients about the lack of available evidence is important if a pharmacological intervention is being considered.
  4. Unregulated stimulants are often contaminated with other substances and co-occurring stimulant and other substance use is common. As a result, withdrawal and treatment can be complex, and individuals may not be aware of all the substances they’ve been exposed to.
  5. Education around harm reduction is always important. Strategies for reducing harms from stimulant use include not using alone, having naloxone available, and ensuring adequate sleep, nutrition, and hydration.
  6. And finally, it is essential that clinicians listen to the needs and goals of patients to work together to decide the best course of treatment, while providing stigma-free and compassionate care.

Claim CME self-learning credits.
 

Resources

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