2026-2027 | On-Demand Session | Opioid Use Disorder: Board Review | September 2026-Opioid Use Disorder: Board Review Recording

Video Transcription

Video Summary

This lecture on opioid use disorder (OUD) combined board review with practical clinical guidance from Montefiore/Albert Einstein faculty. It opened with a strong emphasis on stigma, especially the risk of using drugs alone, and demonstrated a warm handoff to the Safe Spot overdose-prevention hotline, encouraging clinicians to ask patients directly whether they use alone and to save the hotline number for referrals.<br /><br />The presenters reviewed the opioid epidemic, including the four overdose waves: prescription opioids, heroin, fentanyl/synthetic opioids, and stimulant-related deaths often linked to fentanyl contamination. They explained opioid receptor pharmacology, common opioid types, and limitations of urine drug screens. OUD diagnosis was framed using DSM-5 criteria, while withdrawal and overdose were contrasted clinically using tools like COWS and symptomatic signs such as pupil size.<br /><br />Treatment focused on medications for opioid use disorder: methadone, buprenorphine, and naltrexone. Methadone was described as a full agonist, highly effective but heavily regulated in OTPs. Buprenorphine was emphasized for its partial agonist properties, ceiling effect, and multiple induction strategies, including standard, low-dose/microinduction, and rapid injectable approaches. Naltrexone was noted as safe and non-addictive but hard to start because it requires full opioid abstinence.<br /><br />The session also covered chronic pain management, stressing individualized, multimodal care and careful risk-benefit assessment when patients are already receiving opioids. Finally, it highlighted harm reduction strategies such as naloxone distribution, fentanyl/xylazine test strips, and overdose prevention centers, plus awareness of opioid-adjacent substances like kratom, 7-OH products, lean, and tianeptine.

Keywords

opioid use disorder

OUD

stigma reduction

overdose prevention

Safe Spot hotline

fentanyl contamination

DSM-5 criteria

COWS assessment

methadone

buprenorphine

naltrexone

naloxone distribution

harm reduction

urine drug screen

microinduction