Opioid Use Disorder: Board Review (2025-2026 Recording)-Opioid Use Disorder: Board Review Recording

Video Transcription

Video Summary

This didactic session from Montefiore Medical Center/Albert Einstein College of Medicine provided a board-review and clinically practical overview of opioid use disorder (OUD), opioid withdrawal/overdose, and chronic pain management. The presenters emphasized the central role of stigma and person-centered language, noting that stigma delays care and worsens outcomes. They reviewed the opioid epidemic’s “waves” (prescription opioids, heroin, fentanyl/synthetic opioids, and increasing stimulant-related overdoses due to contaminated drug supply), as well as opioid pharmacology, receptor effects, and the limits of urine drug screening for many synthetic/semi-synthetic opioids.<br /><br />A major focus was treatment of OUD with the three FDA-approved medications: methadone, buprenorphine, and naltrexone. Methadone was described as highly effective but tightly regulated through opioid treatment programs (OTPs), with concerns about access, stigma, and outdated rules. Buprenorphine was highlighted as broadly accessible and increasingly used in new initiation strategies, including low-dose (“microinduction”), high-dose, and direct-to-inject long-acting formulations. Naltrexone was discussed as safe and nonaddictive but hard to start and less effective overall, especially for opioid use disorder.<br /><br />The team also reviewed opioid withdrawal scoring tools, naloxone use and compassionate overdose response, and harm reduction strategies such as never using alone, fentanyl test strips, and overdose prevention hotlines. The final section focused on chronic pain and long-term opioid therapy, stressing validation, multimodal care, cautious risk-benefit assessment, and the role of buprenorphine for pain. The session ended with discussion of opioid-adjacent substances like kratom and tianeptine.

Keywords

opioid use disorder

OUD

opioid withdrawal

opioid overdose

chronic pain management

stigma

person-centered language

methadone

buprenorphine

naltrexone

naloxone

harm reduction

fentanyl

microinduction

urine drug screening