ORN Spring 2025 - Case Reports - Diagnosis and Treatments-Recording - 2025-04-30

Video Transcription

Video Summary

In a recent AOAAM webinar, complex cases in opioid use disorder treatment were discussed. Dr. Jessica Moore, an addiction medicine specialist, presented an intriguing case involving presumed extended-release naltrexone precipitated withdrawal in a patient stable on buprenorphine. The patient, a 61-year-old man, mistakenly received naltrexone instead of buprenorphine, leading to severe withdrawal symptoms despite buoyant hospital intervention. The case highlighted the diagnostic utility of naltrexone levels and the potential of buprenorphine as a rescue for precipitated withdrawal.<br /><br />Following Dr. Moore, Dr. Julie Kamek presented another remarkable case regarding a patient with severe intranasal damage attributed to long-term use of xylazine and fentanyl. The 39-year-old woman experienced extensive nasal and oral damage likely worsened by the vasoconstrictive effects of xylazine. Despite a thorough workup ruling out other causes, the patient's damage was presumed due to her prolonged use of these substances. This case underscored the risk of intranasal use and the implications of emerging substances like xylazine.<br /><br />Both cases emphasized the need for careful assessment and innovative treatment approaches in managing opioid use disorder, particularly with the increasing presence of complex pharmacologic challenges.

Keywords

opioid use disorder

naltrexone withdrawal

buprenorphine

xylazine

fentanyl

intranasal damage

addiction medicine

pharmacologic challenges

treatment approaches