The World of Weird Withdrawal (1.5 CME)

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(1.5 CME) In this conference recording from the 2019 Annual Conference, you will learn that:

With changing patterns of opioid use, a growing number of patients are at risk for experiencing opioid withdrawal. Due to convenient access to “pseudo-medical” information via social media and purchasing options on the Internet, patients may be using a variety of substances to “self-detox” or to mitigate withdrawal symptoms at home, such as kratom, ibogaine, and loperamide, all of which have potentially toxic effects. Treatment and recovery providers need to be knowledgeable of how patients self-treat opioid withdrawal, and to understand and manage the complications that arise from such practices. Additionally, patients may present with precipitated withdrawal from buprenorphine, naltrexone, or well-intended naloxone administration. These periods of intense withdrawal place patients at risk for medical complications and can jeopardize the early stages of recovery. Understanding the risks and optimizing management using opioid and non-opioid strategies can comfort patients and improve treatment engagement. This session is an interactive case-based workshop in which clinicians will discuss strategies to manage patients with atypical or unusually severe presentations related to opioid self-detoxification and precipitated withdrawal. Cases will illustrate the expected and unintended consequences related to the use of loperamide, kratom, and ibogaine as agents of self-detoxification. Attendees will develop approaches to diagnose and manage the complications of these so-called “alternative” detoxification agents, and learn to identify and treat the withdrawal that develops after regular use of kratom. We will also review the pathophysiology of precipitated withdrawal, discuss strategies to prevent this complication, and examine options to manage severe withdrawal. As there is currently no consensus on the best practices for treating atypical or complex opioid withdrawal, this session will offer an in-depth look at the benefits, risks, and knowledge gaps in rapid buprenorphine induction after naloxone- or naltrexone-precipitated withdrawal, and evaluate the use of other evidence-based agents such as opioid agonists, alpha-2 agonists, gabapentin, and atypical antipsychotics for patients with these multifaceted opioid withdrawal syndromes.  

Learning Objectives:

1.)  Recognize the toxic syndromes that result from strategies patients use to self-treat opioid withdrawal.

2.)  Discuss the varied clinical presentation and management of patients with atypical or complex opioid withdrawal. 

3.)  Identify methods to minimize the risk of and manage precipitated withdrawal from opioid antagonists or partial agonists.

Aliana R. Steck


Dr. Alaina Steck is a graduate of the Keck School of Medicine at the University of Southern California, did her residency training in Emergency Medicine at Boston Medical Center, and completed fellowship at the Emory University / Centers for Disease Control and Prevention Joint Fellowship in Medical Toxicology. She is board-certified in Emergency Medicine, Medical Toxicology, and Addiction Medicine, and practices all three clinical specialties at Grady Memorial Hospital in Atlanta, Georgia. She serves as an assitant medical director at the Georgia Poison Center and the medical director of the Grady Medication-Assisted Opioid Treatment clinic.

ACCME Accredited with Commendation

ACCME Accreditation Statement

The American Society of Addiction Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

AMA Credit Designation Statement

The American Society of Addiction Medicine designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credit(s).  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ABPM Maintenance of Certification (MOC)

The American Board of Preventive Medicine (ABPM) has approved this activity for a maximum of 1.5 LLSA credits towards ABPM MOC Part II requirements.

ABAM Transitional Maintenance of Certification (tMOC)

This course has been approved by the American Board of Addiction Medicine (ABAM). Physicians enrolled in the ABAM Transitional Maintenance of Certification Program (tMOC) can apply a maximum of 1.5 AMA PRA Category 1 Credit(s)™ for completing this course.

ABIM Maintenance of Certification (MOC)

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn 1.5 Medical Knowledge MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.


Session Recording
Open to view video.
Open to view video. This session was recorded on 4/5/2019 in Orlando, FL
CME Quiz
3 Questions  |  10 attempts  |  2/3 points to pass
3 Questions  |  10 attempts  |  2/3 points to pass Complete the quiz to claim CME.
CME Evaluation
15 Questions
15 Questions Please complete the evaluation to claim CME.
CME Credit and Certificate
Up to 1.50 medical credits available  |  Certificate available
Up to 1.50 medical credits available  |  Certificate available 1.5 AMA PRA Category 1 Credits