The Curbsiders Internal Medicine Podcast #497 Methamphetamine Use Disorder: Tailoring and Ramping up Management with Dr. Phillip Coffin
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Sep 8, 2025 Dr. Phillip Coffin, Director of the Center on Substance Use and Health, discusses the evolving landscape of treating methamphetamine use disorder. He highlights a patient-centered four-step management approach, innovative medications, and the crucial role of harm reduction strategies. The conversation intertwines personal anecdotes with insights into assessing patient exposure and the importance of customized treatment plans. Listeners gain practical knowledge on integrating psychosocial therapies and the latest advancements in addiction medicine.
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Humanizing Personal Hobbies
- Phillip described personal hobbies like kite surfing and costume events, showing humanizing details outside medicine.
- These anecdotes framed him as a clinician who balances intense clinical work with creative and adventurous pursuits.
Long-Term Use Without Disorder Example
- Phillip shared a patient who used meth daily for decades but only had dental decay as a criterion, so he did not meet use-disorder thresholds.
- That case shows the difference between problematic use and formal use disorder and why screening matters.
Four-Tier Clinical Framework
- Use a four-tier approach: assessment, preventive care, use-reduction treatment, then toxicity prevention.
- Explain the framework to patients and revisit each tier across visits to engage them and guide care.