Penn Primary Care Podcast Update on Substance Use Disorders
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Jun 6, 2025 Dr. Ashish Thakrar, internist and addiction medicine researcher; Dr. Maggie Lowenstein, addiction clinician-researcher in primary care; Dr. Rachael Truchil, addiction medicine leader focused on tobacco cessation. They cover smoking cessation strategies and medications like varenicline and NRT. They discuss vaping and harm reduction. They review alcohol use disorder treatments including naltrexone, disulfiram, and pragmatic approaches to start meds before full readiness.
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Consider Combination Therapy For Severe Tobacco Dependence
- Combining varenicline with nicotine replacement is not FDA-recommended but can help patients with severe tobacco dependence.
- Clinicians may pair a long-acting agent plus short-acting gum/lozenge or nasal spray for breakthrough cravings.
Vaping Only As Harm Reduction Not First Line
- Do not routinely recommend vaping but consider it as harm reduction for smokers who won't use first-line treatments and must completely replace combustible cigarettes.
- Explain vapes contain nicotine, propylene glycol, flavorings, and fewer but present volatile organics and metals; emphasize unknown long-term risks.
No Safe Level Of Alcohol For Health Outcomes
- Recent evidence suggests any alcohol exposure carries health harms, especially cancer risk, outweighing earlier ideas of cardiovascular benefit.
- Risks rise sharply with bingeing and over ~14 drinks/week; account for higher modern ABV in beers and larger pours.