Workshops, Papers and Posters

A1: Beyond Induction: Side Effects of Medications for Substance Use Disorders after Initial Period of Treatment – a Master Clinician’s Workshop

Chairpersons: Akhil Anand, MD, Psychiatrist, Cleveland Clinic, Program Director, Addiction Psychiatry Fellowship at University Hospitals Cleveland Medical Center; and Jeremy Weleff, DO, Assistant Professor, University of Alberta / Yale University

Presenters: Akhil Anand, MD, Psychiatrist, Cleveland Clinic, Program Director, Addiction Psychiatry Fellowship at University Hospitals Cleveland Medical Center; Jeremy Weleff, DO, Assistant Professor, University of Alberta / Yale University; and Muhammad Aadil, MD, Assistant Professor of Psychiatry, Albert Einstein College of Medicine

While medication initiation often receives the most clinical attention, challenges during maintenance can significantly affect adherence, treatment retention, therapeutic alliance, and long-term recovery. This 90-minute interactive workshop is designed for clinicians who prescribe medications for substance use disorders and are seeking practical, real-world strategies to address side effects and other barriers that arise beyond the induction phase.

Presenters will share clinical pearls informed by both direct clinical experience and a review of the scientific literature. Topics were selected based on feedback from addiction specialists at the presenters’ affiliated institutions, highlighting areas of greatest clinical relevance. These include dental complications from buprenorphine, naltrexone-induced dysthymia, sexual side effects related to opioid agonist treatment, methadone-induced diaphoresis, and drug-drug interactions that every addiction specialist should be prepared to identify and manage. The workshop will also address persistent pharmacology myths and media-driven narratives that influence prescribing decisions and patient perceptions.

Most importantly, through structured case-based discussions, interactive polling, and facilitated group dialogue, this workshop will foster a highly engaging space for peer-to-peer learning and collaborative problem-solving. Of the total session time, 60 minutes will be devoted to interactive learning. The format is intentionally designed to prioritize attendee participation, and content will be adaptable based on participant feedback and cases.

By the end of the session, attendees will be better equipped to anticipate, recognize, and manage maintenance-phase side effects and prescribing challenges—enhancing their ability to deliver consistent, confident, and individualized care across the continuum of substance use disorder treatment.

Learning Objectives:

• Recognize common and clinically significant side effects associated with
  maintenance-phase pharmacotherapy for substance use disorders
• Apply evidence-based strategies to manage and mitigate these side effects
  in clinical practice.
• Identify prevalent pharmacology myths and media-driven narratives that
  influence prescribing decisions and patient engagement with medications for substance use
  disorders.

A2: Ketamine: The Paradox of Ketamine Addiction and Ketamine as an Emerging Tool for Treatment of Addictions

Chairperson: Madison Buchanan, MD, Psychiatrist, Madison Buchanan MD PC

Presenters: Martin Epson, MD, Psychiatrist, Martin F Epson, MD, Inc; and Emily Tejani, MD, Psychiatrist, Private Practice

Ketamine’s history spans from its 1970 FDA approval and battlefield use in Vietnam to its rise as a club drug in the 1990s and mental health treatment in the 2000s. While its rapid expansion raises concerns—especially with availability of “at-home” ketamine therapy in the absence of psychiatric care—data supports robust effectiveness in the treatment of depression, with burgeoning promise in the treatment of substance use disorders.

Ketamine has potential in treating substance use disorders, particularly those with limited pharmacological treatments such as cocaine use disorder. Many SUDs which overlap with co-occurring depression have positive responses to ketamine. Beyond its biochemical effects, ketamine can induce a profound, often spiritual experience, a state recognized as transformative in addiction recovery. In group settings, it fosters connection, shared insight, and emotional breakthroughs, reinforcing community healing. Though at first blush it may seem radical and risky, ketamine holds potential as a therapeutic tool facilitating established components of addiction treatment: spirituality, community, and mindfulness.

Ketamine misuse is rising, particularly among young people, many of whom present with bladder damage, cognitive impairment, and dependence. Despite its medical potential, ketamine use disorder is often minimized, delaying diagnosis and treatment.

How do we navigate ketamine’s power for both healing and harm? This workshop explores its role as a spiritual catalyst and clinical tool in addiction treatment while emphasizing ketamine addiction itself as a significant and expanding disorder. Appropriate patient selection, route of administration and early recognition of ketamine misuse can empower providers to maximize its benefits while minimizing risk.

Learning Objectives: 

• Participants will learn identification, diagnosis and evidence-based
  treatments of ketamine addiction.
• Participants will learn evidence supporting ketamine use in the treatment
  of other addictions.
• Participants will determine appropriate patient selection , considering risks,
  benefits, appropriate route of administration and setting.

A3: International Models of MOUD Care

Chairperson: Pouya Azar, MD, Addiction Psychiatrist, Vancouver General Hospital, The University of British Columbia

Presenters: Andrew Herring, MD, Chief of Addiction Medicine, Highland General Hospital–Alameda Health System; and Pouya Azar, MD, Addiction Psychiatrist, Vancouver General Hospital, The University of British Columbia

Opioid overdose remains a major cause of preventable death across North America. While medications for opioid use disorder (MOUD) are highly effective in preventing overdose and improving clinical outcomes, significant barriers to access and implementation persist. This workshop will feature international clinicians from the US and Canada, who will share their models of care for expanding and tailoring MOUD to diverse populations. The session will include case discussions, audience polling, and patient testimonials to encourage interaction and practical engagement. Dr. Pouya Azar (Canada) will share his experience leading an interdisciplinary addiction, mental health, and pain consult service, and providing MOUD to patients in Vancouver’s Downtown Eastside, a community with high rates of fentanyl use, co-occurring mental health conditions, and complex social challenges. He will also present his previous work as Addiction Lead at Foundry, a youth health network, where he developed holistic engagement strategies, including virtual care, outreach, and recreational activities, to enhance MOUD access and adherence. Additionally, he will highlight emerging approaches to rapidly initiate buprenorphine, such as symptom-inhibited naloxone inductions and direct initiations onto monthly extended-release buprenorphine. Dr. Andrew Herring (USA) will discuss the California Bridge Program, which facilitates low-barrier MOUD initiation in emergency departments and ambulatory clinics. He will also highlight innovative pilot programs involving emergency medical services to initiate buprenorphine. Furthermore, he will present on high-dose inductions and the management of precipitated opioid withdrawal. Several of these approaches are now reflected in North American guidelines, including the California Bridge Program. By exploring these international perspectives, attendees will gain practical tools for implementing MOUD models tailored to diverse and underserved populations.

Learning Objectives:

• Discuss the rationale, evidence, and utility of interdisciplinary consult
  services that integrate addiction, mental health, and pain care.
• Discuss the rationale, evidence, and utility of tailoring MOUD to diverse
  care settings and patient populations.
• Discuss the rationale, evidence, and utility of emerging buprenorphine
  initiation approaches in enhancing MOUD access.

A4: Harm Reduction in Adolescents: What, When, and How?

Chairperson: Brady Heward, MD, Associate Professor of Psychiatry, University of Vermont Larner College of Medicine

Co-Chair: Peter Jackson, MD, Associate Professor of Psychiatry, University of Vermont Larner College of Medicine 

Presenters: Jennifer Creedon, MD, Assistant Professor of Clinical Psychiatry at LSUHSC New Orleans; Peter Jackson, MD, Associate Professor of Psychiatry, University of Vermont Larner College of Medicine; Anne McBride, MD, Child and Adolescent Forensic Psychiatrist, University of California, Davis; and Brady Heward, MD, Associate Professor of Psychiatry, University of Vermont Larner College of Medicine

Harm reduction has a strong and growing evidence base to support it as a fundamental approach to adults who use substances. Despite recognition that those who develop substance use disorders often start using as adolescents, the application of harm reduction strategies to adolescent substance use has not shared the same emphasis nor research base. This workshop will use cases, media and audience participation to review the existing evidence base, highlight key differences between minors and adults who use drugs, and explore audience comfort in utilizing the same harm reduction techniques with minors as used with adults. Harm reduction will be framed within the prevention and treatment system for adolescent substance use. Particular emphasis will be on how harm reduction can supplement but should not supplant other efforts to reduce risk through prevention, early intervention, and treatment. State specific limits in available adolescent-specific treatment and differences in consent will also be explored in how this may change the need and opportunities to expand harm reduction to minors. Families, parents/guardians, and schools can both facilitate and impede the application of harm reduction in youth.

Learning Objectives: 

• Review the available evidence base on harm reduction practices as applied to adolescents who use substances.
• Frame harm reduction within the adolescent prevention, early intervention, and treatment system with emphasis on limits of current availability and how families, parents/guardians, and schools may be both barriers and facilitators of harm reduction application.
• Recognize opportunities to expand, apply, and educate about harm
  reduction principles to those who work closely with adolescents.

A5: A Step by Step Guide to Forensic Evaluations for Addiction Psychiatrist

Chairperson: Elie Aoun

Co-Chair: Laurence Westreich

Presenters: Carol Weiss, MD, Clinical Associate Professor of Psychiatry and Clinical Associate Professor of Psychiatry in Medicine, Weill Cornell Medical College, New York-Presbyterian Hospital; and Debra Pinals, MD, Senior Medical and Forensic Advisor, National Association of State Mental Health Program Directors

Non-forensically trained addiction psychiatrists are frequently asked to perform forensic evaluations. They often decline to take on the assignment due to a lack of familiarity with forensic evaluation procedures. This workshop aims to provide a practical step by step guide for conducting forensic evaluations examining:

1. Initial contact with attorney
2. Gathering of materials
3. Reviewing materials
4. Feedback to hiring attorney based on the materials
5. Planning the interview
6. Interview
7. Post interview
8. The forensic report
9. Preparation for testimony

Learning Objectives: 

• Gain confidence in one’s ability to conduct forensic evaluation.
• Appreciate the ways forensic evaluations differ from clinical treatment
  evaluations.
• Familiarize oneself with forensic evaluation procedures.

B1: Applying the Sequential Intercept Model to Advance Addiction Treatment Across Systems

Chairperson: Jacob Johnson, MD, Chief Resident and Fellowship, Public Psychiatry, UCSF

Presenters: Shruti Rajan, MD, Psychiatry Resident, San Mateo Psychiatry Residency; Kitt Allenser, Clinical Nurse Educator, San Mateo County, CA Correctional Health Services; and Mary Taylor, LMFT, Clinical Services Manager, San Mateo County Behavioral Health & Recovery Services, Alcohol & Drug Division

This interactive workshop will guide participants through the use of the Sequential Intercept Model (SIM) as a framework to understand and improve addiction treatment across carceral and behavioral health systems. Originally developed by Munetz and Griffin (2006), the SIM identifies six key intercepts community services, law enforcement, initial detention/court hearings, jails/courts, reentry, and community corrections—where interventions can divert
individuals with substance use disorders (SUDs) toward treatment rather than incarceration.

Participants will work in small groups using interactive case-based scenarios to identify where current systems fail individuals with SUDs and where evidence based strategies (e.g., MAT, peer recovery support, co-responder models) can be effectively implemented. Emphasis will be placed on cross-sector collaboration, trauma-informed care, and cultural responsiveness.

Munetz, M. R., & Griffin, P. A. (2006). Use of the Sequential Intercept Model as an approach to decriminalization of people with serious mental illness. Psychiatric Services, 57(4), 544-549.

Learning Objectives:

• Describe the six intercepts of the Sequential Intercept Model and their
  relevance to addiction psychiatry.
• Identify opportunities at each intercept to improve access to addiction
  treatment and recovery support services.
• Apply the SIM to a clinical or community scenario to design a systems-level
  intervention plan.

B2: Knowledge and Skills Workshop: Brief Educational Interventions to Reduce Addiction Stigma among Providers and Patients 

Chairperson: Alena Balasanova, MD, Associate Professor, Nebraska Medicine / University of Nebraska Medical Center

Co-Chair: Jeremy Weleff, DO, Assistant Professor, University of Alberta / Yale University

Presenters: Sandra DeJong, MD, Child/Adolescent Psychiatry Training Director and interim Division Chief, Cambridge Health Alliance, Associate Professor, Harvard Medical School; Michael Dawes, MD, Clinical Professor of Psychiatry, Program Director, BU/VA Addiction Psychiatry Fellowship; and Jacob Givens, MD, Resident Physician, University of Nebraska Medical Center

Stigma towards those who use substances or have substance use disorders (SUDs) is rooted in the longstanding history of moral superiority and “othering” that permeates many cultures towards marginalized sectors of the population. The language used to describe substance use reflects this history: Words like “dirty” and “clean” have permeated our description of people who use substances not yet in treatment, associated paraphernalia, and even the individuals who are in treatment and return to use. The persistence of substance use stigma creates significant barriers to effective treatment and harm reduction, for both patients seeking help and clinicians providing care. Despite advances in understanding SUDs as chronic medical conditions, individual developmental and historical factors intersecting with societal and institutional biases continue to influence perceptions, behaviors, and policies. Stigma is deeply rooted in society and history. Clinicians are often hesitant to treat SUDs, and thus, trainees (and currently practicing physicians) have inherited these biased and toxic beliefs from society and their mentors. Explicitly considering how these beliefs contribute to the Professional identify Formation of our trainees is critical. After defining and describing the various aspects of stigma (public-, self-, and structural), and their relationships to other social determinants, we will present a menu of creative educational interventions to address stigma, ranging across fields from journalism to neuroscience. We will explore aspects of stigma, stigma’s manifestations in the clinical learning environment, and present practical strategies for psychiatric educators to mitigate stigma, with the goal of improving care and harm reduction strategies.

Learning Objectives:

• Distinguish different aspects of stigma (public-, self-, and structural), and
  apply these aspects of stigma to other social determinants.
• Identify ways in which our clinical learning environments may
  unintentionally contribute to stigma and integrate substance use stigma into our learners’ professional identity formation.
• Apply brief educational interventions designed to reduce stigma in clinical
  care and harm reduction settings.

B3: Successes and Lessons Learned in Addiction Psychiatry Public Health Initiatives in California

Chairperson: Michael Hoefer, MD, Addiction Psychiatry Consultant, San Francisco VA

Presenters: Tim Fong, MD, Professor of Psychiatry, Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA; Larissa Mooney, MD, Professor of Clinical Psychiatry and Director of the Addiction Psychiatry Division, Department of Psychiatry and Biobehavioral Sciences at UCLA, Director, UCLA-VA Addiction Psychiatry Fellowship Program, Deputy Chief, Substance Use Disorders Subdivision at Greater Los Angeles VA; Aaron Meyer, MD, Assistant Clinical Professor, University of California San Diego’s Department of Psychiatry; and Jeffrey Devido, MD, FAPA, Chief of Addiction Services, Marin County’s Dept of HHS, Behavioral Health Clinical Director, Partnership HealthPlan of California

Due to geographic, political, and socioeconomic factors California has seen a dramatic increase in homelessness, mental health morbidity, and drug overdoses in recent years. In response to these critical issues, California has invested significantly in healthcare funding, access, and the development of innovative strategies to address the mental health and drug overdose epidemic. The AAAP Annual Meeting will be held in San Francisco, CA November 6th-9th 2025. Our proposed symposium will highlight the successes and lessons learned while implementing innovative public health strategies to address the needs of individuals with substance use disorders in the state of California, including: no cost access to gambling disorder treatment statewide, the roll out of contingency management throughout the state via the Medi-Cal system, the recent approval of statutes allowing for involuntary civil commitment for grave disability of individuals with substance use disorders, and the use of the Medi-Cal Waiver system to fund creative harm reduction initiatives, digital technology solutions, street medicine teams, and integrated peer support recovery programs.

Learning Objectives:

• Identify at least 3 innovative public health approaches implemented in
  California to address the mental health and overdose epidemic.
• Understand how the Medicaid Waiver can be utilized to fund innovative
  strategies to address the treatment needs of individuals with substance use disorders.
• Identify at least 1 new treatment approach that can be implemented in
  your practice setting.

B4: Change Starts with the Body: Addressing Interoceptive Dysfunction during Substance Use Disorder Treatment and Recovery

Chairperson: Zev Schuman-Olivier, MD, Associate Professor in Psychiatry, Director of Addictions Research, Director, Center for Mindfulness and Compassion, Harvard Medical School – Cambridge Health Alliance

Presenters: Sahib Khalsa, MD, PhD, Associate Professor in Residence, Director of Anxiety Disorders Research, West Innovation Chair, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry at UCLA; Wolf Mehling, MD, clinical research fellowship at UCSF, faculty, Department of Family and Community Medicine and UCSF Osher Center for Integrative Health; and Jamie Baik, MD, Med, Resident, Cambridge Health Alliance

Interoception—the nervous system’s mapping of the body’s internal signals—plays a critical role in mental health and substance use disorders. Recent studies from the field of interoceptive neuroscience demonstrate that disrupted interoceptive processing can intensify cravings, impair decision-making, and exacerbate anxiety and depression in substance use disorders. This workshop will introduce key concepts of interoception and its disruption in patients with substance use disorders and co-occurring psychiatric disorders by leaders in basic and clinical interoception science. Brief patient vignettes will illustrate how interoceptive dysfunction can manifest in clinical practice. The presenters will also review evidence from novel interventions that enhance interoceptive awareness and support self-regulation, offering new tools for recovery. Attendees will participate in a brief experiential interoceptive practice designed to address dysregulation and will learn evidence-based behavioral and experiential strategies to address interoceptive dysfunction in their patients.

Learning Objectives:

• Identify symptoms of interoceptive dysfunction in patients with substance
  use disorders.
• Describe scientific evidence linking interoceptive dysfunction to mental health and substance use disorders.
• Apply interoceptive regulation strategies to reduce craving, improve emotion regulation, and enhance decision-making capacity in patients with co-occurring substance use and mental health disorders.

B5: The Resistant Patient, The Family in crisis: What to Do when You Get the Call. “Please Help Me Get My Loved One to Enter Treatment for Their Addiction. We Have Tried Everything! Can You help?

Chairperson: Lisa Goldfarb, MD, Assistant Clinical Professor, NYU Langone Medical Center

Presenters: Carrie Wilkens, PhD, Co-Founder, Clinical Director, Center For Motivation and Change; Charles Silberstein, MD, Medical Director, Martha’s Vineyard Community Services; Stephen Ross, MD, Professor of Psychiatry and Child & Adolescent Psychiatry, NYU Grossman School of Medicine; and Lisa Goldfarb, MD, Assistant Clinical Professor, NYU Langone Medical Center

We will present case material and then discuss skills needed to work with this family who is desperate to get help for their child/ spouse/ partner

We will cover:
The initial phone call from the distraught family member
How to approach the first appointment.

Carrie Wilkens MD will then review the key components of effective evidence-based family-centered approaches such as Community Reinforcement and Family Training (CRAFT), Invitation to Change (ITC), Behavioral Couples Therapy (BCT), and Multi-Dimensional Family Therapy (MDFT). Charlie Silberstein, MD will review self-help family support options including Al-non, Adult Children of Alcoholics, self-help options – SMART for Families, ITC groups, CRAFT for families.

After the presentation of new skills and review of how to best approach this case, we will break up into small groups of 2 or 3 and practice this approach. This will enable the clinicians to practice using the language involved in this evidence-based family approach.

Learning Objectives:

• The addiction psychiatrist should feel comfortable communicating with a
  family member and helping them with the necessary steps to get their loved one good evidenced based care.
• The addiction psychiatrist should be familiar with effective evidence-based
  family-centered approaches such as Community Reinforcement and Family Training (CRAFT), Invitation to Change (ITC), Behavioral Couples Therapy (BCT), and Multi-Dimensional Family Therapy (MDFT).
• The addiction psychiatrist should be familiar with 12 Step self-help groups: What is Alanon? How is it useful for family members? What is Adult Children of Alcoholics? How is it useful for patients and families?

C1: How to Use Rtms for Comorbid Substance Use Disorder and Major Depressive Disorder: Practical Considerations, Guidelines, Case Discussion

Chairperson: Kathleen Brady, MD, Distinguished University Professor, Medical University of South Carolina College of Medicine

Co-Chair: Hamed Ekhtiari, MD, PhD, Psychiatry Resident, Department of Psychiatry

Presenter: Victor Tang, MD, MSc, FRCP(C), Addiction Psychiatrist and Clinician Scientist, Centre for Addiction and Mental Health (CAMH), Assistant Professor, Dept of Psychiatry at the University of Toronto

This workshop provides an in-depth exploration of the application of
repetitive transcranial magnetic stimulation (rTMS) in treating individuals with comorbid Substance Use Disorder (SUD) and Major Depressive Disorder (MDD). Given the high prevalence and complex interplay of these conditions, integrated treatment approaches are imperative. The session aims to equip clinicians and researchers with practical guidance, evidence-based protocols, and personalized considerations for utilizing rTMS effectively in this challenging population.

Led by three renowned experts—Kathleen Brady, Hamed Ekhtiari, and Victor Tang—the workshop offers diverse perspectives spanning addiction psychiatry, addiction medicine, and clinical neuroscience. Kathleen Brady will discuss recent advances in neurostimulation techniques and their implications in SUD treatment and its comorbidities. Victor Tang will focus on guidelines and protocols tailored to patients with comorbid MDD and SUD, emphasizing safety and ethical considerations. Hamed Ekhtiari will present illustrative case discussions, highlighting real-world applications, troubleshooting, and individualized treatment planning.

Participants will engage in interactive case analyses, exploring decision-making processes, stimulation parameters, and monitoring strategies. The workshop emphasizes practical considerations such as patient selection, contraindications, session scheduling, and integrating rTMS with other therapies. It aims to bridge research findings with clinical practice, fosteringconfidence in implementing rTMS for this complex cohort.

By the conclusion, attendees will have enhanced their understanding of pragmatic approaches, gained insights from expert experiences, and acquired tools for optimizing outcomes in patients facing dual diagnoses. This session underscores the potential of rTMS as a versatile adjunct in managing comorbid SUD and MDD, ultimately advancing personalized psychiatric care.

Learning Objectives:

• To learn about advances in neurostimulation as they apply to SUDs.
• To learn about recent advances in neurostimulant treatment and how these
  apply to the treatment of SUDs.
• To learn about practical considerations such as patient selection,
  contraindications, session scheduling, and integrating rTMS with other therapies.

C2: Food Addiction in Psychiatric Practice: Emerging Roles for GLP-1 Receptor Agonists

Chairpersons: Muhammad Aadil, MD, Assistant Professor of Psychiatry, Albert Einstein College of Medicine; and Robert Rymowicz, DO, Addiction Psychiatrist, Rx Neuroscience, President-Elect, Arizona Psychiatric Society, Associate Professor of Psychiatry, Creighton University School of Medicine, Director of Substance Use and Addiction Treatment, CHI Health

This interactive session will enable participants to define, screen, diagnose,
and treat food addiction. This workshop will introduce the burgeoning concept of food addiction, distinguishing it from other eating disorders. Participants will explore various approaches to screening, focusing on the neural and behavioral aspects of food addiction.

We will examine how high-sodium and high-fat foods trigger brain reward pathway changes, leading to addictive behaviours. Innovative treatment strategies, particularly pharmacological options, will be discussed. Special attention will be given to GLP-1 receptor agonists, such as semaglutide and tirzepatide, highlighting their potential to modulate neural reward pathways and reduce compulsive eating.

The session will provide appropriate prescribing guidelines for GLP-1 receptor agonists, ensuring effective integration into psychiatric practice. Additionally, the workshop will help participants develop a conceptual understanding of food addiction, equipping them with the knowledge to effectively address and manage this condition. By the end, attendees will have a comprehensive understanding of food addiction and practical tools for treatment.

Learning Objectives:

• Define and differentiate food addiction from other eating-related disorders using current neurobehavioral models and diagnostic frameworks. 
• Evaluate evidence-based screening tools and treatment strategies for food
  addiction, including behavioral and pharmacologic interventions.
• Describe the mechanism of action, clinical application, and prescribing
  considerations for GLP-1 receptor agonists (e.g., semaglutide, tirzepatide).

C3: A Multidisciplinary Clinical Approach to Religion, Spirituality, Psychedelics, and Harm Reduction

Chairperson: Kelly Park, MD, Addiction Psychiatrist, LA County DMH

Presenters: Oriana Mayorga; Kelly Park, MD, Addiction Psychiatrist, LA County DMH; and Jeremy Weleff, DO, Assistant Professor, University of Alberta / Yale University

Religion and spirituality (r/s) are distinct but interrelated constructs with
implications for human well-being and growth. Within mental health, r/s have been shown to be important to patients and associated with positive health outcomes and have been of interest within research in substance use and substance use recovery. There has been a growing interest in and use of places of worship and spiritual practices in substance use disorder care, leading to strategic interventions based in spiritual or religious places, languages, and sensibilities. In addition, the growing “psychedelic renaissance” has contributed to an increase in interest in the role of psychedelics as an adjunct in substance use recovery modalities.

Therefore, multidisciplinary clinicians focused on substance use may be called increasingly in the future to attend to religious and spiritual aspects of substance use recovery. In this workshop, we will explore how r/s and psychedelics can be utilized in clinical work, and in particular for harm reduction. We will first present a literature review based on sources from around the world that discuss the intersections of r/s, psychedelics, and harm reduction. We will then facilitate an interactive exercise led by a chaplain for self-reflection and application of findings presented in the literature review.

Learning Objectives:

• Compare and contrast religious and spiritual approaches to harm reduction
  from worldwide literature.
• Discuss the intersections of religion, spirituality, psychedelics, and harm
  reduction in clinical settings.
• Apply multidisciplinary perspectives regarding harm reduction and
  spirituality in a chaplain-led interactive small group exercise.

C4: Club Drugs in Rave America: A Clinical and Cultural Perspective

Chairperson: Akhil Anand, MD, Staff Psychiatrist, Cleveland Clinic

Presenters: Nora Burns, DO, Psychiatrist, Cleveland Clinic Foundation; Eric Dobson, MD, Addiction Psychiatry Fellow, Case Western Reserve University, School of Medicine; and Akhil Anand, MD, Staff Psychiatrist, Cleveland Clinic

“Club drugs” refer to a range of psychoactive substances commonly used in nightlife settings such as raves and music festivals. Popular among young adults, these substances are often taken to enhance sociability, sensory experiences, and sexual behavior. However, they also pose significant medical and psychiatric risks, including acute intoxication, cognitive impairment, withdrawal syndromes, and addiction.

This workshop will explore the pharmacologic, psychological, and sociocultural aspects of three club drugs: methamphetamine, GHB, and MDMA. Each substance will be examined within the context of nightlife and countercultural environments, with discussion of historical background, patterns of use, clinical and recreational applications, and associated harms. Emerging public health concerns, such as high-risk sexualized drug use, will also be addressed.

Sixty minutes of the session will be dedicated to interactive learning. Each drug-specific segment will include a clinical case to support practical decision-making and illustrate how these substances present and are managed in real-world clinical settings. A sensory demonstration—integrated throughout the workshop—will use music, lighting (if feasible), and safe, non-intoxicating props such as miracle berries and candy to simulate a club-like environment. Adapted from the National Neuroscience Curriculum Initiative and the presenters’ training programs, this activity has received enthusiastic feedback from learners and is designed to foster a deeper understanding of the subjective experience of drug use. It is also easily replicable in other teaching settings and may be something workshop attendees choose to use in their own educational environments. Additional audience engagement will include interactive polling and a 10-minute Q&A focused on clinical complexities.

Learning Objectives:

• Summarize the historical and cultural context of club drug use in nightlife
  and countercultural settings.
• Describe the pharmacology, psychological effects, and patterns of use of
  GHB, methamphetamine, and MDMA.
• Identify and manage acute and chronic complications of substance use,
  including intoxication, withdrawal, and addiction, using evidence-based treatment strategies.

C5: Introduction to EMDR: What is Trauma Response Cycle? How Do We Recognize and Treat Trauma in Our patients?

Chairperson: Lisa Goldfarb, MD, Assistant Clinical Professor, NYU Langone Medical Center

Presenters: Carol Weiss, MD, Clinical Associate Professor of Psychiatry and Clinical Associate Professor of Psychiatry in Medicine, Weill Cornell Medical College, New York-Presbyterian Hospital; and Lisa Goldfarb, MD, Assistant Clinical Professor, NYU Langone Medical Center

We often hear the question, “What is trauma?” How do we identify it in our patients? What treatments can be helpful? We will explain what is meant by “trauma”. Where is trauma stored in our nervous systems.

We will review the trauma response cycle: Fight, Flight, Freeze, Fawn and Appease.

We will explain the EMDR treatment for trauma and then will teach the attendees the skill of how to use EMDR for resourcing. We will lead them through an exercise using EMDR bilateral stimulation and “resourcing” to settle their nervous systems.

Learning Objectives: 

• Understand the Trauma Response Cycle.
• Understand the treatment of using EMDR (bilateral stimulation) for trauma
  therapy.
• Be able to use EMDR bilateral stimulation resourcing as one possible skill to
  settle the nervous system.

A1: Modeling the Population-Level Impact of Psychedelic Decriminalization

Jacob Steinle, MD, Resident Physician, Washington University School of Medicine, Department of Psychiatry

As U.S. states and cities move toward decriminalizing and legalizing psychedelic —most notably psilocybin—clinicians, educators, and policymakers are left with critical questions about the potential public health consequences. This presentation reports findings from a national study examining hallucinogen-related emergency department visits and inpatient hospitalizations from 2016 to 2023 using commercial and Medicaid claims data (MarketScan®). The analysis employed a flexible Bayesian change-point model to track trends in monthly hallucinogen related admissions (ICD-10: F16.XX) within the broader landscape of substance-related hospital care.

In this large national cohort of over 1.3 million individuals aged 16–64, we found that fewer than 1% of monthly substance-related admissions involved hallucinogens. When excluding admissions co-occurring with other substance use diagnoses (e.g., alcohol, opioids), this figure dropped below 0.25%. Compared to substances like alcohol and cannabis, hallucinogen-related admissions remain rare. Notably, we observed a decline—not an increase—in hallucinogen-related admissions following the initial wave of psychedelic decriminalization laws in 2020.

These findings carry important implications for front-line clinicians. First, concerns that decriminalization would drive acute psychiatric or toxicologic harm requiring hospitalization have not, thus far, borne out in national data. Second, our data suggest that when hallucinogen-related admissions do occur, they often affect individuals with underlying psychiatric conditions such as mood (35%), anxiety (29%), or schizophrenia spectrum disorders (15%). This underscores the importance of careful mental health screening and patient education as psychedelics become more accessible.

By participating in this session, clinicians will be able to: (1) Recognize current national trends in hallucinogen-related hospital admissions and how they compare to other substance-related admissions in clinical practice; (2) Identify key clinical and psychiatric risk factors associated with hallucinogen-related admissions in the context of increased public access due to decriminalization; (3) Apply evidence-based insights on the limited acute care impact of psilocybin decriminalization to guide patient conversations and inform local substance use risk assessments.

This work informs both clinical and policy responses. It suggests that while vigilance is warranted, particularly among patients with preexisting psychiatric conditions, broad-based alarm over the effects of decriminalization on emergency and inpatient care may be premature. Future research should focus on sub-populations at greater risk and incorporate regional analyses to assess localized policy impacts.

Learning Objectives:

• Recognize current national trends in hallucinogen-related hospital admissions and how they compare to other substance-related admissions in clinical practice.
• Identify key clinical and psychiatric risk factors (e.g., co-occurring substance use disorders) associated with hallucinogen-related admissions in the context of increased public access due to decriminalization
• Apply evidence-based insights on the limited acute care impact of psilocybin decriminalization to guide conversations with patients and inform local substance use risk assessment.

C2: Rising Trends in Suicide and Self-Harm Mortality among U.S. Individuals with Mental and Behavioral Disorders Due to Psychoactive Substance Use (1999-2023)

Humza Saeed, BSc, Medical Student, Rawalpindi Medical University, Rawalpindi, Pakistan

This study analyzes trends in suicide and self-harm mortality among U.S. individuals diagnosed with mental and behavioral disorders due to psychoactive substance use from 1999 to 2023 using CDC WONDER data. Results show a significant rise in age-adjusted mortality rates (AAMRs), with the highest increases among males, middle-aged and older adults, and individuals identifying as non-Hispanic American Indian/Alaska Native or White. Non-metropolitan residents consistently faced higher mortality rates, demonstrating geographic disparities. These findings have important clinical implications, highlighting the need for integrated, culturally competent care that addresses both mental health and substance use, especially in underserved and high-risk populations. For research, the study points to the need for deeper investigations into the social and structural drivers of these trends and the effectiveness of targeted suicide prevention strategies. Educational programs must train providers to assess suicide risk in patients with co-occurring disorders and address stigma and cultural barriers. Policy efforts should focus on expanding access to behavioral health services, improving data infrastructure, and supporting community-based prevention initiatives. This study emphasizes on a growing crisis at the intersection of addiction, mental illness, and suicide that demands a coordinated response across healthcare, education, research, and policy sectors.

Learning Objectives:

• To describe national trends in suicide and self-harm mortality among individuals with mental and behavioral disorders due to psychoactive substance use in the United States from 1999 to 2023.
• To identify key demographic disparities in age-adjusted mortality rates to inform targeted, evidence-based prevention strategies.

A3: New Onset Pharmacotherapy for Adhd in Adulthood and the Later Risk of Developing Substance Use Disorders: A Retrospective Cohort Study

Vinod Rao, MD, PhD, Psychiatrist, Massachusetts General Hospital

This study investigates the relationship between adult onset ADHD pharmacotherapy and subsequent risk of developing stimulant (stimUD) or other substance use disorders (SUD), Using real-world electronic health record data, we compared the effects of stimulants vs. non-stimulants, amphetamine vs. methylphenidate, and immediate-release vs. extended-release stimulants. Contrary to longstanding concerns, we found no evidence of increased stimUD/SUD risk associated with stimulant treatment and, in some cases, a modest protective effect.

Learning Objectives:

• Compare the relative risks of SUD and stimUD associated with stimulant vs.
  non-stimulant ADHD pharmacotherapy in adults.
• Compare how stimulant class (amphetamine vs. methylphenidate) and formulation type (immediate-release vs. extended-release) influence the risk of developing substance use disorders.
• Understand how age at first treatment may moderate the association between stimulant use and SUD development

A4: Trends in Urinary Toxicology among Psychiatric Emergency Service Patients: Shifts in Fentanyl and Cocaine Use

Khaled Draghmeh, MD, Postdoctoral researcher, VA Connecticut Healthcare System

The current opioid crisis in the United States has evolved through multiple waves, with the “fourth The current opioid crisis in the United States has evolved through multiple waves, with the “fourth wave” marked by the growing co-use of opioids and stimulants. Not only have the rates of overdose mortality involving stimulants such as cocaine and methamphetamine sharply risen, stimulant-related deaths are now intertwined with the ongoing opioid epidemic [1–3]. The co-use of stimulants and opioids carries significant health risks, as stimulants can mask symptoms of opioid overdose, thereby reducing the likelihood that naloxone will be administered [4]. Individuals who co-use opioids and stimulants often fail to identify as opioid users, which reduces their likelihood of accessing opioid-specific harm reduction resources, such as fentanyl test strips and take-home naloxone [5].

Our study aimed to examine trends in substance use among veterans presenting to the psychiatric emergency service (PES) at the VA Connecticut Healthcare System. We aimed to compare the findings of this study to prior studies conducted in 2018 and 2022, focusing on the changes in fentanyl use over time and its relationship to other opioids and cocaine. To achieve this, we analyzed urine drug screen (UDS) results from all patients who presented to the PES over a 24-month period between 2022 and 2024.

These findings have multiple implications. Clinically, they highlight the importance of routine UDS testing in psychiatric settings, particularly in detecting unintentional opioid use in patients using stimulants. In addition, further education and training are needed for providers to recognize the complex substance use patterns now seen in emergency psychiatric populations. Policy-wise, there is an urgent need to expand harm reduction efforts, including fentanyl test strip availability and education tailored to stimulant users.

In conclusion, our study contributes novel insights into the dynamic nature of substance use trends among veterans in a psychiatric emergency setting. The shifting patterns highlight a need for responsive public health strategies that align with the evolving drug landscape, particularly the increasing co-use of fentanyl-contaminated stimulants.

Learning Objectives:

• Understand changes in opioid use over time.
• Identify trends in fentanyl and stimulant co-use.
• Identify gaps in Psychiatric Emergency Service toxicology screening.

B1: The Association between Changes in Audit-C Scores and Acute Mental Health Care Utilization over the next Year in a Primary Care Population

Megan Lee, PGY3 Resident, University of Washington

Unhealthy alcohol use (UAU) is common in primary care populations and can significantly impact mental health. Screening for UAU with the AUDIT-C questionnaire within primary care is validated and increasingly used for point-in-time identification of UAU, but it is less clear whether changes in alcohol screening scores over time reflect capture changes in alcohol-related risk. If changes in alcohol screening scores correlate with changes in meaningful health outcomes, such as mental health acute care utilization, it would suggest that repeated alcohol screening scores could be used not only for point-in-time identification of UAU but also to track changes in alcohol risk over time. We hypothesize that increases and decreases in AUDIT-C scores across longitudinal screening will have dose-dependent increases and decreases in non-substance use mental health acute care utilization risks, respectively.

This retrospective cohort study used data from adult primary care patients in a Washington state health system who had completed two AUDIT-C screens 11-24 months apart.  AUDIT-C scores at each time point (T1, T2) were grouped into five categories reflecting increasing levels of alcohol consumption, ranging from “no use” to “very high-risk UAU.” Generalized estimating equation models tested whether changes in AUDIT-C score categories from T1 to T2 (i.e., increases or decreases in self-reported alcohol consumption) were associated with changes in risk for mental health acute care utilization (emergency department, acute care, or hospital admission) over a one-year outcome period following T1 and T2.

In our sample of 165,101 patients (61% female; mean age 55), overall mental health acute care utilization risks were 0.9% and 0.8% during the one-year period after T1 and T2, respectively. For patients who reported stable drinking (i.e., same AUDIT-C score category at T1 and T2), mental health acute care utilization did not substantially change the year after T1 and T2 (0.8% at both time points). For patients who reported a 1-level decrease in AUDIT-C score category, mental health acute care utilization significantly decreased comparing the year after T1 and the year after T2 (1.1% and 0.9%, P<0.01). For patients who reported a 2-level decrease or more, mental health acute care utilization decreased by an even larger magnitude (T1: 2.5%, T2: 1.4%, P<0.001). Increases in AUDIT-C score categories were not associated with increased risk of mental health acute care utilization. 

Our study found that, among primary care patients who had completed two AUDIT-Cs 11-24 months apart, mental health acute care utilization was highest among those with the highest risk drinking categories. Longitudinal decreases in patient-reported alcohol use (reflected by changes in AUDIT-C screening score categories) were associated with changes in a meaningful mental health outcome that is not reliant on patient self-report. These findings suggest that changes in AUDIT-C score categories may be used for longitudinal monitoring purposes, including in primary care settings that have implemented alcohol screening primarily for cross-sectional point-in-time screening of alcohol-related risk. Contrary to our hypotheses, increases in AUDIT-C score categories were not associated with increased risk for mental health acute care utilization; these findings may be due to time lag of greater than one year of increased alcohol use on utilization rates or that there is no association between increased use and increased utilization.

Changes in alcohol screening scores may offer clinicians, health systems, and researchers meaningful information about changes in risk for adverse health outcomes, including risk for adverse mental health outcomes. Providers could use AUDIT-C scores to understand potential consequences of alcohol use on mental health and to communicate the benefits that non-abstinent reductions in drinking may bring for patients. This study’s findings also help validate the AUDIT-C as measure that could potentially be used longitudinally in research to measure changes in alcohol use. Our study shows that reducing UAU is associated with decreased mental health acute care utilization; therefore, treating UAU in primary care and other medical settings could reduce costs and distress associated with mental health-related hospitalizations and emergency department encounters.

Learning Objectives:

• Understand the significance of the application of longitudinal AUDIT-C
  screening in primary care settings.
• Interpret AUDIT-C score changes over time and their association with
  mental health utilization outcomes.
• Communicate to patients about how reductions in alcohol use scores may
  reduce risk for poor mental health outcomes, especially for patients who are not ready to completely stop drinking.

B2: The Impact of a Brief Personally Tailored Opioid-Overdose and Medication for Opioid Use Disorder Education intervention, Relative to control, on the Acceptance of Naloxone in Peripartum Persons

Michelle Lofwall, MD, Professor of Behavioral Science and Psychiatry, Medical Director of First Bridge and Strauss Clinics, University of Kentucky, College of Medicine

This paper presentation demonstrates that peripartum persons on medication for opioid use disorder treatment (MOUD) are willing to accept naloxone if offered, and they are more likely to accept it after a brief personally tailored opioid overdose and MOUD educational (TOME) intervention. The presentation will start with briefly reviewing the increase in opioid-involved overdose deaths among peripartum persons, their unmet clinical needs along the opioid clinical care continuum and discussing common misinformation and ineffective strategies about how to respond to opioid-related overdose (e.g., placing person in cold water/in ice in a tub). The presentation will then share the results from this NIDA-funded Clinical Trials Network study (CTN 0150). This randomized clinical trial evaluated TOME versus a control condition (educational pamphlets from the Substance Abuse and Mental Health Services Administration) on naloxone uptake as a secondary analysis. Lessons learned including specifics on how clinicians can positively impact naloxone access, MOUD and opioid overdose knowledge, and patients’ feelings of stigma related to being on MOUD will be discussed. Quotes will be shared from intervention study staff and patients.

Learning Objectives:

• Develop an approach for engaging a peripartum patient receiving MOUD
  who does not currently have access to naloxone.
• Integrate health literacy assessments about MOUD and opioid overdose
  education into patient care for opioid use disorder.
• Develop an approach for talking with patients on MOUD who may refuse
  free naloxone and express family and/or employer stigma regarding MOUD.

B3: Religion and Spirituality Moderate the Association between Chronic Pain and Substance Misuse among U.S. Adults at Midlife

Yu-Tien Hsu, MD, PhD, Postdoctoral Associate, Yale School of Public Health

This presentation addresses a critical public health issue, as approximately 54.2 million Americans aged 12 and older required treatment for substance use disorders in 2023, yet only 23% necessary care. Understanding how pain experience, social connectedness, financial insecurity, and spirituality influence substance misuse is essential for comprehensive care. Using data from the Midlife in the United States (MIDUS) national sample (N=4,962) and Milwaukee Black American sample (N=876), we investigated how religious attendance, spirituality, and social connectedness interact with pain interference and financial stress in predicting substance misuse.

Pain interference was measured using a five-item Brief Pain Inventory summed scale (0-50) assessing functional impact across daily activities, mood, relationships, sleep, and enjoyment. Financial insecurity was assessed through a 20-item composite score capturing adverse experiences including job loss, housing instability, missed payments, and debt. Substance misuse was defined as non-prescribed medication use or illicit substance use in the past 12 months. Spirituality was measured using five items reflecting inner peace, beauty appreciation, life connection, and caring for others. Religious participation was assessed through frequency of service attendance (infrequent, weekly, frequent). Social connectedness comprised six dimensions, including neighborhood cohesion, social integration, and family/friend support. Multiple linear regression models tested main effects and interaction terms across both samples.

Learning Objectives:

• Identify protective factors: Participants will be able to identify how religious
  attendance and spirituality serve as protective buffers against pain-related substance misuse in different populations, enabling targeted intervention strategies.
• Recognize risk amplifiers: Participants will be able to recognize that
  financial insecurity consistently increases substance misuse risk across diverse populations, and that social connectedness may paradoxically amplify pain-substance misuse relationships in certain communities.
• Apply culturally-tailored approaches: Participants will be able to apply
  population-specific knowledge of religious/spiritual protective factors to develop culturally-responsive substance misuse prevention programs for patients experiencing chronic pain.

B4: Tracing a Decade of Benzodiazepine Use Prescription Patterns, Discontinuation, and Relapse in a Community Outpatient Addiction Recovery Program

Muhammet Celik, MD, Psychiatry Resident, New York Medical College

Benzodiazepines (BZDs) are among the most prescribed medications in the United States, but long-term use raises concerns about dependence, withdrawal, and overdose risks. Over the past 20 years, research has explored patient characteristics and BZD types linked to relapse after discontinuation. However, despite numerous studies, findings remain inconsistent.

One study found lower baseline prescriptions, shorter use duration, male gender, and short half-life BZDs (<24 hours) increased successful discontinuation. Conversely, use of multiple BZDs was associated with relapse.

Another study using Medicaid data showed Sedative, Hypnotic, or Anxiolytic Use Disorder (SHA-UD) diagnoses among young adults with BZD prescriptions rose from 0.52% to 2.00% (2001–2019), while the estimated lifetime U.S. prevalence is 1%. Additionally, between 2004–2011, opioid-related overdose deaths involving BZDs rose from 18.4% to 31%.

BZDs have remained controversial since their introduction. This study uniquely examines BZDs in an outpatient SUD treatment program, aiming to improve prescribing and deprescribing practices.

The Outpatient Addiction Recovery Services program is a community-based, multidisciplinary outpatient SUD treatment program. In this single-site, retrospective chart review study, based on EHR data, 51 patients prescribed BZDs (FY 2014–2024) were identified. Demographics and psychiatric diagnoses were collected.

EHR data were analyzed for BZD initiation, discontinuation, and prescribed types. Relapse, defined by positive urine drug screens for BZDs, was assessed through progress notes and lab records until discharge.

Learning Objectives:

• To understand the patterns of benzodiazepines in a community-based
  outpatient addiction recovery program.
• To identify common co-occurring substance use and psychiatric disorders
  among patients with Sedative, Hypnotic, or Anxiolytic Use Disorder.
• To understand the factors influencing benzodiazepine discontinuation and
  relapse rates, particularly among individuals with co-occurring substance use disorders.

C1: Comparative Effectiveness of Methadone and Buprenorphine-Naloxone in Individuals with a Past-Year Opioid Overdose

Robert Kleinman, MD, Clinician-scientist, Institute for Mental Health Policy Research at the Centre for Addiction and Mental Health (CAMH), Assistant Professor, Department of Psychiatry at the University of Toronto

The proposed activity will present findings from a population-based, retrospective cohort study following the target trial framework that compared the effectiveness of methadone and buprenorphine-naloxone in patients with a past-year history of a non-fatal overdose. The presentation will highlight 1) the high risks of mortality, opioid-involved overdose, and treatment discontinuation experienced by this patient population; 2) the comparative effectiveness of methadone and buprenorphine-naloxone in this patient population. The presentation of the study results will be followed by a question and answer period.

Learning Objectives:

• Describe the risks of mortality, opioid-involved overdose, and treatment
  discontinuation experienced by individuals with a non-fatal opioid overdose.
• Describe the comparative effectiveness of methadone and
  buprenorphine-naloxone in individuals with a past-year non-fatal opioid overdose.

B2: Assessing the Acceptability of Group Based Psychotherapy for Comorbid PTSD and SUD in Incarcerated Populations

Molly Wootten, MPH, DO, PGY4 Psychiatry Resident, University of Arkansas for Medical Sciences (UAMS)

This study examined the acceptability of two types of group therapy, cognitive processing therapy (CPT) and PTSD Coping Skills (PCS), among people with co occurring post-traumatic stress symptoms (PTSS) and substance use disorders (SUD) who were incarcerated in one of two minimum security prisons in a midsouthern state during their group participation. Here, we report data on reasons for enrollment, satisfaction, and perceived impacts. Results can inform practitioners looking to provide acceptable, evidence-based care for PTSS/SUD to a high-need, underserved population.

Learning Objectives:

• Describe the factors influencing the acceptability of two approaches to
  treating co-occurring PTSS and SUD in prisons.
• Evaluate the role of implementation feedback including enrollment
  motivation, satisfaction with, and perceived impact of two approaches to treating PTSS in high-need, correctional populations with co-occurring SUD.

B3: Finances and Treatment: A Qualitative Study of Pwud in New Haven

Razi Kitaneh, MD, Postdoctoral Associate, Yale Program for Recovery and Community Health

We will present findings from an ongoing study exploring the financial lives of People who use Drugs (PWUD). Finances play a significant role in the trajectories of PWUD, from initiating drug use to recovery, and potential relapse, but significant gaps in knowledge exist about the nature of the intersection of finances and drug use/recovery, and whether and how we can intervene around finances to support recovery and prevent relapse. We will present the background, approach, methods and findings of our study, as well as recommendations regarding i) future research, ii) potential tools and educational materials for use in clinical settings, and iii) policy reform targeting the mechanisms that exist for removing financial control from individuals (eg. representative payee, conservatorship), products and services offered by the financial services industry and regulations of this industry, particularly the debt industry.

Learning Objectives:

• Better understanding of the interplay between finances and drug use.
• Better understanding of the role of finances in recovery and relapse.
• Identify specific ways to advise regarding finances to support recovery.

B4: Assessing an ICD-10 Code Approach for Tracking Xylazine-Involved Overdose Deaths in the United States

Joseph Friedman, PhD, MD, MPH, Resident Physician in the research track, Substance Use Researcher, Department of Psychiatry, University of California, San Diego (UCSD)

The prevalence of the veterinary sedative xylazine in US overdose deaths rose between 2018 and 2021. More updated estimates are limited, partially due to the lack of a dedicated ICD-10 code—a primary mechanism used to specify drugs implicated in overdose deaths in the US, including in the CDC WONDER system, which provides public data requests with a 6-month lag. For other emerging substances lacking dedicated codes, umbrella codes have come to de facto represent them, over time, yet it has not been demonstrated if this has occurred for xylazine.

Methods
Overdose deaths in CDC WONDER involving T42.7 (“Antiepileptic and sedative-hypnotic drugs, unspecified”) or T46.5 (“Other antihypertensive drugs, not elsewhere classified”) were compared to two more specific, albeit delayed, sources: NVSS describing national trends in 2018-2021 and SUDORS describing state-level trends in 2020-2022. This CDC WONDER approach was also used to estimate trends in xylazine-involved deaths through Q1 2024 by geography, race/ethnicity, substance co-involvement, and demographic categories.

Results
At the national level, concordance between CDC WONDER records and previous NVSS estimates improved after 2019 and became highly similar in 2021 (3,480 vs 3,468 deaths). Concordance was also high for estimates stratified by race, age, and region. At the state-level, across 49 state-year pairs, correlation between CDC WONDER and SUDORS was 0.97. Estimated xylazine-involved deaths doubled between 2021 and 2024 Q1, and estimated racial inequalities widened.

Discussion
T42.7 or T46.5, together, may have become the de facto coding scheme representing xylazine-involved deaths. This approach provides more up-to-date estimates, showing increasing prevalence and worsening racial inequalities in xylazine-involved deaths into 2024.

Learning Objectives:

• Understand the evidence supporting the use of ICD-10 codes for tracking
  xylazine involved overdose deaths and the spread of xylazine.
• Describe the latest trends in the spread of xylazine, including by
  geography, race, and time.