Recap of random pearls and highlights from SGIM19 Day 2 including: methadone and buprenorphine, perioperative buprenorphine, medical cannabis, HPV vaccination, young adult medicine, academic promotions, long term sequelae of childhood kidney disease, stage 1 hypertension, some great free resources in addiction medicine, and more! Special thanks to the Society for General Internal Medicine for their hospitality. Full show notes available at https://thecurbsiders.com/episode-list. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Written, produced, and cohosted by: Paul Williams MD, Matthew Watto MD, Justin Berk MD, Carolyn Chan MD, Shreya Trivedi MD, Nora Taranto MS4 (soon to be MD!) Edited by: Matthew Watto MD Time Stamps and Links are included below 00:00 Intro and Disclaimer 02:30 Generalists receive the same number of grants, but publish fewer publications and are less likely to achieve professorship versus medical or surgical subspecialists (JGIM 2017) 05:30 GIM division directors differ in their emphasis on peer-reviewed publications for academic promotion (Acad Med 2015) 07:30 Only about 30% of patients are started on MAT after an overdose despite a known mortality benefit and a known mortality rate of 5% twelve month mortality in this population (Larochelle Annals Int Med 2018) 08:48 A representative in NYC has proposed a bill to get rid of the buprenorphine waiver program. 11:00 Stimulant use is not a contraindication to continuing buprenorphine (expert opinion from SGIM session on Addiction Medicine). 11:45 Perioperative buprenorphine: 1) Consider switching to full agonist therapy or 2) Dose buprenorphine 3-4 times daily and continue use during the perioperative period (Expert opinion from SGIM session titled “Buprenorphine 2.0”) 12:40 Options to transition from methadone to buprenorphine: Option 1) Taper methadone to 30-40 mg once daily. Then, hold methadone for 72 hours before starting buprenorphine. Option 2) “Microdosing” with buprenorphine patch while still on methadone and then start oral buprenorphine. Note: This is expert opinion so consult with your local expert before attempting this on your own! 13:46 UCSF has a “Warm Line” for free consultation about substance use https://nccc.ucsf.edu. Get a free buprenorphine waiver from https://pcss.org 15:10 New joint guidelines on transitions remind providers that young adults need help navigating the healthcare system. Many young adults have never accessed healthcare resources on their own (Pediatrics 2018) 18:50 Childhood kidney disease increases risk for end stage renal disease as an adult (NEJM 2018) 20:35 Two studies concluded that stage 1 hypertension in young adults confers an increased risk for morbidity and treating it confers a benefit (Yano AMA 2018; Son JAMA 2018) 23:35 HPV update: The 9 valent vaccine was approved for young adults age 27-45 years old, but this has not yet made it into the guidelines. The HPV vaccine is effective for preventing cervical cancer (Cochrane Review 2018) and provides some herd immunity (Clin Inf Dis 2018) 26:40 Dr Chan offers tips on how to handle resident mistreatment and phrases that you can use to defuse the situation. 31:30 Some broad comments on the use of medical cannabis for pain management (Expert opinion from SGIM session) 36:30 Newer data suggests that even one drink daily might have adverse health outcomes (Lancet 2019). 39:00 Outro Citation Paul Williams MD, Matthew Watto MD, Justin Berk MD, Carolyn Chan MD, Shreya Trivedi MD, Nora Taranto MS4. Recap SGIM19 Day 2”. The Curbsiders Internal Medicine Podcast https://thecurbsiders.com. May 17, 2019.