S3 Ep26: #536 Q&Apalooza: Your Addiction Questions Answered!S3 Ep26: #536 Q&Apalooza: Your Addiction Questions Answered!
The Curbsiders Addiction Medicine Podcast
A panel of addiction medicine clinicians answers audience questions on GLP-1s, naloxone, methadone, buprenorphine and complex pain management. The conversation stays practical and evidence-focused, highlighting both benefits and limits of current treatments for substance use disorders.
1:17:08•17 Aug 2026
Q&Apalooza: Tough Addiction Questions, Straight-Talking Answers
Episode Overview
- First-line, evidence-based medications for alcohol use disorder remain underused and should be prioritised before newer, less-tested options like GLP-1 agonists.
- Standard-dose intranasal or intramuscular naloxone remains effective for fentanyl-era overdoses; the best product is the one people actually have and know how to use.
- For hospitalised patients on methadone with unconfirmed doses, clinicians should use cautious starting doses, close reassessment, and every available route to verify clinic dosing.
- Patients on stable methadone or buprenorphine should usually continue these medications through surgery or acute illness, with additional multimodal and short-acting opioids for pain as needed.
- Flumazenil carries significant seizure and arrhythmia risks in possible benzodiazepine dependence, so supportive care is generally preferred over routine use.
““MOUD is life saving… 50% reduction in mortality.””
Curious about how others navigate their sobriety journey? This Q&Apalooza episode from The Curbsiders Addiction Medicine Podcast lines up real-world questions from clinicians and has the team talk through them with honesty, humour, and a lot of practical detail. The conversation centres on everyday clinical dilemmas in addiction care.
You’ll hear Drs Carolyn Chan and Ira Kryzhanovskaya steer a lively roundtable with colleagues Dr Shawn Cohen and Dr Zina Huxley-Reicher, all framed for health professionals who care for people with substance use disorders. They tackle off-label use of GLP-1 agonists for alcohol use disorder, remind everyone that first-line AUD meds are still underused, and point listeners towards ongoing trials rather than hype.
A big chunk of the chat breaks down naloxone formulations and doses, higher-dose products, and why “the naloxone that’s effective is the naloxone that’s available and that somebody has.” They stress harm reduction, the role of community organisations, and the new over-the-counter availability, while warning about precipitated withdrawal with high-dose products.
Methadone gets plenty of airtime: confirming doses when clinics are closed, starting doses if you can’t verify, rapid titration in the fentanyl era, and why TIP 63 keeps coming up. They dig into perioperative and acute pain management for people on methadone or buprenorphine, pushing for multimodal pain control, higher doses when tolerance is present, and strong coordination with outpatient prescribers.
The team also discuss flumazenil in suspected benzodiazepine overdose (mostly a “no”), cautious use of suzetrigine in acute pain, and practical moves when long-acting injectable buprenorphine doesn’t feel right and someone wants films again.
Throughout, they keep circling back to one core message: “MOUD is life saving… 50% reduction in mortality,” and connection is often the real “magic medicine.” If you’re a busy clinician wanting concrete, evidence-minded tips for tricky addiction cases, this Q&A might be exactly the refresher you need – what questions would you bring to their next round?
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