Objectives: The aim of this is to provide a clinical example of acute alcohol withdrawal management and alcohol use disorder (AUD) relapse prevention, followed by a systematic review of the existing literature that provides clinicians with suggestions regarding treatment of this common clinical scenario. Methods: A case report was prepared with respect to the medical management of a patient that had been seen by our team. We searched “PubMed” and “The UBC Library Online Collections” using the search limits of subject terms for “alcohol withdrawal,” and “pregnancy,” and all fields for “management,” NOT “opioid.” We also reviewed medications frequently used in treating AUD as per the existing literature. Results: One case report met our search criteria. We also reviewed the recently published guidelines by the American Psychiatric Association. Several medications used in acute alcohol withdrawal and relapse prevention are known teratogens. However, several medications appear to be compatible with pregnancy and were found to be Category C and their use may outweigh the risks. Conclusions: There is a paucity of synthesized literature pertaining to alcohol withdrawal treatment and pregnancy. Given the relatively high prevalence of AUD in the population, further investigation is warranted. The current data supports a thorough consideration of the risks of medications against the known teratogenicity of alcohol. We suggest only brief use of benzodiazepines to manage the acute withdrawal from alcohol. Gabapentin, naltrexone, or acamprosate could be considered for AUD relapse prevention. Objectifs: L’objectif est de fournir un exemple clinique de gestion du sevrage alcoolique aigu et de prévention des rechutes liées à l’usage de l’alcool, suivi d’un examen systématique de la littérature existante fournissant aux cliniciens des suggestions concernant le traitement de ce scénario clinique courant. Méthodes: Un rapport de cas a été préparé concernant la gestion médicale d’un patient vu par notre équipe. Nous avons effectué une recherche dans «PubMed» et «Les collections en ligne de la bibliothèque de l’UBC» en limitant la recherche des termes utilisés pour «sevrage alcoolique» et «grossesse» et tous les champs pour «gestion», excluant «opioïdes». Nous avons également passé en revue les médicaments fréquemment utilisés dans le traitement des troubles liés à la consommation d’alcool, conformément à la littérature existante. Résultats: Une analyse de cas répondait à nos critères de recherche. Nous avons également examiné les lignes directrices récemment publiées par l’American Psychiatric Association. Plusieurs médicaments utilisés dans le sevrage alcoolique aigu et la prévention des rechutes sont connus comme agents tératogènes. Cependant, plusieurs médicaments semblent être compatibles avec la grossesse et se sont avérés être de la catégorie C et les effets bénéfiques l’emportaient sur les risques. Conclusion: Il existe peu d’études synthétisées sur le traitement de sevrage alcoolique en lien avec la grossesse. Compte tenu de la prévalence relativement élevée de troubles liées à la consommation d’alcool dans la population, des investigations supplémentaires sont nécessaires. Les données actuelles justifient un examen approfondi des risques des médicaments contre la tératogénicité connue de l’alcool. Nous suggérons de n’utiliser que brièvement les benzodiazépines pour gérer le sevrage aigu de l’alcool. La gabapentine, la naltrexone ou l’acamprosate pourraient être envisagés pour la prévention des rechutes liées à l’alcoolisme.

Objective: Despite increased public awareness and use of opioid agonist therapy (OAT), there is little published data on contraception among women on methadone or buprenorphine/naloxone. This study aimed to characterize patterns of contraception use among this population.Methods: We conducted a cross-sectional survey between May 2014 and October 2015 at 6 medical clinics, pharmacies, and community organizations in British Columbia. Trained surveyors used the Canadian Sexual Health Survey (CSHS) to collect information on contraceptive practices and barriers to health care access. Descriptive analysis was performed on the subset of women on OAT who were at risk for unintended pregnancy.

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Background Creating appropriate and sustainable treatment plans for patients with concurrent disorders presents a challenge to psychiatrists and addiction medicine specialists alike. Although varenicline has been found to be the most effective medication for smoking cessation and abstinence when compared to results from placebo medications, nicotine patches and bupropion, caution is needed when starting patients on this medication. With the high prevalence of concurrent mental health and substance use disorders in vulnerably-housed populations in Canada, it becomes increasingly important to advocate for increased guidance and research into treating concurrent disorders. Case presentation In this case, a young female patient provisionally diagnosed with bipolar I disorder was hospitalized for a manic episode in the context of substance use and medication noncompliance. She also endorsed a long history of tobacco, alcohol, cocaine, cannabis and ketamine use. Perceptual abnormalities, including auditory hallucinations, were not recorded at admission. In addition to being stabilized for bipolar diagnosis, the patient was started on nicotine replacement therapy on Day 7 of admission followed by initiation of varenicline for smoking cessation on Day 14 of admission. Soon after the varenicline treatment was started, the patient developed auditory hallucinations, paranoia and referential beliefs. However, her insight was intact, and she had minimal thought form disorganization. In this case, these symptoms were thought to be secondary to varenicline after the consideration of potential alternative contributors. Conclusion The occurrence of side effects as a result of varenicline use in patients with diagnosed mental health conditions is rare and underlying psychiatric illness is not labeled as an absolute contraindication in the prescription of varenicline. However, it is important to advocate for increased guidance and research on the treatment of substance use disorders in patients with bipolar I disorder. Patients may also benefit from increased collaboration between psychiatric and addiction services as that may allow for earlier recognition and intervention of symptoms to minimize distress.