Emerging Illicit Substances: What Clinicians Need to Know

EP 02 🎙 Special Series: ASAM's 56th Annual Conference

This episode is part of a special four-part series spotlighting key sessions from ASAM’s 56th Annual Conference.

In this episode of ASAM Practice Pearls, Dr. Stephen Taylor is joined by Drs. Jeanmarie Perrone and Alaina Steck to explore key insights from their session, Emerging Illicit Substances: What Clinicians Need to Know. The conversation covers emerging drugs of concern, clinical challenges, and practical strategies for clinicians navigating this rapidly evolving field.

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Stephen M. Taylor, MD, MPH, DFAPA, DFASAM

Dr. Stephen M. Taylor is ASAM's President and is board-certified in general psychiatry, child and adolescent psychiatry, addiction psychiatry, and addiction medicine. With over 30 years of practice experience, Dr. Taylor is dedicated to helping adolescents and adults overcome addiction and co-occurring psychiatric disorders. He has served as the Medical Director of the NBA and NBPA Player Assistance and Anti-Drug Program for 16 years and is the Chief Medical Officer of Pathway Healthcare, which operates multiple outpatient addiction and mental health treatment offices across six states.

Expert

Jeanmarie Perrone, MD

Dr. Jeanmarie Perrone is a Professor in the Department of Emergency Medicine and the founding Director of the Center for Addiction Medicine and Policy at the University of Pennsylvania. Dr. Perrone leads programs for the treatment of Opioid and Alcohol Use Disorders in the emergency department (ED) and a virtual telehealth bridge clinic (CareConnect). Her work has been funded by city health departments and by NIDA, PCORI, CDC, and SAMHSA. She has advocated at the state and national levels and contributed to working groups to enhance low-barrier treatment access for substance use disorders. She has been recognized with awards for leadership, education and mentorship and her initiatives have been featured in the media including National Public Radio, the New York Times and USA Today.

Expert

Alaina Steck, MD

Dr. Alaina R. Steck is an Associate Professor in the Emory Department of Emergency Medicine. She completed her residency training in Emergency Medicine at Boston Medical Center in Boston, MA, and her fellowship in Medical Toxicology at the Emory / Centers for Disease Control and Prevention Combined Fellowship in Medical Toxicology, followed by board certification in Addiction Medicine. She currently serves as the Medical Director of the Grady Medication for Alcohol and Opioid Use Disorder Treatment clinic, the Addiction Medicine Clerkship Director, Assistant Medical Director at the Georgia Poison Center, and Pharmacology Thread Director at the Emory School of Medicine.

📖 Show Segments

• 00:05 – Introduction
• 00:59 – An Overview of the Emerging Illicit Substances Session
• 02:08 – What Practitioners Should Know about Emerging Illicit Substances
• 03:36 – Specific Substances of Growing Concern
• 04:35 – Challenges in Clinical Practice
• 05:33 – Surprising Insights and Discussion from the Session
• 06:40 – Resources for Recent Data Trends
• 07:19 – Key Lessons for Practitioners to Implement Now
• 08:56 – Unique Withdrawal Syndromes 
• 11:27 – Anecdotal Examples of Rising Illicit Substances
• 14:06 – Communicating with Colleagues
• 16:14 – Conclusion and Additional Learning Opportunities

📋 Key Takeaways

• Emerging Illicit Substances: The landscape of psychoactive substances is evolving rapidly, with new agents continually appearing on the market.
• The Rise of Medetomidine as an Illicit Drug Adulterant: Medetomidine, a veterinary anesthetic, is an emerging concern as it seeps into the fentanyl drug supply as a replacement for xylazine in some parts of the country.
• New Withdrawal Syndromes: Medetomidine has led to a unique withdrawal syndrome that requires high-dose opioids and other sedative agents for management.
• Importance of Naloxone: Despite the emergence of new substances, fentanyl remains a major driver of opioid