The most dangerous phrase in senior health might be “I’ve always handled it fine.” We dive into how aging reshapes the risks of alcohol, benzodiazepines, opioids, nicotine, and today’s ultra‑potent cannabis—and why familiar habits can turn hazardous after 65. Drawing on frontline cases and recent research, we unpack the baby boomer lived experience, from “mother’s little helper” to daily cocktail hours in senior communities, then connect it to the biology of aging: slower metabolism, reduced kidney and liver function, impaired balance, and sharper sensitivity to side effects.

You’ll hear why DSM‑5 criteria still apply but require age‑aware interpretation, what “code cannabis” looks like in the ER when edibles or high‑THC products masquerade as stroke, and how subtle red flags—poor sleep, irritability, shakiness, forgetfulness, falls—signal a brewing problem. We get practical about safer detox for older adults, the reality of kindling with alcohol withdrawal, and the medication decisions that matter: when to taper sedatives, how to avoid dangerous interactions, and why nutrition and B‑vitamins can’t be an afterthought. Two real-world cases ground the lessons—titrating decades‑long benzodiazepine and Z‑drug use while reducing fall risk, and using naltrexone strategically for late‑onset alcohol use without tipping a patient into instability.

If you care for an older adult—or you are one—this conversation offers clear steps to lower risk and raise quality of life: rethink sleep meds, reduce alcohol use, check cannabis potency, simplify regimens, and choose therapy and support groups that fit your season of life. Subscribe, share this with a friend or colleague, and leave a review with your biggest takeaway so we can keep building smart, stigma‑free care for older adults.

To contact Dr. Grover: ammadeeasy@fastmail.com

Food isn’t just fuel and obesity isn’t just willpower. We sat down with bariatric surgeon Dr. Mark Vierra to unpack what weight-loss surgery really changes, why genetics and hormones can overpower the best intentions, and how a careful program decides who needs a scalpel and who needs a different plan. From GLP‑1 surges and ghrelin drops to PYY’s “brake,” we walk through how surgery reshapes appetite signals and why even modest weight loss can dramatically improve diabetes and cardiovascular risk.

The conversation goes beyond the operating room. Dr. Vierra explains why five of six referrals don’t get surgery, how he and his partner analyze food diaries, depression, and daily constraints, and when medications like bupropion or GLP‑1s make more sense. We explore binge patterns, the messy reality of predicting who will do well after weight loss surgery, and the tough calls around patients who’ve been told their BMI is destiny when their labs and function say otherwise. The story shifts sharply when we talk alcohol: after gastric bypass, blood alcohol rises faster and stays higher, which raises the risk of alcohol use disorder over time. We share practical ways to screen motives for drinking, plan safeguards with families, and use craving meds thoughtfully.

What ties it all together is respect for biology and the person in front of us. Genetics like MC4R variants and syndromes such as Prader–Willi can drive lifelong hyperphagia; ultra‑processed foods and liquid calories amplify the problem; stigma keeps people from care. We push for a different bias—against soda and engineered foods, not against people—and for care that follows patients long after the incisions heal. If you want a grounded, humane guide to obesity treatment, this conversation delivers clarity without blame.

If this resonated, follow the show, share it with a friend, and leave a review so others can find it. Your support helps us keep building informed, stigma‑free conversations about health.

To contact Dr. Grover: ammadeeasy@fastmail.com

This episode is the second episode of a four part series on stigma.

This episode is done in collaboration with Central Coast Overdose Prevention (CCODP) and was made possible by California Overdose Prevention Network Accelerator funding from the Public Health Institute's Center for Health Leadership and Impact.

In this episode, Gabrielle shares her powerful journey from fentanyl addiction to recovery, highlighting the unexpected moment of compassion from a correctional officer that changed everything. Her story reveals how respect and dignity can transform recovery outcomes, while exploring the deep impact of self-stigma and family support.

She shares her experience:

• Hitting rock bottom on Christmas Eve 2022 after stealing her mother's car during active fentanyl addiction
• Experiencing six overdoses, with each one bringing her closer to death
• Finding transformation through a year-long program at Teen Challenge
• Encountering a correctional officer who showed unexpected compassion and dignity
• Battling intense self-stigma despite having family who never gave up on her
• Receiving an ultimatum from her pregnant sister that became a powerful motivator
• Learning that recovery meant becoming a different person, not just the same person without drugs
• Moving from shame about her addiction to being open about her recovery journey
• Finding ways to help others by showing kindness and treating "humans like humans"
• Building a life she couldn't have imagined three years ago, working six days a week and helping with her sister's child

If you or someone you know is struggling with addiction, remember you don't have to do it alone. There are many avenues to recovery, and compassion can make all the difference.

To Contact Dr. Grover: ammadeeasy@fastmail.com

How much do you know about Kratom? Who takes it and why? How does Kratom withdrawal present and how do you treat it? And what do you do in the case of a Kratom overdose? In this episode we do an evidence based review on Kratom to answer all of these questions and more.

Have you had a patient ask you about using Topiramate to treat their alcohol use disorder? Or maybe you've heard a colleague talk about it, but don't know much about it? In this episode we review the use of the medication topiramate in treating alcohol use disorder. Spoiler alert! This may be practice changing!

How often do you see patients who regularly use cannabis who get recurrent abdominal pain, nausea, and vomiting? It seems like this comes up at least every other shift in the Emergency Department. In this episode we review all aspects of Cannabinoid Hyperemesis Syndrome, from pathophysiology, to diagnosis, to treatment. 

Have you heard reports of first responders having overdoses on fentanyl after just touching it? Do you actually know how well fentanyl is absorbed through the skin? What PPE should first responders use if they know they are going to be exposed to fentanyl? In this episode we do a mega deep dive to find out what is the risk of fentanyl exposure to first responders and what can we do to mitigate that risk?

How familiar are you with cannabis toxicity? Do you know the symptoms of a cannabis overdose? If your patient told you that she "greened out" last night, would you know what she was talking about? In this episode we do an evidence-based review of cannabis toxicity, including what it means to "green out"

Pink Elephants anyone? In this episode we review Delirium Tremens, also know as alcohol withdrawal delirium. It's not too common, but it makes people impressively sick when it develops. Listen in for an evidence based review of the diagnosis and treatment of delirium tremens. 

Have you heard about microdosing buprenorphine? Have your patients asked you if it's an option for them? In this episode we do a deep dive on the topic of microdosing buprenorphine...including how it might be the best option for patients using illicit fentanyl to start bupe without experiencing precipitated withdrawal.

Have you heard of Xylazine? I sure don't remember it from pharmacology in medical school. It turns out Xylazine is a veterinary medicine that is being increasingly cut into the illicit drug supply in the US. Why is it being cut into drugs, what does it do, and how is a Xylazine overdose treated? We cover everything you need to know about Xylazine in this episode. 

Have you found all the different formulations of buprenorphine confusing? What is Zubsolv and how is it different from regular sublingual buprenorphine? And what about Belbuca? Or BuTrans? When can you use injectable Buprenex? What about Sublocade? In this episode we do a deep dive into all the different formulations of buprenorphine, including what they are used for and how to dose them. We also discuss how challenging it can be to convert between different formulations. 

Another bonus episode! I was asked to give a lecture on medications for alcohol use disorder to some of my colleagues in my area. We have made such incredible improvements in how we treat opiate use disorder with medication...it's time to do the same with alcohol use disorder. So...in this lecture I tried to convince my colleagues that we need to start routinely treating patients with alcohol use disorder with medication for alcohol use disorder. Take a listen...hopefully I can convince you too. 

This episode is the first episode of a four part series on stigma.

This episode is done in collaboration with Central Coast Overdose Prevention (CCODP) and was made possible by California Overdose Prevention Network Accelerator funding from the Public Health Institute's Center for Health Leadership and Impact.

In this episode, Ana Alamo shares her powerful journey from addiction to recovery, revealing how her personal struggles now help her connect with clients as a peer support specialist.

• Born and raised in Salinas, Anna experienced childhood trauma at age five that shaped her early years
• She started using cannabis in middle school and developed a pattern of fighting and substance use
• Her use progressed to using pills including Norcos and Xanax from age 20-25
• Legal trouble became her wake-up call after being involved with fentanyl-laced pills that caused someone's death
• She now works as a peer support specialist and recently graduated with an Associate's degree in Addiction Studies
• She uses her lived experience to connect authentically with clients, especially teenage girls
• She does her best to balance accountability with compassion 
• Family took approximately four years to fully trust her again
• Therapy helped her develop vulnerability and begin the ongoing process of self-forgiveness
• She plans to continue her education at CSUMB pursuing psychology

We discuss the stigma and judgement that she felt along the journey through her addiction

And we also discuss how she makes sure her clients with addiction don't feel judgment or stigma from her now that she is a peer support specialist

If you're struggling with addiction, know that recovery is possible. Ana's story shows how our darkest moments can become our greatest strengths in helping others.

To contact Dr. Grover: ammadeeasy@fastmail.com

We need more Addiction Medicine physicians, both here in the United States and all over the world. In the United States, board certification in Addiction Medicine is supervised by the American Board of Preventative Medicine (ABPM). In this episode we review the process for how to obtain board certification in Addiction Medicine in the US. It turns out that the ABPM has a practice pathway that allows for board certification in Addiction Medicine without having to do a fellowship for those who already are doing addiction medicine in their current practice. Could you be eligible to apply for board certification in Addiction Medicine? Listen in and find out!

I don't know about you but I was taught stimulants didn't have a withdrawal syndrome, and yet many of my patients - after a post methamphetamine crash - will complain of being in withdrawal. So...how much do you know about stimulant withdrawal? In this episode we review stimulant withdrawal - how to diagnose it, how to treat it, and how it feels to patients. 

A follow up to Episode #27 on labs and alcohol use disorder. So you're at work and you have a patient who you're pretty convinced has an alcohol use disorder, but you're not sure which test you should order to assess their alcohol use. LFTs? Carbohydrate deficient transferrin? Ethyl glucuronide? Phosphatidylethanol? In this episode we take another look at lab tests that can help you with your assessment of patients who use alcohol...including some lab tests that you probably have never heard of (but might find useful)

A bonus episode! This isn't really on the topic of addiction...but it does involve opioid sparing and alternative to opioid treatment protocols (and avoiding a new start of opioids may prevent someone from developing opioid dependence or opioid use disorder). 

I put together a lecture on the non-opioid management of renal colic a few months back. I thought the topic was really useful, so I presented it to the docs that I work with where I practice as a part of our monthly physician education. I literally just recorded my presentation with my iPad while I was giving the lecture to my group (thus the lousy audio...my apologies). In any case - I hope you find this lecture helpful. I review non opioid pain management of renal colic in detail, including NSAIDs, lidocaine infusions, antispasmodics, and tamsulosin. 

How much do you know about hallucinogens? Do you know the differences between LSD, psilocybin, and MDMA? In this episode we review hallucinogens as a general class of drugs, specific hallucinogenic drugs, and how to manage the acutely intoxicated in the ED and acute care setting. 

Given how prevalent methamphetamine use is, this topic is WAY overdue. In this episode we take a broad look at methamphetamine use disorder - how methamphetamine affects the brain, the clinical features of methamphetamine use disorder, and how to treat methamphetamine use disorder. 

You just had a patient arrive via ambulance on an involuntary hold who is clearly psychotic. As the paramedics are giving report, you hear that the patient was found using methamphetamine on scene. So...is this schizophrenia? Or is it meth psychosis? Can you tell the difference? In this episode, we do a deep dive into methamphetamine psychosis, to review the clinical features, prognosis, risk factors, and treatment - including a discussion of the differences between primary psychotic disorders and methamphetamine induced psychosis. 

This episode is on the topic of the label "drug-seeking" that is often given to patients. Dr. Grover reviews a clinical case and reviews a perspective piece written on this topic. How would you handle a patient in pain who has an allergy to multiple medications, is refusing non-opioid options, and is asking for morphine? Is it addiction? Severe pain? Or is the patient in withdrawal? In this episode we delve into the complex and nuanced topic of the so-called "Drug-Seeking" patient. 

You've probably heard patients talking about going to AA (Alcoholics Anonymous), but how much do you actually know about what AA does? In this episode we review mutual support groups and 12 step programs (such as AA) - what they are and how they work. 

We all know that buprenorphine is an effective medication to treat opiate withdrawal, yet most of us only use buprenorphine to treat opiate withdrawal from abstinence from opioids. It turns out that buprenorphine can also treat the opiate withdrawal that patients experience when they are given naloxone after an opioid overdose. In this episode we review the literature on using buprenorphine after naloxone rescue, and how to actually do it in your practice. We also take on a few other topics around this issue, including whether or not naloxone can be given electively to induce withdrawal to facilitate a rapid buprenorphine induction. 

Dr. Casey Grover explores the challenging world of benzodiazepines, explaining why these commonly prescribed medications can create more problems than they solve for patients struggling with anxiety and other conditions.

• Benzodiazepines work like alcohol in pill form, enhancing the brain's natural "downer" chemical GABA
• Long-term use leads to tolerance, dependence, and potentially Benzodiazepine-Induced Neurological Dysfunction (BIND)
• The four most commonly prescribed benzos are diazepam (Valium), lorazepam (Ativan), clonazepam (Klonopin), and alprazolam (Xanax)
• Benzodiazepine withdrawal can cause seizures months after the last dose, making it particularly dangerous
• Unlike opioid addiction, there are no specialized medications to treat benzodiazepine addiction
• Tapering from benzodiazepines is extremely challenging, often taking months or years with patients experiencing severe rebound symptoms
• Modern medical understanding now recognizes benzos as inappropriate for long-term anxiety treatment
• Case studies demonstrate how patients prescribed benzos for anxiety often never learn proper coping skills and suffer increasingly worse symptoms

Thanks for listening and remember treating addiction saves lives.

To contact Dr. Grover: ammadeeasy@fastmail.com

Wait, what??? Drinking Alcohol + Naltrexone = Cure for Alcohol Use Disorder??? In this episode we do a detailed review of a different way to use naltrexone for alcohol use disorder, which is to continue drinking while using naltrexone. This method is often referred to as the Sinclair Method, and may be effective in up to 80% of patients to reduce alcohol consumption or stop drinking entirely. This episode is based on the book "The Cure for Alcoholism" by Roy Eskapa, PhD

Have you ever had this case in your ED? A patient purchases a cannabis edible candy bar or pastry. She or he eats a small amount and waits 30-60 minutes. Feeling nothing, the patient proceeds to eat the whole bar and then comes to the ED via ambulance or with a friend about an hour later completely panicked and hallucinating. 

In this episode we dig in to Cannabis Induced Psychosis - why it happens, how THC content contributes to the development of psychosis, how common it may be, and how to treat it. 

We all have had this scenario...a patient comes to the ED or is getting admitted for a medical complaint...and you notice a few findings on their lab tests that make you wonder if they have an alcohol use disorder. An elevated MCV. An elevated AST. Have you ever asked yourself - how accurate are these tests are detecting and diagnosing an alcohol use disorder? Or on the flip side - how often do we see a patient presents to the ED requesting help with alcohol after years of heavy drinking and has essentially normal labs? In this episode we dig into the limited literature on this topic and try to answer the question - how accurate are lab tests in determining if a person is consuming alcohol, and if so how much?

Methamphetamine use disorder...we see it every day in the Emergency Department, and yet it feels like we have nothing to offer as far as treatment. Could there be some hope that we finally have some medications for methamphetamine use disorder? In this episode we review a recent study on the use of Bupropion and Naltrexone for the treatment of methamphetamine use disorder. 

Have you heard of the kindling phenomenon? Have you ever wondered why alcohol withdrawal seems to get worse the longer people drink? In this episode we review kindling in alcohol withdrawal - what it is, why it happens, and why it matters clinically. 

Ok. So you've induced your patient with opiate use disorder successfully on to buprenorphine. Nice work! But what happens if they need surgery? Should they still get treated with full agonist opioids after surgery? Will full agonist opioids even work given buprenorphine's pharmacology? In this episode we dig into how to handle pain control and medication management for patients with buprenorphine in the preoperative setting. 

Sure...you ask your patients if they vape, but how much do you know about the world of vaping? Are they using a cigalike, a vape pen, or a JUUL? And are they using standard cartridges or have they bought a custom vape juice? What types of vape juice are most associated with EVALI? In this episode we review vaping - the history of the industry, the health effects, and the societal trends. 

In this episode we take a very deep dive into the topic of illicit fentanyl. We review the history of the opiate epidemic in the United States that has led us to our current time where 100,000 Americans have died of a drug overdose in the past year. And more importantly, we discuss what we as healthcare providers can do to fight back against this crisis of illicit fentanyl (and worse) in our drug supply causing so many fatal overdoses. 

When was the last time you used phenobarbital for alcohol withdrawal? How familiar are you with how to dose it and when to give it? It turns out that phenobarbital is as effective as benzodiazepines for alcohol withdrawal, and might be a medication that you want to consider using in your practice for alcohol withdrawal. In this episode we dive into the topic of phenobarbital for alcohol withdrawal and try to figure out what's the best way to use phenobarbital when treating patients with alcohol withdrawal.

What does it mean to be well? In this episode we dig into the perspective of a person living with an opiate use disorder. Dr. Grover reads a piece on opiate addiction that he wrote with a patient who has lived experience with an opiate use disorder. The original article can be found here https://www.kevinmd.com/blog/2017/03/mean-well-ask-opiate-addict.html 

This is a joint episode between the Addiction Medicine Made Easy Podcast and the Kratom Sobriety Podcast

Check out the Kratom Sobriety Podcast: https://kratomsobriety.com/

Trauma and addiction are deeply intertwined, with unresolved PTSD often driving substance use as people attempt to manage overwhelming emotions and physical sensations.

• Understanding PTSD beyond combat veterans—recognizing both "big T" traumas and accumulated "little t" stressors
• Dr. Grover shares his personal journey with PTSD from emergency medicine and the stigma he faced
• The Adverse Childhood Experiences (ACE) scale reveals how early trauma predicts addiction risk
• Multiple diagnoses often overlap—ADHD, PTSD, and addiction create complex treatment challenges
• Medication options for PTSD include prazosin for nightmares, propranolol for triggering, antidepressants, and more
• Innovative treatments like stellate ganglion blocks can reduce physiological reactivity from trauma
• Trauma-informed care requires providers to create safety and understand the person beyond their addiction
• Breaking stigma requires vulnerability—sharing our stories helps others recognize they're not alone

Visit mdcalc.com to check out the Adverse Childhood Experiences score, and listen to the Last Day podcast episode with Dr. Gabor Maté for more insights on trauma and addiction.

To contact Dr. Grover: ammadeeasy@fastmail.com

Has this ever happened to you at 11 pm on a Saturday Night..."Hey doc, I'm on 85 mg of methadone and I missed my daily dose yesterday. Can you give me a dose?" In Episode 19 we discuss methadone, how methadone is regulated, and what to do when a patient on methadone for OUD presents to the ED asking for a missed dose or needs inpatient admission.

In this episode, we review Post Acute Withdrawal Syndrome (PAWS). Haven't heard of it? You're not alone. It's a common, yet understudied syndrome experienced by people in early recovery. Unfortunately the data is limited, but Dr. Grover summarizes the best information we have on PAWS including pathophysiology, naming, symptoms, and treatment. 

Buprenorphine precipitated opiate withdrawal is the worst! Patients feel awful, and we as healthcare providers feel awful for making them feel awful. In this episode we review the literature on and discuss some local expert opinion on buprenorphine precipitated opiate withdrawal, including the best way to treat it if it happens. 

How much do you know about stigma? Would you believe experiencing stigma can shorten a person's lifespan by 12 years? In this episode we review stigma - what it is, how it affects patients with stigmatizing conditions, and how to reduce how much stigma there is in health care. Dr. Grover just did a Grand Rounds presentation on Stigma - and this episode is a rapid review of all the material covered in the Grand Rounds presentation. 

In this episode we do a review of a recent paper on the safety and efficacy of using high dose (up to 32 mg) buprenorphine in the emergency department. The title of the article is "High Dose Buprenorphine in the Emergency Department for Treatment of Opioid Use Disorder" by Dr. Andrew Herring and his colleagues. 

This episode has been on the to-do list for quite a while. In Episode 15, Dr. Grover tackles the huge topic of alcohol withdrawal - from definitions, to pathophysiology, to diagnosis, to management. 

Have you had patients ask you about information on cannabis that they received from a cannabis dispensary? Perhaps they have been told that they need a certain THC:CBD ratio to treat their condition. How good is that information? In this episode we’re going to be talking about Cannabis Dispensaries. Most specifically, who works there, what do they tell people about cannabis, and how good is the information that they give out.

How much do you remember from your training on alcoholic ketoacidosis? Do you remember which IV fluids need to be given? In Episode 13, we review the topic of alcoholic ketoacidosis - from a brief history of the condition, to pathophysiology, to making the diagnosis, and how to treat it.

In this episode Dr. Grover tackles medications for alcohol use disorder. These are medications to prevent a relapse on alcohol and to reduce the desire for drinking. You may not have used these medications much in your practice, but after listening to this episode hopefully you'll start using them. Episode 12 reviews two papers on medications for alcohol use disorder, reviewing their indications, dosing, side effects, efficacy, contraindications, and cost. 

Do you have any idea what is truly in the street drugs your patients are buying and using? No? Turns out your patients probably don't either. And worse yet, your hospital doesn't have ready access to testing to find out. Is that really heroin your patient is using or is it quinine?

In this episode we review a few papers on how street drugs are cut and adulterated. From quinidine, to acetaminophen, to baking soda, to levamisole - you'll be amazed what ends up in our street drug supply. 

We discuss practical strategies for staying up-to-date with addiction medicine research in this collaborative episode between Addiction Medicine Made Easy and the Addiction Medicine Journal Club podcast.

• Featuring a four-person roundtable with Dr. Casey Grover, Dr. John Keenan, Dr. Sonia Del Tredici, and Thomas Bannard
• Understanding why evidence-based medicine matters in addiction care
• Incorporating lived experience into addiction education and combating stigma
• Developing personalized approaches to staying current with medical literature
• Various learning strategies from reading journals to podcasts to collaborative discussions
• Finding your motivation for continuing education in addiction medicine
• Strategies for making learning "stick" through teaching and knowledge application
• Making knowledge "count twice" by developing resources from what you learn
• The value of consistent, sustainable learning processes over ambitious but unrealistic goals

To contact the Addiction Medicine Journal Club Podcast: addictionmedicinejournalclub@gmail.com  

To contact Dr. Grover: ammadeeasy@fastmail.com 

Finally! A medication option for the treatment of Cannabis Dependence and Cannabis Withdrawal. Dr. Grover shares a case from his practice in the Emergency Department and does a deep dive into the literature supporting gabapentin as a treatment for Cannabis Dependence and Cannabis Withdrawal. 

On this episode we'll be covering the topic of harm reduction. Most people know a little bit about it, but in this episode we dive deep into harm reduction, and why it is extremely important for patients with an active substance use disorder. Dr. Grover reviews a brief history of harm reduction, how it helps people get into long term recovery, key concepts of harm reduction, how to incorporate it into your practice, and why it can be controversial - including a discussion of syringe exchange programs. 

We all know how devastating opioid overdose deaths are in the United States and around the world. However we don't know as much about non-fatal opioid overdoses, including how likely they are to lead to fatal opioid overdoses. In this episode we review the 2020 Annals of Emergency Medicine paper "One Year Mortality of Patients After Emergency Department Treatment for Nonfatal Opioid Overdose".