Withdrawal, Discontinuation Syndromes, or Nil for Atypical Substances of Misuse

Saturday, April 25, 2026

1:30 PM - 2:45 PM PT

Location: Seaport Ballroom, Level 2

Presenter(s)

Robert Cole Pueringer, MD

Addiction Medicine, Medical Toxicology; Medical Director of Substance Use and Addiction Care Program
Essentia Health
Duluth, Minnesota

Slides
Timothy J. Wiegand, MD, DFACMT, FAACT, DFASAM

Director of Medicine, Toxicology and Addiction Consulting PLLC and CMO Toxicology Consults
Medicine Toxicology & Addiction Consulting PLLC
University of Rochester School of Medicine & Dentistry
Rochester, New York
JoAn Laes, MD

Addiction Physician
Allina
Minneapolis, Minnesota
Ashley Haynes, MD

Medical Toxicology, Addiction Medicine
University of Kansas, School of Medicine - Wichita
Andover, Kansas

Non-presenting author(s)

Sarah Usher, MD

Addiction Medicine Physician Fellow; Emergency Medicine Physician
University of Minnesota
Minneapolis, Minnesota
Evan S. Schwarz, MD, FASAM

Clinical Professor of Emergency Medicine, Medical Toxicology Fellowship Director
UCLA
Los Angeles, California

Patients increasingly present to the hospital and medical detoxification units with withdrawal syndromes from nontraditional or emerging substances. This case-based session delivers practical, protocol-ready guidance for risk stratification and withdrawal management of dextromethorphan, kratom, cannabis, ketamine, gamma-hydroxybutyrate (GHB), and phenibut. We review clinical phenotypes, risk stratification, and inpatient withdrawal management regimens (first-line and reasonable alternatives), including when to involve Addiction Medicine or Toxicology services and bridging therapy to outpatient care. We will emphasize where evidence is strong vs. provisional.

Learning Objectives:

Learners will be able to:

Describe intoxication and withdrawal physiology and phenotypes for dextromethorphan, kratom, cannabinoids, ketamine, gamma-hydroxybutyrate (GHB), and phenibut.
Compare evidence-informed pharmacologic and supportive strategies for acute withdrawal management, including established and emerging protocols.
Describe risk stratification and practical order sets with monitoring tailored to medical detoxification unit resources.

Disclosure(s):

Robert Cole Pueringer, MD: No financial relationships to disclose

Timothy J. Wiegand, MD, DFACMT, FAACT, DFASAM: No financial relationships to disclose

JoAn Laes, MD: No financial relationships to disclose

Ashley Haynes, MD: No financial relationships to disclose

Sarah Usher, MD: No financial relationships to disclose

Evan S. Schwarz, MD, FASAM: No financial relationships to disclose