Volume 10 | December 2023

Maine SUD Learning Community Newsletter

Samuela Albert Manages, MD, FAAFP

Dr. Manages received her medical degree from Ross University School of Medicine and completed her family medicine residency at Rutgers Health/Robert Wood Johnson Medical School. Following residency, she began a career practicing at Pines Health Services, a Federally Qualified Health Center in Rural Maine, while also serving as a preceptor for Maine Medical Center/Tufts University trainees. Recently, Dr. Manages graduated from Massachusetts General Hospital-Harvard Medical School Addiction Medicine Fellowship, where she experienced extensive hands-on training on the full scope of addiction care. Having created an office-based opioid use disorder treatment program for pregnant patients within Pines Health Services prior to the addiction fellowship, her goal now is to take the knowledge she gained to create a comprehensive Addiction Care Service (including Office Based Addiction Treatment Program (OBAT), Bridge Clinic, Emergency Department induction with Medication for Opioid Use Disorder (MOUD)) to treat individuals struggling with substances in her northern Maine community.

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Hello again, colleagues!

Alcohol use disorder (AUD) is a disease that affects one in seven people. 1  And while treatment options exist, more of them, with more efficacy, are needed. Prazosin has been studied for treatment of nightmares in PTSD and for alcohol use disorder (AUD), two conditions with frequent overlap. The results for alcohol use have been mixed. This paper makes a strong case that the presence of low-level alcohol withdrawal predicts the effectiveness of prazosin in AUD. This may help to untangle the inconsistencies in the existing body of evidence, and reinvigorate the quest to take advantage of alpha blockade in AUD treatment.

While it’s not time to offer clinical guidance based on this study, the effect of 16mg/day of prazosin found here draws attention. With prazosin, there was a 50% reduction in drinking days (OR 0.5 P<0.01) and 76% reduction in heavy drinking days (OR 0.23, p <0.0004) among people with mild alcohol withdrawal symptoms, while no effect of prazosin was seen in people with fewer or no alcohol withdrawal symptoms. Could it be that we’ve had a highly effective option in our midst but we didn’t know who to use with? Maybe. It’s worth thinking about the findings here as we reabsorb prior- and look to future- research, including one just out on prazosin and alcohol use in active duty soldiers (referenced below for eager readers2). I hope this un-patented medication that shows promise for a subset of people with AUD can find its way into quality studies that further elucidate its role.

Thank you for reading,


Andrea Truncali, MD MPH


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Is there an over the counter test for detection of fentanyl in urine?

The FDA cleared Alltest Fentanyl Urine Test Cassette, the first over the counter test for the preliminary detection of fentanyl in urine. The test works by placing three drops of fresh urine onto a cassette containing a fentanyl test strip. After 5 minutes the test result will appear as colored lines.

The test provides only preliminary results. A more specific alternative chemical method (confirmation testing) must be used in order to obtain a confirmed test result. The test includes a pre-addressed mailing box for shipping samples to the manufacturer’s laboratory for confirmation testing.

See news announcement, FDA Roundup: October 27,2023

For these questions and technical assistance, contact the ME SUD Learning Community


ME SUD Learning Community Adolescents & Young Adults ECHO: Expanding Services for OUD/SUD, Mental Health and Other Complexities

December 13, 2023 | 12:00-1:00PM

Speaker: Amy Mayhew, MD, MPH

Alcohol Use Disorder and Withdrawal Management

December 15, 2023 | 12:00-1:00PM

Speaker: Brian Fuehrlein, MD, PhD


Project ECHO: Ambulatory Alcohol Withdrawal Management and Treatment | Engagement/Motivational Interviewing for Decreasing EtOH Use

January 5, 2024 | 12:00-1:00PM

Speaker: David Lawrence, MD, FASAM 

Disentangling Co-Occurring Bipolar Disorder in Youth with OUD/SUD

February 13, 2024 | 12:00-1:00PM

Speaker: Amy Yule, MD

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Personal Recovery Story

Wes Salvucci

By Amy Paradysz

Wes Salvucci finds meaning in matching people in early recovery with dignified work.

MaineWorks has been a big part of 23-year-old Wes Salvucci’s recovery story. And now, as Director of Operations, he’s in a position to help others in recovery find solid careers in Maine, New Hampshire and Massachusetts.

“I’m in the construction field but also get to help people find a life like I did, with two career job offers at 10 months sober,” Wes says.

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