Objective: To explore the incidence of alcohol use disorder (AUD) after bariatric surgery and the associated risk factors and specific manifestations of increased AUD risk, such as increased alcohol sensitivity and earlier symptom onset. Methods: This review adhered to PRISMA guidelines. Data were sourced from PubMed, Google Scholar, Cochrane, and Science.gov using search terms related to alcohol, bariatric surgery, and nutrition. Articles were screened based on inclusion and exclusion criteria: Inclusion criteria were English language articles published from 2013–present, availability in full text or open access, and adult patients (≥18 years) who had bariatric surgery. Exclusion criteria were non-English articles, articles written before 2013, unavailable full text or open access, articles that featured pediatric patients or patients who did not use alcohol or had bariatric surgery, and abstracts or opinion pieces. A final total of 11 studies were found. Data Extraction: Studies published from 2013 to the present that involved adult bariatric surgery patients with a history of alcohol consumption. Results: Findings suggest an elevated risk of AUD post-bariatric surgery, particularly following sleeve gastrectomy or Roux-en-Y gastric bypass surgery. There was strong evidence of increased alcohol sensitivity and AUD symptoms post-surgery, causing potential health effects. Conclusions: These results underscore the importance of comprehensive preoperative assessments and tailored interventions for bariatric surgery patients with AUD.

Rapid methadone metabolism in patients with opioid use disorder could complicate methadone treatment. Toxicology screenings to monitor methadone levels may show negative for methadone, despite adherence regular regimen. A patient receiving treatment for opioid use disorder tested negative for methadone in 11 out of 22 toxicology screenings (50.0%). We hypothesized that the patient was a rapid methadone metabolizer. After tapering doses to a maintenance level and using supervised urine collection, the patient was negative for methadone in 7 out of 7 tests (100.0%) but positive for cocaine in 5 out of 7 tests (71.4%). Chronic cocaine use and genetic factors, particularly CYP2B6 polymorphisms, have been found to cause rapid methadone metabolism. Clinicians should be vigilant for unusual metabolic reactions and modify dose and monitoring schedules accordingly. More investigation into the physiological and genetic aspects of methadone metabolism is needed.

Rapid methadone metabolism in patients with opioid use disorder could complicate methadone treatment. Toxicology screenings to monitor methadone levels may show negative for methadone, even with regular adherence to a regimen. A patient receiving treatment for opioid use disorder tested negative for methadone in 11 out of 22 toxicology screenings (50.0%). We hypothesized that the patient was a rapid methadone metabolizer. After tapering doses to a maintenance level and using supervised urine collection, the patient was negative for methadone in seven out of seven tests (100.0%), but positive for cocaine in five out of seven tests (71.4%) near the end of the maintenance period. Chronic cocaine use and genetic factors, particularly CYP2B6 polymorphisms, have been found to cause rapid methadone metabolism. Clinicians should be vigilant for unusual metabolic reactions and modify dose and monitoring schedules accordingly. More investigation into the physiological and genetic aspects of methadone metabolism is needed.