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  • Evaluating Drug Dependence: Regulatory, Methodological and Clinical Challenges (1.5 CME)

    Product not yet rated Contains 3 Component(s), Includes Credits

    Evaluating drug withdrawal effects is an integral component of dependence potential, which informs the overall safety, appropriate dosing, and scheduling of a drug. Understanding withdrawal phenomenon is critical in the care and management of patients who are physically dependent on medication or drugs of abuse. This workshop will address the regulatory and methodological considerations that are rapidly evolving in this active area of research and will cover case examples of studies examining drug withdrawal and dependence. In addition, the clinical relevance of dependency and mitigation of symptoms in the clinical setting will be discussed.

    Evaluating drug withdrawal effects is an integral component of dependence potential, which informs the overall safety, appropriate dosing, and scheduling of a drug. Understanding withdrawal phenomenon is critical in the care and management of patients who are physically dependent on medication or drugs of abuse. The methodological approaches to assess dependence continue to evolve and require careful evaluation of both preclinical and clinical data. Physical dependence can manifest from various drug classes including classes of drugs that are and are not associated with substance use disorder (e.g. beta blockers, corticosteroids). Preliminary approaches often include animal models to evaluate behavioral and physical manifestation of withdrawal, however translation to humans can be challenging. In the clinical setting, evaluation of withdrawal requires characterization of a drug's pharmacology to determine what type of symptoms may manifest upon abrupt discontinuation. Furthermore, rebound phenomenon resulting in a worsening of symptoms of the treated disease as a result of abrupt discontinuation, is also an important study assessment (Fontaine at et 1984). Study populations must be carefully considered, particularly in patient populations that cannot be safely withdrawn from study drug. Clinical trials must determine what population, duration of maintenance and endpoints are relevant for a given drug. For example, the time to establish dependence to a benzodiazepine can vary by drug type and dose and can range from 4 to 12 weeks (Mackinnon and Parker, 1982). Commonly adverse events and drug-specific withdrawal scales are included to evaluate withdrawal symptoms, however other pharmacodynamics measures may also be considered. The administration of endpoints and safety monitoring requires also practical considerations in the context of larger patient trials, where confined stays may not be possible following abrupt discontinuation. This workshop will address the regulatory and methodological considerations that are rapidly evolving in this active area of research and will cover case examples of studies examining drug withdrawal and dependence. In addition, the clinical relevance of dependency and mitigation of symptoms in the clinical setting will be discussed.

    Beatrice Setnik

    PhD

    Dr. Setnik has been working in the area of clinical drug development and abuse potential (AP) assessment since 2005.  Dr. Setnik is currently the Vice President of Clinical Pharmacology at INC Early Phase and an Adjunct Professor at the University of Toronto (Department of Pharmacology and Toxicology).  Dr. Setnik earned her doctorate degree in Pharmacology and the Collaborative Program in Neuroscience from the University of Toronto in 2005.  In her previous role as Senior Director, Clinical Sciences (King Pharmaceuticals and Pfizer, Inc), Dr. Setnik lead the clinical development, regulatory filing, and lifecycle management, including abuse potential evaluation, of several pain compounds including abuse deterrent opioid formulations. In her previous role as a Research Scientist (formerly Ventana / Decisionline Clinical Research, Toronto, Canada), Dr. Setnik was responsible for providing scientific input on various specialty phase I-II clinical trials including abuse potential studies for CNS drugs.   Dr. Setnik has published numerous research articles in internationally recognized peer-reviewed journals and has presented at several scientific meetings and conferences.  In addition, she chairs the clinical sub-team within the Cross Company Abuse Liability Council and has been an active member since 2008. Dr. Setnik is also an active member and participant in several congresses including the College on Problems of Drug Dependence. She has also been actively engaged in many aspects of abuse potential assessment including development of patient reported outcome instruments and contributing to post-marketing surveillance studies.

    Jack Henningfield

    PhD

    Dr. Henningfield was trained in abuse liability assessment and related sciences in the Psychopharmacology Program at the University of Minnesota and the Behavioral Biology Program of The Johns Hopkins University School of Medicine in the 1970s. In the 1980s and 90s, at the National Institute on Drug Abuse (NIDA), he served as Chief of the Clinical Pharmacology Branch, and the Abuse Potential Assessment Section and contributed to NIDA's drug scheduling recommendations. In 1996 he left NIDA to consult on these issues with Pinney Associates to pharmaceutical developers.Dr. Henningfield is proud to be a recipient of the 1996 ASAM Annual Award "for expanding the frontiers of the field of addiction medicine and broadening our understanding of the addictive process, through research and innovation." He has published more than 400 articles and books related to addiction and contributed to NIDA's abuse potential assessment monographs in the 1980s, FDA's first draft guidance in 1990, and expert reviews and special conferences on abuse potential in the 2000s leading to FDA's 2010 draft guidance and the 2017 Final Guidance. His decades of research, product evaluation and contribution to regulation provide his expert perspectives on the science base, the regulatory implications, and the overall value of the Final Guidance. This Guidance, along with FDA’s 2015 Guidance on Abuse-Deterrent Opioid is among FDA’s many efforts to more effectively address substance abuse and overdose by improving new drug product evaluation and labeling. He has long advocated for comprehensive drug control approaches that move us closer to achieving the goal espoused by former Surgeon General C. Everett Koop, who stated it as follows in a 2003 National Press Club address: “We must greatly expand our efforts to help those with addictions so that getting treatment will be as easy as getting addictive drugs.” (Military Medicine, 2003).

    Alicja Lerner

    MD, PhD

    Dr. Lerner has years of experience in neurology, neuroimaging and neuroscience research at NIH, University of Iowa and regulatory science at FDA.  At NIH (2000-2008) the activity included the clinical and research fellowships at NINDS and NIMH where she participated in the development of about half a dozen of clinical research protocols as a Principal Investigator and co-investigator. This research resulted in published papers on neural networks involved in the Tourette’s syndrome, dystonia and suppression of natural urges as shown by positron emission tomography (PET) research studies. During the PhD program at the Dept. of Anatomy and Cell Biology at the University of Iowa (1991-1996) her research was focused on the revealing anatomical complexities of the neural circuits connecting cerebellum, thalamus and basal ganglia. Since 2008 she works at FDA as medical officer at Controlled Substance Staff, CDER, and her particular interest is a development of the most effective ways to evaluate dependence and withdrawal in the clinical trials during the drug development.
    Dr. Lerner acquired the medical degree at Medical Academy, Warsaw, Poland, after which followed the internship in Poland, residency in anesthesiology in Germany, and residency in neurology in US, in North Carolina, and the fellowship in movement disorders and neuroimaging at NINDS, NIH.

    Pierre Geoffroy

    MDCM, MSc, FCFP, DABAM

    Pierre Geoffroy is Vice President of Early Phase Research at INC Research in Toronto, where he is involved in early phase clinical trials and human abuse liability studies. Trained in Emergency Medicine and Family Medicine at McGill University in Montreal, he has pursued a career in both clinical research and medicine, allowing him to apply practical experience to clinical research for nearly 25 years. He also holds a Master’s degree in epidemiology from McGill and an MSc in Nutrition from the University of Toronto. While having directed late stage drug development for many years in large pharma, he has been involved in early phase research in several CROs in both in Canada and Japan for over 10 years. Dr. Geoffroy is a fellow of the College of Family Physicians of Canada and is board-certified in Addiction Medicine. He is an actively practicing physician in Toronto in both family medicine and addiction medicine and has a keen interest in human abuse liability testing in recreational drug users and the development of new medicines to combat the growing addiction epidemic.

  • New Frontiers in the Treatment of Co-Occurring Alcohol Use Disorder and Anxiety (1.5 CME)

    Product not yet rated Contains 3 Component(s), Includes Credits

    In this presentation, I will provide a critical review of two key assumptions that have driven much of the comorbidity research over the past 35 years (since the introduction of DSM III): that the various subtypes of anxiety disorder like social phobia each have a distinct relationship to alcohol use disorder and that alleviating a co-occurring anxiety disorder through conventional psychiatric treatments, either alone or in conjunction with AUD treatment, is the most effective clinical response to comorbidity.

    Anxiety disorders frequently co-occur with AUD, more than doubling the likelihood or relapse in the months following AUD treatment. In clinical samples, about 50% of AUD treatment patients can be diagnosed with a co-occurring anxiety disorder, and numerous community-based epidemiological samples show that alcohol dependence is two to four times more common among individuals with anxiety disorders. This symposium will highlight evidence indicating that the overall internalizing load (amount of negative affect), rather than the presence of any particular anxiety (or depressive) disorder, dictates risk for AUD. In addition, it will feature results from an NIAAA-sponsored RCT showing that augmenting AUD treatment with a cognitive-behavioral program designed to reduce drinking to cope improved alcohol outcomes to a significantly greater degree than did augmentation with treatment aimed at reducing anxiety. The symposium will also provide an overview of the rates of co-occurring alcohol use disorders (AUD) and posttraumatic stress disorder (PTSD) in the general population, as well as among active duty military personnel and military veterans. Challenges in treating this particular comorbidity will be briefly described, and an overview of the findings from the behavioral treatment outcome literature will be provided. Finally, commonalities in the neurobiology of PTSD and AUDs will be reviewed, with special emphasis on implications for the development of novel therapeutic targets. This will include an overview of pharmacotherapeutic trials informed by research on putative common PTSD/AUD pathways involving the noradrenergic system, the hypothalamic-pituitary-adrenal axis, and other systems involved in both addictive and anxiety disorders.

    Deidra Y. Roach

    MD

    Dr. Roach has more than 30 years of experience in the field of addiction treatment. She currently serves as a Program Director for the National Institute on Alcohol Abuse and Alcoholism where, among other responsibilities, she manages research portfolios addressing the treatment of co-occurring mental health and alcohol use disorders and alcohol-related HIV/AIDS among women. She also serves on the Interagency Coordinating Committee on Fetal Alcohol Spectrum Disorders (ICCFASD) and the NIH Coordinating Committee for Research on Women’s Health. Dr. Roach chairs the Women Drinking, and Pregnancy Work Group of the ICCFASD.

    Matt G. Kushner

    PhD

    Dr. Kushner has been a Professor in the Department of Psychiatry at University of Minnesota-Minneapolis since 1991 and has held the rank of full professor since 2006.  He obtained his B.A. in psychology and philosophy from the University of Nebraska in 1983, and his Ph.D. in clinical psychology in 1991 from University of Missouri – Columbia.  He completed an Internship in Clinical Psychology at the Medical College of Pennsylvania in 1991.   Dr. Kushner has studied the association of alcohol use disorders with co-occurring anxiety disorders for more than 25 years with continuous funding support for over 20 years from the US National Institutes of Health (NIH).  Dr. Kushner has also served as an NIH scientific review group member for the National Institute on Alcohol Abuse and Alcoholism and the National Institute on Drug Abuse .  He has published over 70 peer reviewed articles in journals such as The American Journal of Psychiatry, JAMA Psychiatry and Biological Psychiatry that, collectively, have been cited more than 5000 times.  He is the Director of an NIH post-doc training program (T32) and is the Principal Investigator on an ongoing NIH-funded project to develop and test specialized treatments for substance abusers with co-occurring psychiatric disorder.  In 2013 he was awarded the Dan Anderson Award for making unique and significant contributions to the field with the potential to change clinical practice in alcohol use disorders treatment.  He is a Minnesota Psychological Association Distinguished Scholar and a University of Missouri Distinguished Alumnus.

    Tracy Simpson

    PhD

    Tracy Simpson, PhD, is a Clinician Investigator with the Center of Excellence in Substance Abuse Treatment and Education at the VA Puget Sound Healthcare System. She is also an Associate Professor in the Department of Psychiatry and Behavioral Sciences, University of Washington. Her primary research areas include evaluating interventions for alcohol use disorders with and without co-occurring PTSD, mechanisms of behavior change, assessment methods, and women veterans' substance use and mental health. She provides clinical care for women veterans with PTSD and addiction and is actively engaged in mentoring junior faculty, post doctoral fellows, and clinical psychology interns.

    Kathleen T. Brady

    MD, PhD

    Kathleen T. Brady, MD, PhD is a Distinguished University Professor and Vice President for Research at the Medical University of South Carolina (MUSC). She received her PhD in Pharmacology from the Medical College of Virginia, Richmond, and her MD degree from tMUSC.  She is an experienced clinical and translational researcher and her research focuses on innovative treatments for drug and alcohol abuse/addiction, gender differences in addictions and comorbid conditions such as posttraumatic stress disorder and other anxiety disorders.  She has been continuously funded by NIH for over 30 years. 

  • Clinical Case Presentations and Interactive Discussion (1.5 CME)

    Product not yet rated Contains 3 Component(s), Includes Credits

    Clinical cases involving alcohol use disorder, methadone induced QTc prolongation, traumatic brain injury (TBI), and pain and addiction, will be presented and discussed. This session is meant to be interactive, with participants discussing how they would manage the clinical dilemmas.

    Clinical Cases will be presented in power point slide format. The cases will be "real" cases which have been managed by the presenter. There will be breaks in the presentation to enable interactive discussions, which will be encouraged, concerning diagnoses and next steps in management. At the conclusion of the case presentation, there will be a brief didactic review of the evidence base, supporting the management of the patient. Clinical outcomes will be discussed. Cases will include; 1. Pain management in an opioid addicted individual. 2. Traumatic Brain Injury and Substance Use Disorders. 3. Alcohol Use Disorder 4. A Case of Drug Induced Hemorrhagic Cystitis 5. Management of the prolonged QTc interval in a methadone maintained patient 6. Synthetic benzodiazepine use disorder 7. Other cases which present after abstract submission

    Edwin A. Salsitz

    MD, DFASAM

    Dr. Edwin A. Salsitz has been an attending physician in the Mount Sinai Beth Israel , Division of Chemical Dependency, New York City, since 1983, and is an Assistant Professor of Psychiatry at the Mount Sinai School of Medicine. He is the principal investigator of the Methadone Medical Maintenance (office-based methadone maintenance) research project. 

    Dr. Salsitz is certified by the American Board of Addiction Medicine (ABAM), as well as by the Board of Internal Medicine and Pulmonary Disease. He has published and lectures frequently on addiction medicine topics.Dr. Salsitz is a course director for ASAM sponsored buprenorphine trainings,and is a mentor in the PCSS-MAT mentoring program. He has co-chaired the ASAM Review Course, the ASAM Common Threads Course, the ASAM State of the Art course and is a reviewer for the Journal of Addiction Medicine and Drug and Alcohol Dependence. He is the chair of the ASAM REMS course on safe and effective prescribing of opioids. 

    Dr. Salsitz was the Co-chair of the ASAM CME committee and Chair of the New York Society of Addiction Medicine CME and Education committee. Dr. Salsitz is a member of the medical advisory panel, for the New York State Office of Alcohol and Substance Abuse Services.  Dr. Salsitz is the recipient of the 2014 ASAM Annual Award, and the 2018 ASAM Annual Educator of the Year Award.

    R. Jeffrey Goldsmith

    MD, DLFAPA, DFASAM

    Dr. Goldsmith began his addiction medicine career in 1974 as a medical student, learning about the disease of alcoholism as a counselor for one of the Department of Transportation's Alcohol Safety Action Projects. He received his medical training at the University of Cincinnati College of Medicine from 1973-1977 and finished his residency in Psychiatry at UC in 1981.

    Recent Employment history

    In 1994 Dr. Goldsmith joined the VA fulltime. From 1994-2009, he split his time between Dual Diagnosis Services and other duties including all of the psychiatric consultations for the hospital (1994-1997) and research with the Clinical Trials Network (1995-2009). He was an active member of Cincinnati's NIDA research group, and Cincinnati's principal investigator for its pivotal study of buprenorphine/naloxone for opiate addiction. Dr Goldsmith also created an integrated Primary Care Mental Health program with the director of Primary Care, initiated in 2007 and still active.

    Currently Dr. Goldsmith works in the VA Buprenorphine Treatment Clinic.

    Teaching

    In 1994, Dr. Goldsmith developed an ACGME accredited Addiction Psychiatry Fellowship and the following year was funded by the Dept. of Veterans Affairs for a two year Addiction Medicine Fellowship. He holds the title of Professor of Clinical Psychiatry in the Department of Psychiatry and Behavioral Neuroscience at the University of Cincinnati. He was addiction fellowship director from 1989 to 2007 and continues to teach in addiction fellowships: Psychiatry and ABAM.

    ASAM involvement

    Dr. Goldsmith joined ASAM in 1984, became ASAM certified in 1986 and got his CAQ in Addiction Psychiatry in 1994. He has been on the CME committee since then, and was its chair for nine years from 2000-2009. Dr Goldsmith is President of ASAM 2015-2017.

  • Integrating Recovery Coaches into General Medical Settings (1 CME)

    Product not yet rated Contains 3 Component(s), Includes Credits

    “Recovery coaches” (RCs), peers sharing the lived experience of addiction and recovery, are increasingly being integrated into general medicine. RCs can help fill the large substance use disorder treatment gap and partner with vulnerable patients to help them connect with and navigate healthcare and other services. Building off of a hospital system-wide RC program and qualitative study on the RC role, this workshop will introduce participants RCs and use a step-by-step, interactive case study to walk participants through designing a recovery coach program for their practice.

    Only 10% of people with substance use disorder (SUD) receive treatment, partially due to inadequate access to specialty SUD care and limited management within primary care. "Recovery coaches" (RCs) are peers sharing the lived experience of addiction and recovery and are increasingly being integrated into primary care, where they may serve as a cost-effective treatment component. Peer support has long been a part of twelve-step programs, and professional peer support workers have been effective in other areas of chronic disease management. Existing evidence on RCs within professional SUD care suggests that they may have positive impacts for specific populations. Findings from our qualitative study on RCs indicate that RCs appear to play a valuable role for patients with SUD, providing both tangible system navigation and intangible, social support that promote recovery and might not otherwise be available. Importantly, they can help patients who feel alienated by the healthcare system connect with and navigate care. RCs are a new and innovative way to support patients in the outpatient setting. Addiction medicine physicians could benefit from understanding the RC role, strategizing about how to integrate RCs into their practice or primary care practices that they support, and sharing strategies about their ongoing work with RCs. As many practices transition to value-based payment models, there will be incentives and funds available for practices to change care delivery models to reduce preventable utilization, potentially facilitating use of RCs. We will begin this workshop with an introduction to RC training and roles. Much of the remainder of the workshop will be devoted to small group exercises to help participant think through what it would be like to start a RC program in their practice. Participants will create an RC job description, prepare strategies for RC hiring and interviews, and discuss how to respond to challenging situations that arise with integrating RCs, including team hierarchy or recurrence of coach substance use. Using quotes from patients and coaches to inform these discussions will help participants develop a patient-centered approach to RC program development and will allow often marginalized voices to be part of program design. Periodically throughout the discussion, we will share design features and strategies that the Massachusetts General Hospital has used to create and grow the its RC program and will solicit ideas and experiences from participants. By learning about the RC role and discussing RC integration, participants will become aware about this novel, low-cost treatment option; will develop an understanding of strategies for integrating RCs into their practice; and will be inspired to consider integration of peer workers into their practice.

    Helen E. Jack

    MD

    Helen Jack is a fourth year student at Harvard Medical School. In medical school, her research has focused on how lay health workers, including recovery coaches and community health workers, can contribute to care access and outcomes. She also helps organize the Student Coalition on Addiction, a group of medical students from across Massachusetts engaged in advocacy on addiction medicine education and access to treatment services. She holds a Visiting Researcher position at the Institute of Psychology, Psychiatry, and Neuroscience at King's College London. With KCL, she conducts mental health systems research in Zimbabwe and works on a Wellcome Trust-funded project to build mental health research capacity in southern Africa. Helen graduated from Yale University in 2012. Following graduation, she got a second BA in Philosophy, Politics, and Economics at Oxford University as a Rhodes Scholar. 

    Devin Oller

    MD

    Devin Oller, MD is a graduate of Temple University School of Medicine, where he received the Thomas M Durant Prize in Internal Medicine. He completed his internal medicine residency at Massachusetts General Hospital, and was one of the inaugural fellows in Rural Health Leadership prior to returning to MGH as the Primary Care Chief Resident. He attends on MGH's inpatient Addictions Consult Team and the Bridge Clinic, a low-threshold model for delivering care to people who use drugs.

    John Kelly

    PhD

    John F. Kelly, Ph.D. ABPPDr. Kelly is the Elizabeth R. Spallin Associate Professor of Psychiatry in Addiction Medicine at Harvard Medical School-the first endowed professor in addiction medicine at Harvard. He is also the founder and Director of the Recovery Research Institute at the Massachusetts General Hospital (MGH), the Program Director of the Addiction Recovery Management Service (ARMS) and the Associate Director of the Center for Addiction Medicine at MGH. Dr. Kelly is a former President of the American Psychological Association (APA) Society of Addiction Psychology, and is also a Fellow of the APA and a diplomate of the American Board of Professional Psychology. He has served as a consultant to U.S. federal agencies and non-Federal institutions, and foreign governments. His clinical and research work has focused on addiction treatment and the recovery process, mechanisms of behavior change, and in reducing stigma and discrimination among individuals suffering from addiction

    Jessica F. Magidson

    PhD

    Dr. Jessica Magidson, PhD, is an Instructor at Massachusetts General Hospital/Harvard Medical School specializing in behavioral research for addiction treatment, including implementation science, international addiction science, and the intersection of HIV and substance use. She is currently funded by a NIDA K23 award to evaluate peer and community health worker-delivered substance use treatment integrated into HIV primary care in Cape Town, South Africa. 

    Sarah Wakeman

    MD, FASAM

    Sarah E. Wakeman, MD is the Medical Director for the Mass General Hospital Substance Use Disorder Initiative, program director of the Mass General Addiction Medicine fellowship, and an Assistant Professor of Medicine at Harvard Medical School. She is also the Medical Director of the Mass General Hospital Addiction Consult Team, co-chair of the Mass General Opioid Task Force, and clinical lead of the Partners Healthcare Substance Use Disorder Initiative. She is the Medical Director of RIZE Massachusetts, a state-wide, private sector initiative created to build a $50 million fund to implement and evaluate innovative interventions to address the opioid overdose crisis. She received her A.B. from Brown University and her M.D. from Brown Medical School. She completed residency training in internal medicine and served as Chief Medical Resident at Mass General Hospital. She is a diplomate and fellow of the American Board of Addiction Medicine. She is chair of the policy committee for the Massachusetts Society of Addiction Medicine. She served on Massachusetts' Governor Baker’s Opioid Addiction Working Group. Nationally, she is chair of the American Society of Addiction Medicine Drug Court Task Force and serves on their ethics committee.Clinically she provides specialty addiction and general medical care in the inpatient and outpatient setting at Mass General Hospital and the Mass General Charlestown Health Center. Her research interests include evaluating models for integrated substance use disorder treatment in medical settings, recovery coaching, physician attitudes and practice related to substance use disorder, and screening for substance use in primary care.

  • Culture Shifting: Integrated Treatment of Opioid Use Disorder in Hospital Systems (1 CME)

    Product not yet rated Contains 3 Component(s), Includes Credits

    Medication treatments for opioid addiction have been validated in primary care and hospital based settings. Despite the clinical potential associated with medications for addiction treatment, there has been limited adoption of pharmacotherapies in the treatment of opioid use disorder in these settings. This focus session will review strategies to integrate the delivery of pharmacotherapies in the treatment of opioid use disorder in primary care and hospital settings.

    The efficacy and practicality of using medications to treat opioid use disorder has been validated in primary care and hospital based settings. Despite the clinical potential associated with medications for addiction treatment, there has been limited adoption of pharmacotherapies in the treatment of opioid use disorder in these settings. This exacerbates known gaps between opioid use disorder treatment need and capacity. Expanding the use of pharmacotherapies in the treatment of opioid use disorder therefore has the potential to narrow the treatment gap and improve outcomes. Implementing a program for delivering medications for opioid use disorder in primary care and hospital based settings requires overcoming regulatory, cultural, medical resource, patient-level, and funding barriers. Within this context, understanding the role of bias, stereotypes, and stigma in the health care team is critical to expanding the use of medications to treating opioid use disorder, given that health care team members can hold stereotypical and stigmatized views of patients with opioid use disorder and about pharmacotherapy. Expanding the use opioid use disorder pharmacotherapies in primary care and hospital based settings must address funding and regulatory barriers, build on-site technical capacity, advance provider readiness, and stimulate patient engagement in treatment. Key factors that enhance this implementation are clinic and hospital level regulations promoting the use of opioid use disorder pharmacotherapies, a mandate from hospital and clinic leadership, organization-wide culture that embraces medications to treat of opioid use disorder, and the provision of tools and resources to providers to facilitate care delivery. This focus session will review strategies to integrate the delivery of pharmacotherapies in the treatment of opioid use disorder in primary care and hospital settings. The presenters will share their experiences in implementation and discuss barriers and facilitators they encountered. The findings from stakeholder interviews will be reviewed, showing a wide range of familiarity of acceptance of evidence based practices for opioid use disorder treatment including pharmacotherapies. These views were across departments, in ambulatory care and emergency room physicians, nurses, and pharmacists. Further, results from a curriculum implementation that enhances clinician readiness to use medication assisted treatment will be presented. Lastly, pre post survey results demonstrating the impact of implementation of new systems of care for opioid use disorder on clinician attitude, preparedness and clinical practice will be discussed. This focus session will present real-world strategies to overcome barriers to opioid use disorder pharmacotherapies when resistance is encountered in hospital-based health systems. Additionally, approaches to support individual clinicians, clinics, and systems to provide quality care where there is "no wrong door" to opioid use disorder pharmacotherapies will be reviewed. The session will include time for audience participants to discuss the advantages and disadvantages of the approaches presented by the panelists and discuss their own experience with the adoption of evidence based practices for opioid use disorder treatment in their own settings.

    Brian Hurley

    MD, MBA, DFASAM

    Dr. Brian Hurley is an addiction psychiatrist and Medical Director for Co-Occurring Disorder Services for the Los Angeles County Department of Mental Health (LACDMH), supporting the identification and management of co-occurring substance use among patients with mental illness served by LACDMH. He is an assistant professor of Addiction Medicine at UCLA. 

    Brian serves as the Treasurer and is a Distinguished Fellow of the American Society of Addiction Medicine. Brian joined ASAM in 2002 as a first year medical student, and has served on the ASAM Board of Directors in various capacities since 2003. Brian previously served as chair of ASAM’s Membership Committee and Physicians-in-Training Committee and is formerly ASAM’s alternate delegate to the American Medical Association. Brian additionally served on the EVP/CEO search committee in 2010 that led to Penny Mill’s selection as ASAM’s current EVP/CEO. He has additional served in various roles for the Massachusetts Society of Addiction Medicine, New York Society of Addiction Medicine, and California Society of Addiction Medicine.

    Brian completed the Robert Wood Johnson Foundation Clinical Scholars Program at the University of California, Los Angeles (UCLA), and was previously a Veterans Administration National Quality Scholar at the VA Greater Los Angeles Healthcare System. He completed residency training at the Massachusetts General Hospital and McLean Hospital, where he was Chief Resident in Addiction Psychiatry and addiction psychiatry fellowship training at Bellevue Hospital and the New York Veterans Administration. Brian is a graduate of the Keck School of Medicine and Marshall School of Business of the University of Southern California. He was a 2012 American College of Psychiatrists Laughlin fellow, a 2010-2013 American Psychiatric Association (APA) Public Psychiatry Fellow, and a 2015-2017 Group for Advancement of Psychiatry Fellow. Brian has previously served on the Board of Trustees of the APA.

    Sarah Wakeman

    MD, FASAM

    Sarah E. Wakeman, MD is the Medical Director for the Mass General Hospital Substance Use Disorder Initiative, program director of the Mass General Addiction Medicine fellowship, and an Assistant Professor of Medicine at Harvard Medical School. She is also the Medical Director of the Mass General Hospital Addiction Consult Team, co-chair of the Mass General Opioid Task Force, and clinical lead of the Partners Healthcare Substance Use Disorder Initiative. She is the Medical Director of RIZE Massachusetts, a state-wide, private sector initiative created to build a $50 million fund to implement and evaluate innovative interventions to address the opioid overdose crisis. She received her A.B. from Brown University and her M.D. from Brown Medical School. She completed residency training in internal medicine and served as Chief Medical Resident at Mass General Hospital. She is a diplomate and fellow of the American Board of Addiction Medicine. She is chair of the policy committee for the Massachusetts Society of Addiction Medicine. She served on Massachusetts' Governor Baker’s Opioid Addiction Working Group. Nationally, she is chair of the American Society of Addiction Medicine Drug Court Task Force and serves on their ethics committee.Clinically she provides specialty addiction and general medical care in the inpatient and outpatient setting at Mass General Hospital and the Mass General Charlestown Health Center. Her research interests include evaluating models for integrated substance use disorder treatment in medical settings, recovery coaching, physician attitudes and practice related to substance use disorder, and screening for substance use in primary care.

    Rebecca Trotzky-Sirr

    MD

    Rebecca Trotzky public-healthifies LAC+USC, one of the busiest ERs & public hospitals in the Country. As a Family Medicine snowflake & Associate Professor in USC Department of Emergency Medicine, she slayed a million meetings to win outpatient naloxone and buprenorphine in LA’s Department of Health Service’s pharmacy. Rebecca wrote the first prescription for buprenorphine to treat opioid use disorder in pregnant incarcerated women in LA County Jail, which almost caused a heart attack in her staff. A leader of SafeMed LA, Rebecca supports the gigante coalition of providers, hospitals, pharmacies and payors across LA County for safer opioid prescribing. 
    As the Director of Urgent Care, she’s proud of support from California Health Care Foundation to provide complex care for high utilizers of ER, who experience homelessness, mental illness, concurrent chronic pain and substance use disorders, who are often pre-contemplative of change. With Whole Person Care in California, Rebecca aims to provide engagement and navigation services for care of patients with substance use disorders. She believes everyone should have open door access to excellent integrated health services, regardless of insurance or immigration status. In medical school, Rebecca won a Fulbright Scholarship to research health systems transformation in Venezuela. 
    Before all that, Rebecca was a juvenile delinquent, high school dropout, and young single mom on food stamps. She’s glad she ignored her social worker’s advice, to leave four-year college, and focus on something more practical. Rebecca remains pre-contemplative about changing her bicycle addiction. She double clicked ""like"" on her high schooler's last status update.

  • Combatting the Opioid Epidemic by Expanding Medication Assisted Treatments (1.5 CME)

    Product not yet rated Contains 3 Component(s), Includes Credits

    The United States is in the midst of an unprecedented opioid epidemic resulting in serious morbidity and mortality. More people died from drug over dose in 2014 than in any year on record and more than 60% involved an opioid. The Department of Health and Human Services announced an initiative to reduce prescription opioid overdose by expanding the use of Medications Assisted Treatment (MAT) that combines the use of medication with counseling to treat Substance Use Disorders (SUDs).

    The United States is in the midst of an unprecedented opioid epidemic. On an average day in the US, more than 650,000 opioid prescriptions are dispensed; 3900 people initiate nonmedical use of prescription opioids, 580 people initiate heroin use (CDC, 2011)1, and 78 people die from an opioid overdose. More people died from drug over dose in 2014 than in any year on record and more than 60% involved an opioid (CDC, 2015)2. The opioid epidemic has resulted in serious morbidity consisting of increased number of infants born with neonatal abstinence syndrome, and spread of infections of HIV and viral hepatitis C and mortality. Opioid epidemic costs the US an average of $78 billion annually. In 2015, the Department of Health and Human Services announced a targeted initiative aimed at reducing prescription opioid overdose, which includes expanding the use of Medications Assisted Treatment (MAT) that combines the use of medication with counseling to treat Substance Use Disorders (SUDs)3. New medications and new formulations of approved medications are being investigated to treat opioid use disorders (OUDs). The purpose of this symposium is to review the nature and extent of the opioid epidemic and the advances in the development of MAT for OUDs that are expected to help in combatting this devastating epidemic. The presenters will discuss new therapies available for the treatment of opioid over doses. Dr. Charles Gorodetzky will discuss the development of lofexidine for the treatment of opioid withdrawal, Dr. Phillip Coffin will discuss the use of naloxone for opioid safety, and Dr. Ivan Montoya will discuss the new medications and formulations of MAT that are being supported by NIDA.

    Jag Khalsa

    PhD, MS

    Dr. Jag Khalsa, with about 50 years of experience in drug research, serves as the Chief of the Medical Consequences Branch, National Institute on Drug Abuse, NIH, DHHS; is responsible for developing/administering a national and international program of clinical research on medical and health consequences of drug abuse and co-occurring infections (HIV, HCV, and others). Prior to joining NIDA in 1987, he served for ~10 yrs as a pharmacologist/toxicologist assessing safety (carcinogenic/teratogenic) potential of chemicals [INDs/NDAs] and food additives) and clinical evaluator at FDA. He has published in pharmacology, toxicology, epidemiology and medical journals. He serves on editorial boards of Journals of Addiction Medicine, Research on HIV/AIDS and Palliative Care, Frontiers of Neuroscience, and Clinical Infectious Diseases. He also serves on numerous Federal and NIH level committees including the HHS Viral Hepatitis Implementation Group (VHIG), National Commission on Digestive Diseases and its two sub-committees (Liver Research, Diabetes Research), Federal Task Force on TB, NIH Steering Committee on Centers for AIDS Research. He has received distinguished service awards from the FDA Commissioner, NIDA and NIH Directors, Society of Neuro-Immune-Pharmacology (SNIP), Life Time Achievement Awards from SNIP and International Conference on Molecular Medicine (India) and MIT, India; a commendation from the US Congress, Awards of Merit from the International Society of Addiction Medicine (ISAM), the President of the American Society of Addiction Medicine (ASAM), and a Certificate of Appreciation from the Office of Assistant Secretary for Health (Drs. Howard Koh and Ron Valdiserri), DHHS. He has a Ph.D. in neuro-psycho-pharmacology, a Master's degree in herbal pharmacology/medicine, post-doctoral training in CNS/Cardiovascular pharmacology at SK&F, and Toxicology at SRI International. E-mail: jk98p@nih.gov

    Charles W. Gorodetzky

    MD, PhD

    After obtaining my B.S. at M.I.T. in 1958, I earned an M.D. at Boston University School of Medicine (1962) and a Ph.D. in Pharmacology from the University of Kentucky Medical Center (1975).  I served for 21-years as a USPHS Officer in the intramural NIH research program at the NIDA (formerly NIMH) Addiction Research Center (ARC) in Lexington, KY; and was the last Director of that facility (from 1981-84).  My major research interests were the clinical pharmacology and metabolism of drugs of abuse, with extensive work in the development and clinical application of urine screening methodology.  I served on the FDA’s Drug Abuse Advisory Committee from 1978-83.  I entered the pharmaceutical industry in 1984, and worked for the next 21 years in Clinical Development primarily of CNS drugs.   My last positions was Vice President at Marion Merill Dow, then Hoechst Marion Roussel and then at Quintiles.  I served on the NIDA Medications Development Initial Review Group (NIDA-E, then NIDA-L) from 1996-2003 and am a frequent consultant to NIDA.  I have been active in the College on Problems of Drug Dependence (CPDD), in which I am a Charter Fellow, since 1963.  I have made numerous presentations of all types at the annual meeting. I have served 2 elected terms on the Board, been a member of many CPDD committees, chaired the Rules Committee since 1978, and in recent years reestablished and served as chair of the Industry/Government/Academia Relations Committee.

    I have had extensive experience in development, conduct and management of Phase I-IV clinical trials (particularly in CNS), preparation of INDs and NDAs, and preparation and presentation to FDA Advisory Committees and in Europe to the CPMP (Oral Explanation). Since March 2005 I have been actively engaged as a Consultant in Pharmaceutical Medicine. 

    Philip O. Coffin

    MD, MIA, FACP

    Phillip Coffin, MD, MIA, is a clinician investigator. He is a board-certified, practicing internist and infectious disease specialist, including inpatient and outpatient care. Dr Coffin's research focuses on reducing the medical morbidity of substance use. His active studies include clinical trials and observational studies evaluating pharmacotherapies for substance use disorders and HIV prevention, opioid overdose prevention and naloxone availability, and hepatitis C treatment for persons who inject drugs.

    Ivan Montoya

    MD, MPH

    Dr. Montoya is the Deputy Director of the Division of Therapeutics and Medical Consequences (DTMC) and Senior Medical Officer at the National Institute on Drug Abuse (NIDA). He received an M.D. from the University of Antioquia (Colombia), a Masters in Public Health from The Johns Hopkins School of Public Health, and completed residency training in Psychiatry at the University of Antioquia and the University of Maryland Hospital (Baltimore). He was a Fulbright-Hubert H. Humphrey Fellow at The Johns Hopkins School of Public Health, Visiting Foreign Fellow at the Intramural Research Program of NIDA, Director of the Practice Research Network of the American Psychiatric Association, and consultant for the World Health Organization's Pan American Health Organization. He has published extensively in the areas of etiology, prevention, treatment (pharmacological and non-pharmacological), and medical consequences of drug abuse.

  • Addiction Medicine Can Save Lives and Treat Addiction During and After Incarceration (1.5 CME)

    Product not yet rated Contains 3 Component(s), Includes Credits

    Incarcerated populations have high rates of substance use disorders (SUDs), yet treatment of these disorders is rare in US jails and prisons. This workshop will explore some of these models and the changing landscape of options for improving the health of incarcerated persons who have OUD and other SUDs. We will describe innovative models from 2 states, and will offer small group discussion about how to expand treatment in your own community.

    Incarcerated populations have high rates of substance use disorders (SUDs), yet treatment of these disorders is rare in US jails and prisons. Recent trends in treatment and policy changes have implications for care of incarcerated persons during incarceration and after release. These include the federal government's decision to de-privatize federal prisons, availability of both agonist and antagonist options for treating opioid use disorder (OUD), the expansion of use of naloxone for overdose prevention (in the face of rising overdose risks caused by fentanyl-like drugs), and expansion of Medicaid coverage that is leading to improved access to treatment post-incarceration. Although most incarcerated persons still do not receive treatment for OUD there are many communities around the country that are experimenting with treatment during incarceration or at the time of release. This workshop will explore some of these models and the changing landscape of options for improving the health of incarcerated persons who have OUD and other SUDs. The workshop will begin with brief presentations (7-10 minute overviews by each of the four of us, Komaromy, Wakeman, Rich, and Trigg) (40 minutes total): 1. Epidemiology of SUDs in US incarcerated populations (Wakeman) a. SUDs in populations incarcerated in US jails and prisons b. Risk of overdose death c. Rates of treatment engagement post incarceration 2. SUD treatment in jails and prisons, and the impact of recent policy changes (Komaromy) a. Overview of current availability of treatment for SUDs in US jails and prisons, and efforts to provide post-incarceration care b. Changes in policy and treatment trends that have an impact on treatment of incarcerated populations 3. Impact of continuing or initiating MAT for OUD in incarcerated persons; a. Experience in Rhode Island (Rich) b. Experience in New Mexico (Trigg) Interactive discussions: (Participants choose between small groups discussions): 40 minutes This activity will start with participants completing a worksheet that will walk them through a draft plan for providing SUD treatment in one of their local jails or prisons, which they will then use during the small group discussion. 1. Expanding treatment for SUDs in jail and prison 2. Helping released inmates to connect with SUD treatment and avoid overdose Large group de-brief/discussion (10 minutes)

    Miriam S. Komaromy

    MD, FACP, DFASAM

    Dr. Komaromy is an Associate Professor of Medicine and Associate Director of the ECHO Institute (echo.unm.edu), which is a program based at the University of New Mexico Health Sciences Center that is aimed at expanding access to treatment for traditionally underserved populations. She is Director for the Integrated Addictions and Psychiatry teleECHO program, which engages and supports primary care teams in treating addiction and behavioral health disorders. Through this program she has trained more than 500 physicians to provide buprenorphine treatment for opioid use disorder. She is board certified in Addiction Medicine through the American Society of Addiction Medicine. She serves on several national committees focused on addiction medicine.. She practices addiction medicine in a primary care outpatient clinic setting, and is a newly elected Board Member for the American Society of Addiction Medicine (ASAM). She has served as medical director for the NM State Addiction Treatment Hospital. She lectures nationally on clinical and health policy issues related to integration of addiction treatment into the primary care setting, and on the use of the ECHO model to train primary care providers to treat common, complex diseases such as behavioral health and substance use disorders. 

    Sarah Wakeman

    MD, FASAM

    Sarah E. Wakeman, MD is the Medical Director for the Mass General Hospital Substance Use Disorder Initiative, program director of the Mass General Addiction Medicine fellowship, and an Assistant Professor of Medicine at Harvard Medical School. She is also the Medical Director of the Mass General Hospital Addiction Consult Team, co-chair of the Mass General Opioid Task Force, and clinical lead of the Partners Healthcare Substance Use Disorder Initiative. She is the Medical Director of RIZE Massachusetts, a state-wide, private sector initiative created to build a $50 million fund to implement and evaluate innovative interventions to address the opioid overdose crisis. She received her A.B. from Brown University and her M.D. from Brown Medical School. She completed residency training in internal medicine and served as Chief Medical Resident at Mass General Hospital. She is a diplomate and fellow of the American Board of Addiction Medicine. She is chair of the policy committee for the Massachusetts Society of Addiction Medicine. She served on Massachusetts' Governor Baker’s Opioid Addiction Working Group. Nationally, she is chair of the American Society of Addiction Medicine Drug Court Task Force and serves on their ethics committee.Clinically she provides specialty addiction and general medical care in the inpatient and outpatient setting at Mass General Hospital and the Mass General Charlestown Health Center. Her research interests include evaluating models for integrated substance use disorder treatment in medical settings, recovery coaching, physician attitudes and practice related to substance use disorder, and screening for substance use in primary care.

    Josiah D. Rich

    MD, MPH

    Josiah D. Rich, MD, MPH is Professor of Medicine and Epidemiology at Brown Medical School and a practicing infectious disease specialist since 1994 at The Miriam Hospital and the Rhode Island Department of Corrections, both in Providence, Rhode Island. He completed medical school at the University of Massachusetts Medical School and Internship and Residency at Emory University in Atlanta, Georgia. He subsequently received his MPH from Harvard School of Public Health, and completed HIV/AIDS and Infectious Diseases fellowships at Harvard Medical School and the Brigham and Women's Hospital in Boston, Massachusetts. 

    For over 20 years, Dr. Rich has provided medical care both at The Miriam Hospital and at the Rhode Island State Correctional Facility. He is an Infectious Disease, HIV and Addiction Specialist. He is Principal Investigator or Co-Investigator on several research grants involving the treatment and prevention of HIV infection and Opioid Use Disorder, including the PI of two R01's and a K24 all focused on incarcerated and/or addicted populations.  Dr. Rich is also an advocate for public health policy changes to improve the health of people with addiction, including improving legal access to sterile syringes and increasing drug treatment for incarcerated populations.  He is currently the Director and Co-Founder of the Center for Prisoner Health and Human Rights at The Miriam Hospital Immunology Center, www.prisonerhealth.org. Also Co-founder of the nationwide Centers for AIDS Research (CFAR) collaboration in HIV in corrections (CFAR/CHIC) initiative.

    Bruce Trigg

    MD

    Dr. Trigg is a public health physician. He worked for 23 years with the New Mexico Department of Health where he served as medical director for the Sexually Transmitted Disease (STD) Program, started a correctional public health program, and worked with the Milagro Perinatal Substance Use Program at the  University of New Mexico (UNM).  

    His harm reduction work included the development of  a statewide syringe exchange program,  a buprenorphine treatment program,  and expansion of overdose prevention programs.  In 2005, Dr. Trigg started a methadone maintenance program at the Bernalillo County Metropolitan Detention Center, in Albuquerque, that is still operating.
    Dr. Trigg was the medical director for several Opioid Treatment Programs in New Mexico. He worked with the UNM ECHO Program to provide physician buprenorphine waiver trainings. In 2007, he was the co-convener of a national roundtable meeting on medication-assisted treatments (MAT)  in correctional settings.
    For the past six years Dr. Trigg has been a global public health consultant in addiction treatment in several Southeast Asian countries. He worked with Australian AID in Cambodia, Vietnam and Indonesia, with Médecins du Monde in Burma, and in 2015, with SAMHSA, CDC and the Government of Vietnam.  
    Dr. Trigg recently moved to New York City where he plans to continue his work with MAT. 
    He graduated from George Washington University School of Medicine in 1981 and did his pediatric residency training at Albert Einstein College of Medicine in NYC and the UNM Health Sciences Center. From 1983 to 1986 he worked as a general medical officer with the Indian Health Service of the US Public Health Service in Native American communities in New Mexico and Arizona.

  • Development of a Community-Based Collaboration for a Medical Student Elective for SUD (1.5 CME)

    Product not yet rated Contains 3 Component(s), Includes Credits

    Drug overdose is a leading cause of accidental death in the US, mainly due to the increased prevalence of opioid abuse. Rising rates of prescription opioid and heroin abuse with overdose deaths have brought renewed energy to approaching addiction from a recovery-based model of substance use disorders (SUD) treatment rather than through the criminal justice system. Demand grows for more effective and nuanced addiction treatments, but lack of capacity of healthcare practitioners with addiction knowledge has become apparent.

    Drug overdose is now the leading cause of accidental death in the United States, mainly due to the increased prevalence of opioid abuse. Increased rates of prescription opioid and heroin abuse have brought renewed energy to approaching addiction from a recovery-based model of treatment rather than through the criminal justice system. As demand grows for more effective and nuanced addiction treatments, the lack of enough healthcare practitioners with addiction knowledge has become more apparent. It is generally understood in the healthcare community that addiction is a brain disease, often co-occurring with other psychiatric illnesses like bipolar disorder, PTSD and other medical illnesses like HIV/AIDS, HCV and others; thus it requires a comprehensive biological, socio-cultural, and psychological approach. Attitudes continue to frame addiction as a moral failing rather than a medical illness and it is heavily stigmatized. Many physicians are thus disinclined to treat substance use disorders only re-inforced by the relative lack of robust addiction training in medical education and leads to many physicians who are unprepared to diagnose and treat addiction. Further, many are unaware of the resources available to them for screening and referral. As a result, addiction care in the US is often left to minimally trained counselors, most of whom are unable to address medical issues that arise and are often the sequelae of drug use such as gastro-intestinal, cardiovascular disorders, infectious diseases (HIV/AIDS, HCV), etc. Despite evidence-based effective treatment models incorporating medication assisted treatment and community programs, there is a severe gap in capacity building to produce physicians that can recognize and treat addiction and its co-morbidities. To address this gap, this workshop will outline some efforts to address the lack of medical student education about substance use disorders. We will discuss addiction education in US medical schools and describe our institution's preclinical and clinical curricula for medical student addiction education. We will describe the development of an innovative clinical elective medical student rotation on addiction/substance use disorders that is based on a collaboration with a local comprehensive substance abuse treatment program that is based on the Therapeutic Community Model in a team-based setting. We will report on how our collaboration was developed; have audience Q & A for strategy discussion; provide skill demonstrations for adding mini-modules of addiction training in any setting to help educators transmit information within busy clinical demands. We realize it isn't always possible to easily expand, edit or change medical school curricula but elective rotations can usually be added for more intensive training. We will show how the development of a Medical School collaboration with an existing community based therapeutic community afforded an opportunity for students to learn in a hands-on way how team-based comprehensive care can and does effectively treat addiction in many. We will direct participants to the wealth of available educational and curricular resources that can help them expand educational opportunities in their own environment.

    Cheryl A. Kennedy

    MD

    Cheryl Ann Kennedy, M.D. is Associate Professor of Psychiatry at the Rutgers New Jersey Medical School, Newark, NJ and immediate past President of the NJ Society for Addiction Medicine, and President-elect of the Tri-County Chapter of the NJ Psychiatric Association. She has expertise in trauma, terror medicine and disasters, HIV/AIDS, addictions and violence. Dr. Kennedy has extensive cross-cultural experience in Asia, Latin America and Eastern Europe. She has worked with the urban community in Newark NJ for over 25 years, serving on the Board of Trustees of Integrity, Inc., a local drug and alcohol rehab center for 25 years. She is expert at crisis intervention, psychiatric care of patients with major medical and surgical problems, including the Psychiatric aspects of transplant medicine. Dr. Kennedy has extensive experience in training medical students, residents, psychiatrists and other mental health workers in a variety of settings and cultures around NJ, the US and Vietnam, Cambodia, Laos, Myanmar, Bosnia-Hercegovina, Cuba, Guatemala and Peru. Dr. Kennedy is Board Certified in Psychiatry, Addiction Medicine, and Psychosomatic Medicine. She has multiple peer reviewed publications, textbook chapters and abstracts. She is current Chair of the Institutional Review Board (IRB) of Rutgers Behavioral Health Sciences (RBHS), Newark and Camden. Dr. Kennedy is a Distinguished Life Fellow of the American Psychiatric Association, a Fellow of the American Society of Addiction Medicine and an elected member of the American College of Psychiatrists. She was Vice Chair of the Department of Psychiatry for over 10 years and is currently the Director of Medical Student Electives for the Department of Psychiatry and former Psychiatry Clerkship Director.

    Connie Hsaio

    BS

    Connie Hsaio, BS, is a medical student at Rutgers New Jersey Medical School.

    Rahul Vasireddy

    BS

    Rahul Vasireddy is a fourth year medical student at Rutgers New Jersey Medical School. He is planning to pursue a residency in psychiatry and has a particular interest in addiction and community psychiatry and its intersections with public mental health. He is looking forward to attending the ASAM conference and learning about approaches to addiction medicine education. 

    Marcus Hughes

    BA

    My name is Marcus Hughes, B.A. and I am a third-year medical student from Rutgers, New Jersey Medical School in Newark, NJ interested in the field of psychiatry.  I grew up in southern New Jersey in the urban city of Pleasantville.  Throughout my childhood I was subjected to the ills of substance abuse and addiction, and am now aiming to use my medical education to make a difference for future generations of individuals affected by these disorders.  I am particularly interested in the barriers African Americans, and other marginalized groups, face with regards to treatment for mental health issues.  In my free time I am an avid painter, 35 mm photographer, and writer of poetry.  I am looking forward to participating in this conference and learning a great deal.  Thank you for having me. 

  • Policy Plenary: Addiction Policy Outlook in the New Administration (1.5 CME)

    Product not yet rated Contains 3 Component(s), Includes Credits

    What should addiction medicine specialists and their clinical teams expect from the new Administration and Congress? This plenary session will give an overview of the new President's health care policy priorities and how important addiction policies such as CARA, DATA 2000 and parity might be impacted. Speakers will give an overview of the new Administration's health policy platform, discuss early impacts of the landmark changes to addiction medicine policy that passed in 2016, and examine opportunities and challenges for their implementation under the new Administration.

    What should addiction medicine specialists and their clinical teams expect from the new Administration and Congress? This plenary session will give an overview of the new President's health care policy priorities and how important addiction policies such as CARA, DATA 2000 and parity might be impacted. Speakers will give an overview of the new Administration's health policy platform; discuss the possible implications of various proposals to repeal and replace the Affordable Care Act on access to addiction treatment; share early impacts of the landmark changes to addiction medicine policy that passed in 2016; and examine opportunities and challenges for their implementation under the new Administration. Todd Askew, Director of Congressional Affairs for the American Medical Association, will give an overview of the new President's health policy priorities. Carol McDaid, Principal of Capitol Decisions Inc., will give an overview of the implementation of CARA to date and discuss the outlook for funding and implementation of its provisions. Dr. Kim Johnson, Director of the Center for Substance Abuse Treatment at SAMHSA, will discuss the implementation of the Final Rule to raise the DATA 2000 patient limit as well as CARA's provisions to expand prescribing privileges to nurse practitioners and physicians assistants.

    Todd Askew

    Todd Askew is the Director of the Division of Congressional Affairs for the American Medical Association, a position he has held since 2006.  In that capacity, Todd oversees that AMA’s team of Congressional lobbyists and develops and implements strategies to advance organized medicine’s priorities before the United States Congress.

    Prior to becoming Director, Todd was an Assistant Director for the division, working primarily with House Democratic leadership and the House Committees on Energy and Commerce and Ways and Means, the committees with primary jurisdiction over most health care and public health issues.  From 1994-2000, Todd worked for the American Academy of Pediatrics Department of Federal Affairs.  In this role, he worked extensively on legislative and regulatory matters dealing with health care financing and public health, including the 1997 enactment of the Children’s Health Insurance Program.  Todd began his career in Washington in the office of then Representative Nathan Deal of Georgia.
    Todd has a B.A.in History from Washington and Lee University in Lexington, VA.

    Carol McDaid

    Carol McDaid serves as Principal at Capitol Decisions, Inc.  Capitol Decisions has a special expertise in addiction and mental health policy.  For 25 years, Ms. McDaid has worked with mental health and substance use disorder treatment systems, addiction physicians, prevention and educational organizations and addiction and mental health consumer organizations to refine public policy addressing addiction and mental health.  
    With over 30 years of Federal legislative experience in Washington, Ms. McDaid provides clients with government relations consulting on issues that span the breadth of health care, including behavioral health, Medicare, Medicaid, and private sector reimbursement issues. 
    Ms. McDaid helped establish and coordinate activities for the Parity NOW Coalition, which was influential in passage of the 2008 “Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act.”  This landmark legislation requires insurers to treat addiction, mental, and physical health problems equally.
    To expand both addiction and mental health coverage at parity, McDaid served as strategist to a behavioral health Coalition during the health care reform debate in Congress.  Capitol Decisions also served as consultants to the Coalition to Stop Opioid Overdose (CSOO) who were part of the successful multi-coalition effort to pass the bipartisan Comprehensive Addiction and Recovery Act in 2016 as well as to include mental health and substance use disorder and mental health provisions in the 21st Century Cures Act.
    Ms. McDaid is a founding Board Member of Faces and Voices of Recovery and currently serves on the Board of Young People in Recovery.  In 2007, she received the Johnson Institute’s America Honors Recovery Award and in 2016, she received the American Society of Addiction Medicine’s John P. McGovern Award.

    Kim Johnson

    PhD

    Kimberly A. Johnson, PhDDirectorCenter for Substance Abuse Treatment

    Kimberly A. Johnson, Ph.D., Director, Center for Substance Abuse Treatment, leads the center’s activities to improve access, reduce barriers, and promote high quality, effective substance use disorder treatment and recovery services. Dr. Johnson’s extensive experience in and contributions to the behavioral health field ensure the center’s programs are correctly focused and support SAMHSA’s mission.
    Dr. Kimberly A. Johnson began her tenure as Director, Center for Substance Abuse Treatment, in February 2016. Previously, Dr. Johnson was the Deputy Director for Operations of CHESS/NIATx, a research center at the University of Wisconsin, Madison that focuses on systems improvement in behavioral health and the development of mobile applications for patient self-management. Dr. Johnson was also co-director of the national coordinating office of the Addiction Technology Transfer Center. 
    Dr. Johnson’s contributions to the behavioral health field have earned her numerous awards – including the Federal DHHS Commissioner’s Award for Child Welfare Efforts and the National Association of State Alcohol and Drug Abuse Directors’ Recognition for Service to the field of Substance Abuse Treatment and Prevention. Dr. Johnson is a highly-regarded thought leader, who has authored a variety of publications on topics important to the addiction and recovery field, including e-health solutions for people with alcohol problems, using mobile phone technology to provide recovery support for women offenders, and new practices to increase access to and retention in addiction treatment. She is co-author of a book on the NIATx Model and co-author of the chapter on quality improvement in the text ASAM Principles of Addiction Medicine. Dr. Johnson has a master’s degree in counselor education, an M.B.A. and a Ph.D. in population health.

    Kelly J. Clark

    MD, MBA, DFAPA, DFASAM

    Dr. Kelly J. Clark is the President Elect of ASAM. She currently chairs the Public Policy Council, consisting of the Legislative Advocacy, Payer Relations, and Public Policy Committees.

    Board certified in addiction medicine and psychiatry, she has focused her career on issues of prescription drug abuse, evidence informed behavioral health care, and payment reform.  Dr. Clark is Chief Medical Officer of CleanSlate Centers, a multi-state medical group currently treating over 5,000 opioid addicted patients with medication management, and which has received a SAMHSA Science to Service Award for Office Based Opioid Treatment.   She is active on the Association of Managed Care Pharmacy’s Addiction Treatment Advisory Group; served on the writing committee of the Johns Hopkins Bloomberg School of Public Health’s recent policy document, “The Prescription Drug Epidemic: An Evidence Based Approach”; and led the workgroup on Health Systems and Reimbursement at SAMHSA’s Buprenorphine Summit.
    As the Behavioral Health Medical Director of CDPHP, a non-profit health plan in New York, she provided the clinical leadership for in-sourcing the management of behavioral health benefits.  As Chief Medical Officer for Behavioral Health Group, she again focused on opioid addiction.  Her expertise in payment models, quality metrics, medical-behavioral health integration, and clinical care delivery systems, as well as her clinical work treating people with addictive disease, all allow her to offer insights and recommendations to address the current epidemic.  
    As faculty of the University of Massachusetts Medical School for eight years, Dr. Clark trained students and resident physicians on addiction. She is currently a member of the American Psychiatric Association’s Integrated Care Work Group; the National Rx Drug Abuse Summit Advisory Board; and the faculty of the Virginia Tech Carilion School of Medicine.

  • Beyond CIWA: Alcohol Withdrawal Treatment Protocols Using Brief Withdrawal Scales (1 CME)

    Product not yet rated Contains 3 Component(s), Includes Credits

    Effective treatment of alcohol withdrawal requires provision of symptom triggered benzodiazepines using a withdrawal scale. The 10-item CIWA-Ar is the most broadly-used scale but is cumbersome to use. Therefore, there is interest in developing and implementing simpler scales. The presenters will review some of the scales in use and present a novel 5-item scale that has been implemented at Johns Hopkins Hospitals.

    Alcohol use disorders are common among hospitalized patients and these individuals are at risk for severe withdrawal if not treated properly. The standard of care for treatment of alcohol withdrawal is symptom-triggered dosing of benzodiazepines using the CIWA-Ar to guide treatment. However, the 10-item CIWA-Ar is cumbersome to use - especially for clinicians who have limited experience with treating withdrawal - and there is interest in developing shorter scales. There are a number of other scales that have been proposed, but there is limited evidence of their efficacy in practice. We will review the development of the CIWA-Ar and the evidence behind its adoption. We will then present a number of shorter withdrawal scales that have been developed and the evidence for their utility. Finally, we will focus on the development and implementation of a simple alcohol withdrawal protocol using the 5-item Brief Alcohol Withdrawal Scale (BAWS) at Johns Hopkins. We will present data on the comparison of the BAWS with CIWA-Ar and the outcomes of patients who were treated with this protocol.

    Darius Rastegar

    MD

    Dr. Rastegar provides treatment for substance use disorders in an outpatient primary care setting and an inpatient unit.  He is an Associate Professor of Medicine at Johns Hopkins University School of Medicine and is the medical director for the Chemical Dependence Unit at Johns Hopkins Bayview Medical Center.  He is the co-author of The ASAM Handbook of Addiction Medicine.

    Anika Alvanzo

    MD, MS, FASAM, FACP

    Anika Alvanzo, MD, MS is an Assistant Professor in the Department of Medicine at Johns Hopkins University School of Medicine where she is also the Medical Director of the Johns Hopkins Hospital Substance Use Disorders Consultation Service (SUDS). Dr. Alvanzo is a graduate of the George Washington University School of Medicine and Health Sciences and holds a master's degree in biostatistics from Virginia Commonwealth University. She is board certified in both Internal Medicine and Addiction Medicine. As the Director of the SUDS, Dr. Alvanzo oversees a multidisciplinary consultation service that performs brief behavioral interventions and counseling for hospitalized patients, facilitates linkage to hospital and community-based alcohol and drug treatment programs, provides guidance on the clinical management of substance withdrawal syndromes, and educates patients, families, healthcare professionals and the community to prevent, identify, and treat persons living with addiction. Dr. Alvanzo is also the Director of the Substance Use Disorders Rotation for the Johns Hopkins Medicine-Pediatrics Urban Health and Urban Health Primary Care Residency track programs. Her research interests include gender and race/ethnicity differences in the risk for substance use disorders, integration of technology for screening, brief intervention and referral to treatment in diverse settings and the association between psychological trauma, traumatic stress, and substance use. In particular, she is interested in the mechanisms by which histories of physical and/or sexual violence confer increased risk for substance use disorders and in the development of interventions for co-occurring traumatic stress and substance misuse in women.