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  • Combining Medications with 12 Step, Abstinence-Based Treatment for Opioid Use Disorders (1 CME)

    Contains 3 Component(s), Includes Credits

    This focus session will describe the combination of use of medications with 12 Step programs in three different settings. We will provide data and information showing that medication and 12 Step approaches work well in combination, and in fact enhance outcomes. Research describing 12 Step meeting attendance by those in methadone maintenance programs will be presented. The experience of combining these treatment methodologies in an inner city outpatient treatment program will be described. Data will also be presented from a national 12 Step oriented treatment system associated with opioid use disorder outcomes comparing 12 Step, abstinence based treatment as usual with the combination of 12 Step, abstinence based treatment and buprenorphine/naloxone or extended release naltrexone.

    Addiction treatment providers must end the conflict over two divisive issues: the use of maintenance medications in addiction treatment and the primary goal of treatment. The questions in dispute are 1) whether buprenorphine and methadone are compatible with successful treatment, and 2) whether recovery is the primary goal of treatment (abstinence, including no use of alcohol, marijuana and other drugs). Healing the persistent and self-destructive rift in the addiction treatment field regarding the proper use of opioid substitution medications and defining the primary goal of treatment are high priorities in our field. Many clinicians working in traditional 12-Step abstinence-oriented treatment programs adamantly maintain that the extended use of these maintenance medications is incompatible with recovery from addiction. More specifically, they believe that their use is an obstacle to working the 12-Steps. At the other extreme, some physicians only provide medications and do not use psychosocial treatments or 12 Step programs. Hazelden Betty Ford Foundation (HBFF) -- among the oldest and most respected of the 12-Step-based programs -- facing a crisis of young patients with opioid use disorders dropping out of treatment, many of whom relapsed, some overdosing on leaving treatment, added buprenorphine and extended release naltrexone as options in their structured abstinence-oriented program. Thus, HBFF has defined the use of medications, including maintenance medications, as "medicines" and not as "drugs" when they are used as prescribed and consider them fully compatible with recovery just as antidepressants are considered. Three years of experience has shown that integration of buprenorphine and naltrexone into the Hazelden abstinence-oriented program is not only possible, but that patients using and not using medicines can be treated in the same programs by the same staff to the benefit of all concerned. This innovation has improved outcomes and healed this festering conflict in the interests of their patients and their families. In this focus session, Dr. Marvin Seppala will present the results of this initiative, along with a comparison group that received treatment as usual, showing that medication and 12 Step approaches work well in combination, and in fact can enhance outcomes of all patients, those who use medications and those who do not. In addition, Dr. Robert DuPont will describe the history of these conflicts and research about 12-Step meeting attendance by those in traditional methadone maintenance programs. He will also speak to some of the challenges faced by these patients. Dr. George Kolodner will describe the experience of combining these treatment options in an abstinence-oriented intensive outpatient rehabilitation program.

    Marvin Seppala

    MD, PC

    Marvin D. Seppala, MD, is chief medical officer at Hazelden Betty Ford Foundation, and an adjunct Assistant Professor at the Hazelden Graduate School of Addiction Studies. His responsibilities include overseeing all interdisciplinary clinical practices at Hazelden Betty Ford Foundation, maintaining and improving quality of care, and supporting growth strategies for Hazelden Betty Ford Foundation's residential and nonresidential addiction treatment programs. Seppala obtained his M.D. at Mayo Medical School in Rochester, Minnesota, and served his residency in psychiatry and a fellowship in addiction at University of Minnesota Hospitals in Minneapolis. Seppala is author of Clinician's Guide to the Twelve Step Principles, and a co-author of When Painkillers Become Dangerous, Pain-Free Living for Drug-Free People, and Prescription Painkillers, Hazelden Betty Ford Foundation Publishing. 

    Robert L. DuPont

    MD, DFASAM

    For more than 40 years, Robert L. DuPont, M.D. has been a leader in drug abuse prevention and treatment. He served as the first Director of the National Institute on Drug Abuse (1973-1978) and as the second White House Drug Chief (1973-1977). From 1968-1970 he was Director of Community Services for the District of Columbia Department of Corrections, heading parole and half-way house services. From 1970-1973, he served as Administrator of the District of Columbia Narcotics Treatment Administration. Following this distinguished public career, in 1978 Dr. DuPont became the founding president of the Institute for Behavior and Health, Inc., a non-profit organization that identifies and promotes new ideas to reduce illegal drug use. He has been Clinical Professor of Psychiatry at the Georgetown University School of Medicine since 1980. 

    A graduate of Emory University, Dr. DuPont received an M.D. degree in 1963 from the Harvard Medical School. He completed his psychiatric training at Harvard and the National Institutes of Health in Bethesda, Maryland. 

    Dr. DuPont is a Life Fellow of the American Society of Addiction Medicine. His activities in ASAM include chairing the forensic science committee from 1995 to 2004, and serving as Co-Chair of the two White Paper writing committees that produced The Role of the Physician in “Medical” Marijuana in 2010 and State-Level Proposals to Legalize Marijuana in 2012. He served as Chair of the writing committee that produced Drug Testing: A White Paper of the American Society of Addiction Medicine in 2013. He is also a Life Fellow of the American Psychiatric Association and was chairman of the Drug Dependence Section of the World Psychiatric Association from 1974 to 1979. In 1989 he became a founding member of the Medical Review Officer Committee of ASAM."

    George Kolodner

    MD, DLFAPA, FASAM

    George Kolodner, M.D., FASAM is the Medical Director of the Kolmac Clinic, a Clinical Professor of Paychiatry at both the Georgetown And University Schools of Medicine, and the current president of MDSAM, the Maryland State Chapter of ASAM. His specialty interests are the treatment of addictions in an outpatient setting.and the treatment of co-occuring disorders.

  • Contingency Management in General Treatment Populations and Special Groups (1 CME)

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

    Contingency management (CM) is a powerful treatment approach with strong empirical support and large effects, but which is underutilized in community treatment. This workshop will provide information and interactive experience to explore the barriers to CM use and encourage implementation of practical, cost-effective techniques.

    Contingency management (CM) is a powerful treatment approach which is underutilized in community treatment but forms the basis of some of the most successful treatment approaches in special populations such as physicians and drug courts. This workshop will draw on the successes of CM methods in these special populations while exploring barriers to CM use in general treatment populations. Contents and Methods: (1) Background. David Lott will present background information including an overview of the behavioral principles that guide CM approaches, a synopsis of the large body of CM research demonstrating its effectiveness, and highlights of experiences with CM methods in various settings. (2) Special Populations. Danesh Alam will describe treatment in physician health programs with monitoring and high success rates, make connections to the CM theoretical principles, and draw conclusions for improving use of these same principles in other treatment settings. (3) Implementing a CM Program in community treatment. David Lott will describe the process of choosing a CM approach and starting it in the adolescent treatment program at Linden Oaks Addiction Treatment Programs and present data showing the impact of this CM program on financial, staff, and patient outcomes. (4) Questions and Discussion. This session will provide valuable training by helping participants learn a powerful but underutilized treatment approach. Through didactics and discussion, attendees will learn the rationale and methods of contingency management and address the challenges often faced during implementation of a CM program.

    David C. Lott

    MD, DFAPA, DFASAM

    Dr. Lott is Medical Director of Addiction Services at Linden Oaks at Edward-Elmhurst Healthcare in Naperville, Illinois where he is an active clinician and helps direct residential, inpatient, and other treatment services. He is a Clinical Assistant Professor of Psychiatry at the University of Illinois at Chicago and remains active in research and teaching residents and other trainees. He is a Distinguished Fellow of the American Psychiatric Association and the American Society of Addiction Medicine and currently serves as Treasurer of the Illinois Society of Addiction Medicine. He received his undergraduate degree from Duke University and his medical degree from Johns Hopkins. He then completed a residency in Psychiatry at The University of Chicago and a Fellowship in Addiction Psychiatry at The University of Illinois at Chicago, and he is board certified in Addiction Psychiatry and Addiction Medicine. He has published several research articles in areas including opioid addiction, genetics, and contingency management. Finally, Dr. Lott is a past recipient of the ASAM Ruth Fox Endowment Fund Scholarship and the American Academy of Addiction Psychiatry Research Award.

    Danesh Alam

    MD, DFAPA, FASAM

    Danesh Alam, MD, DFAPA, FASAM is the Medical Director of the Northwestern Medicine Central Dupage Hospital.

  • Methadone & Long QTc: Clinical Prediction, 5-Year Prevalence, and Causes-Interventions (1 CME)

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

    The goal of the session is the prevention and early intervention of long QTc in patients receiving methadone maintenance treatment (MTT). The presentations are based on observations made over a five-year period in a MMT program. These observations range across a novel clinical biomarker, epidemiological observations made over 300 patient-years, along with clinical diagnosis, intervention, and outcome. We will engage our participants such that they can apply our findings to their clinical populations receiving MMT.

    The goal of the session is the prevention and early intervention of long QTc in patients receiving methadone maintenance treatment (MTT). The presentations are based on observations made over a five-year period in a MMT program. These observations range across a novel clinical biomarker, epidemiological observations made over 300 patient-years, along with clinical diagnosis, intervention, and outcome. We will engage our participants such that they can apply our findings to their clinical populations receiving MMT. The first presentation by Dr. Scott McNairy explains our efforts at identifying a readily available methadone parameter than might show an association with QTc duration. Of seven methadone parameters studied, one parameter (the ratio of methadone dose to body weight) showed a moderate correlation with QTc duration at high significance (p < .001). We assessed this parameter due to the distribution of methadone in body fat as well as its concentration in numerous organs (heart, lung, and other organs) plus the weak, often inconsistent relationship of methadone dose to long QTc. This novel dose/weight ratio produced a high-sensitivity, low-specificity ratio that could be used for routine screening purposes, and another low-sensitivity, high-specificity ratio that could be used in urgent/emergent clinical settings for MMT patents presenting with symptoms suspicious for long QTc (i.e., palpitations, slow or fast pulse, abnormal rhythm, chest discomfort, weakness, fatigue). Use of these ratios might help with individualizing the expert panel recommendations that MMT patents receive regular EKG tests to assess for long QTc. Second, Dr. Gihyun Yoon presents epidemiological data on the prevalence and recurrence of long QTc among 69 patients during 300 patient-years of observation. Long QTc occurred in 32% of MMT patients during the 5-year period. In addition, about 58% of patients who had one long QTc episode were prone to a second or a third recurrent episode. These episodes ranged from asymptomatic (67%) to symptomatic (33%), including two cases of torsade de pointes. Third, Dr. Joseph Westermeyer focuses on the causes of long QTc. Causes were identified based on interventions that successfully returned the QTc to normal. Three general categories were identified, consisting of (1) prescribing decisions involving particular medication groups, (2) re-addiction with opioids and benzodiazepines, and (3) certain conditions affecting metabolism (i.e., renal insufficiency, dehydration, sudden weigh loss, post-childbirth). Recurrences can involve the same of difference causes. Cause could not be determined in two patients, who recovered spontaneously. One mortality occurred in an asymptomatic patient who refused to consider a methadone dose reduction and died suddenly six months later. At the beginning of the presentation, Dr. Heather Swanson will lead a group exercise in which audience members consider common clinical problems. Audience members will report their clinical decisions, followed by a question-and-answer period. At the conclusion of all three sessions, a panel of the three discussants will be convened to consider how the information and conclusions from all three sessions might be integrated and applied in MMT programs. Dr. Patricia Dickmann will chair this panel-audience interaction.

    Joseph Westermyer

    MD, PhD, MPH

    Joe Westermeyer has worked in methadone programs since serving in one of the initial VA methadone programs in the mid-1970s.  Subsequently he served as a consultant to the World Health Organization.  The latter role involved aiding countries identify the nature and extent of opioid and other substance disorders,  undertake broad-based approaches to prevention and early intervention, and  (as appropriate) consider treatment and rehabilitation programs.  Such programs included utilizing methadone treatment in various ways, including short- and long-term withdrawal regimens, as well as short- and long-term maintenance methods (as described in an edited book by Arif and Westermeyer).  His recent work in this area grows out of intensive observation and clinical work with a group of methadone maintenance patients over several years.
    This most recent work depends on longitudinal observation and study over a long time, with repeated use of methadone blood levels (trough and 3-hour peaks) and electrocardiographs.  He collaborated with cardiologists Drs. Adabag and Anand in obtaining hand-measured QT intervals and comparing them with computer-derived QT intervals.  These data were obtained both routinely (upon induction and then annually) and as warranted when clinical symptoms or disability arose.  This work builds on original basic work done with methadone decades ago, but then abandoned – with many clinical questions unanswered. 

    Patricia Dickmann

    MD

    Patricia Dickmann MD is a staff psychiatrist at the Minneapolis VA Medical Center. She splits her time between addiction psychiatry, a clinic for homeless vets, teaching, and research. She serves as the Medical Director of the Minneapolis VA's Opioid Treatment Program. Dr. Dickmann is also the Minneapolis VA's Psychiatry Residency Site Director. She is involved in several research projects, two involving neuromodulation (tDCS, tMS). 

    Gihyun Yoon

    MD

    Dr. Yoon is a staff psychiatrist at the VA Connecticut Healthcare System and an Assistant Professor in the Department of Psychiatry at Yale University School of Medicine. His research interests include (1) pharmacotherapy for addictive disorders (especially alcohol use disorder) and (2) pharmacotherapy for psychiatric disorders (especially major depressive disorder).

    Scott McNairy

    MD, FASAM

    Scott has 36 years experience in the delivery of clinical health care focused on treatment for chronic pain, addictive and combat stress disorders. He is Board Certified in the Addiction Psychiatry. His post-graduate training in psychiatric medicine began at the Mayo Clinic 1975-1979. He is most indebted to early Mayo consultants for pioneering novel addiction and pain medicine treatment practices which serve as a foundation for his practice at the VA today. . Scott was an early board member for Minneapolis Pathways, one of the first health crisis resource centers for life-threatening medical illness in the country. Many of those practices are now well–integrated in to treatment for palliative and end of life care. He champions greater use of addiction pharmacotherapy in primary care and psychiatry and trains physicians for the DEA buprenorphine waivered licensure. He is using  utilization of pharmacy data mining for monitoring treatment outcomes that will enhance patient safety and evidence-based care.His clinical outcome studies include 1) development of a medication management support group for opioid dependent patients treated with buprenorphine to promote treatment success and 2) the use of parenteral depot naltrexone for high medical risk, chronic and treatment refractory alcohol dependent veterans which dramatically reduces overall costs of care and disease progression.At the University of Minnesota - VA campus he directs the fellowship in addiction psychiatry and site directs the ABAM addiction medicine fellowship  recognized by ABMS.  He is recognized for his excellence in teaching and modeling positive clinical encounters. He places primary emphasis on restoration of function and prevention of deterioration as outcomes for success. Scott is an integral part of a treatment team comprised of physicians, nurses, social workers and psychologists without whom he could not have achieved the success that he has had.

  • Together at Last - Addiction Medicine Joins Primary Care and Behavioral Health (1 CME)

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

    The integration of three disciplines, addiction medicine, primary care, and behavioral health, is essential to optimizing care for the substance use disorder patient. This presentation describes the addition of addiction medicine into an already integrated primary care-behavioral health federally qualified health center. The discussion will include concept formation, staff development, implementation, and a review of early effectiveness data.

    The overwhelming prevalence of binge drinking, 66.7 million Americans in the past thirty days, heavy alcohol use, 17.3 million in the past month, and illicit substance use, 27.1 million users in the past thirty days, requires an integrated and comprehensive approach on the part of clinicians to address this public health crisis. The recognized disproportionately high prevalence of co-morbid psychiatric and medical illnesses in the substance use disorder population further demands a consolidated treatment strategy to care for these patients. Cherokee Health Systems (CHS), a large, multi-center FQHC long a leader in behavioral health and primary care integration, has embarked on an ambitious program of graduated introduction of addiction medicine services into every day clinical practice for all medical (including obstetrics) and behavioral health providers. This CHS program integrates addiction medicine services at the level of the primary care provider and behavioral health consultant using screening, brief intervention, and referral to treatment (SBIRT) tools consistent with ASAM Level 0.5 care; provides for medication assisted treatment, office based opioid treatment, intensive outpatient treatment programs, and, ultimately, a partial hospitalization program delivered by an addiction medicine specialist, psychiatrists, and psychologists consistent with ASAM levels 2.1 and 2.5 care; through to an innovative, integrated complex care team comprised of an addiction medicine specialist, primary care providers, obstetricians, psychologists, nurses, community health coordinators, and administrative staff all working together with team-based patient encounters to provide services to pregnant women and the most seriously ill, high co-morbid disease burden patients. Staff required training regarding the disease model of addiction, conduct of SBIRT and incorporation into work-flow, introduction to medication assisted treatment using FDA-approved medications, and referral guidelines for the complex care team and higher level addiction care services. Implementation of this program necessitated the recruitment and hiring of additional staff in the areas of primary care and nursing as well as reallocation and remodeling of physical space within the main clinical site to allow for efficient performance of medical and administrative duties. CHS embraced its role as a community provider and partnered with multiple local and state agencies, including Recovery Courts, local hospitals and other substance use disorder treatment providers, State Substance Abuse Services administration, and city, county, and state public health authorities to make these services widely known and available to patients in need. With implementation of the program, the complex care team plans to enroll patients receiving medication assisted treatment or other non-medication addiction treatment services; patients will be referred from primary care and behavioral health providers as a direct result of SBIRT implementation; and community partners will refer individuals for treatment at CHS. Data collection regarding treatment retention, relapse rates, neonatal outcomes, and psychiatric and medical co-morbidity treatment is ongoing and will stimulate redirection of the program as indicated.

    Mark A. McGrail

    MD

    Mark A. McGrail, M.D.Director, Addiction Medicine ServiceCherokee Health SystemsDiplomate, American Board of Family Medicine and American Board of Addiction MedicineDr. McGrail received his undergraduate degree from the University of Maryland at Baltimore and his medical degree from the Uniformed Services University.  He completed a family medicine residency at Eisenhower Army Medical Center and a fellowship in Primary Care Behavioral Medicine at the University of Tennessee Medical Center in Knoxville.  Dr. McGrail retired from the U.S. Army in October 2016 after a 34 year career during which he served in multiple operational and clinical leadership positions.  He then joined Cherokee Health Systems in Knoxville, TN as the Director for Addiction Medicine Services and provides addiction and primary care to a largely underserved patient population.

    Suzanne Bailey

    PsyD

    Suzanne Bailey, PsyD is the Director of Integrative Services at Cherokee Health Systems, a comprehensive community healthcare organization in east Tennessee. Dr. Bailey leads Cherokee's integrated care implementation, provides leadership, oversight, and guidance on clinical services, and is involved in consultation and training in integrated care.  Dr. Bailey serves as the Associate Training Director for Cherokee’s APA accredited Predoctoral Psychology Internship and Behavioral Medicine Fellowship.  She earned her doctorate at Xavier University.

  • Vermont Hub and Spoke Model of Care for Opioid Use Disorders (1 CME)

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

    Vermont established a Chronic Care Initiative that made opioid use disorder part of the Blueprint for Health and designated funding for an integrated model of care linking medical providers with regional Opioid Treatment programs (designated as hubs) and provided Community Health teams to assist buprenorphine prescribers (designated as spokes) in their practices. We describe this model and successes showing total increase in treatment enrollees, increase in number of physicians waived to prescribe buprenorphine and numbers of patients per provider, provision of a triage tool to determine hub or spoke placement and use of a learning collaborative to increase overall knowledge base statewide for opioid use disorder treatment.

    The Vermont Hub and Spoke Model is an integrative state-wide model of care to create a seamless system of treatment for opioid use disorders similar to other chronic illnesses. State wide stakeholders, addiction medicine providers, and health department officials joined together to create this system and the funding mechanism to create it will be described. Hubs were renamed from Opioid Treatment Programs and Spokes were created from office based buprenorphine prescribers and linked in each region of the state. It created regional Hub and spoke connections so that no one would lose care if they became unstable and Hubs would provide consultation and expertise to community buprenorphine providers when needed. MAT teams were created to support buprenorphine prescribers in the office setting and to increase the provider satisfaction in prescribing buprenorphine. Hubs were allowed to use buprenorphine so that people could start in a hub and go to a spoke or go from a spoke to a hub if unstable. Creation of community health teams known as MAT teams (medication assisted treatment) was key to the adoption of the model by buprenorphine providers and the roles of these teams will be explained. Finally, increases in the number of DATA 2000 waivered physicians and the patients they served will be reviewed as the overall penetration of MAT in Vermont exceeded 1% of the total population.

    John Brooklyn

    MD

    Dr. John Brooklyn is Board Certified in Family Medicine and Addiction Medicine. He is Associate Clinical Professor of Family Med and Psychiatry at the University of Vermont College of Medicine and is Medical Director of UVM Substance Abuse Treatment Center with major research interests in heroin and cocaine use and directed multiple studies of buprenorphine past and currently. He helped create the first program in Vermont for treating pregnant opioid users. He currently is the Medical Director of 3 of the opiate treatment programs in Vermont. He is a statewide and national consultant to doctors for methadone and buprenorphine treatment. He conceived of the Hub and Spoke Model in Vermont.He is the former medical director and current staff physician at the Community Health Center in Burlington for 23 years. He is an avid bicyclist and skier and has 3 grown children.

    Anthony Folland

    BA

    Tony Folland is the Clinical services Manager and State Opioid Treatment Authority for Vermont. Prior to the last 7 years in state government,  he was employed in the social services field for nearly 20 years, having worked in both rural and urban mental health centers in a variety of capacities including: emergency services, outpatient treatment and case management, program development and staff supervision, Drug treatment courts and Medication Assisted Treatment for opioid use disorders. 

  • Ethical Issues in Addiction Medicine- Case Based Dilemmas (1 CME)

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

    Ethical issues abound in caring for patients with addiction, with clinical dilemmas related to difficult patients, manipulative behavior, refusal of care and legal issues. The workshop will briefly review the ethical principles of Autonomy, Beneficence, Non-maleficence, Justice, Fidelity and Futility. The understanding of these terms will serve as the basis of case based discussions.

    Ethical issues abound in caring for patients with addiction, with clinical dilemmas related to difficult patients, manipulative behavior, refusal of care and legal issues. The workshop will briefly review the ethical principles of Autonomy, Beneficence, Non-maleficence, Justice, Fidelity and Futility. The understanding of these terms will serve as the basis of case based discussions. There will be six patient scenarios (touching on varied clinical dilemmas) presented. Each case will be presented briefly and then the audience will break up into small groups to discuss and come up with an answer (there may not be only one right answer). Each group will briefly report its answer. There will also be an opportunity for participants to present their own patient care dilemmas that pose ethical questions. The hope is that the session will validate participants unease in caring for patients in certain situations and help build clinical confidence, by gaining skill in being able to make decisions in clinical situations using an ethical framework.

    Michael Fingerhood

    MD, FACP

    Dr. Michael Fingerhood is an Associate Professor of Medicine at the Johns Hopkins University. He is the Chief of the Division of Chemical Dependence and medical director of the Comprehensive Care Practice (CCP) at Johns Hopkins Bayview Medical Center. The CCP integrates substance abuse treatment with primary medical care, including care for HIV and hepatitis C.

  • Hepatitis C Screening, Education, and Treatment Program for People Who Use Drugs (1 CME)

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

    This workshop will examine unique models of interdisciplinary HCV care delivery tailored to different clinical settings where persons who use drugs may present including: primary care, opioid treatment programs, syringe exchanges, and safety net programs for the homeless. We will review basics of treatment models after which we will hold an interactive session where small groups will review pertinent cases.

    The public health burden of Hepatitis C virus (HCV) among people who use drugs (PWUD) is enormous. Worldwide, about 10 million PWUD have been infected with HCV; however, under 10% of HCV-infected PWUD have initiated treatment for HCV. With the advent of all oral, well tolerated treatment for HCV, or direct acting antivirals (DAA), we now have the ability to make a significant impact on this large disease burden, specifically among PWUD. However, this can best be achieved by focusing on HCV prevention and treatment among PWUDs, key drivers of the HCV epidemic. Some of the barriers to treating HCV among PWUD include limited access to treatment, concerns for ongoing substance use, potential for reinfection after treatment, and stigma. Successful HCV treatment and cure in this crucial population must be a public health priority and depends on innovative models of care that integrate drug treatment with HCV treatment. The objectives of this workshop are to examine unique models of interdisciplinary HCV care delivery tailored to different clinical settings where PWUD present including: primary care, opioid treatment programs, syringe exchanges, and safety net programs for the homeless. After brief faculty introductions and overview of unique treatment models, interdisciplinary session participants will separate into faculty-facilitated small groups to engage in a case-based card game where each participant is assigned a specific role (physician, nurse, social worker, pharmacist, navigator). Next, each group will be assigned a case patient with various demographic and clinical characteristics which may complicate treatment paradigms (i.e., homelessness, ongoing substance use, various HCV genotypes, stage of liver fibrosis or cirrhosis, HIV co-infection, etc). Then participants will draw cards from a "resource card deck" (syringe access program, access to rapid HCV testing with reflex RNA and genotype, methadone clinic access, MAT access, supportive family, housing, primary care provider, DOT services) and a "challenges card deck" (lack of knowledge about HCV, stigma against PWUD, medication prior authorization rejected, patient relapse, lost meds, jailed, new dx HCC, Medicaid restrictions, etc). The object of the game is to develop a treatment plan to cure the patient of HCV and reduce ongoing risk. Bonus points will be assigned to groups which develop a system to eradicate HCV from your community.

    Jenna Butner

    MD

    Jenna Butner is clinical instructor of internal medicine at Yale School of Medicine. She completed her residency training in family medicine at Albert Einstein Yeshiva University. She went on to complete a palliative care and hospice medicine fellowship at Mount Sinai Beth Israel Medical Center, and completed an addiction medicine fellowship at Yale School of Medicine. Her primary interests include treating substance use disorders and treating hepatitis C and HIV in those with substance use disorders.

    Jeanette M. Tetrault

    MD, FACP, FASAM

    Dr. Tetrault’s scholarly work focuses on care of patients with addicition and the medical co-morbidities associated with substance use, mainly HIV and Hepatitis C. She is a diplomate of the American Board of Addiction Medicine. Dr. Tetrault is a physician providing primary care and buprenorphine/naloxone treatment at the Central Medical Unit of the APT Foundation, a multi-specialty addiction treatment facility, and is an attending physician at Yale New Haven Hospital (YNHH). She is the co-director of the Addiction Recovery Clinic in the Adult Primary Care Clinic at the St. Raphael's Campus of YNHH, which serves both a clinical care and a teaching mission. She was selected as a Macy Foundation Faculty Scholar in 2017. She is the Program Director for the Yale Addiction Medicine Fellowship Program and serves on the Board of Directors for The Addiction Medicine Foundation and the Addiction Medicine Fellowship Directors Association. She is a past-president of the New England Region of SGIM and co-chair of the Alcohol, Tobacco and Other Drug Use Interest Group for SGIM.

    Lamia Haque

    MD, MPH

    Lamia Y. Haque, MD, MPH is an addiction medicine fellow at Yale University in collaboration with the APT Foundation, a multi-specialty addiction treatment facility. She completed her internal medicine training in the Yale Primary Care Residency Program. She is a recipient of the Next Generation Award for Adolescent Substance Use Prevention sponsored by the Conrad N. Hilton Foundation and is working to enhance SBIRT delivery in school-based health centers. She has been involved in multiple educational efforts such as organizing trainee-led shared medical appointments for veterans who are prescribed opioids for chronic pain, providing training for medical students and residents through the SAMHSA-funded Medical Health Professional Training SBIRT Program at Yale, and engaging in global health education and capacity-building at a rural primary care center in West Kalimantan, Indonesia through the support of the Johnson and Johnson Global Health Scholars Program. She has had a variety of research experience, ranging from assessing social determinants of cancer treatment among underinsured immigrants through a Gold Foundation for Humanism in Medicine Research Fellowship to delineating national trends in opioid use in hospitalized patients with cirrhosis. Under the mentorship of her program director Jeanette M. Tetrault, MD, FACP, FASAM, she is exploring the epidemiology, treatment, and prevention of substance use disorders and addiction-related comorbidities including chronic hepatitis C infection and decompensated cirrhosis. She plans to seek additional training in gastroenterology and transplant hepatology with the aim of exploring the role of integrated addiction treatment in these subspecialty settings, and hopes to devote her clinical and academic work toward the development of models of care for patients with substance use disorders and chronic illnesses.

    Colleen S. Lynch

    MD, MPH

    Colleen S. Lynch, MD, MPH is the current Medical Director of Care Coordination for the San Francisco Health Network (SFHN), the clinical arm of the San Francisco Department of Public Health. She acts as co-lead of the Primary Care Based Hepatitis C treatment initiative at the SFHN, and is responsable for oversight of the Complex Care Management teams and the post-discharge transitions work in primary care. She also supervises Internal Medicine residents at the University of California San Francisco during their outpatient clincial time. Through her work on the hepatitis C treatment initiative, she has trained and collaborated with multidisciplinary providers across sites including primary care clinics, methadone treatment centers, needle exchange programs, and shelder programs. This work has helped to expand access to hepatitis C treatment for patients throughout the safety net in San Francisco.

    Colleen completed her residency training in Internal Medicine and Primary Care in 2012 at the University of California, San Francisco (UCSF). She completed her National Research Service Award Fellowship within the Division of General Internal Medicine at Mount Sinai in New York, and received her MPH degree with a focus in outcomes research through the Mount Sinai School of Medicine in May of 2015. During her fellowship, her research focus was on patient attitudes toward hepatitis C treatment, and on evaluation of unique models of care for complex patients. She collaborated with the hepatitis C treatment clinic at Mount Sinai and the New York Department of Health and Mental Hygiene on hepatitis C related programming, and has been treating hepatitis C in the primary care setting since 2014. 

    Anna Shmayenik

    PharmD

    Anna Shmayenik, PharmD, is a Pharmacist at Cedra Pharmacy.

  • Integrative Health and Addiction Medicine: Treating the Whole Person (1.5 CME)

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

    An interactive workshop that will introduce Integrative Addiction Medicine by giving a context for this whole person treatment approach, and providing a 'sampler' of clinical approaches that will include: nutrition, mindfulness, supplements, sleep and CAM case examples. Some of the evidence-base will be presented. This workshop will include interactive tools that will be practiced within the workshop, time for discussion, and will end with participants creating their own practice-change action plan.

    Dr Abramowitz will run this 90 minute interactive workshop. She has been active in CSAM's educational committee, as chair, vice-chair and on the planning committee of several CSAM conferences. She is an experienced medical educator in addiction medicine and is a long-time motivational interviewing trainer. She is both an integrative medicine fellow and faculty member. She is author of the chapter on Mindfulness in ASAM's forthcoming book on chronic pain and opioids. Part 1: Introductions --Pair off- 'Summarization Exercise' to hear why learners are here Part 2: Introduce the concept of 'Integrative Addiction Medicine' --How 'one pill for every ill' led to the chronic pain-opioid crisis and the need for a whole person health model of care --12-step tradition and its integration of spirituality into recovery --SUD patients (often due to suffering adverse childhood events) suffer with a high rate of chronic metabolic and cardiovascular conditions. --Lifestyle changes required for SUD recovery can be an entry into whole health recovery. --Why addiction medicine can better serve patients by practicing whole person health informed by the principles of integrative medicine Part 3: Review how to do a simple Integrative addiction medicine assessment --Review a practice-ready intake form --Teach & practice brief MI tool: 'A Typical Day', for nutritional & chronic pain assessment Part 4: Nutritional principles & supplements and early recovery --Introduce diet, health and recovery principles --Brief alcohol and vitamin deficiencies evidence review --Give example of NAC, a supplement that may be useful in recovery Part 5: Exercise & recovery --Evidence review --Teach & practice engagement tool for exercise, 'brief action planning' Part 6: Sleep & recovery --Evidence for non-pharmacological approaches to sleep problems in recovery --Teach how to use 'Menu of Choices' to engage in sleep hygiene Part 7: Mindfulness/Relaxation practices & recovery --Review evidence of usefulness in recovery --Teach and practice a simple mindfulness practice that can be taught in the office Part 8: Integrating learning into practice --Questions, answers and discussion --Pair off and create a practice change action plan based on what has been learned Note: didactics will be presented in mostly a case-based form

    Sharone Abramowitz

    MD, FASAM

    Sharone Abramowitz MD, FASAM is a psychiatrist & ABAM addiction medicine specialist; Behavioral & Addiction Medicine Dir. and Premed Student Health Coach Project Founder, Internal Medicine Residency, Alameda Health System; Faculty & Student, Interprofessional Fellowship Integrative Health & Medicine, AIHM, OHSU; and Member, Motiviational Interviewing Network of Trainers. She also has a private practice in Northern California and is the founder of Abramowitz Healthy Communicating. Additionally, she is on the CSAM executive council and chaired past CSAM annual conferences. Publications include: Bodenheimer T, Abramowitz S, Helping Patients Help Themselves: How to Implement Self-Management Support, California Healthcare Foundation, 2010; Abramowitz S, Flattery D, Franses K, Berry L, Linking a motivational Interviewing Curriculum to the Chronic Care Model, J Gen Intern Med 2010; Abramowitz S, Emphasizing Self-Management Support and Skills in Health Behavior Change Counseling in Motivational Interviewing: Principles and Practical Applications, Oakstone Practical Reviews 2016; and she authored the chapter on Mindfulness in ASAM's forthcoming book on chronic pain and opioids.

  • Medication Assisted Therapy for Drug Court (1.5 CME)

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

    This presentation will provide an overview of how the state courts are structured, discuss in-depth how drug and other specialty court programs work, and explore strategies for building partnerships between the courts and the medical community (specifically with the use of MAT).

    In 2011, the National Association of Drug Court Professionals (NADCP) made a series of resolutions on Medication Assisted Therapy (MAT) that includes distinct requirements for court professionals and substance abuse treatment providers to (1) learn about MAT, (2) obtain expert consultation on the appropriate use of MAT and (3) forbid blanket prohibitions against the use of MAT for their participants. Despite this, only 44% of courts nationwide are using MAT. Consequently, there are great opportunities for addiction medicine physicians to partner with local drug courts to deliver high quality MAT services. This presentation will provide an overview of how the state courts are structured, discuss in-depth how drug and other specialty court programs work, and explore strategies for building partnerships between the courts and the medical community (specifically the use of MAT). Participants will leave with a general understanding of the function of different types of state courts (e.g. district, circuit, probate) and how court ordered probation works. Drug courts, an intensive form of probation, will be discussed in-depth so participants understand how the programs work and what makes them unique in the criminal justice and behavioral health systems. Finally, conversation will be with audience members to understand how partnerships can be formed and how to navigate legal barriers (e.g. confidentiality, liability, funding) between the courts and medical providers. In conclusion, this workshop will provide a broad overview of the courts, in-depth understanding of drug courts, and give audience members the skills to help them effectively interact with Drug Courts and an understanding of the current legal landscape around MAT in drug courts.

    Cara Poland

    MD, MEd

    Cara Poland, MD, M.Ed was trained in internal medicine at St. Joseph Mercy Hospital in Ann Arbor, Michigan and in addiction medicine at Boston Medical Center in Boston, Massachusetts. She has an interest in education physicians and physicians-in-training to improve care for patients with substance abuse and alcohol disorders. She is interested in medical student curriculum development and assessment, student well-being and identifying ways to improve the process of medical training. She sits on the Board of Directors for the Red Project and multiple leadership boards of various professional societies such as the Midwest Society of General Internal Medicine and American Society of Addiction Medicine. She is currently a physician at Spectrum Health's Center for Integrative Medicine.

    Andy Brown

    MPA, MSW

    Andrew Brown is the Drug Court Coordinator for the 20th Judicial Circuit Court in Ottawa County, Michigan.  He has served in this position for seven years and holds Masters Degrees in Public Administration and Social Work and is a Certified Court Manager through the National Center for State Courts.  His drug court is currently recognized as one of nine national mentor courts in the United States by the US Department of Justice and the National Association of Drug Court Professionals.  Andrew has a strong desire to build constructive working relationships with between the courts and community partners who serve our common clientele.

  • Be A Guiding Light: A Special Performance and Session (1 CME)

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

    Be inspired by a live performance by Joseph Green and recorded performances and brief interviews from young people whose lives are touched by addiction.

    This engaging session is led by Opening Plenary presenter Joseph Green, spoken word artist, educator, and motivational speaker. Be inspired by a live performance by Joseph Green and recorded performances and brief interviews from young people whose lives are touched by addiction. In the fight for prevention, treatment, and recovery, one of the most profound obstacles is the negative stigma lingering from the days when substance use disorder was treated as a moral failing rather than a disease. Through the power of spoken word poetry, humanity and dignity can be restored to a space that has been denied such for far too long.

    Joseph Green

    Joseph Green is a spoken word artist, educator, and motivational speaker.  Over the past 10 years Joseph’s passion for youth development has led to him supporting young people in a multitude of facets.  He the co-founder and former Program Manager of poetryN.O.W., an after school creative writing program that worked with students throughout the DC metropolitan area.  After five years of successful programming, poetryN.O.W. was acquired by Split This Rock, a Washington DC based poetry and social justice organization, where Joseph now supervises youth programs in over 25 high schools.  In his work with poetryN.O.W. and Split This Rock, Joseph has also crafted an extensive creative writing curriculum now used in classrooms throughout the country.

    In his prevention work with high schooled aged youth, Joseph facilitates interactive workshops to create transformational original poems on the effects that substance abuse and addiction has had on their lives. By empowering students to speak truth to power, Joseph has provided opportunities for them to share their stories with policy makers at the White House for the US Office of National Drug Control Policy and the US Department of Education. In his role as Program Manager at the Mentor Foundation USA, Joseph led the effort to revamp the interactive drug prevention youth rally known as Shattering the Myths.  As part of this initiative, he also served as host for the three day program that included a full day of writing workshops and leadership training.
    2015 marked Joseph’s fifth return to Poetry Slam International’s national slam, this time as a representative of the DC Poetry Slam Team. He represented the Oneonta slam team in 2005 and 2006 as their Grand Slam Champion, Slam Richmond in 2009, and DC’s Beltway Poetry Slam team in 2011. He also represented DC in 2011 at the Individual Poetry Slam, ranking 16th in the world. As a solo artist, Joseph has performed, hosted, and featured at venues and schools throughout the United States, including the White House and Kennedy Center. He has over ten years experience as a professional spoken word artist and writer.
    Joseph believes in the power of using lived experiences to catalyze positive personal change, and often pulls from his own unique set of experiences to engage groups of all ages and backgrounds. In 2012 he started the interactive performance series, Dive Every Day Project, with the intent of opening dialogue around the topic of substance use disorder, addiction, and recovery. The Dive Every Day Project pulls from a catalog of original work dealing directly with these issues, drawing from personal and family experiences. Dive Every Day serves to be a tool of inspiration and guidance for all who encounter it and is a testament to self-forgiveness, redemption, and the irreplaceable role of love in the human revolution.