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  • Buprenorphine Dose and Treatment Outcomes: is 16 mg/day Enough? (1 CME)

    Contains 3 Component(s), Medical Credits Offered

    Despite over 10 years of office-based treatment for opioid dependence, the optimal dose for buprenorphine therapy is still not known. In this focus session we will review existing evidence from the literature about the relationship between buprenorphine dose and treatment outcomes. We will then share results from our recent study that specifically addressed this question. We will then conclude with a discussion about optimal buprenorphine dosing for outpatient practice and methods for studying it.

    Focus Session Proposal:

    Office-based treatment for opioid dependence with buprenorphine has expanded access to treatment for individuals with opioid use disorders and has proven to be effective in a variety of settings. However, despite over 10 years of experience, there are still questions about the optimal dose for buprenorphine treatment. In this focus session, we will review existing evidence from the literature about the relationship between buprenorphine dose and physiologic measures and patient outcomes. Early studies suggested that doses of 8 to 16 mg per day of the the sublingual formulation should be sufficient and some insurers have limited access to doses higher that 16 mg/day as a result. Some guidelines have discouraged use of doses higher than 16 mg/day. However, there is growing clinical data that suggests that higher doses may lead to improved treatment retention and outcomes. This includes a recent study that we have conducted that specifically addressed this question. ¨The focus session with then conclude with an opportunity for discussion about optimal buprenorphine dosing for outpatient practice and methods for studying it. In this discussion, the relative risks and benefits of dose limits will be considered. Tension may exist between the goal of increasing treatment retention and the goal of minimizing drug diversion and cost, and these factors will be considered.

    Anthony J. Accurso, MD

    Assistant Professor of Medicine

    Anthony Accurso, MD, grew up in New York City and attended Hunter College High School. He received his B.A. with honors in Biology from Dartmouth College in 1999. He taught high school science for six years before enrolling in medical school. He completed medical school at SUNY Downstate, in Brooklyn NY in 2010. He completed his residency in Internal Medicine at Johns Hopkins Bayview in 2013, and then joined the faculty there. He is currently an Assistant Professor of Medicine in the Division of Chemical Dependence. He is an ASAM member and passed the Addiction Medicine board exam in October 2015. He is also the faculty director of Providers for Responsible Ordering, a group that promotes high-value care.

    Darius Rastegar, MD, FASAM

    Associate Professor

    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.

  • Implementing CONTINUUM: The ASAM Criteria Decision Engine(TM) in Your Practice and System (1 CME)

    Contains 3 Component(s), Medical Credits Offered

    ASAM began addressing the adversarial prior authorization process with managed care with the 1991 ASAM Criteria. After 20 years of research, ASAM has released CONTINUUM – The ASAM Criteria Decision Engine™ nationwide. This workshop will provide the practical exposure to help active clinicians and program administrators understand how to organize, introduce and use this new clinical standard for success. The workshop will review counselor and patient evaluations from the alpha, beta and national demonstration projects. Attendees will review evaluation findings, the Harvard Business School study, the national survey of state requirements, and undergo a tour of the tool. The workshop will explain how to use CONTINUUM to address the federal Parity Act and the summer 2015 federal Medicaid specifications for external third party review of all substance use disorder placements. Attendees will assess the software’s ease of use, learning curve, impact on clinical assessment and potential for managed care reform. The discussion will examine the practical issues of HIPAA and 42cfr data privacy and how these support the national patient data registry.

    Addiction assessment is in a sorry state of affairs – there's literally no standard model. Counselors use an approach that might charitably be called “intuitive". As a result, managed care utilization review nurses keep demanding more data from treatment providers – and let the telephone tag begin. Then, there is the problem of proprietary medical necessity criteria, which gives managed care companies rampant control of access to care on the basis of cost, not quality. METHOD: ASAM began addressing this with the publication of its Patient Placement Criteria, beginning in 1991. After 20 years of research, over $8 million of research and validation, and support from SAMHSA, ASAM is releasing CONTINUUM – The ASAM Criteria Decision Engine™ to the entire US treatment field. This workshop will provide the practical explanation, background, and interview experience to help active clinicians and program administrators understand how to organize, introduce and use this new clinical standard for success. The workshop will review counselor and patient evaluations from the alpha, beta and national demonstration projects. RESULTS: Attendees will review recent findings that CONTINUUM's decision engine can effectively revolutionize or even eliminate telephone prior authorizations and utilization review, as predicted by a Harvard Business School study and as currently being considered by states and county Medicaid systems across the U.S. The Workshop will review findings from a national survey of state requirements of the ASAM Criteria (more than 30 require or endorse it) and which states, counties, managed care companies and healthcare systems have shown interest in or have already begun adopting CONTINUUM™. A tour of the tool will demonstrate the counselor-ready structured interview, the intricate branched-chain algebraic decision tree that implements every adult admission criteria decision rule in the current 2013 ASAM textbook, and how CONTINUUM finally standardizes medical necessity admissions criteria. The Workshop will explain how to use CONTINUUM to meet the new requirements of the federal Parity Act for publicly available medical necessity criteria and to meet the summer 2015 federal Medicaid specifications for state Medicaid 1115 Waivers, requiring independent, external third party review of all substance use disorder placements. DISCUSSION: Through the Workshop, attendees will gain their own perception of the software's ease of use, learning curve, impact on the clinical assessment process and impact on managed care reimbursement – with both public and commercial payers. Attendees will learn how treatment systems were able to implement CONTINUUM across all adult levels of care, even achieving mandated use across all clinicians. The discussion will examine the practical issues of HIPAA and 42cfr data privacy. Finally, attendees will assess the software's potential for nationwide adoption for addiction treatment evaluation, placement and periodic re-evaluation. This includes consideration of its potential for: reforming or eliminating telephonic prior authorization and utilization review, integrating with electronic health records, and establishing a national addiction patient clinical registry.

    David Gastfriend


    David R. Gastfriend, MD, served on the faculty of Harvard Medical School for 25 years, most recently as Director of the Addiction Research Program at Massachusetts General Hospital (MGH). His studies of the Patient Placement Criteria published by the American Society of Addiction Medicine (ASAM) have been supported by the NIH's National Institute on Drug Abuse, the National Institute on Alcohol Abuse and Alcoholism, the U.S. Centers for Disease Control, U.S. state governments, managed care corporations, including Aetna Behavioral Healthcare, and foreign governments, including Belgium, Finland, Iceland, Israel, Norway, Switzerland, and the World Health Organization. The author of over 125 scientific publications, he has served on the Boards and Editorial Boards of a number of societies and journals, including ASAM and the International Society of Addiction Medicine (ISAM). He is co-editor of the leading book on treatment matching in the field, The ASAM Patient Placement Criteria for Substance-Related Disorders and editor of Addiction Treatment Matching. In addition to his role at RecoverySearch, Dr. Gastfriend is also Vice President for Scientific Communications at Alkermes, Inc. (NASDAQ: ALKS) where he is involved in research, education and scientific publication on extended-release naltrexone (VIVITROL®) and the company's efforts in the field of addiction treatment.

    Paul Earley


    Dr. Earley has been an Addiction Medicine Physician for 30 years. He treats all types of addictive disorders and specializes in the assessment and treatment of health care professionals. As a therapist, he works with patients already in recovery, providing long term therapy for those who suffer from this disease. His professional expertise extends to advocacy for professionals before agencies and licensing boards.

    Dr. Earley is a dynamic speaker and educator; he speaks and trains on topics of addiction, its treatment and addiction among health care professionals. In addition, he trains therapists about the neurobiological basis of addiction and psychotherapy. In his travels, he has provided training in the United States, Canada, the United Kingdom, Italy and Switzerland.

    He is the author numerous books and articles on addiction and its treatment, including The Cocaine Recovery Book. He has contributed to the American Society of Addiction Medicine (ASAM) Textbook: Principles of Addiction Medicine, as author of the chapter: Physician Health Programs and Addiction among Physicians. He is also a minor author to the ASAM Criteria.

    His work was featured in the documentary series on addiction entitled Close to Home by Bill Moyers. Dr. Earley is a Fellow of ASAM and has been on the board of ASAM for over 14 years in several capacities and is currently a director-at-large. He has been the Medical Director of two nationally acclaimed addiction programs specializing in the care of addicted health care professionals. Currently, he is the Medical Director of the Georgia Professionals Health Program, Inc. and a principal with Earley Consultancy, LLC, a training and consulting firm.

    David Mee-Lee


    David Mee-Lee, M.D. is a board-certified psychiatrist, and is certified by the American Board of Addiction Medicine (ABAM). Based in Davis, California, he trains and consults both nationally and internationally.  Dr. Mee-Lee is Chief Editor of the American Society of Addiction Medicine's (ASAM) Criteria for the Treatment of Addictive, Substance-Related, and Co-Occurring Conditions and is President of DML Training and Consulting. He is co-founder of the Institute for Wellness Education. Dr. Mee-Lee has forty years of experience in person centered treatment and program development for people with co-occurring mental health and substance use conditions.

    Desiree Crevecoeur-MacPhail


    Desirée A. Crèvecoeur-MacPhail, Ph.D. received her doctorate from Claremont Graduate University in social psychology and master's degree in clinical psychology from Pepperdine University. She has worked in program evaluation for almost 20 years with various institutions examining areas as diverse as substance use disorder treatment, “housing first” programs, anti-hate violence/anti-discrimination educational interventions in high schools and student satisfaction with graduate school. She has worked at the University of California Los Angeles (UCLA) Integrated Substance Abuse Programs (ISAP) as a project director and research psychologist for over 15 years and is currently the Principal Investigator of the Los Angeles County Evaluation System: An Outcomes Reporting Program examining treatment engagement, retention and performance management. Dr. Crèvecoeur-MacPhail has worked with OPCC (formerly Ocean Park Community Center) as an external evaluator for several years. She is the author of over 24 papers and book chapters on topics including the treatment system in Los Angeles County, the impact of substance withdrawal on the body, how addiction affects the brain, addiction medications, the increase in use of methamphetamine for American Indians and Latinos, substance use disorder treatment effectiveness, health disparities, and program evaluation. She works with federally qualified health centers (FQHCs) to assess and improve treatment integration. She has extensive experience in health research, including quantitative and qualitative methods and outcomes measurement. In addition to her research, Dr. Crèvecoeur-MacPhail has taught at a number of colleges and universities including UCLA, California State University Dominguez Hills, Chapman University and Claremont Graduate University.

  • Population Health: The Promise, Perils, and Pitfalls of the Electronic Health Record (1 CME)

    Contains 3 Component(s), Medical Credits Offered

    The mandate to adopt electronic health records (EHR) has created great promise and opportunity throughout medicine. The promise has been in efforts to meaningfully use the information contained in the EHR to improve patient safety and outcome. With this opportunity comes challenge. In this focus session, three principal investigators from the NIDA Clinical Trials Network will share their work covering the promise, perils, and pitfalls of the electronic health record as related to the identification, treatment, and privacy of patients who use alcohol, tobacco, and other drugs. Dr. Li-Tzy Wu will show a population health initiative that identifies comorbid mental health and substance use diagnoses in Type 2 diabetics. Dr. Katharine Bradley will address systems quality improvement through EHR initiatives on marijuana and alcohol screening in primary care settings. Dr. Gavin Bart will address the complexities of privacy protections in the era of the EHR and solicit audience feedback on how privacy protections are implemented within their EHR.

    The mandate to adopt electronic health records (EHR) has created great promise and challenge throughout medicine. The promise has been in efforts to meaningfully use the information contained in the EHR to improve patient safety and outcome. With this opportunity comes challenge. In this focus session, three principal investigators from the NIDA Clinical Trials Network will share their work covering the promise, perils, and pitfalls of the EHR as related to the identification, treatment, and privacy of patients who use alcohol, tobacco, and other drugs. Dr. Li-Tzy Wu will share her experience in utilizing a large EHR data warehouse with data from more than 170,000 adults to identify comorbid substance use and mental health diagnoses in patients with type 2 diabetes mellitus (T2DM). Prevalent diagnoses among adults with T2DM were mood (21.22%), SUD (17.02%: tobacco 13.25%, alcohol 4.00%, drugs 4.22%), and anxiety diagnoses (13.98%). The data sets allow for identification of risk groups in general medical settings that can be used to inform the need and structure of collaborative care models and to identify utilization patterns. Dr. Katharine Bradley will describe collaboration with health system clinical and IT leaders to integrate marijuana and drug screening into the EHR. Working in a learning healthcare environment, these partnerships have allowed over 12,000 patients to be screened in the first 6-months. She will present rates of drug and marijuana screening, rates of standardized substance use disorders assessment for high risk patients, and rates of marijuana- and drug- related discussions documented in primary care progress notes. How this process allows for greater monitoring of practice performance and impact on HEDIS measures for initiation and engagement of patients with drug use disorders in care at the level of health system, practice, and practitioner will be discussed. Dr. Bradley will also discuss the challenges of obtaining meaningful data from the EHR progress note through automated natural language processing. Given the high prevalence of marijuana use and the focus of health plans nationwide on HEDIS measures, she will facilitate an audience discussion of perceptions of primary care “best practices" for addressing marijuana use and for improving HEDIS measures. Dr. Gavin Bart will address the complexities of patient privacy protections as specified in 42 CFR Part 2 in the age of the EHR. These protections enacted more than 40 years ago could not have predicted the adoption of the EHR and the integration of addiction and general medical care. Whether 42 CFR Part 2 hampers patient safety through the segregation of medical information in EHRs or threatens the ability to improve population health through the analysis of data in EHR and claims/utilization databases will be discussed. Because there is little understanding of the variability in how the rule is interpreted by health systems, the audience will be encouraged to share their experiences in how the rule has influenced their EHR roll out and ability to track patience centered outcomes and utilization.

    Gavin Bart


    Dr. Gavin Bart is Director of the Division of Addiction Medicine at Hennepin County Medical Center and Associate Professor of Medicine at the University of Minnesota. He received his MD from the University of Minnesota and trained in internal medicine at the Hennepin County Medical Center. His PhD is in experimental and clinical pharmacology, also from the University of Minnesota. He trained in addiction medicine at The Rockefeller University where he continued as Director of Clinical Research until moving to Minnesota where is is co-PI of the NorthStar Node of the NIDA Clinical Trials Network. His areas of expertise include clinical pharmacology and the pharmacological management of opioid dependence. 

    His current research areas include the population pharmacokinetics of methadone, genetic influences of methadone pharmacology and treatment outcome, electronic health record privacy provisions of 42 CFR Part 2, and clinical decision support tool development for SUD. 

    He is Chair of the Life-Long Learning and Self-Assessment committee for the American Board of Addiction Medicine and is ASAM Region VI (IA, IL, IN, MI, MN, WI) director. Internationally, he is co-director of the SAMHSA-funded Vietnam HIV and Addiction Technology Transfer Center and provides ongoing technical assistance for the Substance Abuse and Mental Health Administration in South East and Central Asia.

    Ryan Caldeiro


    Ryan Caldeiro obtained his medical degree from Case Western Reserve University School of Medicine in Cleveland, OH. He then completed residency training in Psychiatry and Addiction Psychiatry from the University of Washington in Seattle. During his education and training, he participated in research studies exploring pharmacotherapies for addictive disorders and treatment outcomes for patients with co-occurring chronic pain. Upon completing training, he joined Group Health Cooperative of Washington, where he serves as the Chief of Chemical Dependency Services and Consultative Psychiatry. Group Health is both the largest medical group in Washington State, providing integrated multispecialty care, as well as the largest HMO in Washington State. In his position, he oversees clinical delivery of services for substance use disorder care within the physical healthcare delivery system and provides medical leadership in directing health plan operations as it administers chemical dependency benefits for its members within a contracted network of providers. He also oversees consultative psychiatry services. Within the medical group, he works closely with Primary Care leadership and primary care providers in evaluating and managing patients with substance use disorders and developing capacity and support for delivery of office based buprenorphine in primary care settings developing integrated behavioral health services which includes screening, assessment and population management for patients with depression and substance use disorders. He continues with research activities through the Group Health Research Institute with investigations in collaborative care models for patients with substance use disorders.

    Li-Tzy Wu

    ScD, RN, MA

    Dr. Wu is a Professor in the Department of Psychiatry and Behavioral Sciences at Duke University Medical Center, Durham, North Carolina, USA. She received pre-doctoral and post-doctoral training in psychiatric and drug addiction epidemiology from the School of Public Health at the Johns Hopkins University, Baltimore, Maryland. She is one of the node Principal Investigators of the National Drug Abuse Treatment Clinical Trials Network.

    Katharine A.Bradley

    MD, MPH

    Katharine Bradley, MD, MPH is a general internist and health services researcher who, for the past 25 years, has conducted research on how alcohol-related care can be practically integrated into medical settings. She is Senior Investigator at Group Health Research Institute, Affiliate Professor of Medicine and Health Services at University of Washington, and Associate Investigator at Veterans Affairs (VA) Puget Sound Health Care System in the U.S. Her research has included validation of the 3-item AUDIT-C and collaboration with VA clinical and quality leaders to implement alcohol screening and brief alcohol interventions in over 900 VA sites nationwide. Ongoing research includes the NIAAA-funded CHOICE trial of nurse-delivered collaborative care for alcohol use disorders (AUDs); an NIAAA-funded study developing a patient decision aid for AUDs; and a pragmatic trial of implementation of alcohol screening, brief alcohol interventions, and shared decision making for AUDs across 25 primary care clinics in a regional integrated health delivery system in the U.S. Dr. Bradley is currently supported by an NIAAA Mid-career Mentoring Award and is a multiple PI, along with Drs. Weisner and Campbell, on the new Health Systems Node of the NIDA Clinical Trials Network. Finally, NIDA CTN has funded pilot research on marijuana and drug screening in 3 primary care clinics which Dr. Bradley will be presenting at ASAM.

  • CNS Pharmacogenetics Determine Pain Perception, Opioid Risk, Addiction Treatment and Non-Opioid Alternatives (1 CME)

    Contains 3 Component(s), Medical Credits Offered

    Earn 1 AMA PRA Category 1 credits while learning about CNS Pharmacogenetics (PGx) studies of pain, addiction risk and treatment. Our goal is determining which variants (single nucleotide polymorphisms: SNPs) affect patient's pain perception, require higher analgesic doses, increase opioid risk, and affect treatment outcome. While various SNPs predict pain sensitivity and opioid risk; their value is during the acute injury before chronic pain and opioid use. The discovery of COMT SNPs grouped into low, average and high pain sensitivity haplotypes has been reproduced in clinical studies showing prolonged morbidity in high pain sensitive patients with TMJ disorders, motor vehicle accidents and postherniotomy pain. Additional SNPs include voltage-gated sodium and calcium channel variants with new non-opioid treatment. Melanocortin-1, associated with red hair, and new research correlates eye color with pain tolerance. SNPs associated with addiction include Dopamine: DRD2, ANKK1, DRD4, DBH and DAT1. GABA α 2 correlates with adult addiction, yet in adolescents, rule-breaking behaviors. Additional SNPs with opioid risk include serotonin transporter 5HTTLPR and STin2, COMT and BDNF vs. the protective effects of Vasopressin/Oxytocin system. Finally the δ and κ opioid receptors are reviewed.

    Pharmacogenetics (PGx) studies the treatment of pain management [1] addiction risk [2] and medication-assisted treatment [3]. Precision medicine focuses on single nucleotide polymorphisms (SNPs) in the DNA that encode for receptors, transporters and other CNS enzyme variants. Our goal is determining which SNPs affect patient's exaggerated pain perception [4] require higher doses of analgesics [1] and be at increased risk of opioid or other addiction [2] along with response/treatment outcome[3]. Despite isolating various SNPs, the end result depends upon multiple feedback pathways to up- or down-regulate the mRNA and production of proteins (GABA, glutamate, serotonin & dopamine receptors, transporters, etc.) within the mesocorticolimbic pathway stimulating the Ventral Tegmental Region [VTA] to Nucleus Accumbens [NAc] dopamine release, among other pathways [5]. Similarly, the feedback loop of the Raphe Nucleus on afferent nociceptive pain fibers and the Locus Coeruleus on afferent neuropathic pain fibers are integral to new discoveries of non-opioid pain treatments [6]. While various SNPs help predict pain sensitivity and risk of substance abuse; these analyses need to be done early during the acute phase of injury, or pain process. The longer a patient is on opioids stimulating NAc dopamine release, regulation feedback on RNA affects protein/receptor density. An early pain study found Catechol-o-methyltransferase (COMT) Val158Met variant having reduced activity and subsequent increased OPRM1 receptor density due to continuous dopamine bombardment down-regulating natural endorphin production [7]. The original discovery of 4 COMT SNPs grouped into three haplotypes, low, average and high pain sensitivity [4] has continued to be reproduced from the bench to the bedside in clinical studies showing exaggerated and prolonged pain in high pain sensitive patients in TMJ disorders, minor motor vehicle accidents [8] and postherniotomy pain [9] adding GTP cyclohydrolase (GCH1) to the COMT. Additional SNPs include the calcium channel complex subunit CACNA2D2, which increased sensitivity to opioid treatment [10], and the importance of voltage-gated sodium channel variants in new non-opioid pain treatments [11]. Several of these SNPs also have significant affects based upon gender [12]. Melanocortin-1, closely associated with red hair color has some equivocal findings with pain sensitivity, and new research correlates eye color with pain tolerance. Several key SNPs associated with opioid abuse and addiction includes Dopamine: DRD2, ANKK1, DRD4, DBH and DAT1 [13] but varies by the allele in regards to addiction risk vs. another allele in poor responders to buprenorphine [14] Other SNPs correlating with addiction include GABA α 2 (GABRA2) in adults, but race specific as some variants were addiction protective in African Americans [15]. In adolescents it was associated with rule-breaking behaviors that may lead to addiction vulnerability [16]. Additional SNPs with opioid risk include serotonin transporter, SLC6A4, specifically 5HTTLPR and STin2, COMT, BDNF [17] including stress-related reward affects on DA release in the NAc and protective effects of Vasopressin/Oxytocin system in reducing addiction and relapse [18]. Finally the importance of the δ and κ opioid receptors will be reviewed.

    Daniel A. Schwarz


    Dr. Schwarz obtained his M.D. from the University of Illinois at Chicago, and then completed his Surgery Residency at the University of Toledo, becoming Board Certified in 1994. He combined productive surgical research at the University of Michigan, while an active Level-1 Trauma Surgeon/Clinical Instructor of Surgery at the University of Toledo. After a business sabbatical, he returned to the University of Michigan where he expanded the Craniofacial Research Lab, was awarded several grants, research awards and co-authored an NIH RO1 funded grant, with Steven Buchman, MD. He mentored a dozen students, fellows and some residents.

    Recognizing increased opioid abuse in surgical and pain management patients, he pursued a formal Addiction Medicine fellowship at St. John's Brighton Hospital under John Hopper, MD, becoming Board Certified in 2010. He initiated the first prospective study correlating addiction after gastric bypass, published 2010. He became MRO certified, is CLIA high-complexity certified in toxicology, and laboratory director for office EIA and reference LC-MS/MS laboratories. He practices pain management and addiction medicine, specializing in co-occurring disorders, primarily ADHD. He was Medical Director for Summit Diagnostics, LLC, overseeing both toxicology and Pharmacogenetics (PGx), and then became Chief Medical Advisor for Iverson Genetics, educating physicians before joining Proove Biosciences as Executive Director R&D;Medical Director Pain and Addiction. He authored and was P.I. for two large IRB approved, multi-center longitudinal studies on pain and PGx, and commercialized a reproducible pain perception PGx test, originally published in 2004. He went on to develop his own PGx algorithms in pain and addiction, as Principal of JAS Consulting, LLC, and interprets genetic tests for physicians, while speaking, educating, and consulting. He is currently authoring three manuscripts: Pain Management, Addiction Medicine and PGx in Toxicology for Elsevier's Clinics in Laboratory Medicine series.

    Mark K. Greenwald


    Mark Greenwald, Ph.D. (tenured Professor) is the Associate Chair for Research, and directs the Substance Abuse Research Division, its Human Pharmacology Laboratory and outpatient opioid treatment clinic in the Dept. of Psychiatry and Behavioral Neurosciences at Wayne State University (WSU) School of Medicine in Detroit, Michigan. He is jointly appointed in the WSU Dept. of Pharmacy Practice. Dr. Greenwald has published about 90 research papers and book chapters, and over 165 research abstracts. His research program focuses on (1) pharmacological, environmental and individual difference – including genetic – determinants of drug seeking/use as they relate to progression, persistence and relapse problems; (2) using brain-imaging techniques (e.g. PET to measure mu-opioid receptors, MRS to measure glutamate), pharmacokinetics, and behavioral phenotyping (laboratory models of drug motivation) to advance the clinical neurobiology of substance use disorders; and (3) developing novel medication and behavioral treatments for substance use disorders (e.g. opioid, cocaine and cannabis). The National Institutes on Health (NIH) has continuously funded his research since 1996. He has been principal investigator and co-investigator on many federally funded grants (especially related to opioids and buprenorphine treatment), has consulted for pharmaceutical companies related to emerging addiction medicine products, regularly reviews grant applications and has peer-reviewed manuscripts for more than 30 substance abuse and psychiatric journals. He is a past President of Division 28 (Psychopharmacology and Substance Abuse) of the American Psychological Association. Dr. Greenwald proudly mentors tenure-track junior faculty members, medical residents, postdoctoral fellows, graduate students, postbaccaulaureate, and undergraduate honors students.

    Inna Belfer

    MD, PhD

    Inna Belfer, MD PhD is a human geneticist with a primary interest in the relationship between genes and complex traits such as human pain, psychiatric diseases, and addictions. Her research focuses on identifying genetic and pharmacogenomic signatures predicting acute and chronic pain and analgesic response. Dr. Belfer is a nationally and internationally recognized expert in human pain phenotyping and genotyping as well as in modifiers of genetic effects on pain, analgesia and opioid addiction. Currently Dr. Belfer is a Clinical Analyst at the Division of Analgesic, Anesthetic and Addiction Products at the Food and Drug Administration. In addition she is an Adjunct Professor of Medicine and Human Genetics at the University of Pittsburgh, Pittsburgh, Pennsylvania and an Adjunct Professor of Neuroscience at McGill University, Montreal, Canada.

  • The Role of Screening, Brief Intervention and Referral to Treatment Everyone’s Business (1.5 CME)

    Contains 3 Component(s), Medical Credits Offered

    Screening, Brief Intervention and Referral to Treatment (SBIRT) is a public health approach to identifying and addressing substance use in our patients. The SBIRT model will be examined via a panel presentation. Each presenter will provide examples of SBIRT implementation in a variety of settings (health and community health) and the utilization of technology-based SBIRT delivery systems. The panel will examine what role SBIRT can play with patient’s health and wellness.

    Screening, Brief Intervention and Referral to Treatment (SBIRT) is a public health approach to identifying and addressing substance use in our patients. The SBIRT model will be examined via a panel presentation. Each presenter will provide examples of SBIRT implementation in a variety of settings (health and community health) and the utilization of technology-based SBIRT delivery systems. The panel will examine what role SBIRT can play with patient's health and wellness. At the end of the session participants will be able to: understand the Screening, Brief Intervention and Referral to Treatment (SBIRT) model and the role it can play with patient's health and wellness, describe technology-based interventions that deliver SBIRT in a variety of health care settings and apply SBIRT to their current work environment. The goal of this presentation is to create a community of providers who share a passion for reducing and/or eliminating substance use problems in society.

    Peter Luongo


    Before joining IRETA in 2011, Dr. Peter Luongo worked in the behavioral health field for over thirty years as a social worker and administrator. In Maryland, Dr. Luongo was the Single State Authority under three governors as the director of the Department of Health and Mental Hygiene Alcohol and Drug Abuse Administration. He also served within the Montgomery County, MD Department of Health and Human Services for over two decades in a variety of clinical and administrative leadership roles. He received his B.A. and M.A. in Psychology from The Catholic University of America and his Ph.D. in Social Work from the University of Maryland. Dr. Luongo has served as a faculty associate at Johns Hopkins University where he received the Johns Hopkins University Excellence in Teaching Award in 1996. In 2008, he received the Maryland Social Worker of the Year award from the National Association of Social Workers and in 2012, he was selected as one of “50 Heroes for Justice” by The University of Maryland School of Social Work. In 2015 Dr. Luongo was nominated and elected a Class A Trustee of the General Services Board of Alcoholics Anonymous.

    Richard L. Brown

    MD, MPH

    Dr. Brown is a family physician and a tenured full professor in the Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin. His academic focus has been the primary care management of alcohol and drug disorders and other behavioral risk factors and conditions. He has conducted NIH-funded research, published dozens of peer reviewed articles, made numerous presentations, and conducted workshops in these realms on four continents. He served as president of the Association for Medical Education and Research in Substance Abuse (AMERSA) from 1997 to 1999 and received AMERSA's McGovern award for excellence in medical education in 2002. From 1999 to 2004, he served as the founding director of Project MAINSTREAM (, a federally funded program that enhanced substance abuse education for twelve health professions and improved education for over 10,000 trainees. Since 2006, he has served as Director for the Wisconsin Initiative to Promote Healthy Lifestyles ( WIPHL has helped 40 general healthcare settings provide over 110,000 screens and 25,000 interventions, garner excellent patient satisfaction, and elicit substantial declines in risky and problem drinking. Dr. Brown is owner and CEO of Wellsys, LLC (, which provides software, consulting, training and clinical support to enable healthcare settings to provide systematic, evidence-based, cost-saving screening and intervention services for the behavioral risks and disorders responsible for over 40% of deaths, most chronic disease and disability and nearly $1 trillion in costs per year.

    Thomas Freese, PhD

    Principal Investigator and Co-Director, Pacific Southwest Addiction Technology Transfer Center (Pacific Southwest ATTC, HHS Region 9)

    Thomas E. Freese, Ph.D., received his doctorate degree in clinical psychology from the California School of Professional Psychology in 1995. Dr. Freese is currently the Director of Training for UCLA ISAP, Principal Investigator and Director of the SAMHSA-funded Pacific Southwest Addiction Technology Transfer Center (PSATTC, HHS Region 9), and Principal Investigator and Co-Director of the SAMHSA-funded Center of Excellence on Racial and Ethnic Young Men Who Have Sex with Men and Other Lesbian, Gay, Bisexual, and Transgender Individuals (YMSM+LGBT CoE). Dr. Freese has served as Principal Investigator on projects funded by the California Department of Alcohol and Drug Programs and Department of Health Care Services to train providers to implement Screening, Brief Intervention, and Referral to Treatment (SBIRT). Dr. Freese has also led several large projects that assist providers in implementing integrated treatment for co-occurring mental health and substance use disorders. He has been a featured presenter at conferences and meetings nationally and internationally on the impact and treatment of methamphetamine and opioid dependence. In addition, Dr. Freese has served as the Project Director on a number of studies including research on methamphetamine use. He has worked in the addiction field since 1983, and has developed and conducted trainings in 45 states and internationally, providing training and workshops for clinicians-in-training at the all levels.

    Brian Suffoletto

    MD, MS

    Brian Suffoletto, MD MS, is an Assistant Professor in the Dept. of Emergency Medicine at the University of Pittsburgh. As a clinical investigator, he has developed a specific focus on designing and evaluating mHealth interventions that use time-varying EMA data to understand contextual and time-varying contributors to substance use. He is currently a recipient of a K23 award from the NIAAA with a focus on advancing the science of adaptive mHealth alcohol interventions and a co-Investigator on an R34 from the NIAAA focused on testing a telemedicine and text message platforms aimed at reducing alcohol misuse among community college students. He is also a co-Investigator on a NIDA-Emergency Medicine Foundation grant to study the potential effectiveness of a text messaging program on substance use relapse rates and is conducting pilot studies that use mobile phone sensor data to predict alcohol use occasions. Based on these experiences, he has found that mobile communication devices can be powerful tools to understand substance use, but balancing design between data collection and usability is critical for success.

  • Overview of Addiction Medicine (1.5 CME)

    Contains 3 Component(s), Medical Credits Offered

    Using The ASAM Principles of Addiction Medicine, fifth edition as a guide, presenters will review articles spanning neurobiology, pharmacology, intoxication and withdrawal, screening and diagnosis, treatment, mutual help, and special topics and populations.

    This symposium will provide a rapid review of recent updates from the scientific literature from 2015 to 2016 in addiction medicine. We will begin with articles related to the neurobiology of addiction and progress to epidemiology, pharmacology, intoxication and withdrawal syndromes, screening and diagnosis, mutual help, special topics including harm reduction, special populations including the criminal justice population, and end with an overview of addiction treatments including pharmacologic and behavioral interventions. We will review key articles from the past twelve months, with a focus on those published in high impact factor journals and studies with particularly noteworthy findings. We will structure this as a "rapid-fire journal club" and will encourage audience participation. We will also discuss implications of research findings and possible relevance to clinical practice. The goal of this symposium is to provide the learner with a concise, structured, and evidence-based summary of the most recent scientific evidence in the field using The ASAM Principles of Addiction Medicine, fifth edition as a guide.

    Sarah Wakeman


    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.

    Joshua D. Lee

    MD, MSc, FASAM

    Joshua D. Lee MD, MSc is an Associate Professor in the Departments of Population Health and Medicine at the NYU School of Medicine. He is board-certified in Internal Medicine and Addiction Medicine and is a physician at Bellevue Hospital Center, NYU Langone Medical Center, and in the NYC jails. He directs the NYU ABAM Fellowship in Addiction Medicine. His research focuses on novel and medication treatments for addiction among criminal justice and primary care populations.

  • Reduction in Drug Use and Improved Health (1.5 CME)

    Contains 3 Component(s), Medical Credits Offered

    For the first time a seminal finding shows that reduction in drug use is associated with improved health in general. Specifically we will show that reduction in cocaine use by chronic cocaine users improves their cardiac health and this can be diagnosed by measuring plasma levels of Endothelin-1, a biomarker of coronary endothelial function.

    Reduction in Drug Use and Improved Health Jag H. Khalsa, MS, PhD, National Institute on Drug Abuse, NIH, USA Ivan Montoya, MD, National Institute on Drug Abuse, NIH, USA In 2014, an estimated 27 million people aged 12 or older were current users of an illicit drug in the United States. Although only an estimated 1.5 million were the cocaine users in the US, worldwide, an estimated 13-19 million people used cocaine in the past year. Drug use is associated with serious morbidity and mortality. Besides affecting the CNS, cocaine abuse is also associated with cardiovascular disease (CVD). It is projected that in 2030, an estimated 24 million people will die from CVD. In addition, not only HIV infection is associated with cardiovascular complications, but the highly active antiretroviral therapy (HAART) that has substantially reduced AIDS-related mortality and thus non-HIV-related mortality, is also increasingly associated with CVD. In this symposium, the clinician/researchers, Drs. Shenghan Lai (Johns Hopkins) and Alex Manini (Mount Sinai, NY) will present their latest research on cocaine and HIV-associated CV effects, and also show that reduction in cocaine use is associated with improved cardiac health. Further, they will also discuss the role of various biomarkers in diagnosing cardiovascular effects of stimulants including cocaine and amphetamines in HIV infected substance abusing populations. Dr. David Fiellin (Yale), By using the Veterans Aging Cohort Index (VACS), Dr. David Fiellin (Yale) will present his research on reduced drug use and improved health in a Veterans cohort of HIV-infected individuals on opioid agonist therapy. We will also discuss the latest funding opportunities available at NIDA/NIH.

    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:

    Shenghan Lai

    MD, MPH

    Professor of Pathology, Radiology, Psychiatry, Medicine & Epidemiology

    John Hopkins University School of Medicine

    Alex Manini

    MD, MS

    Dr. Manini is Associate Professor of Emergency Medicine at the Icahn School of Medicine at Mount Sinai in New York City, where he is the Co-Director of the Medical Toxicology Division, and Associate Director of the Clinician Scientist Training Program (T32) in Emergency Care Research. He is an established, independent investigator with a track record in clinical investigation related to drug overdose, substance use, and emergency medicine, with over 60 peer-reviewed publications. He is currently PI on a NIDA R01 entitled "Predicting adverse cardiovascular events due to drug overdose emergencies". His completed funding includes a career development award from the National Institute on Drug Abuse, as well as grants from the City of New York, the New York State Department of Health, the Emergency Medicine Foundation, and the Medical Toxicology Foundation.

    David A. Fiellin


    Professor of Medicine, Investigative Medicine and Public Health

    Yale University School of Medicine

    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.

  • Medication Assisted Treatment for Tobacco Addiction: Putting Evidence into Practice (1.5 CME)

    Contains 3 Component(s), Medical Credits Offered

    Tobacco is the most common addiction for which medications are approved by the FDA to treat this deadly addiction. However, due to a variety of system, patient and practitioner level barriers, medication assisted treatment is rarely offered. Moreover, the presence of comorbidities such as other addictions or mental illnesses inhibit practitioners from assisting tobacco addicted individuals. This workshop will review the evidence base on the use of FDA approved smoking cessation medication in these populations. Learners will understand how to prescribe combination therapy safely. The session will be case based and interactive with a focus on safety while using medications to assist tobacco addicted individuals achieve and maintain a permanent remission.

    Tobacco addiction is the leading cause of preventable death in North America, killing nearly half a million North Americans every year. Current smokers are more likely to be less educated, live in poverty and suffer from other addictions and or mental health disorders. The USPTF in September 2015 provided Grade A evidence to intervene with every smoker. Addiction treatment and primary care settings are optimal to provide combined evidence based behavioural and medication assisted treatment. , However, a lack of specialized knowledge in medication assisted treatment for tobacco addiction pose a challenge to adapting and tailoring treatment for patients with other mental illnesses and or addictions. Additionally, the challenge of variable motivation and firmly held beliefs regarding tobacco use pose a challenge for practitioners and patients.

    This workshop will assist practitioners adapt the latest evidence to their patients with comorbid addictions and or mental illnesses.  This dynamic and interactive session will give attendees practical, relevant knowledge and skills to incorporate evidence-based approaches to tobacco dependence treatment in their practice, with particular emphasis on adapting and tailoring pharmacotherapy for patients with co-morbid conditions. Attendees will leave the session with a better understanding of how to recommend and prescribe pharmacotherapy for tobacco addicted individuals and explore evidence-based approaches for patients with mental health problems as well. This session emphasizes learner engagement, interaction and practice though large and small group discussions, case-based learning and reflective exercises. Workshop participants will receive links to clinical tools and resources to facilitate sharing with colleagues and community stakeholders.

    Peter Selby


    Peter Selby MD is the Director of Medical Education and a Clinician Scientist at the Centre for Addiction and Mental Health. He is a Professor in the Departments of Family and Community Medicine, Psychiatry, and the Dalla Lana School of Public Health at the University of Toronto. He is also a Clinician Scientist in the Department of Family and Community Medicine. Dr. Selby is the Executive Director and creator of the TEACH project; a continuing education certificate program in Applied Counselling for Health with a focus on smoking cessation, through the University of Toronto. Dr. Selby’s research, as a Principal Investigator at the Ontario Tobacco Research Unit, includes smoking cessation especially in smokers with co-morbid conditions. As the Principal Investigator of the STOP Study, he investigates the effectiveness of NRT and counselling in different types of intervention settings. He is also the PI of CANADAPTT- a unique Canadian Smoking Cessation Guideline development and dissemination project. Dr. Selby also continues his clinical research with pregnant women who use substances and is the PI of a knowledge translation program (PREGNETS) to increase the adoption of evidence-based interventions with pregnant smokers. 

    He has received grant funding totaling over 80 million dollars from CIHR, NIH, and Ministry of Health and has published 130 peer reviewed publications. He has published 5 books (including 4 edited), is the author of 30 book chapters, and 32 research reports prepared for the government. He is the Co-Chair for the Ministry of Health Cessation Task force and the Chair of the Canadian Centre on Substance Abuse National Task Force on Treatment for Prescription Drug Misuse. Dr. Selby mentors Fellows in Addiction Medicine and Addiction Psychiatry, junior investigators and medical students. Dr. Selby a sought after speaker for various topics including addictive disorders, motivational interviewing, and health behavior change.

  • President’s Symposium - Advances in Pain Management: Collaborative Solutions to a Complex Problem (1.5 CME)

    Contains 3 Component(s), Medical Credits Offered

    ASAM’s President will lead an in-depth exploration into new developments in the field of pain management. This high-level symposium will not only explore the difficult overlap between chronic pain and addiction but also the complexities of inter-professional collaboration.

    ASAM's President will lead an in-depth exploration into new developments in the field of pain management. This high-level symposium will not only explore the difficult overlap between chronic pain and addiction but also the complexities of inter-professional collaboration. Collaboration is ubiquitous and necessary for many of the healthcare innovations of the past few years. Presenters will discuss new changes in pain management that are being promoted by the AMA and how these changes will affect the medical culture surrounding pain treatment. Experts will also discuss inter-professional management issues and the patients who have chronic pain and a high risk of addiction. Doctors have found that some patients will feel abandoned if their pain medicine is stopped suddenly. Physicians and other members of the care team need to help their patients understand the risk of brain changes and how to use alternatives to addictive pain medicines to develop a new lifestyle. This session will provide a new viewpoint on the present and future of pain management

    R. Jeffrey Goldsmith


    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.


    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.

    Mark A. Weiner


    Dr. Weiner received his undergraduate degree (B.S. Psychology) at the University of Michigan, Ann Arbor. He earned his medical degree at Cornell University Medical College in New York City. He completed his internship and residency in Internal Medicine at Northwestern University McGaw Medical Campus in Chicago, Illinois. He is Board Certified in Internal Medicine and Addiction Medicine. Since 2008, Dr. Weiner has worked at Pain Recovery Solutions in Ann Arbor, Michigan practicing full time Addiction Medicine and Pain Medicine. He is the Section Head of Addiction Medicine at Saint Joseph Mercy Hospital - Ann Arbor. He has participated in planning the ASAM preconfernece, Common Threads: Pain and Addiction, since 2011 and is the current vice chair. He also is a member of the ASAM Annual Meeting planning committee since 2014 and is an editor on the up-and-coming ASAM Pain and Addiction Handbook.

    Herbert L. Malinoff


    I am the president and founder of Pain Recovery Solutions and began this private practice in 1999. I am certified in Internal Medicine, Pain Management, Addiction Medicine, and Medical Oncology. I specializes in treating patients with chronic pain syndromes, addiction, and in detoxification as well as internal medicine needs. I have the understanding of the relationship between medical problems, pain, and addiction led to the establishment of a practice that provide services to patients that address multiple related problems using an integrated, comprehensive approach. I received my Medical Degree from the University of Michigan in 1978. I trained in Internal Medicine at Michael Reese Hospital in Chicago, and completed fellowships in Hematology/Oncology and Nuclear Medicine at the University of Michigan. I have an associate degree in Healthcare Risk Management and Quality Review. I present lectures internationally on Chronic Pain and Addiction and am an active member of the American Society of Addiction Medicine where I am co-chairman of the Pain and Addiction-Common Threads Course. I am a Fellow of both the American College of Physicians and the American Society of Addiction Medicine. I am the immediate past president of the Michigan Society of Addiction Medicine and on the faculty of the Department of Anesthesia at the University of Michigan Medical Center. No Disclosures

  • Payment for Addiction Medicine Services- ASAM Advocacy in Action (1.5 CME)

    Contains 3 Component(s), Medical Credits Offered

    This session will provide an overview of the health care financing system in the United States as related to health plan coverage of addiction medicine services, as well as describe more efficient and effective ways to manage the prior authorization process in your practice. Learn how insurers make coverage decisions, what types of payment models exist, and what that insurance card in your wallet really means.

    Are you tired of spending hours filling out prior authorization forms only to be denied coverage? Are you puzzled as to why people can pay premiums but not have addiction services covered, even after “parity"? Do you wonder what that insurance card in your wallet really means? ASAM has a newly developed Payer Relations Committee to address a multitude of payment issues. In order to advocate for our profession, our practices, and our patients to access payments for addiction treatment services, we must start by understanding the system in place. This workshop will begin by providing an overview of the health care financing system in the United States as related to health plan coverage of addiction medicine services, how insurers make coverage decisions, and what types of payment models exist. We'll discuss efficient and effective ways for addiction physicians to handle the prior authorization and other processes with payers - what does and does not work to get coverage approvals. And we will discuss the mission of the new Payer Relations Committee and the many areas for improvement you can help identify.

    H. Westley Clark


    Dr. H. Westley Clark, Director of the Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services, leads the agency's national effort to provide effective and accessible treatment to all Americans with addictive disorders. Dr. Clark was the former chief of the Associated Substance Abuse Programs at the U.S. Department of Veterans Affairs Medical Center (DVAMC) in San Francisco, California and a former associate clinical professor, Department of Psychiatry, University of California at San Francisco (UCSF). In addition to his duties at the DVAMC, Dr. Clark served as a senior program consultant to the Robert Wood Johnson, Substance Abuse Policy Program, a co-investigator on a number of the National Institute on Drug Abuse-funded research grants in conjunction with UCSF.

    Dr. Clark is a noted author and educator in substance abuse treatment, anger and pain management, psychopharmacology, and medical and legal issues. He has received numerous awards for his contributions to the field of substance abuse treatment, including a 2008 President of the United States Rank of Distinguished Executive Award in recognition of his personal commitment to excellence in government and public service; and a 2003 President of the United States of America Rank of Meritorious Executive Award in the Senior Executive Service for his sustained superior accomplishments in management of programs of the United States Government and for noteworthy achievement of quality and efficiency in the public service, 2003. In addition, he was awarded the 2008 John P. McGovern Award from the American Society of Addiction Medicine for his contributions toward increased understanding of the relationship between addiction and society.

    Other awards include the U.S. Department of Health and Human Services Secretary's Award for Distinguished Service far exceeding Departmental standards of achievement by exhibiting outstanding teamwork and timeliness on the complex task of completing the Methadone Final Rule which required coordination among several Federal agencies, 2001; Vernelle Fox Award from the California Society of Addiction Medicine for excellence in Addiction Medicine, Education and Public Service, 2000.

    Dr. Clark received a B.A. in Chemistry from Wayne State University in Detroit, Michigan; he holds a Medical Degree and a Masters in Public Health from the University of Michigan, Ann Arbor; where he completed a Psychiatric Residency at University Hospital, Neuropsychiatric Institute. He obtained his Juris Doctorate from Harvard University Law School and completed a two-year Substance Abuse Fellowship at the DVAMC-SF. Dr. Clark received his board certification from the American Board of Psychiatry and Neurology in Psychiatry and sub-specialty certification in Addiction Psychiatry. Dr. Clark is licensed to practice medicine in California, Maryland, Massachusetts and Michigan. He is also a member of the Washington, D.C., Bar Association.

    Kelly Clark


    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.