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

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

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

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

    Brian Hurley

    MD, MBA, DFASAM

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

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

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

    Sarah Wakeman

    MD, FASAM

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

    Rebecca Trotzky-Sirr

    MD

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

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

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

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

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

    Jag Khalsa

    PhD, MS

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

    Charles W. Gorodetzky

    MD, PhD

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

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

    Philip O. Coffin

    MD, MIA, FACP

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

    Ivan Montoya

    MD, MPH

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

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

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

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

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

    Miriam S. Komaromy

    MD, FACP, DFASAM

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

    Sarah Wakeman

    MD, FASAM

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

    Josiah D. Rich

    MD, MPH

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

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

    Bruce Trigg

    MD

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

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

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

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

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

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

    Cheryl A. Kennedy

    MD

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

    Connie Hsaio

    BS

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

    Rahul Vasireddy

    BS

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

    Marcus Hughes

    BA

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

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

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

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

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

    Todd Askew

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

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

    Carol McDaid

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

    Kim Johnson

    PhD

    Kimberly A. Johnson, PhDDirectorCenter for Substance Abuse Treatment

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

    Kelly J. Clark

    MD, MBA, DFAPA, DFASAM

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

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

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

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

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

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

    Darius Rastegar

    MD

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

    Anika Alvanzo

    MD, MS, FASAM, FACP

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

  • Addiction Medicine 2.0- Practicing on the Cloud (1 CME)

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

    This session will explore the emerging role of telemedicine in the provision of addiction medicine care, particularly in small and/or remote communities.

    Telemedicine has the ability to remove many of the time and distance barriers that prevent patients from accessing effective, convenient and evidence-based addiction care. Yet despite the huge potential of this technology to improve care, it remains seldom utilized. As a leading provider of telemedicine-based addiction care, TrueNorth (www.truenorthmedical.com) has gained substantial "first-hand" understanding of the various technological, administrative and regulatory barriers that stand in the way of effectively delivering addiction medicine care on "The Cloud". TrueNorth now delivers "hassle-free" (no wait list, no referral needed) Methadone and Buprenorphine treatment to more than a dozen under-served communities throughout Ontario. Much of the care we provide is delivered via telemedicine. This workshop will outline the pros and cons of a "Cloud-based" approach to Opioid Treatment. We will also be explore some of the more common challenges and opportunities of implementing a cloud-based approach to opioid agonist treatment in both Canada and the U.S.

    Chris Cavacuiti

    MD, CCFP, MHSc, FCFP, DFASAM

    Dr. Chris Cavacuiti BA, MD, CCFP, MHSc, (C)ASAM, FCFP, (D)ABAM, CCSAM, DFASAM is the medical director for the TrueNorth Medical Centres and an assistant professor at the University of Toronto.

    Before founding the TrueNorth Medical Centres in 2013, he worked as a staff physician at St. Michael’s Hospital, the Casey House Aids Hospice and the Seaton House homeless shelter. His clinical, research and advocacy work focuses on addiction medicine, LGBT issues, HIV/AIDS, and Immigrant/Refugee Health.
    The TrueNorth Medical Centres now have over a dozen addiction medicine clinics serving a variety of communities across Ontario. 
    He was the lead editor of the 2012 American Society of Addiction Medicine textbook entitled Principles of Addiction Medicine: The Essentials.

  • 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.