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

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

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

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

    Mark A. McGrail

    MD

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

    Suzanne Bailey

    PsyD

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

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

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

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

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

    John Brooklyn

    MD

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

    Anthony Folland

    BA

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

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

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

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

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

    Michael Fingerhood

    MD, FACP

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

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

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

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

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

    Jenna Butner

    MD

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

    Jeanette M. Tetrault

    MD, FACP, FASAM

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

    Lamia Haque

    MD, MPH

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

    Colleen S. Lynch

    MD, MPH

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

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

    Anna Shmayenik

    PharmD

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

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

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

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

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

    Sharone Abramowitz

    MD, FASAM

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

  • Medication Assisted Therapy for Drug Court (1.5 CME)

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

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

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

    Cara Poland

    MD, MEd

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

    Andy Brown

    MPA, MSW

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

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

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

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

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

    Joseph Green

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

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

  • A Low Threshold Clinic for Medically Complex Patients with Substance Use Disorder (1 CME)

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

    The Mass General Bridge Clinic is an immediate access clinic which provides low threshold transitional support and treatment to patients following hospitalization or directly from the emergency department (ED) and other outpatient clinics. The clinic predominantly serves individuals who would otherwise be unable to access care. The goal of the clinic is first and foremost engagement, followed by rapid treatment initiation, stabilization, and linkage to community-based treatment. This focus session will describe the nuts and bolts of starting and running this type of a clinic model, review lessons learned, and discuss early outcomes.

    Building Bridges in Times of Crisis: an urgent care and post discharge clinic for medically complex patients with addiction Massachusetts is among the states hit hardest by the opioid epidemic, with an estimated 1,659 lives lost in Massachusetts in 2015. The expected death toll for 2016 is even higher. In the context of the current crisis, low threshold treatment models which target high risk populations are needed. Recent Department of Public Health data found that starting pharmacotherapy for opioid use disorder following a non-fatal overdose reduced the risk of death in the subsequent year by more than 50%, yet less than 5% of those who survive overdose begin treatment. Overdose risk increases after periods of reduced tolerance, including hospitalization. Despite the risks, a minority of patients engage in addiction treatment following hospital discharge. The Mass General Bridge Clinic is an immediate access clinic which provides low threshold transitional support and treatment to patients following hospitalization or directly from the emergency department (ED) and other outpatient clinics. The clinic predominantly serves individuals who would otherwise be unable to access care. The goal of the clinic is first and foremost engagement, followed by rapid treatment initiation, stabilization, and linkage to community-based treatment. This clinic also serves in a complementary role to an inpatient addiction consult team, providing ongoing care to patients started on addiction pharmacotherapy in the hospital and allowing a pathway for same-day initiation of pharmacotherapy for ED patients. The clinical care team is multidisciplinary and includes an addiction medicine physician, a psychiatric nurse practitioner, a psychiatric clinical pharmacist, a recovery coach, a patient service coordinator, and a resource specialist. This focus session will describe the nuts and bolts of starting and running this type of a clinic model, review lessons learned, and discuss early outcomes. Objectives: 1. Describe the need for low threshold treatment models for medically complex patients with substance use disorder. 2. Identify the types of services and supports patients leaving an inpatient medical setting or emergency department require to enhance engagement, stabilization, and treatment success. 3. Develop a blueprint for starting innovative treatment models for high-risk and medically complex patient populations. References: 1.http://www.mass.gov/eohhs/docs... 2. D'Onofrio G, et al. JAMA. 2015. 3. Liebschutz JM, et al. JAMA Intern Med. 2014. 4. Naeger S, et al. J Subst Abuse Treat. 2016.

    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.

    Laura G. Kehoe

    MD, MPH, FASAM

    Dr. Kehoe is an Assistant Physician at Massachusetts General Hospital and an Assistant Professor of Medicine at Harvard Medical School and is board certified in both Internal Medicine and Addiction Medicine.  She attended Tufts University School of Medicine and Boston University School of Public Health and completed her residency in Internal Medicine at Massachusetts General Hospital.   At Massachusetts General Hospital, she is the Medical Director of the Substance Use Disorder Bridge Clinic, an immediate access, urgent care addiction program.   She is actively involved in medical student and resident education as an attending physician on the inpatient Addiction Consult Team (ACT), and she is the co-chair of the hospital-wide Substance Use Disorder Education Committee, where she works with other team members to expand evidence-based treatment of patients with addiction. 

    Outside of MGH, she was the Medical Director of Baycove Treatment Center for Opiate Addictions Methadone Maintenance program and she treats patients as part of a multidisciplinary addiction team at the supportive housing and outpatient non-profit, Right Turn.   Lastly, Dr. Kehoe is a founding member of W.A.T.E.R.town (Watertown Access to Treatment Education and Recovery), a community coalition working to expand prevention, intervention and treatment for people with substance use disorder in Watertown, MA.

    Jessica L. Moreno

    PharmD, BCPP

    Dr. Jessica Moreno is a Board-Certified Psychiatric Pharmacist in a co-funded faculty role at Northeastern University and her clinical practice site is at Massachusetts General Hospital where she works on the inpatient Addictions Consult Team and in the outpatient Bridge Clinic. The MGH Bridge Clinic is a post-discharge clinic that provides transitional addiction treatment to patients following release from the hospital or the emergency department while working to establish longitudinal community-based care. She received her BSE in Chemical Engineering and Doctor of Pharmacy at the University of Michigan. She completed a post-doctoral industry fellowship program at Massachusetts College of Pharmacy and Health Sciences in conjunction with Cubist Pharmaceuticals. She then went on to complete a PGY1 pharmacy residency at the Ann Arbor VA Medical Center and PGY2 psychiatric pharmacy residency at the William S. Middleton VA Hospital in Madison, WI.  Her clinical role exclusively involves patients with substance use disorders. She makes treatment recommendations to the interdisciplinary teams she works with and, in the outpatient setting, she is developing clinical pharmacy services with the ultimate goal of having collaborative drug therapy management. Her faculty role consists of teaching Doctor of Pharmacy students in the experiential setting at her clinical practic site as well as developing and delivering the psychiatric lectures in a core curriculum course called Comprehensive Disease Management at Northeastern. Regarding research, she is currently the primary investigator on three retrospective studies that will be used as foundations for future prospective, randomized research in the field of substance use disorders. 

  • The Relief That Binds You: Pain Induced by Opioid Use and Withdrawal (1 CME)

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

    This session will provide participants with an overview of the literature on pain from opioid use and withdrawal by focusing on three topic areas: opioid-induced hyperalgesia, withdrawal-induced hyperalgesia, and withdrawal-associated injury site pain. Clinical implications for those with opioid use disorders and/or chronic noncancer pain will be discussed including risk factors and potential mitigators. Interactive case presentations will follow with participants encouraged to share their experience.

    Opioids have been used for thousands of years to relieve both physical and emotional suffering. Yet exposure due to an opioid use disorder or through prescription use for chronic non-cancer pain can alter the nervous and immune systems resulting in more pain sensitivity, termed opioid-induced hyperalgesia (OIH) (1,2). When opioids are stopped the underlying pain sensitivity can be revealed, exacerbated by other withdrawal features to produce even more pain termed withdrawal-induced hyperalgesia (WIH). Both OIH and WIH appear to be both dose dependent and withdrawal episode dependent (3,4). Recently, the presenter and colleagues reported in a mixed methods study a novel opioid pain phenomenon involving the reactivation of old healed injury site pain during opioid withdrawal (5). This withdrawal-associated injury site pain (WISP) was shown to be a barrier to opioid detoxification and a risk factor for relapse. Clinicians need to understand these opioid related phenomena to better educate and treat their patients. This 60 minute focus session will involve a didactic overview of key studies on OIH, WIH, and WISP, including mechanisms and possible treatments. Then cases will be presented from the author's research and clinical experience. Participants will be encouraged to share their own cases along personal experiences to round out the interactive discussion. By the end of the session participants will be able to list three pain phenomena associated with opioid use or cessation identified in the literature beyond generalized withdrawal myalgias and arthralgias, discuss possible mechanisms for opioids increasing pain with use and withdrawal, and identify potential mitigators of opioid associated pain based on current evidence that may be relevant for clinical practice. With the opioid crisis looming world-wide, it is important to understand problems related to opioid use and barriers to opioid detoxification. Pain caused by opioid use and withdrawal appears to be a key factor in perpetuating opioid use. Finding practical evidence based solutions is vital now and going forward. This focus session will provide material that can advance participants' knowledge and skill in management of opioid related pain phenomena.

    Launette Marie Rieb

    MD, MSc, CCFP, FCFP, DABAM, FASAM

    Dr. Launette Rieb is a Clinical Associate Professor in the Department of Family Practice at the University of British Columbia (UBC), Canada. She is a Family Physician and diplomat of The American Board of Addiction Medicine. She did her graduate work in the area of pain physiology. She completed a postgraduate UBC Clinical Scholar's Program in 2015 and a NIDA sponsored Canadian Addiction Medicine Research Fellowship in 2016 resulting in publication on a newly described opioid pain phenomenon - withdrawal-associated injury-site pain (WISP). She has also published on fentanyl and heroin overdose deaths in BC, as well as on addiction in a variety of marginalized populations. Dr. Rieb is the Medical Director of a multidisciplinary team at OrionHealth (Vancouver Pain Clinic), and works as a consultant for the Rapid Access Addictions Clinic at St. Paul’s Hospital in Vancouver. In addition, she does addiction medicine consultations for The Orchard Recovery Centre, on Bowen Island. Dr. Rieb has taught addiction medicine in the undergraduate and postgraduate medical programs at UBC, and at national and international conferences for 24 years. Dr. Rieb was the co-creator and initial Physician Director of the St. Paul’s Hospital Goldcorp Addiction Medicine Fellowship (now the BC Centre on Substance Use Addiction Medicine Fellowship). She is a member of the Canadian Society of Addiction Medicine’s Education Committee and the College of Family Physician of Canada's Competency Creation Working Group for the Certificate of Added Competency in Addiction Medicine. Dr. Rieb is the past recipient of a UBC Faculty of Medicine Post Graduate Teaching Award. 

  • Thriving Under Value-Based Reimbursement with Behavioral Screening and Intervention (BSI) (1 CME)

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

    As value-based reimbursement continues to expand, healthcare organization leaders increasingly appreciate the importance of behavioral health but aren’t sure what to do about it. Simply hoping that providers will recognize and treat or refer patients for behavioral health issues will no longer “cut it.” In this session, attendees will learn how to advise healthcare leaders on Behavioral Screening and Intervention, an evidence-based, cost-saving, proactive approach to identifying and addressing behavioral risks and disorders.

    Healthcare organizations across the nation are scrambling to adapt to value-based reimbursement. Most healthcare leaders know that behavioral health is important, but they aren't sure what to do about it. This is a huge opportunity for addiction treatment professionals who can offer solutions beyond conventional referral resources. Under MACRA, primary healthcare settings must choose to be reimbursed through alternative payment models (APMs) such as accountable care organizations (ACOs), or through the Merit-based Incentive Payment System (MIPS). Under bundled payment programs, Medicare will provide one lump-sum reimbursement for patients with certain conditions, regardless of actual costs. Under APMs, MIPS and bundles, the financial well-being of healthcare organizations will hinge on their success at improving health outcomes and controlling healthcare costs across large populations of patients. Behavioral health issues are key determinants of outcomes and costs. Simply hoping providers will recognize and treat or refer patients for behavioral health issues will no longer cut it. A proactive, population-wide approach is necessary. That approach is behavioral screening and intervention (BSI). All patients are systematically screened for key behavioral risks and disorders. Healthcare teams are expanded with coaches, who have the training and time to provide robust, evidence-based interventions - motivational interviewing and behavior change planning for smoking and unhealthy drinking and drug use, and collaborative care for depression. Although coaches and primary care providers can handle most issues, BSI will generate more referrals for mental health and addictive disorders. This session will cover the prevalence, health effects and economic impacts of behavioral issues. It will define and describe the process of BSI. It will cite research on the effectiveness and cost savings of components of BSI. It will describe how BSI was implemented at dozens of healthcare settings in Wisconsin and the results - high patient satisfaction, substantial improvement in behavioral outcomes, and nearly $800 two-year, net healthcare cost savings per Medicaid patient screened. It will describe how BSI can serve as the framework for primary care/behavioral health integration and the hub for chronic disease management. The participants will learn how to advise healthcare organizations on integrating BSI into a variety of general healthcare settings, enhance their credibility as systems-level behavioral health consultants, and help their organizations thrive under value-based reimbursement.

    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 (www.projectmainstream.net), 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 (www.wiphl.com). 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 (www.wellsys.co), 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.