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  • Fentanyl and Analogs, Oh My: Their Impact on Patients and Public Health (1 CME)

    Product not yet rated Contains 4 Component(s), Medical Credits Offered

    Earn 1 AMA PRA Category 1 Credit(s)™ while learning about the myths and facts of fentanyl and analogs from this conference recording from The ASAM 49th Annual Conference (2018).

    (1 CME) In this conference recording from the 2018 Annual Conference, you will learn about the origins, prevalence, known pharmacology, and harmful clinical effects of fentanyl, fentanyl analogs, and other novel non-fentanyl opioids, as well as the treatment response including naloxone dosing. 

    We are presently in the midst of a massive opioid epidemic, partly due to a recent increase in heroin adulterated with fentanyl and its analogs.(Rudd 2016) Deaths from heroin overdoses began to rise in 2009 with overdoses associated with synthetic analogs rapidly increasing since 2013.(Rudd 2016;Peterson 2016) Although fentanyl was the initial adulterant found during the present epidemic, multiple other analogs such as carfentanil, acetylfentanyl, and butyrylfentanyl, as well as other non-fentanyl-derived opioids such as U-47700 are increasingly found in the heroin supply.(Lucyk 2017) There were eight seizures involving acetylfentanyl in 2013 with the number rising to 2001 in 2015.(Prekupec 2017) In addition to their increased prevalence, these analogs are incredibly potent. As an example, carfentanil is 10,000 times more potent than morphine and 100 times more so than fentanyl.(Wax 2003) The pharmacokinetics of novel fentanyl analogs such as their duration of effect or the amount of naloxone required for reversal is not well described in the published literature. As such, this makes it difficult to understand the potential effects on patients who are exposed to these opioids. While little is available in the peer-reviewed literature, much is written in the lay press regarding purported toxicity from ambient secondary exposures to healthcare providers and law enforcement officers. Many of these reports about first responders describe toxicity from routes of exposure that are pharmacologically implausible and portray symptoms inconsistent with an opioid overdose. Unfortunately, these sensationalistic reports rapidly disseminated leading to increasing concern and potentially poorly informed and dangerous decision-making about first responder and healthcare workers’ safety. Given the prevalence and morbidity of these agents, testing our patients for fentanyl has increased relevance, and rapid immunoassays are under development. Although advanced laboratory testing can identify some fentanyl analogs, this is expensive, not widely available, and not sufficiently rapid to impact patient care. Rapid testing may be beneficial to public health and law enforcement officials when identifying outbreaks and to improve risk communication. Clinical benefit, however, is unclear given the need to generally make decisions prior to the results returning. Our focus group plans to discuss what is known about these novel opioids and their impact on both clinical care and public health concerns

    Evan Schwarz

    MD

    Dr. Evan Schwarz is an Assistant Professor of Emergency Medicine at the Washington University School of Medicine in Saint Louis. He is the Medical Toxicology section chief and directs their inpatient and outpatient clinical services. This includes managing inpatients with substance use disorders as well as following them in the outpatient toxicology and addiciton medicine clinic. In addiction to his clinical activities, he is a core faculty member of the emergency medicine residency, the Vice President for the Missouri College of Emergency Physicians, and a member of the Board of Directors for the American College of Medical Toxicology.

    JoAn Laes

    MD

    JoAn Laes, MD, Attending Physician, Division of Addiction Medicine, Hennepin County Medical Center, Minneapolis, MN; Core Medical Toxicology Faculty, Minnesota Poison Control System, Minneapolis, MN; Medical Director, Mission Detox Center, Plymouth, MN and 1800 Detox, Minneapolis, MN, ASAM Medical Toxicology workgroup Chair.Dr. Laes' practice is focused on inpatient addiction medicine and toxicology consultation and outpatient treatment of opioid and other substance use disorders. She is board certified in Internal Medicine, Addiction Medicine, and Medical Toxicology. She completed internal medicine residency at Hennepin County Medical Center and medical toxicology fellowship at Regions Hospital in St. Paul, Minnesota.

    Lewis Nelson

    MD

    Dr. Nelson is Professor and Vice-Chair in the Department of Emergency Medicine at New York University School of Medicine, and an attending physician at both NYU Langone Medical Center and Bellevue Hospital Center. He is the Director of the Fellowship in Medical Toxicology at NYUSOM and the New York City Poison Control Center. He is a Past-President of the American College of Medical Toxicology, former Chair of the FDA Drug Safety and Risk Management Advisory committee, and an editor of the textbook Goldfrank's Toxicologic Emergencies, now in its 10th edition. He organized the NYC Task Force on Opioid Misuse, and participated with the American College of Emergency Physicians Opioid Guideline Writing Panel, a CDC-funded panel of toxicologists and medical examiners to develop guidelines for the classification of opioid-related death, and the CDC Chronic Opioid Therapy Guideline Expert Panel. He continues to research, publish, and speak on the subject of prescription opioid misuse, drugs of abuse, and medication safety.

    ACCME Accredited with Commendation

    ACCME Accreditation Statement

    The American Society of Addiction Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

    AMA Credit Designation Statement

    The American Society of Addiction Medicine designates this enduring material for a maximum of 1 AMA PRA Category 1 Credit(s).  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    ABPM Maintenance of Certification (MOC)

    The American Board of Preventive Medicine (ABPM) has approved this activity for a maximum of 1 LLSA credits towards ABPM MOC Part II requirements.

    ABAM Transitional Maintenance of Certification (tMOC)

    This course has been approved by the American Board of Addiction Medicine (ABAM). Physicians enrolled in the ABAM Transitional Maintenance of Certification Program (tMOC) can apply a maximum of AMA PRA Category 1 Credit(s)™ for completing this course.

  • New Approaches Using Contingency Management to Reduce Substance Use in the CJS (1.5 CME)

    Product not yet rated Contains 4 Component(s), Medical Credits Offered

    Earn 1.5 AMA PRA Category 1 Credit(s)™ while learning about innovative ideas for reducing the substance use of individuals who are under criminal justice supervision and review evidence on program effectiveness, from this conference recording from The ASAM 49th Annual Conference (2018).

    (1.5 CME) In this conference recording from the 2018 Annual Conference, you will learn that, on a typical day in 2015, there were more than 4.7 million adults under community supervision and thousands of others awaiting trial in the community. An additional 2.2 million were incarcerated. With so many of those passing through the criminal justice system having a substance use problem, there are many millions of opportunities each year to reduce problematic substance use and promote public health and safety, almost all of which are missed. What should police officers, judges, and probation officers do when they believe reducing the substance use of individuals they encounter would benefit the user and/or society more generally? 

    This workshop, based on a chapter in the forthcoming ASAM textbook Principles of Addiction Medicine, will highlight innovative ideas for reducing the substance use of individuals who are under criminal justice supervision and review evidence on the effectiveness of such programs. We will begin with a discussion of the role of contingency management in reducing substance use, with a special focus on Physician Health Programs. In addition to reviewing evidence on the use of positive incentives in treatment and non-treatment settings, the workshop will also discuss a different—but theoretically consistent—approach involving frequent substance testing with swift, certain, and proportionate sanctions for violating judicial orders to abstain from consumption (e.g., 24/7 Sobriety). We will also discuss the pathways to treatment via criminal justice agencies ranging from drug courts to the oft-discussed Portuguese model that diverts those arrested for possessing small amounts of drugs to a “Commission for the Dissuasion of Drug Addiction” that is outside of the criminal justice system. We will not argue that one or the other of these approaches is the most effective or cost-effective; that would require randomized controlled trials and even then some approaches would work better for particular individuals. Rather, we view the collection as proof of the fallacy inherent in debating the merits of prison vs. treatment, and as an inspiration for those seeking to invent and evaluate additional creative implementations of the basic concept of contingency management.

    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."

    Beau Kilmer

    PhD

    Beau Kilmer is a senior policy researcher at the RAND Corporation, where he codirects the RAND Drug Policy Research Center. He is also a professor at the Pardee RAND Graduate School. His research lies at the intersection of public health and public safety, with a special emphasis on crime control, substance use, illicit markets, and public policy. Some of his current projects include assessing the consequences of alternative marijuana policies; measuring the effect of 24/7 Sobriety programs on drunk driving, domestic violence, and mortality; and evaluating other innovative programs intended to reduce crime. 

    Kilmer's articles have appeared in leading journals such as Lancet Psychiatry, New England Journal of Medicine, Proceedings of the National Academy of Sciences, and his commentaries have been published by CNN, Los Angeles Times, New York Times, Newsweek, San Francisco Chronicle, USA Today, Wall Street Journal, and other outlets. His co-authored book on marijuana legalization was published by Oxford University Press and the second edition was released in 2016. He serves as an assistant editor for Addiction and is a trustee of the International Society for the Study of Drug Policy. 

    Kilmer received a NHSTA Public Service Award for his “leadership and innovation in the areas of alcohol and drug-impaired driving program and policy research” and his co-authored work on 24/7 Sobriety received honorable mention for the Behavioural Exchange Award for Outstanding Research. Before earning his doctorate at Harvard University, Kilmer received a Judicial Administration Fellowship that supported his work with the San Francisco Drug Court.

    Keith Humphreys

    PhD

    Keith Humphreys is a Professor and the Section Director for Mental Health Policy in the Department of Psychiatry and Behavioral Sciences at Stanford University.  He is also a Senior Research Career Scientist at the VA Health Services Research Center in Palo Alto and an Honorary Professor of Psychiatry at the Institute of Psychiatry, King's College, London.  His research addresses the prevention and treatment of addictive disorders, the formation of public policy and the extent to which subjects in medical research differ from patients seen in everyday clinical practice.

    For his work in the multinational humanitarian effort to rebuild the psychiatric care system of Iraq and in the national redesign of the VA health system's mental health services for Iraq war veterans, he won the 2009 American Psychological Association Award for Distinguished Contribution to the Public Interest.  He and the authors of "Drug Policy and the Public Good" won the 2010 British Medical Association's Award for Public Health Book of the Year.

    Dr. Humphreys has been extensively involved in the formation of public policy, having served as a member of the White House Commission on Drug Free Communities, the VA National Mental Health Task Force, and the National Advisory Council of the U.S. Substance Abuse and Mental Health Services Administration.  During the Obama Administration, he spent a sabbatical year as Senior Policy Advisor at the White House Office of National Drug Control Policy. He has also testified on numerous occasions in Parliament and advises multiple government agencies in the U.K.  

    ACCME Accredited with Commendation

    ACCME Accreditation Statement

    The American Society of Addiction Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

    AMA Credit Designation Statement

    The American Society of Addiction Medicine designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credit(s).  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    ABPM Maintenance of Certification (MOC)

    The American Board of Preventive Medicine (ABPM) has approved this activity for a maximum of 1.5 LLSA credits towards ABPM MOC Part II requirements.

    ABAM Transitional Maintenance of Certification (tMOC)

    This course has been approved by the American Board of Addiction Medicine (ABAM). Physicians enrolled in the ABAM Transitional Maintenance of Certification Program (tMOC) can apply a maximum of 1.5 AMA PRA Category 1 Credit(s)™ for completing this course.

  • Navigating the Minefield of Substance Use Testing: Understanding Your Patient's Report (1 CME)

    Contains 4 Component(s), Medical Credits Offered

    Earn 1 AMA PRA Category 1 Credit(s)™ while learning about the common pitfalls to urine and oral fluid drug testing from this conference recording from The ASAM 49th Annual Conference (2018).

    (1 CME) In this conference recording from the 2018 Annual Conference, you will learn about to identify common pitfalls to urine and oral fluid drug testing in the setting of Substance Use Disorders.

    Appropriate use of drug testing for the treatment of Substance Use Disorders requires an intimate knowledge of the patient, the test and the prevalence of drug use in an area. With the variety of options for testing, selection of appropriate testing can be a challenge for providers. Recent American Society of Addiction Medicine (ASAM) guidelines have provided an excellent overview of this field including an introduction to the types of testing and insightful observations (1, 2). Nonetheless, a very sophisticated understanding is required to successfully navigate the choices of immunoassay and chromatographic testing. Some common ways that the interpretation of a drug test's result can be significantly impacted include test cutoff levels, differences in antibody affinities from one immunoassay to another and length of detection windows. In a largely case-based format, this presentation will discuss several common questions that arise when interpreting urine drug testing. In these examples, we will review cases that hinge on the choice of testing method, challenges posed by questionable specimen validity, common drug mimics such as nutritional or natural therapies and the current limitations of testing practices in an ever-evolving landscape of designer and synthetic drug use. By the end of the session, participants will have insight into some of the strengths and challenges of drug testing based on current evidence.

    Jill Warrington

    MD, PhD

    Jill Warrington MD, PhD is an Assistant Professor in the Department of Pathology and Laboratory Medicine at the Robert Larner MD College of Medicine at the University of Vermont. She also serves as Chief Medical Officer and Medical Director at Aspenti Health, a clinical toxicology laboratory that focuses on serving the Substance Use Disorder population and developing data-driven support tools that optimize best practices for providers. Jill earned her B.A. degree in Molecular Biology at Princeton University followed by an MD/PhD at Tufts University School of Medicine. She completed an Anatomic and Clinical Pathology residency at Duke University where she was chief resident. She has been in the field of laboratory medicine for approximately 15 years with a focus on clinical toxicology and appropriate test utilization.

    ACCME Accredited with Commendation

    ACCME Accreditation Statement

    The American Society of Addiction Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

    AMA Credit Designation Statement

    The American Society of Addiction Medicine designates this enduring material for a maximum of 1 AMA PRA Category 1 Credit(s).  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    ABPM Maintenance of Certification (MOC)

    The American Board of Preventive Medicine (ABPM) has approved this activity for a maximum of 1 LLSA credits towards ABPM MOC Part II requirements.

    ABAM Transitional Maintenance of Certification (tMOC)

    This course has been approved by the American Board of Addiction Medicine (ABAM). Physicians enrolled in the ABAM Transitional Maintenance of Certification Program (tMOC) can apply a maximum of AMA PRA Category 1 Credit(s)™ for completing this course.

  • Reducing Alcohol-Related Emergency Visits: An Innovative Model of Care to Improve Outcomes (1 CME)

    Product not yet rated Contains 4 Component(s), Medical Credits Offered

    Earn 1 AMA PRA Category 1 Credit(s)™ while learning about an innovative rapid access medical withdrawal management service from this conference recording from The ASAM 49th Annual Conference (2018).

    (1 CME) In this conference recording from the 2018 Annual Conference, you will learn about an innovative rapid access medical withdrawal management service.

    Background: Alcohol use accounts for up to 40% of Emergency Department (ED) visits, and a large proportion of 30-day ED re-visits, with alcohol intoxication and/or withdrawal being key presenting problems. Objective: To describe the development, implementation, and evaluation of a rapid access alcohol medical withdrawal management service (Alcohol Medical Intervention Clinic; AMIC) created to reduce 30-day alcohol-related ED revisits and increase access to care. Methods: AMIC, located at a regional addiction and mental health centre in Ottawa, Canada, was created in collaboration with hospital and community partners. Patients presenting to The Ottawa Hospital ED (multi-campus tertiary acute care hospital; TOH-ED) for an alcohol-related issue were referred to AMIC. Referred patients “walk-in” to AMIC post-discharge from the ED. AMIC’s multidisciplinary team provides assessment, treatment, triage, and navigation to community services. Collaborative, cross-institutional partnerships with hospital, community, and primary care providers ensure clients are seamlessly transitioned to appropriate levels of care. Patients presenting to AMIC (N=197) completed measures of sociodemographics, substance use, and mental health at intake and at 30-day follow-up. Clients also completed satisfaction measures. ED visit data on AMIC clients was collected via medical chart review. Data was also collected on all ED visits to The Ottawa Hospital for an alcohol-related cause during the year prior to, and following the launch of AMIC. Results: Most patients served in AMIC were male (65%), over 30 years old (81%), and presented within 3 days of referral (59%). At intake, nearly all clients reported hazardous/harmful drinking (98%) and moderate to severe alcohol dependence (74%), as well as use of other substances (90%) and intermediate-severe dependence on other substances (32%). Most clients reported moderate to severe depression (57%) and anxiety (69%). At 30-day follow-up, AMIC clients showed significant reductions in alcohol use as well as symptoms of depression and anxiety (p < .001). The majority of AMIC clients (61%) were assessed by a systems navigator and connected to additional community services. Clients report great satisfaction with the ease of access to care, timeliness of the service, and services received. For clients served by AMIC, there was an 83% reduction in 30-day TOH-ED revisit rates (p < .001). AMIC also impacted the overall TOH-ED system: When comparing alcohol-related TOH ED re-visits for all clients who visited the TOH-ED between May 25 2015-May 25 2016 and May 26 2016-May 26 2017 (when AMIC was launched), results demonstrated a 8.1% reduction in alcohol-related 30 day TOH-ED revisit rates, and a 10% reduction in alcohol-related TOH-ED visits. Conclusions: AMIC demonstrated positive impact on clients, the healthcare system, and our community. AMIC reduced ED utilization, increased access to care, improved substance use and mental health outcomes, connected patients with community services, and built system capacity to treat people with alcohol use disorders. Key to the success of AMIC is the development of collaborative cross-sectoral, inter-agency partnerships and seamless care pathways between hospital, mental health, community, and primary care services. Our model could be adapted to other regions similarly striving to manage alcohol problems in their regions.

    Kim Corace

    PhD, C Psych

    Dr. Kim Corace, PhD,CPsych., is the Director of Clinical Programming and Research in the Substance Use and Concurrent Disorders Program at The Royal Ottawa Mental Health Centre, an Associate Professor in the Department of Psychiatry at University of Ottawa, a Clinical Investigator with the Institute of Mental Health Research, and a Clinical Health Psychologist. Working at regional, provincial, and national levels, her work focuses on improving treatment access and outcomes for vulnerable populations struggling with substance use and mental health co-morbidities, with a focus on developing collaborative care models. In 2013, the Ontario Ministry of Health Innovation Fund awarded the “Best Innovation in Mental Health Care Delivery” to Dr. Corace and her colleague for their Regional Opioid Intervention Service.

    Melanie Willows

    MD

    Dr. Melanie Willows (BSc MD CCFP CCSAM Diplomate ABAM) is an addiction medicine physician and is the Clinical Director of the Substance Use and Concurrent Disorders Program at The Royal Ottawa Mental Health Centre. She is an Assistant Professor at the University of Ottawa, a diplomate with the American Board of Addiction Medicine and  president-elect of the Canadian Society of Addiction Medicine. Dr. Willows is committed to collaborating with clinicians and researchers to develop new services that address gaps in care for substance use and mental health problems. 

    ACCME Accredited with Commendation

    ACCME Accreditation Statement

    The American Society of Addiction Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

    AMA Credit Designation Statement

    The American Society of Addiction Medicine designates this enduring material for a maximum of 1 AMA PRA Category 1 Credit(s).  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    ABPM Maintenance of Certification (MOC)

    The American Board of Preventive Medicine (ABPM) has approved this activity for a maximum of 1 LLSA credits towards ABPM MOC Part II requirements.

    ABAM Transitional Maintenance of Certification (tMOC)

    This course has been approved by the American Board of Addiction Medicine (ABAM). Physicians enrolled in the ABAM Transitional Maintenance of Certification Program (tMOC) can apply a maximum of AMA PRA Category 1 Credit(s)™ for completing this course.

  • Medications for Opioid Use Disorder: A Toolkit for Improving Practice (TIP) (1.5 CME)

    Product not yet rated Contains 4 Component(s), Medical Credits Offered

    Earn 1.5 AMA PRA Category 1 Credit(s)™ while learning about SAMHSA's Toolkit for Improving Practice, or TIP, in response to the opioid crisis under the Comprehensive Addiction and Recovery Act of 2016, which outlines up-to-date information about using medications to treat OUD in order to expand the use of effective treatments, from this conference recording from The ASAM 49th Annual Conference (2018).

    (1.5 CME) In this conference recording from the 2018 Annual Conference, you will learn that, opioid use disorder (OUD) has serious, increasingly significant effects on Americans’ health, social, and economic well-being. In response to a Congressional mandate contained in the Comprehensive Addiction and Recovery Act of 2016, the Substance Abuse and Mental Health Services Administration (SAMHSA) initiated development of a Toolkit for Improving Practice (TIP) to respond to the opioid crisis. 

    Through this publication, SAMHSA aims to provide up-to-date information about using medications to treat OUD in order to expand the use of effective treatments and to reduce the negative consequences of OUD. This five-part TIP reviews the use of buprenorphine, methadone, and naltrexone. These three Food and Drug Administration-approved medications for the treatment of OUD have been shown in randomized clinical trials to reduce the use of illicit opioids and can play an important role in addressing the opioid epidemic. This TIP was drafted collaboratively by an Expert Panel and SAMHSA’s Knowledge Application Program content experts based on reviews of the literature and their own knowledge and experience. 

    A scientific review team provided feedback in an intensive, iterative drafting process. The draft was then field-reviewed by additional experts representing the TIP’s multiple target audiences, representatives of SAMHSA’s various Centers, and reviewers at 10 additional federal agencies prior to its finalization. The TIP is available for free on SAMHSA’s Publications Ordering webpage (www.store.samhsa.gov), where it can be accessed digitally or ordered in hard-copy format.

    • Part 1 is for all audiences. It introduces medications for OUD and lays the groundwork for understanding treatment concepts discussed in later parts of this TIP. 
    • Part 2 is for healthcare professionals in general medical and specialty addiction treatment settings. It offers guidance on screening, assessment, treatment, and referral for treatment of OUD. 
    • Part 3 is for healthcare professionals who wish to, or are providing pharmacotherapy for OUD. It reviews the use of medications to treat OUD as well as patient monitoring and counseling. 
    • Part 4 discusses how addiction treatment counselors and program administrators can collaborate with healthcare professionals and their patients treated with medications. 
    • Part 5 provides a collection of resources for all audiences. This session will review the major contents of the TIP with an emphasis on updates from the previous TIPS on buprenorphine and treatment in OTPs. 

    There will be an opportunity for dialogue with the presenters.

    Robert P. Schwartz

    MD

    Dr. Schwartz is a psychiatrist and Medical Director of the Friends Research Institute. He is Co-Principal Investigator of the Mid-Atlantic Node of the National Institute on Drug Abuse (NIDA) Clinical Trials Network. He has studied pharmacotherapy for Opioid Use Disorder in the community and in jail and prison through numerous NIDA grant award and has over 150 scientific publications. Dr Schwartz is Associate Professor of Psychiatry and is the recipient of the Dole-Nyswander Award from the American Association for the Treatment of Opioid Dependence.

    Michelle R. Lofwall

    MD, DFASAM

    Dr. Lofwall completed residency training in Psychiatry and a clinical research fellowship in behavioral pharmacology at Johns Hopkins University. She now is an Associate Professor of Behavioral Science and Psychiatry in the Center on Drug and Alcohol Research at the University of Kentucky. She is a strong addiction treatment advocate and has an active outpatient addiction treatment practice. She also teaches residents, medical students, and other allied health professionals about treatment of substance use disorders. 

    She spends the majority of her time engaged in clinical research aimed at improving substance abuse treatment and better understanding the behavioral pharmacology of drugs of abuse. Dr. Lofwall is the immediate past President of the Kentucky Chapter of the American Society of Addiction Medicine, Editor of the American Academy of Addiction Psychiatry newsletter, and member of the Kentucky Governor's state prescription monitoring program Advisory Council.

    Anthony Campbell

    RPH, DO, CDR, USPHS

    Dr. Anthony Campbell is currently a board eligible candidate in the field of addiction medicine who currently services as a Clinical Specialty Consultant with the Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment in the Division of Pharmacologic Therapies (SAMHSA/CSAT/DPT). He and serves as a Commander in the United States Public Health Service. In his role at SAMHSA, he is responsible for planning, directing and evaluating the development of pharmacotherapy-based treatment standards and guidelines that require specialized DPT medical review. In addition he is an adjunct professor at both Howard University Colleges of Pharmacy and Medicine in Washington DC.

    Dr. Campbell earned two bachelor’s degrees from Howard University; Chemistry (85) and Pharmacy (88). He earned his Doctorate of Osteopathic Medicine from Ohio University (94). Additional training followed including a residency in Internal Medicine, with current board certification.

    ACCME Accredited with Commendation

    ACCME Accreditation Statement

    The American Society of Addiction Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

    AMA Credit Designation Statement

    The American Society of Addiction Medicine designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credit(s).  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    ABPM Maintenance of Certification (MOC)

    The American Board of Preventive Medicine (ABPM) has approved this activity for a maximum of 1.5 LLSA credits towards ABPM MOC Part II requirements.

    ABAM Transitional Maintenance of Certification (tMOC)

    This course has been approved by the American Board of Addiction Medicine (ABAM). Physicians enrolled in the ABAM Transitional Maintenance of Certification Program (tMOC) can apply a maximum of 1.5 AMA PRA Category 1 Credit(s)™ for completing this course.

  • Psychiatry for Non-Psychiatrists: The DSM-5 Express (1.5 CME)

    Product not yet rated Contains 4 Component(s), Medical Credits Offered

    Earn 1.5 AMA PRA Category 1 Credit(s)™ while learning about psychiatric and medical co-morbidities from a psychiatrist perspective. This conference recording from The ASAM 49th Annual Conference (2018), serves as a fundamentals of psychiatry and is designed strictly for non-psychiatrist addiction medicine professionals.

    (1.5 CME) In this conference recording from the 2018 Annual Conference, you will learn about the prevalence of unhealthy alcohol use appears to be increasing, yet attention to it has not been commensurate with its prevalence and impact on health and society. It seems to be hidden or forgotten. First we will review data (some, conflicting) on the rising prevalence and impact of alcohol use on health, and the role alcohol plays in consequences of other drug use. Next, we will discuss validated approaches for identification, challenges in assessment relevant to general health settings, and initial management. Management of alcohol withdrawal will be reviewed by clinical champions contributing to ASAM's practice guideline revision. We will review the evidence for the 4 FDA approved medications and address the efficacy or lack thereof for others. Finally, we address integrated care management for alcohol use disorder including generalists and addiction specialist roles. The main goal is to review what clinical science tells us about how to care for people with unhealthy alcohol use.

    Petros Levounis

    MD, MA, DFASAM

    Dr. Levounis is a Phi Beta Kappa graduate of Stanford University where he studied chemistry and biophysics before receiving his medical education at Stanford University School of Medicine and the Medical College of Pennsylvania. During medical school, he received an MA degree in sociology from Stanford before moving to New York City where he trained in psychiatry at Columbia University. He graduated from Columbia receiving the National Institute of Mental Health Outstanding Resident Award and went on to complete his fellowship in addiction psychiatry at New York University. From 2002 to 2013, he served as director of the Addiction Institute of New York.
    Dr. Levounis has written numerous articles and monographs; has lectured extensively on addiction topics throughout the United States and abroad; and has been interviewed by all major television networks. Dr. Levounis serves on the Board of Directors of the American Society of Addiction Medicine (ASAM) and from 2005 to 2009 chaired the national Committee on Addiction Treatment of the American Psychiatric Association. Dr. Levounis is a Betty Ford Scholar, a recipient of a U.S. State Department Speaker and Specialist Award, a distinguished fellow of the APA and ASAM, and an honorary member of the World Psychiatric Association. 

    Dr. Levounis has published thirteen books including the self-help paperback “Sober Siblings: How to Help Your Alcoholic Brother or Sister—and Not Lose Yourself,” the textbook of “Substance Dependence and Co-Occurring Psychiatric Disorders,” “The Behavioral Addictions,” “Motivational Interviewing for Clinical Practice,” “Becoming Mindful,” and the “Office-Based Buprenorphine Treatment of Opioid Use Disorder,” now in its second edition. His books have been translated into German, Hungarian, Japanese, Portuguese, and Spanish. 

    Dr. Levounis is married to actor Lukas Hassel and lives in New York City.

    ACCME Accredited with Commendation

    ACCME Accreditation Statement

    The American Society of Addiction Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

    AMA Credit Designation Statement

    The American Society of Addiction Medicine designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credit(s).  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    ABPM Maintenance of Certification (MOC)

    The American Board of Preventive Medicine (ABPM) has approved this activity for a maximum of 1.5 LLSA credits towards ABPM MOC Part II requirements.

    ABAM Transitional Maintenance of Certification (tMOC)

    This course has been approved by the American Board of Addiction Medicine (ABAM). Physicians enrolled in the ABAM Transitional Maintenance of Certification Program (tMOC) can apply a maximum of 1.5 AMA PRA Category 1 Credit(s)™ for completing this course.

  • Transitions in Care and Linkage to Treatment from Acute Care Settings (1 CME)

    Product not yet rated Contains 4 Component(s), Medical Credits Offered

    Earn 1 AMA PRA Category 1 Credit(s)™ while learning, through multiple cases, about barriers and solutions of care of the addicted patient in the acute care setting and how to integrate with community resources and outpatient care, from this conference recording from The ASAM 49th Annual Conference (2018).

    (1.0 CME) In this conference recording from the 2018 Annual Conference, you will learn that people with substance use disorders (SUD) have high rates of emergency care, hospitalization, readmission, long lengths of stay, and skyrocketing healthcare costs. Yet, models for improving care of patients with addiction in the emergency room or hospital setting are limited. The acute care setting can provide reachable moments for initiating addiction care. Medications for opioid and alcohol use disorders can be initiated promoting engagement in outpatient SUD care and MAT, with potential to reduce readmissions and morbidity associated with SUD. 2-6 Workshop attendees will work through multiple cases revolving around models of addiction care transition from the emergency room and inpatient hospital setting. 

    Three unique protocols being used by the workshop presenters at their respective institutions will be discussed. Attendees will better understand the barriers and solutions of care of the addicted patient in the acute care setting and how to integrate with community resources and outpatient care. 

    1. Inpatient Care with transition to Opioid Treatment Program or Office Based Pharmacotherapy - An addiction medicine consultation team, comprised of medical providers and licensed alcohol and drug counselors (LADC), provides consultations to inpatient medical-surgical units and inpatient psychiatry units of a 500 bed hospital. The majority of consults are to pharmacotherapy management services for patients with alcohol and opioid use disorder. A unique aspect of the service is the ability to refer to the hospital affiliated opioid treatment program or office based addiction clinic for continuation of pharmacotherapy management. 
    2. Emergency Medicine Care with transition to affiliated Addiction Psychiatry Clinic – Opioid withdrawal management in the emergency department includes observation for withdrawal and medication protocols using buprenorphine. Upon discharge, follow up is scheduled within days at a hospital affiliated Addiction Psychiatry clinic, staffed by an addiction psychiatrist as well as a physician board certified in Emergency Medicine, Addiction Medicine, and Medical Toxicology. Clinic services include pharmacotherapy and outpatient treatment. 
    3. Emergency Medicine Bridge Clinic – patients that present to the ED in withdrawal or seeking help with opioid treatment are seen and evaluated in the ED. If appropriate, the patient will receive buprenorphine for withdrawal management and a follow-up appointment within 1-3 days with a physician board certified in Addiction Medicine, Emergency Medicine, and Medical Toxicology in an Emergency Room based clinic. Services include medical evaluation and PEER advocacy to provide bridging pharmacotherapy with buprenorphine, referrals and linkage to community resources and treatment programs.

    Ross Sullivan

    MD, FASAM

    Dr. Sullivan completed his medical school education at SUNY Upstate Medical University. After, he entered and finished a residency in Emergency Medicine at the same hospital.  Dr. Sullivan then completed a medical toxicology fellowship at the SUNY Upstate Poison Control Center and SUNY Upstate Emergency Department. Dr. Sullivan is also board certified in Addiction Medicine. 

    Dr. Sullivan is currently the medical director of medical toxicology and the fellowship director of the medical toxicology fellowship. He also is the director of the Upstate Emergency Medicine Opioid Bridge Clinic, as well as the medical director for Syracuse Behavioral Health.

    Dr. Sullivan has several publications related to overdose and addiction, including “Cardiac conduction disturbance after loperamide abuse”, “Synthetic Cannabinoid Withdrawal”, and  “Baclofen overdose mimicking brain death”.

    Dr. Sullivan currently is a member of the Medical Advisory Panel to OASAS (NYS Office of Alcoholism and Substance Abuse Services), the NYS -DOH buprenorphine work group, and Co-Chair of the Health Care Provider subcommittee of the Onondaga County Task force. 

    JoAn Laes

    MD

    JoAn Laes, MD, Attending Physician, Division of Addiction Medicine, Hennepin County Medical Center, Minneapolis, MN; Core Medical Toxicology Faculty, Minnesota Poison Control System, Minneapolis, MN; Medical Director, Mission Detox Center, Plymouth, MN and 1800 Detox, Minneapolis, MN, ASAM Medical Toxicology workgroup Chair.Dr. Laes' practice is focused on inpatient addiction medicine and toxicology consultation and outpatient treatment of opioid and other substance use disorders. She is board certified in Internal Medicine, Addiction Medicine, and Medical Toxicology. She completed internal medicine residency at Hennepin County Medical Center and medical toxicology fellowship at Regions Hospital in St. Paul, Minnesota.

    Alaina Steck

    MD

    Dr. Alaina R. Steck, MD is an Assistant Professor of Emergency Medicine at Grady Memorial Hospital, in the Emory Department of Emergency Medicine. She completed her residency training in Emergency Medicine at Boston Medical Center in Boston, MA and her fellowship in Medical Toxicology at the Emory / Centers for Disease Control and Prevention Combined Fellowship in Medical Toxicology, followed by board certification in Addiction Medicine. She currently serves as the Medical Director of the Grady Medication-Assisted Opioid Treatment clinic, clerkship director for Medical Toxicology, Assistant Director at the Georgia Poison Center, and co-chair of the Drug Safety Task Force of the Injury Prevention Reserach Center at Emory.

    ACCME Accredited with Commendation

    ACCME Accreditation Statement

    The American Society of Addiction Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

    AMA Credit Designation Statement

    The American Society of Addiction Medicine designates this enduring material for a maximum of 1 AMA PRA Category 1 Credit(s).  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    ABPM Maintenance of Certification (MOC)

    The American Board of Preventive Medicine (ABPM) has approved this activity for a maximum of 1 LLSA credits towards ABPM MOC Part II requirements.

    ABAM Transitional Maintenance of Certification (tMOC)

    This course has been approved by the American Board of Addiction Medicine (ABAM). Physicians enrolled in the ABAM Transitional Maintenance of Certification Program (tMOC) can apply a maximum of AMA PRA Category 1 Credit(s)™ for completing this course.

  • Using Public Health Datasets to Understand the Opioid Overdose Crisis (1 CME)

    Product not yet rated Contains 4 Component(s), Medical Credits Offered

    Earn 1 AMA PRA Category 1 Credit(s)™ while learning how to describe commonly used datasets and highlight how public health data analysis can inform clinical and policy recommendations as well as advocacy from this conference recording from The ASAM 49th Annual Conference (2018).

    (1 CME) In this conference recording from the 2018 Annual Conference, you will learn that the opioid overdose crisis has evolved significantly in recent years. Between 2010 and 2015, annual opioid prescribing actually dropped from 782 MME to 640 MME per capita but opioid overdose deaths increased by 63%, mainly due to an increase in overdoses involving heroin and fentanyl. To understand this changing epidemiology, state and local agencies are increasingly relying on analyses of large datasets to inform the public health response. In this focus session, addiction specialists, academic researchers and public health experts working in two states, Illinois and Massachusetts, will describe commonly used datasets and highlight how public health data analysis can inform clinical and policy recommendations as well as advocacy. 

    We will begin the session with a brief overview of different datasets commonly maintained by state agencies, including vital records, hospital and emergency room administrative data, emergency medical service logs, syndromic surveillance of emergency room visits, infectious diseases surveillance systems and prescription monitoring programs (PMP). 

    Detailed examples of analyses of these datasets will be presented. For example, in Illinois and Massachusetts PMP records were linked to death certificates of individuals who died of opioid overdose. We found that in Massachusetts, opioids that had been prescribed were often not present on overdose toxicology and were rarely the sole opioids present at death. In Illinois, we identified demographic differences such as sex, race and rural vs. non-rural residence between the fatal overdoses involving commonly prescribed opioids as opposed to those involving heroin, fentanyl, or fentanyl analogues. Other analyses to be presented include prescribing patterns of opioids and benzodiazepines in the last year of life, missed opportunities to intercept with high risk individuals in the setting of non-fatal overdose, rates of substance use disorder diagnosis at the time of fatal overdose, and prescribing of buprenorphine prior to death. 

    The examples above illustrate how public health agencies utilize population level datasets to inform public health policy, clinical guidelines, funding applications and treatment advocacy. We will highlight the advantages and limitations of this approach and appraise the implications for clinical research and practice. We will discuss common challenges in performing such analyses, including laws governing access to data and agency siloing. Potential strategies to address these barriers will be described, including stakeholder engagement and legislative change. Participants will be invited to discuss how this integrated approach to public health data might affect their patients’ care and privacy.

    Alexander Y. Walley

    MD, MSc, FASAM

    Alexander Y. Walley, M.D., M.Sc., is an Associate Professor of Medicine at Boston University School of Medicine, a general internist and addiction medicine specialist at Boston Medical Center. He is the director of the Addiction Medicine Fellowship program and founded the Inpatient Addiction Consult Service at Boston Medical Center. He does clinical and research-related work on the medical complications of substance use, specifically HIV and overdose. He provides primary care and office-based buprenorphine treatment for HIV patients and methadone maintenance treatment. He is the medical director for the Massachusetts Department of Public Health’s Opioid Overdose Prevention Pilot Program. 

    Elizabeth M. Salisbury-Afshar

    MD, MPH, FAAFP, FASAM, FACPM

    Elizabeth Salisbury-Afshar, MD, MPH serves as the Medical Director of Behavioral Health for the Chicago Department of Public Health and is an Assistant Professor in the Departments of Family Medicine and Psychiatry, Section of Population and Behavioral Health, at Rush University Medical Center. She is certified in family medicine, addiction medicine and preventive medicine/general public health. Elizabeth previously served as Medical Director of Behavioral Health Systems Baltimore- a quasi-public entity that oversees all publicly funded addiction and mental health treatment in Baltimore City. In this role, she helped develop and implement the Baltimore City Overdose Prevention Plan. Elizabeth came back to Chicago in 2014 and served as Medical Director of Heartland Health Outreach (HHO), a federally qualified health center and healthcare for the homeless provider (330H) in Chicago. While at HHO, she expanded their addiction treatment services and developed a medication assisted treatment program. 

    Elizabeth has been working with the Chicago Department of Public Health since September of 2016 and continues to volunteer seeing patients in the medication assisted treatment program at HHO. In her role with the City Health Department, she guides the Department's work in the area of substance use as it relates to data analysis, policy, programming initiatives, and funding allocation.

    Mai Tuyet Pho

    MD, MPH

    Mai Tuyet Pho, MD MPH is an infectious diseases physician and health outcomes researcher at the University of Chicago. Her work seeks to improve health outcomes and public policy at the intersection of HIV, hepatitis C, and substance use. Current projects includes understanding the shifting epidemiology of HCV and opioid overdose, network characterization of people who inject drugs in rural communities, linkage to HCV care at reentry for criminal justice involved individuals, and economic evaluation of treatment coverage policies. Dr. Pho served as the interim Chief Medical Officer at the Illinois Department of Public Health and is currently a Medical Advisor for Healthcare Policy and Research. She leads multiple efforts at the Department around the opioid epidemic and HCV, including analysis on fatal and nonfatal overdose, HCV surveillance, naloxone overdose prevention and GME education around safe opioid prescribing. She is a member of the Illinois Statewide Opioid Crisis Response Advisory Council. 

    Ali B. Abbasi

    MSci, MPhil

    Ali Abbasi MSci MPhil is a Medical Student at the University of Chicago. He also works at the Illinois Department of Public Health (IDPH), assisting the office of Director Nirav Shah on data research projects. He focuses on linking large state datasets to help policy makers better understand the epidemiology of opioid overdoses in Illinois. He holds an MPhil in Computational Biology from the University of Cambridge.

    ACCME Accredited with Commendation

    ACCME Accreditation Statement

    The American Society of Addiction Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

    AMA Credit Designation Statement

    The American Society of Addiction Medicine designates this enduring material for a maximum of 1 AMA PRA Category 1 Credit(s).  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    ABPM Maintenance of Certification (MOC)

    The American Board of Preventive Medicine (ABPM) has approved this activity for a maximum of 1 LLSA credits towards ABPM MOC Part II requirements.

    ABAM Transitional Maintenance of Certification (tMOC)

    This course has been approved by the American Board of Addiction Medicine (ABAM). Physicians enrolled in the ABAM Transitional Maintenance of Certification Program (tMOC) can apply a maximum of AMA PRA Category 1 Credit(s)™ for completing this course.

  • Addiction Medical Management with Patients that Use Cannabis (1 CME)

    Product not yet rated Contains 4 Component(s), Medical Credits Offered

    Earn 1 AMA PRA Category 1 Credit(s)™ while preparing yourself as a clinician to provide addiction medical management and/or psychiatric care in patients who also use cannabis, from this conference recording from The ASAM 49th Annual Conference (2018).

    (1.0 CME) In this conference recording from the 2018 Annual Conference, you will learn that the prevalence of cannabis use is expected to increase in light of ongoing regulatory changes permitting the legal sale and use of cannabis. People with any substance use disorder use cannabis at a greater rate than those without a substance use disorder, and additional availability of cannabis is associated with increased rates of cannabis use in this population. Further, there is a well documented association between cannabis use and chronic psychotic disorders, with some investigators suggesting a causal relationship between cannabis use and the development of a subsequent chronic psychotic disorder. Therefore, people who come to the attention of addiction medicine physicians and to psychiatrists are increasingly likely to use cannabis. Furthermore, a firm understanding of the association between cannabis use, other substance use disorders, and psychiatric symptoms and conditions will be critical to the modern practice of addiction medicine. 

    This presentation is designed to prepare clinicians to provide addiction medical management and/or psychiatric care in patients who also use cannabis. This presentation will be divided into three sections. First, recent research on the treatment of substance use disorders and other psychiatric disorders with co-occurring cannabis use will be reviewed. In addition, a sample patient handout that summarizes this material will be provided. Management implications will be discussed, specifically including the importance of motivational interviewing to clarify patients’ own motivation to change their cannabis use, as a component of their medical treatment. Next, the presenters will review motivational interviewing techniques, including using the brief negotiated interview, and discuss how it can be utilized when managing patients who present with co-occurring cannabis use. 

    In the last section, participants will be divided into small groups and practice using motivational interviewing techniques applied in the context of three sample cases of patients who regularly use cannabis. These cases will include: 1) a 27-year-old college student who seeks treatment for anxiety, 2) a 45-year-old veteran who seeks treatment for insomnia and PTSD symptoms, 3) and a 17-year-old adolescent who is brought by parents for chronic irritability. The workshop will conclude with an open discussion of these cases and the implications of cannabis on addiction medicine and psychiatric clinical practice.

    Iman Parhami

    MD, MPH

    Iman Parhami, MD, MPH is a double-board certified child and adolescent psychiatrist focused on addictions. Dr. Parhami currently sees adult patients at a LA County's community mental health clinic, where he is also the co-leader of the Co-Occurring Disorders Clinic. In addition, he is the psychiatrist for two residential treatment centers for adolescents with substance use problems and he sees patients at USC's University Center for Excellence in Developmental Disabilities at Children's Hospital of Los Angeles. 

    Dr. Parhami completed his child and adolescent psychiatry fellowship at Johns Hopkins University and his adult psychiatry residency at Delaware's State program. During his training, he received multiple national recognition awards, which included a research training grant from the American Academy of Children and Adolescents and National Institute of Drug Use, and other awards from the American Academy of Addiction Psychiatry and American Psychiatric Association. Dr. Parhami has published multiple peer-reviewed scientific journal articles focusing on addictive disorders. Notably, Dr. Parhami completed a postdoctoral research fellowship at UCLA focusing on psychosocial interventions for behavioral addictions and a clinical fellowship at the Psychoanalytic Center of Philadelphia.

    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.

    ACCME Accredited with Commendation

    ACCME Accreditation Statement

    The American Society of Addiction Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

    AMA Credit Designation Statement

    The American Society of Addiction Medicine designates this enduring material for a maximum of 1 AMA PRA Category 1 Credit(s).  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    ABPM Maintenance of Certification (MOC)

    The American Board of Preventive Medicine (ABPM) has approved this activity for a maximum of 1 LLSA credits towards ABPM MOC Part II requirements.

    ABAM Transitional Maintenance of Certification (tMOC)

    This course has been approved by the American Board of Addiction Medicine (ABAM). Physicians enrolled in the ABAM Transitional Maintenance of Certification Program (tMOC) can apply a maximum of AMA PRA Category 1 Credit(s)™ for completing this course.

  • Collateral Damage: Pregnant Women with Interruption of MAT Due to Incarceration (1 CME)

    Product not yet rated Contains 4 Component(s), Medical Credits Offered

    Earn 1 AMA PRA Category 1 Credit(s)™ while comparing and contrasting the harmful and unintended effects, evident through three case studies, that involve pregnant, opioid-dependent patients, who became incarcerated, from this conference recording from The ASAM 49th Annual Conference (2018).

    (1.0 CME) In this conference recording from the 2018 Annual Conference, you will learn about how the opioid epidemic continues to rage across the nation, it is estimated that as many as 85% of inmates have a substance use disorder. An estimated 25%--and growing—of those people have opioid dependence. For some people, their opioid dependence is upon medication-assisted treatment with either methadone or buprenorphine. "Jailhouse Detox", or interruption of medication-assisted treatment due to incarceration, has been demonstrated to have deleterious effects on people with opioid use disorder. When people who are previously established on MAT are incarcerated and no longer receiving their medication, not only do those people suffer prolonged, severe withdrawal, but may also resort to substance use while incarcerated, often with unsafe injection practices which increase risk of transmission of HIV, Hepatitis B and C, and bacterial infections. Increased rates of recidivism, overdose, and death are also demonstrated upon release. People who experience an interruption or cessation of MAT while incarcerated are less likely to return to treatment upon release. Although pregnant women are perhaps the population with the best access to MAT while incarcerated, there persist significant barriers to continuation of pharmacotherapy in many areas of the country. When medication-assisted treatment is interrupted due to incarceration, pregnant women suffer. Stopping medication-assisted treatment in pregnancy is in direct opposition to every major organizations’ recommendations regarding MAT in pregnancy; there is unanimous agreement that continued receipt of MAT in pregnancy improves both maternal and fetal outcomes, and is considered the standard of care. 

    In a collaborative agreement between Denver Health and Hospital Outpatient Behavioral Health Services and Denver County Jail, we have developed a mechanism for methadone induction and/or continuation for pregnant women with opioid use disorder. However, due to significant differences between Denver County and surrounding county jail systems, we have documented several cases within the past year of poor maternal outcomes for pregnant women who experience interruption of medication-assisted treatment. 

    Utilizing these case studies, we will examine area of weakness and opportunities for growth in caring for pregnant, incarcerated women with opioid use disorder. Exploring and learning from these women's experiences has motivated increased policy and political advocacy among medication-assisted treatment and obstetric providers, who seek to increase equivalence of care for pregnant women with respects to MAT. Increasing access to MAT for all incarcerated people should be a priority, starting with pregnant women as one of these most vulnerable populations.

    Kaylin Klie

    MD, MA, FASAM

    Kaylin A. Klie, MD MA is a dually-board certified physician in Family Medicine and Addiction Medicine, with a clinical focus in perinatal addiction and the integration of addiction medicine into primary care at the University of Colorado, whereshe  is an Assistant Professor in the Department of Family Medicine. Prior to medicine, Dr Klie trained as a Marriage and Family Therapist. She then completed medical school at Rush Medical College. She completed residency in Family Medicine followed by fellowship in Addiction Medicine at the University of Colorado. She is the founder of the Denver Health and University of Colorado OB Addiction Medicine clinics, where pregnant and mothering women are provided integrated prenatal/post-partum care and substance use disorder treatment. She serves as the associate director for the University of Colorado Addiction Medicine Fellowship, and is core faculty for the University of Colorado Addiction Psychiatry Fellowhip. She enjoys teaching and mentoring medical students, PA students, residents from a variety of training programs, and addiction fellows.She is an active member of the American Society of Addiction Medicine, Colorado Society of Addiction Medicine, the Colorado Substance Exposed Newborn Collaborative, Alpha Omega Alpha, and the ASAM Women's Action Group. She lives in Denver, CO with her husband and son.

    Michelle Gaffaney

    PA-C

    Michelle Gaffaney PA-C, Behavioral Health Consult Liaison Service at Denver Health Hospital and Outpatient Behavioral Health Services, University of Colorado Department of Psychiatry Faculty. Masters of Physician Assistant Studies from the University of Colorado Anschutz Medical Campus CHA/PA Program. Bachelors of Arts in Biological Sciences from North Dakota State University.

    Amanda Langer

    LCSW, CACII

    Amanda Langer, LCSW, CACII is a Licensed Clinical Social Worker and Certified Addiction Counselor , and currently works as a Therapeutic Case Worker and Care Manager in Denver Health’s integrated health care system.  Ms. Langer’s primary focus is working with pregnant patients struggling with substance use, with a history of substance use, or on a Medicated Assisted Treatment Medication. Patients are referred to and assessed for service needs by Ms. Langer for coordination of care during pregnancy through outpatient settings, the jail system, and the Women’s Care Clinic. Ms. Langer connects them to both community and hospital-based services, and provides care throughout the pregnancy and post-partum. Ms. Langer graduated from University of Colorado in 2003 with a BA in Psychology and Sociology and worked as a residential treatment counselor with at-risk youth until returning to school to obtain her Master’s in Social Work in 2011. Since graduating, Ms. Langer has worked providing clinical and case management services to patient’s struggling with addiction releasing from incarceration, with probation and parole sentences, co-occurring disorders, and providing therapeutic services for high-risk patients on Medicated Assisted Treatment Medications. Ms. Langer began working with addiction during pregnancy specialist Dr. Kaylin Klie, MDMA in the Denver Health System in February of 2017 to help connect pregnant women and their partners to treatment services and decrease the ripple of trauma for families.

    ACCME Accredited with Commendation

    ACCME Accreditation Statement

    The American Society of Addiction Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

    AMA Credit Designation Statement

    The American Society of Addiction Medicine designates this enduring material for a maximum of 1 AMA PRA Category 1 Credit(s).  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    ABPM Maintenance of Certification (MOC)

    The American Board of Preventive Medicine (ABPM) has approved this activity for a maximum of 1 LLSA credits towards ABPM MOC Part II requirements.

    ABAM Transitional Maintenance of Certification (tMOC)

    This course has been approved by the American Board of Addiction Medicine (ABAM). Physicians enrolled in the ABAM Transitional Maintenance of Certification Program (tMOC) can apply a maximum of AMA PRA Category 1 Credit(s)™ for completing this course.