Addressing Complex Issues in Buprenorphine Prescribing: a Workshop (1.5 CME)
(1.5 CME) In this conference recording from the 2018 Annual Conference, you will learn that buprenorphine became available for the treatment of opioid dependence in the United States in 2002. The accompanying regulations also allowed that the treatment be done outside of Opioid Treatment Programs (OTPs) or methadone clinics in a variety of settings including office-based providers and various types of outpatient programs by physicians (and now advanced providers) who obtain X-waiver certification. While it is clear that buprenorphine is an effective treatment for patients with opioid dependence with retention in treatment, reduction in illicit opiate use, decreases in craving and improvements in function on a variety of levels supported as evidence-based outcomes various issues come up in prescribing patients buprenorphine. Some physicians ignore the problems and others have zero tolerance for any deviations from what is expected. In this workshop two physicians with many years’ experience from outpatient treatment programs, Emergency Departments, detoxification units and hospital settings as well as primary care practice, will present and moderate case-based discussions in addressing complex issues in buprenorphine prescribing. These issues include running out of medication early or encounters with patients who report lost or stolen medications. What does one do when the urine has been adulterated or substituted or does not show any buprenorphine? How should one optimally approach patients that are using other substances such as alcohol, cocaine, marijuana or prescription sedatives and benzodiazepines when prescribed buprenorphine? These issues are discussed and often debated yet typically don’t come to easy resolution. The authors of this workshop will present and moderate discussion for various cases and provide examples of and support for approaches for challenging patient encounters that providers prescribing buprenorphine are confronted with. The format is through moderated case discussion and the audience will be encouraged to present their thoughts and responses for discussion during this session as well. Where available references to support decision making and to clarify pharmacologic, toxicologic and forensic principles, such as interpretation of drug testing results, will be provided. Cases will also serve to reinforce basic addition medicine competencies in these areas though interactive discussion and presentation rather than didactic lecture.
Timothy J. Wiegand
MD, FACMT, FAACT, FASAM
Tim Wiegand MD, DABAM, FACMT, FAACT was trained in internal medicine and completed fellowship training in Medical Toxicology at the University of California, San Francisco in 2006. He was the Medical Director of the Rochester Poison Center until 2010. Dr. Wiegand has been successful in developing a full time, bedside, medical toxicology consultation service and is very active in the practice of Addiction Medicine, having successfully completed his board certification recently.
In addition to his primary appointment as Associate Professor of Emergency Medicine at the University of Rochester School of Medicine & Dentistry in Rochester, NY, Dr. Wiegand serves as Medical Director for Huther Doyle Chemical Dependency Treatment Program in Rochester, NY and as a detoxification specialist for Syracuse Behavioral Health in Rochester, NY.
Dr. Wiegand serves on the New York Society of Addiction Medicine (NYSAM) Board of Directors as the Communication Committee Chair and he was recently elected to the American College of Medical Toxicology Board of Directors to begin a 3 year term in October, 2015. He currently serves as the chair of the Addiction Medicine Section for the American College of Medical Toxicology and he recently organized a very successful Addiction Medicine Academy for ACMT prior to their main Annual Scientific Meeting in Clearwater, Florida in March, 2015. Dr. Wiegand has presented for the ASAM Review Course on Pharmacology & Toxicology, MRO and drug testing principles at previous Review Course conferences.
MD, FASAM, FAAFP
Dr. Wetterau is a practicing rural family physician whose practice is mainly addiction medicine. He is the Liaison from ASAM to AAFP, to the PCPCC, and co-chair of the STFM addiction interest group. He is immediate past president of NYSAM and co-chair of ASAM Chapters Council. He is also on the board of COPE (Coalition on Physician Education in Substance Abuse) and clinical assistant professor of family medicine at the University Rochester School of Medicine. In addition he teaches a annual course in behavioral health at Hope Africa Medical School in Burundi.
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.