April 11

ASAM Board Approves Dues Increase

The ASAM Board of Directors met Wednesday and took the following actions:

  • The Membership Committee increased the dues rate for the 2015 calendar year an average of 2-3 percent, depending on the member category.
  • The Membership Committee also made a motion to have Max Schneider, MD, FASAM, ABAM Diplomate, former ASAM President and Chair of the Ruth Fox Memorial Endowment Fund Committee, become an Emeritus Member. Throughout the years he has made significant contributions to the society.
  • The Board approved the Publications Council’s motion to approve production of a new society publication, tentatively titled The ASAM Addiction Medicine Handbook, which would be available next year.
  • The Board accepted the 2013 financial audit. ASAM received an unmodified opinion that states that all materials presented are in accordance with generally accepted accounting principals.

Component Session Helps Prepare for ABAM Certification Exam

ASAM members can prepare for the American Board of Addiction Medicine (ABAM) certification exam by attending Component Session 13, “ABAM Certification 101,” from 4:30 to 6 pm Saturday in Orlando Ballroom V, Lower Level. This is a session that has been beneficial in preparing for the exam, said Kevin Kunz, MD, FASAM, ABAM Executive Vice President.

The session will address eligibility criteria, examination format, content, and the scoring and notification process. The exam application will be reviewed, and it will be possible to begin registration for the exam at the session.

More than 900 physicians sat for the exam in each of the last two test cycles. The pass rate for first-time examinees has averaged approximately 85 percent. For those taking the recertification exam, now known as Maintenance of Certification (MOC) Part III, Cognitive Examination, the pass rate averages 93 percent, Dr. Kunz said.

The five-hour, 250-question certification exam is designed by the ABAM Examination Committee, with members representing the eight major specialties treating or preventing addiction in collaboration with the National Board of Medical Examiners. An ASAM fellowship is not required to take the exam.

To be eligible to take the exam, physicians must have an active medical license, have completed a primary residency in any field, have earned 50 CME credits related to addiction, and have 1,920 hours of activity in the field of addiction prevention and treatment over the last five years. The activity in the field can include clinical hours, research, teaching, or administration. The regular exam application deadline is May 31, and the final deadline is July 15.

Physicians passing the exam can enroll in the ABAM MOC program. ABAM is working to gain recognition of addiction medicine as a specialized field of medical practice and continue a certification process through collaboration with the American Board of Medical Specialties (ABMS) and its member boards. All ABMS specialties and subspecialties are required to have a four-component MOC program. Board certification and MOC have become expected of physicians throughout health care as a sign of their medical knowledge, competence, and professionalism.

MOC is an ABMS requirement that ABAM has adopted for its ABAM Diplomates, Dr. Kunz said.

“MOC assures that the physician is committed to lifelong learning by requiring ongoing measurement of six core competencies adopted in 1999 by ABMS and the ACGME [Accreditation Council for Graduate Medical Education],” he said. “There’s ample evidence to suggest that physicians who have participated in MOC have a greater impact on the quality of care that patients receive.”

ASAM also presented a Component Session Thursday night to help ABAM diplomates prepare for the MOC Part III Cognitive Exam.

Shelly Greenfield to Receive Smithers Award

The challenges in the treatment of female addiction patients have grown as more women take prominent positions in the workforce and research shows how they differ from male patients. A leader in recognizing and defining these differences will receive the R. Brinkley Smithers Distinguished Scientist Award Friday.

Shelly Greenfield, MD, MPH, FASAM, will deliver her address, “Gender Differences in Addiction: Implications for Women’s Addiction Treatment,” when she accepts the Smithers Award during the Opening Scientific Plenary, from 8:30 to 10 am Friday in Orlando Ballroom III, Lower Level.

“The winner of the Smithers Award is recognized for accomplishments related to the care and research for substance use disorders, and in particular alcohol dependence,” said Gavin Bart, MD, PhD, FASAM, ABAM Diplomate, Chair of the Med-Sci Program Committee. “Dr. Greenfield won in recognition of her accomplishments for education related to substance use disorders, and more specifically education about women’s issues related to substance use disorders.

“Much of what we have learned about issues that women may face when they are seeking treatment for substance use disorders or when they are affected by substance use disorders has been compiled and disseminated through Dr. Greenfield’s writings and teachings. She is one of the most widely recognized experts in this area.”

Dr. Greenfield is a Professor of Psychiatry at Harvard Medical School and a principal investigator and co-investigator on federally funded research focusing on treatment for substance use disorders, gender differences in substance disorders, and health services for substance disorders.

At McLean Hospital in Belmont, Massachusetts, she is Chief Academic Officer and the Director of Clinical and Health Services Research and Education in the Alcohol and Drug Abuse Treatment Program, Division on Alcohol and Drug Abuse. She also was Director of the Harvard Medical School/Partners Addiction Psychiatry Fellowship and directed the substance abuse clinical rotations of the Adult Psychiatry Residency Program of Massachusetts General and McLean Hospitals from 2005 to 2010.

Dr. Greenfield served as the Founding Scientific Director of National Alcohol Screening Day. She is a former Chair of the American Psychiatric Association’s Council on Addiction Psychiatry, and is a member of the Board of Directors of the American Academy of Addiction Psychiatry.

Course, White Paper Show Renewed Emphasis on Clinical Drug Testing

Louis E. Baxter, Sr., MD

Louis E. Baxter, Sr., MD

A key to improved treatment of patients with drug addiction lies in knowing more about those patients, so ASAM has developed a white paper and is offering a four-hour, two-part course, “Clinical Drug Testing in Medical Care.”

The white paper was released during a Component Session Thursday night and the course will be presented from 10:30 am to 12:30 pm and 2:30 to 4:30 pm Friday in Orange Ballroom C, Lower Level.

“The white paper was needed because drug testing is becoming the MRI of addiction treatment. ASAM developed the white paper because there were no standards or national guidelines that could be applied in a general or specific way for interpretation,” said Louis E. Baxter, Sr., MD, FASAM, ABAM Diplomate, one of the authors of the white paper and an organizer and speaker at the course. “This is our special tool for diagnosing substance use disorders. It helps assess effectiveness of treatment plans, and it serves as a deterrent for individuals struggling with recovery.”

“Clinical Drug Testing in Medical Care” differs from ASAM’s other course about drug testing, which was designed for medical review officers and was geared toward testing required in the transportation industry.

“This new course is designed to give the clinician practical clinical advice and information on how to apply clinical drug testing in their practices,” said Michael Sprintz, DO, ABAM Diplomate, also an organizer and speaker at the course. “We will talk about the way drug testing is performed on urine, oral fluid, hair, and blood. We will talk about the differences between a screening test and a confirmation.

“We also will go into a lot more depth on which patients we should be testing, how to test those patients, and specialty-specific issues. Another important difference is that the final section of the course is the nuts and bolts of how to start doing clinical dug testing in your own practice. We will talk about billing and compliance, and how to get reimbursed.”

ASAM has not offered a course about clinical drug testing since 2006, and a lot has changed since then. Pain management has grown, leading to the epidemic of prescription drug abuse, said Dr. Baxter, Executive Medical Director of the Professional Assistance Program of New Jersey.

“Now, more urine drug testing is required,” he said. “Primary care physicians are needing to use urine testing, and we want to make sure they have state-of-the-art information and guidance. There are various modalities. Breath testing is most appropriate for certain issues. We also use swabs, hair, and patches. With all of these modalities, it is important to know which one to select.”

Speakers at the course will discuss the science of drug testing, clinical drug testing basics, discussing test results with patients, and how to apply drug testing in practice. It also will include a case study and a test interpretation, said Dr. Sprintz, Founder and Chief Medical Officer of the Sprintz Center for Pain and Dependency, The Woodlands, Texas.

The sessions also will review the results of ASAM’s Millennium drug testing survey to gauge the physician knowledge base, he said.

“We found that most physicians are not regularly testing their patients for prescription drug abuse and illicit drug abuse,” Dr. Sprintz said. “We are not able to get people help if we don’t know that they have a problem. That is a big reason why we thought that now is an important time to start a clinical drug testing course.

“We need to teach physicians not just how to do drug testing, but how to know which patients to test, how to do it smartly to make it clinically relevant, and testing in a way that minimizes the predictability for patients. To quote Howard Heit, MD,  clinical drug testing is something we do for our patients, not to our patients.”

Two-Part Symposium to Address Women’s Issues

Women’s issues in addiction medicine will be the focus of two Symposia presented Friday. Symposium 2A, “Update on Women’s Issues—Part I,” will be presented from 10:30 am to 12:30 pm and Symposium 2B, “Update on Women’s Issues—Part II,” will be presented from 2:30 to 4:30 pm, both in Orange Ballroom D, Lower Level.

In Part I, Shelly Greenfield, MD, MPH, will look at gender differences in addiction and its treatment. She will share study results from the Women’s Recovery Group, a 12-session relapse prevention group therapy that uses a cognitive-behavioral approach. Dr. Greenfield will spotlight recent epidemiologic trends, including the narrowing of the gender gap in prevalence of these disorders, as well as gender differences in risks for substance use disorders.

Dr. Greenfield is Chief Academic Officer and Chief of the Division of Women’s Mental Health at McLean Hospital and Professor of Psychiatry at Harvard Medical School. She also is Director of the Clinical and Health Services Research and Education in the Division of Alcohol and Drug Abuse at McLean Hospital, Belmont, Massachusetts.

“While substance use is a growing health problem among women, females are underrepresented in most substance use treatment programs,” Dr. Greenfield said. “However, there are evidence-based, gender-responsive treatments for women with substance use disorders, including the Women’s Recovery Group.”

In 2011, women comprised 42 percent of illicit drug users, 40 percent of tobacco product users, and 50 percent of alcohol users in the United States, she said. That same year, 7.6 million women over age 12 had a substance use disorder.

Part II of the symposium will focus on consequences and subgroups of women’s drinking. The most serious consequences of drinking during pregnancy are Fetal Alcohol Spectrum Disorders (FASD), including Fetal Alcohol Syndrome. Children with FASD have been found to have growth delays, central nervous system problems, facial abnormalities, behavioral and academic problems, and psychosocial problems. The deficits are lifelong and not easily treatable. Presenters will discuss the latest research findings, with a special emphasis on screening and diagnosis, referral to treatment, and promising approaches to treatment. Additionally, presenters will touch on current research on HIV-infected women with co-occurring alcohol misuse and other mental health disorders, emphasizing co-occurring anxiety and depression.

The two sessions are relevant because there is ongoing research on women’s issues and it is important to have periodic updates to continuously refine treatment said speaker Joan Zweben, PhD, Clinical Professor of Psychiatry at the University of California, San Francisco, and Executive Director of the East Bay Community Recovery Project, Oakland, California.

“We hope people will take away practical information they can use to improve treatment in their own community,” she said.

New NIAAA Director to Address Annual Business Meeting

ASAM Medical-Scientific Conference attendees will have the opportunity to meet the newly appointed director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA). George Koob, PhD, is the featured speaker at the ASAM Members Annual Business Meeting and Breakfast from 7 to 8:30 am Friday in Orlando Ballroom V-VI, Lower level.

Dr. Koob will oversee the NIAAA, which primarily funds alcohol-related research in a range of scientific areas, including genetics, neuroscience, epidemiology, prevention, and treatment. The NIAAA also coordinates and collaborates with other research institutions and federal programs on alcohol-related issues. Dr. Koob plans to make medication and behavioral treatment a priority.

“While I don’t expect there will ever be a pill that will cure all alcoholism, I do expect there will be medications that help people, much like we see in other major psychiatric disorders,” Dr. Koob said. “So, for one thing, I am going to be reaching out to the pharmaceutical companies to help us with medications development at NIAAA.”

Dr. Koob comes to his new position by way of the Scripps Research Institute, where he is on a leave of absence from serving as Chairman of the Committee on the Neurobiology of Addictive Disorders and Director of the Alcohol Research Center.

Dr. Koob’s early research interests were directed at the neurobiology of emotion, with a focus on the theoretical constructs of reward and stress. His contributions have led to the understanding of the anatomical connections of emotional systems and the neurochemistry of emotional function. Dr. Koob also is an authority on alcohol and drug addiction.

The NIAAA is the primary U.S. agency for conducting and supporting research on the causes, consequences, prevention, and treatment of alcohol abuse, alcoholism, and alcohol problems.

Other goals, Dr. Koob said, will be to understand the role of alcohol in organ pathology and develop effective prevention and treatment strategies for such pathology, develop improved approaches for the delivery of health services for alcohol disorders, and promote and recruit young investigators, women, and minorities to the alcohol field. The NIAAA plans to work with NIDA and the National Cancer Institute (NCI) to integrate resources and expertise to advance substance use, abuse, and addiction science research, and public health outcomes.

“In the last five years, the NIAAA has been doing fantastic work. The NIAAA really has a leg up on addressing many of the problems we face in addiction medicine,” Dr. Koob said.

Fundamentals Course Aimed at Primary Care Professionals

0411Selby_Featured

Peter Selby, MBBS

A new Med-Sci Pre-Conference course, “The ASAM Fundamentals of Addiction Medicine,” helped members and non-members learn more about addiction medicine and how to recognize, treat and/or refer patients.

Thursday’s daylong course featured an energetic and interactive format, with active roundtables and facilitators. Sessions were heavily focused on active learning, such as skills demonstration and skills building, and less on lecturing. Audience response devices were used throughout the day to challenge attendees to test their new knowledge.

“The goal of the course was to build expertise among primary care physicians and psychiatrists to treat patients with addiction with the same confidence they would have in treating any other chronic illness. This will help empower participants to confidently embark on a very rewarding professional journey to incorporate addiction medicine into their daily practices and save countless lives,” said Peter Selby, MBBS, CCFP, FASAM, ABAM Diplomate, the Course Chair and Curriculum Director.

The growing need to expand the physician’s role in treating addiction is due, in part, to medical and psychiatric illnesses among patients with substance use disorders, he said. Contributing to the need is the development of new medications and access to those medications and medical care through coverage available because of the Affordable Care Act.

With the expansion of the physician’s role and increased patient access to medical care, it is appropriate that the need for early intervention starts to take place in primary care and general psychiatry practice, Dr. Selby said. Attendees left the course better equipped to identify their feelings and attitudes that promote or prevent therapeutic responses to their patients with substance use disorders. Attendees will be contacted three and six months after the course for feedback about the changes they have made to their practices.

Speakers at the session discussed the three major neurocircuits underlying addictive disorders and their clinical implications, universal screening tools to identify substance use in patients, counseling strategies to motivate patients, and how to conduct a biopsychosocial and developmental ambulatory assessment. The day concluded with a session on proven and effective medications to treat a variety of addictions, notably alcohol, opioid, and tobacco addictions.

“Addiction is a chronic, relapsing disorder that is immensely treatable,” Dr. Selby said. “Early treatment can save lives, helping not only the individual, but families and society. It’s unfortunate that this segment of the population has been neglected for so long.”

Pain and Addiction Course Focuses on Use of Buprenorphine

0411-Pain_Panel

(From left) R. Corey Waller, MD, MS, Mark A. Weiner, MD, and Robert B. Raffa, PhD, listen to Howard G. Kornfeld, MD, make a point during the Pain and Addiction Course Thursday.

One of the staples of the Med-Sci Conference, the Pain and Addiction Course, received a makeover this year. The daylong session moved from presenting an overview of several topics to zero in with in-depth presentations on current uses of buprenorphine in a variety of areas, and the roles of other pain and addiction treatment strategies, from marijuana to benzodiazepines.

“We made a significant effort to change not only the content, but the way it was delivered. The content was concentrated heavily on buprenorphine as both a medication for the treatment of opioid addiction, but also the treatment for patients who have both addiction and pain,” said R. Corey Waller, MD, MS, ABAM Diplomate, Vice Chair of the Pain and Addiction Common Threads Program Committee.

“We discussed how that plays into the chronic treatment of those patients and how we guide treatment of patients in a hospital who happen to be on these medications but need treatment for surgery, delivery of child, or a number of other areas,” said Dr. Waller, Director of the Center for Integrative Medicine at Spectrum Health, Grand Rapids, Michigan.

The course opened with four presentations about buprenorphine, starting with its development in the 1960s to its molecular mechanisms to its current role in treating pain around the world. One of the leading researchers of buprenorphine, Joseph Pergolizzi, MD, Adjunct Assistant Professor at Johns Hopkins University School of Medicine, discussed how it is used to a greater degree in Europe than in the United States.

“It was nice to get a perspective about how well this medication works internationally. Its effectiveness crosses cultural boundaries really well. We talked about the ‘super-utilizer’ patients and the difficult approach with non-compliant patients with complicated pain syndromes,” Dr. Waller, said adding that presentations explained the use of clinically relevant pathways in treatment.

“We delved into this group of patients who are of interest. The super-utilizers are those 5 percent of patients responsible for 40 percent of medical costs, and a very high percentage of those have a substance use disorder.”

Other presentations focused on patients with chronic pain using marijuana, and patients treated for pain after surgery using buprenorphine-based medications.

“There is evidence and there are established pathways to treat these complicated patients with chronic pain so we don’t have to ignore them or worry as much. There are safe pathways to treat their pain as well as their opioid-use disorder,” Dr. Waller said. “It also is important to find ways to assist our hospital-based colleagues in the treatment of their patients.”

The course concluded with presentations more focused on addiction issues, such as pharmacologic and non-pharmacologic treatments.

“We talked about what role benzodiazepines play and how complicated it can be to treat co-occurring disorders, especially with other controlled substances, such as benzodiazepines,” Dr. Waller said. “The research shows that there is not much place for the use of benzodiazepines.

“The integration of pharmacologics with 12-step programs becomes very important because one without the other is much less effective. When you apply both, you get this force multiplier effect. Just writing a prescription doesn’t fix the patient and just talking to them doesn’t fix them.”

Hepatitis C Comorbidities Persist Despite Treatment Advances

Much of the focus on treating hepatitis C virus (HCV) patients in recent years has been on using medications to treat the infection. While advances are promising, most patients today are untreated, particularly those who use illicit drugs and are struggling with comorbidities. These issues will be addressed Friday in Symposium 3, “Neuropsychiatric Complications of HCV Among Drug Users.”

“Hepatitis C has extra-hepatic manifestations that are becoming increasingly well known,” said Jeffrey Samet, MD, MA, MPH, one of the symposium organizers. “This is a hot topic issue that is bringing this infection to the fore. Every addiction medicine physician has patients with these conditions, and whether these issues are being addressed or ignored, they are affecting the patients. One of the organ systems that is markedly affected is the brain, so this symposium will broadly address three topic areas—depressive symptoms, cognitive function, and pain.”

The symposium, which will be presented from 2:30 to 4:30 pm Friday in Orange Ballroom A, Lower Level, features experts in each of those domains, said Dr. Samet, Professor of Medicine and Community Health Services at Boston University Schools of Medicine and Public Health.

Addressing the treatment of depressive symptoms will be Glenn Treisman, MD, PhD, Professor at Johns Hopkins Medicine and Director of its AIDS Psychiatry Service.

“You try to control the depressive symptoms, and for reasons that are not understood, HCV is having some adverse effect on depressive symptoms in drug users,” Dr. Samet noted. “Glenn will talk about how he goes about treating these patients with antidepressant medications.”

Symposium speaker Judith Tsui, MD, MPH, FASAM, Assistant Professor of Medicine at Boston University School of Medicine, will discuss pain, which is perhaps the least understood of these three HCV neurological comorbidities.

“There are interesting mechanisms hypothesized that state that pain is affected by inflammation,” Dr. Samet said. “HCV, as well as HIV, increases the inflammatory burden on the individual. The implications of such a hypothesis for how one might go about treating an individual from an anti-inflammatory or anti-cytokine perspective will be discussed. This area is a bit more exploratory because the data about the direct therapeutic implications is quite limited.”

The third speaker, Igor Grant, MD, Professor and Executive Vice Chair of the Department of Psychiatry at the University of California, San Diego School of Medicine, will discuss the area of cognitive function.

“You can say almost the same thing about cognitive impairment as you can about depressive symptoms,” Dr. Samet said. “The problem is how one addresses cognitive impairment because there are not good medications.”

Jag Khalsa, PhD, MS, Chief of the Medical Consequences Branch of NIDA and the co-developer of the session with Dr. Samet, will explore with the speakers the future of dealing with hepatitis C comorbidities, including why extra-hepatic liver-psychiatric relationships exist.

“The big issue in all three of these areas is that it is anticipated that in the next five years we will see a major increase in anti-HCV therapy being given to patients,” Dr. Samet said. “We are poised to have HCV be cured with effective treatment, but it will be expensive. The question is what becomes of these neuropsychiatric complications? Will they get better? Does the cognitive function improve?

“I have to believe that in the same way our treatments for HIV were a combination of treatments, we will see a comparable dual approach to the neuropsychiatric problems of hepatitis C. That should be very interesting.”

New Edition of Principles of Addiction Medicine Available

HB 8.5x11fat 4C spineMed-Sci attendees can get an early preview of the fifth edition of The ASAM Principles of Addiction Medicine. Revised every six years, the newest edition will be available for purchase during the conference. Senior Editor Richard Ries, MD, FASAM, ABAM Diplomate, said it is the go-to source in addiction medicine, blending scientific principles with the practical essentials of clinical addiction medicine.

Clinicians and researchers rely on The ASAM Principles of Addiction Medicine to define the terminology and science of addiction, and provide a comprehensive overview of the diagnosis and treatment of addictive disorders. In addition, policy makers, members of the press, and other professionals with an interest in addiction use the text as the key reference in the field of addiction medicine.

Much of the fifth edition is updated, said Dr. Ries, Professor of Psychiatry and Director of the Division of Addictions at the University of Washington and Harborview Medical Center, Seattle. The authors also added new chapters and sidebars that are timely, including addictions in the military, post-traumatic stress disorder, and expanded sections on pain management, addictions in prison, and opioid overdose management. Because two of the editors are based in primary care, the book is written with primary care doctors, health care reform, and medical care issues in mind.

“The book represents a state-of-the-art resource in addiction medicine, not only because of the stature and qualifications of its authors and editors, but because of its linkage to ASAM,” he said. “Its chapters and sections are written by physicians from across all specialties, from surgery and medicine to psychiatry and pain.”

Contributing authors are recognized experts, covering areas such as cutting-edge neuroscience and pharmacology of addiction disorders, clinical diagnosis, assessment and early intervention, pharmacologic and behavioral interventions, mutual help, and 12-step programs. Authors also address addiction and co-occurring medical pain, and psychiatric disorders—backed by the latest research data and successful treatment methods, Dr. Ries said.

Readers receive a thorough grounding in both the scientific principles behind the causes of addiction and the practical aspects of clinical care.

“Having a wonderful set of co-editors with different backgrounds and strengths makes the book what it is; these editors include Dr. David Fiellin, Dr. Richard Saitz, Dr. Shannon Miller and myself. All the editors are deeply grateful for the great deal of work put in by the section editors and chapter authors,” Dr. Ries said.

The ASAM Principles of Addiction Medicine features numerous figures, tables, and diagrams to support the text, case examples, a list of data research reports provided at the end of each chapter, and expansive chapters on everything from club drugs to approaches to pain management. Purchasers of the fifth edition get access to an eBook version of the text, which is bundled with the print text, or available as a separate eBook purchase. The eBook is accessible on tablet, smartphone or online. In addition to portability, the eBook provides advantages such as enhanced navigation, a powerful search feature that pulls results from content in the book, readers’ notes, and the web. It has cross-linked pages, references, the ability to highlight and share text, and an interactive question bank with more than 300 questions.

“While some of the chapters are primarily research-focused, most of the book’s content provides practical tips for busy clinicians to manage the day-to-day addiction problems with practical methodology and evidence-based care,” Dr. Ries said.