2014 Conference News

ASAM Welcomes Associate Members

Change is in the air as ASAM welcomes associate members to the organization and the Med-Sci Conference following the creation of a new membership category.

After launching the associate membership category in September 2013, ASAM has seen a steady rise in interest from both current ASAM members and nonphysician professionals. The Society has received several ASAM member-endorsed applications from masters-level drug and alcohol counselors, which was omitted from the list of professionals originally approved by ASAM. That prompted the organization to refine the eligibility criteria.

Many nonphysician professionals have relevant and extensive teaching, research, and clinical work in the field of addiction, despite being ineligible for ASAM membership, so it was only natural for the organization to evolve in this way, said ASAM Membership Co-Chairs Surita Rao, MD, and Brian Hurley, MD, MDA.

“ASAM has always had a collaborative spirit toward nonphysician addiction professionals. Now, we’ve simply made it official by offering this category, which allows associate members to participate in ASAM’s Associate Member Section and take advantage of benefits, including special rates to attend the Medical-Scientific Conference,” said Dr. Hurley, Clinical Fellow in Addiction Psychiatry at the New York University School of Medicine’s Bellevue Hospital.

Associate membership is open to individuals who teach, conduct research, or provide clinical care for individuals who are at risk for or have a substance use disorder. As the field of addiction medicine evolves, ASAM recognizes the trend toward more team-based treatment approaches to join.

“ASAM is in a unique position to foster a strong and cohesive voice for addiction medicine. We recognize that all professionals involved in addiction treatment need access to the latest research, cutting-edge technology, community, and knowledge exchange that a professional society provides,” said Dr. Rao, Chairman and Director of the Behavioral Health Department at St. Francis Hospital, Hartford, Connecticut.

All professionals applying for associate membership must be sponsored by an ASAM member in good standing.

ASAM Steps Up Efforts to Reduce Incidence of NAS

The incidence of Neonatal Abstinence Syndrome (NAS) increased 600 percent from 2003 to 2009, which has fueled increased efforts to address the problem. ASAM has joined that effort with educational events at Med-Sci along with other health care groups outside of the conference.

“NAS refers to a collection of syndromes that infants can display if their mother takes a drug that causes dependency. The baby gets that drug during the pregnancy, and once the cord is cut, the drug supply is cut off and the baby may have withdrawal symptoms,” said Jacquelyn J. Starer, MD, FASAM, ABAM Diplomate.

“The term ‘NAS’ implies that it is an opioid withdrawal syndrome, but many substances can cause NAS, including sedatives, barbiturates, nicotine, alcohol, and even SSRIs. The biggest epidemic now is opioid use,” said Dr. Starer, Associate Director, Physician Health Services, Waltham, Massachusetts.

NAS was discussed at two separate sessions at Med-Sci—Symposium 2A, “Update on Women’s Issues,” on Friday and Course 5, “Neonatal Abstinence Syndrome: Understanding the Variations in Expression of Symptoms and Mitigating Them,” on Saturday.

Beyond Med-Sci, ASAM is developing education modules related to NAS and addiction among pregnant women as part of the PCSS-MAT program, Dr. Starer said. PCSS-MAT is the acronym for Providers’ Clinical Support System for Medication-Assisted Treatment. One part of the PCSS-MAT program involves physicians trained in addiction medicine signing up at www.pcssmat.org to serve as mentors to other physicians, such as primary care physicians, pediatricians, and obstetrician/gynecologists, who may deal with women’s issues in addiction.

“If they have questions or difficult cases, I am available, or someone else is available, to talk to them and give them advice,” Dr. Starer said. “This puts the specialist in everybody’s back pocket because many people do not have access to consultants specialized in these conditions. Obstetricians don’t generally have training in managing addiction, so this is a nice way to bring it together.

“The PCSS program is not fully rolled out, but ASAM is developing online educational modules related to primary care and women’s health, especially in the treatment of addiction among pregnant women, in the hopes of impacting NAS. We would like physicians in the community, whether they be obstetricians or pediatricians or family practitioners, to become more comfortable in managing pregnant women with addiction, recognizing NAS in babies and becoming well equipped to provide the best treatment for both.”

As another part of the PCSS-MAT program, ASAM’s efforts include presenting an eight-hour training and certification course on buprenorphine prescribing at the American College of Obstetricians and Gynecologists Annual Clinical Meeting. The course will enable obstetricians to obtain the Drug Enforcement Administration “X” waiver, allowing them to prescribe buprenorphine for opioid dependence.

“This is helpful because a lot of doctors are uncomfortable about treating women with buprenorphine when they are pregnant,” Dr. Starer said. “If we can get enough obstetricians on board, they can provide the prescription while the woman is pregnant and in the post-partum period. With the mentoring program, they will have the resources available to be comfortable in providing this care even if they don’t have a lot of experience.”

ASAM began working on these programs in January 2013, and also extends its efforts into other women’s issues through the ASAM Women and SUDS (Substance Use Disorders) Action Group.

“It is critically important to take integrated approaches to pregnant women with substance use disorders because both obstetrics and addiction tend to be segmented and somewhat separate from general medical care,” Dr. Starer said. “While respecting patients’ confidentiality is important, we need these women to understand that it is in their best interests to have their providers communicate, and consent to the sharing of information. The more information you have you can present a convincing case to the woman to do something that is beneficial to her.”

ASAM Awards Luncheon Spotlights Top Achievers

This year’s top achievements in addiction medicine were the focus of Saturday’s 2014 ASAM Medical-Scientific Awards Luncheon. ASAM honored nine professionals with awards during the luncheon—from the John P. McGovern Award to Best Paper.

Among the winners was Paul N. Samuels, JD, recipient of the John P. McGovern Award. Samuels is the Director and President of the Legal Action Center, the only national non-profit law and policy organization designed to fight discrimination against people with histories of addiction, HIV/AIDS, or criminal records, and to advocate for sound public policies in these areas. The John P. McGovern Award honors an individual who has made highly meritorious contributions to public policy, treatment, research, or prevention that has increased the understanding of the relationship of addiction and society.

“This award means even more to me coming from ASAM, which has such a long and prestigious history of leadership in addiction medicine,” Samuels said. “Being an advocate, I cannot resist the temptation to mention the extraordinary opportunities for accomplishing the Legal Action Center’s goals, which were created by the Affordable Care Act and the Mental Health Parity and Addiction Equity Act, and what we need to do to make the most of those opportunities.”

Samuels’ passion extends to issues related to treatment gaps, coverage, the availability of quality services, integration and coordination of care, criminal justice, and discrimination.

“As you probably imagine, increasing understanding within the health care system and the public that substance use and mental disorders are illnesses deserving of the same quality and quantity of health responses as other illnesses is the wonderful world we’d like to create,” he said. “It can be the pot of health care gold at the end of the rainbow—the elimination or drastic reduction of addiction and discrimination against those in recovery or still suffering.”

During the awards luncheon, Samuels shared the spotlight with Shelly Greenfield, MD, MPH. Dr. Greenfield received  the R. Brinkley Smithers Distinguished Scientist Award. She is Chief Academic Officer at McLean Hospital in Belmont, Massachusetts, and Professor of Psychiatry at Harvard Medical School. The award honors individuals who have publicly shared the message of hope and the promise of help, and individuals whose work in the field of alcoholism has had a positive impact in the fight against America’s most misunderstood disease.

U.S. Rep. Paul Tonko (D-New York) was honored with the ASAM Public Policy Award for his outstanding contribution in advancing addiction treatment policy, while Greg Williams, MA, was selected for the 2014 Media Award for his film, The Anonymous People. The documentary spotlights the more than 23 million Americans living in long-term recovery from alcohol and drug addiction. This award recognizes Williams’ achievement in the media for providing a scientific, comprehensive, unflinching, and compassionate look at addiction, and its effects on families and society as a whole.

ASAM’s Annual Award went to Edwin Salsitz, MD, FASAM., Beth Israel Medical Center, for a strong commitment to improving the quality of continuing medical education through sustained multi-year committee and course involvement, and to recognize his unwavering dedication to the organization.

Shonali Saha, MD, an Adolescent Medicine Fellow at Johns Hopkins University, received ASAM’s Young Investigator Award. It is bestowed on an author who is within five years receipt of a doctoral degree. Similarly, the Medical-Scientific Program Committee Award for Best Paper went to Kathleen Decker, MD, Staff Psychiatrist/Clinical Assistant Professor at Eastern Virginia Medical School, Norfolk. Dr. Decker’s abstract achieved the highest rating for its scientific merit.

Kenneth Blum, PhD, President and CEO of IGENE, LLC, Austin, Texas, received the ASAM/Millennium Labs Medical-Scientific Program Committee Award.

Sarah Bagley, MD received the ASAM Millennium Research Fellowship Research Award. Dr. Bagley is a Fellow in Addiction Medicine, Section of General Internal Medicine at Boston University Medical Center. Both awards provide financial support that allows fellows in addiction medicine to understand and research medication monitoring and drug testing in the early phases of their careers in the field of addiction medicine.

Members and non-members are invited to submit abstracts for course sessions, workshop sessions, component sessions, paper sessions and/or poster sessions. The Young Investigator Award, ASAM/Millennium Labs Medical-Scientific Program Committee Award, and the Medical-Scientific Program Committee Award for Best Paper are chosen through the Abstract Awards Competition. The other awards are chosen by the organization’s Nominations and Awards Council.

ASAM Members to Choose First Vice President in Election

ASAM members are encouraged to participate in the ASAM 2014 election this fall to choose officers and Directors-at-Large including the Society’s first Vice President. The new leaders will take office in April 2015.

The Vice President position was created to lead the Society if the ASAM President is unable to fulfill the duties of office, said Immediate Past President Louis E. Baxter, Sr., MD, FASAM, ABAM Diplomate.

“The idea behind the creation of this office was to have someone who could serve whenever the President is unable to serve, or is designated by the President to serve,” Dr. Baxter said. “Over the years, ASAM has had occasions where the President either resigned to take a government position, or became ill or incapacitated. The President-Elect was thrown into performing the President’s duties, so we thought that developing this new office would help in those situations.

“The qualifications are that the Vice President has served with the organization in the past, served on the Board, and not be interested in running for President-Elect in ensuing elections.”

The ASAM Board of Directors  approved the slate of candidates for the 2014 ASAM Election to include:

  • President-Elect: Kelly Clark and Rich Soper
  • Vice-President: Mark Kraus and Anthony Albanese
  • Treasurer: Brian Hurley
  • Treasurer and Director-at-Large: Ken Roy
  • Secretary and Director-at-Large: Margaret Jarvis and Brad Hall
  • Director-at-Large: John Tanner, Petros Levounis, Marc Galanter, Yngvild Olsen, Michelle Lofwall, Michael Levy, Peter Selby, and Paul H. Earley

ASAM a Partner in Education Efforts Outside Med-Sci

ASAM is involved in three ongoing education programs with other entities outside the Med-Sci Conference. The REMS course educates clinical providers about the use of opioids; the Review Course in Addiction Medicine is a primer for physicians and health care professionals about addiction medicine; and PCSS-MAT educates and mentors health care providers treating opioid use disorders.

REMS Course

ASAM has updated the REMS course to educate clinical providers about the use of extended-release and long-acting (ER/LA) opioids, and will continue to present the course around the country and online.

REMS, the acronym for Risk Evaluation and Mitigation Strategy, is linked to the REMS Program Companies consortium organized by the Food and Drug Administration (FDA). The consortium is funded by manufacturers of ER/LA opioid medications to develop patient and prescriber education materials to reduce risks related to the medications. However, the content of the REMS course is controlled by the FDA.

R. Corey Waller, MD, MS, ABAM Diplomate, a Co-Director of the REMS course, said it has been updated to include new information about medications and concerns about the presentation of the course’s chapter on addiction.

“It was mandated by the government to make sure the physicians are appropriately educated on how to prescribe, especially given the recent, consistent, and alarming rise in accidental opioid overdose,” said Dr. Waller, Director of the Center for Integrative Medicine at Spectrum Health, Grand Rapids, Michigan. “The positive feedback we have received is that this helps them to nail down some very specific clinical concepts of use and understand how to appropriately document and create a safe environment for prescribing use.”

The REMS course is presented by ASAM with its local chapters or organizations, as well as at national courses. To learn about course presentations, go to the “Education” tab on the ASAM website. The course also is available online at the ASAM e-Live Learning Center.

“Why are addiction doctors training other people how to write for medicines we get people off of?” Dr. Waller asked. “If we want to own the conversation and help everyone understand the safest ways to use these so we are not needed as much, then it is important for us to be teaching rather than just treating the aftermath.”

Review Course in Addiction Medicine

The 2014 Review Course in Addiction Medicine, a primer for physicians and other health care professionals preparing for a career in addiction medicine, will be presented September 18-20 at the Hilton Orlando Bonnet Creek Hotel, Orlando, Florida. To register for the course, go to the “Education” tab on the ASAM website.

More than 500 professionals are expected to enroll in the course, which reviews the core content of addiction medicine. The course has been developed for physicians preparing for the ABAM Certification/Recertification Examination in Addiction Medicine, addiction specialists wanting an update on recent developments in addition science and practice, and non-specialist physicians and health care professionals wanting to learn more about identifying and managing issues related to alcohol, tobacco and other drug use.

“On the first day, we will talk about the fundamentals of addiction medicine, going through the different types of drugs of abuse,” said Petros Levounis, MD, MA, FASAM, the Course Director. “The second day we will go through the assessment and treatments for different addictions. The third day, we will talk about special topics and populations, such as pregnancy, ethics, and public policy.”

The course also offers the Board Examination Study Tool (BEST), an Internet-based learning tool that includes study material and competency test questions. Attendees can use BEST through mobile devices and tablets so they can bookmark pages, highlight text, and take notes.

“This year, the curriculum has been streamlined, and the course offers more networking options,” Dr. Levounis said.

“We are giving participants an evening off to be able to have dinner, for a change,” he said. “We will have longer breaks, giving people the opportunity to network and meet the faculty. This year, the course is radically reformulated in that it is much more streamlined. It will have a flow to it, starting from neurobiology of addiction to public health and ethics. We hope to go through the material in a much more systematic and organized fashion, which will make for a better educational experience.”

PCSS-MAT

ASAM is a partner in a SAMHSA-funded program, PCSS-MAT, developed to educate and mentor health care providers treating opioid use disorders. PCSS-MAT is the acronym for Providers’ Clinical Support System for Medication-Assisted Treatment.

PCSS was developed when buprenorphine was introduced, and PCSS-MAT was developed later to mentor providers about the use of all three medications available for treating opioid use disorders—buprenorphine, methadone, and naltrexone, said Daniel P. Alford, MD, MPH, FASAM, ABAM Diplomate, the ASAM PCSS-MAT Clinical Director.

The program is a collaborative effort led by the American Academy of Addiction Psychiatry (AAAP) in partnership with ASAM, the American Osteopathic Academy of Addiction Medicine (AOAAM), the American Psychiatric Association (APA), and the Association for Medical Education and Research in Substance Abuse (AMERSA).

“ASAM’s scope of work for PCSS-MAT includes creating case-based educational modules and identifying mentors within ASAM to do MAT mentoring,” said Dr. Alford, Associate Professor of Medicine at Boston University School of Medicine. Dr Alford and Edwin A. Salsitz, MD, FASAM, Beth Israel Medical Center, led a Component Session Thursday night to discuss ASAM’s role in PCSS-MAT. Dr. Salsitz is the ASAM PCSS-MAT Lead Mentor.

“The session covered the scope of work for ASAM, the background on the education modules we will create, ASAM’s role in the mentoring program, and a general discussion to get ideas on other education modules from ASAM’s perspective so we can give feedback to AAAP,” he said.

To learn more about the program, visit www.pcssmat.org.

Practice Makes Perfect: The Art of Motivational Interviewing

Using a textbook to study the art of motivational interviewing is one thing, but putting it into practice—alongside an expert—is a step up to a higher level of education. That’s the goal of Symposium 10, “Introduction to Building Skills in Motivational Interviewing,” which will be presented at 8 am Sunday in Orange Ballroom D, Lower Level.

Judith Martin, MD, FASAM, ABAM Diplomate, leads the symposium, which will take an interactive approach to educating clinicians about this highly effective and systematic intervention for evoking internally motivated change. Dr. Martin is the Deputy Medical Director for Community Behavioral Health Services and Medical Director for the Substance Use Services for the San Francisco Department of Public Health.

“Motivational interviewing is a way of deciding, with a patient, what they want to do to solve a problem related to any chronic illness or behavior change,” she said. “It’s a good, brief intervention in a busy office, and effective across any specialty.”

The session will leverage the experience of four professionals who will teach the skill at small roundtables, giving attendees an opportunity to hone the skill through role-play and feedback, Dr. Martin said.

Motivational interviewing is grounded in research on a process of natural recovery, with patients moving through stages of change, assisted by the clinician. Evaluation of the discussion of change and readiness to change guides the interaction, she said. Motivational interviewing can be used as the ‘brief intervention’ part of SBIRT—Screening, Brief Intervention, and Referral to Treatment—a hot topic in itself, she said.

The U.S. Preventative Services Task Force (USPSTF) recommends that clinicians screen adults aged 18 years or older for alcohol misuse and provide persons engaged in risky or hazardous drinking with brief behavioral counseling interventions to reduce alcohol misuse. The USPSTF found adequate evidence that brief behavioral counseling interventions are effective in reducing heavy drinking episodes in adults engaging in risky or hazardous drinking. These interventions also reduce weekly alcohol consumption rates and increase adherence to recommended drinking limits, Dr. Martin said. Since then, insurance companies have developed requirements for screening and billing codes for brief interventions.

Unfortunately, research suggests that although a majority of pediatricians and family practitioners report providing some alcohol prevention services to adolescent patients, they do not universally or consistently screen and counsel for alcohol misuse, she said. Barriers include a perceived lack of time, familiarity with screening tools, training in managing positive results, and available treatment resources.

“We think that motivational interviewing is a base skill that anyone who works in the field of addiction medicine and behavior change should have,” Dr. Martin said. “However, even if you know and understand motivational interviewing, the best way to gain confidence is to practice. This session will give you the chance to practice with an expert.”

11 Receive Ruth Fox Scholarships

The 11 Ruth Fox Scholars, and donors to the Ruth Fox Memorial Endowment Fund, were recognized at an invitation-only reception Friday night. The scholarships help winners increase their opportunities to learn about the diagnosis and treatment of substance use disorders.

The Ruth Fox Memorial Endowment Fund, named for ASAM founder Ruth Fox, MD, was established in 1990 to raise $10 million to support the society in times of need or for special projects, said Scholarship Committee Chair Andrea Barthwell, MD, FASAM, ABAM Diplomate. Since its inception, 98 percent of the fund’s principal has come from ASAM members. This year, additional scholarship funding was received from NIDA. In addition, ASAM’s Kentucky chapter made separate funding available to support a resident to attend Med-Sci.

Chapter funding for resident scholarships is another great way to expose more residents to addiction medicine education at Med-Sci.

Dr. Barthwell said the scholarships represent an investment in the future of addiction medicine.

“This is the one place the board has authorized us to spend money,” she said. “This year, we expanded our scholarships, as we want to accelerate our ability to reach more people and bring more talent to the field. It’s a very worthwhile investment.”

This year’s recipients are:

  • Sarah Bagley, MD, Addiction Medicine Fellowship, Boston University Medical Center, and the winner of ASAM’s Millennium Research Institute (MRI) Fellowship Award
  • Shonali Saha, MD, Adolescent Medicine Fellowship, Johns Hopkins School of Medicine
  • Deepali Gangahar, MD, Psychiatry Residency, MedStar Georgetown University Hospital, Washington, DC
  • Neil Paterson, MD, PhD, University of California, Los Angeles Psychiatry Residency Training Program, Semel Institute
  • Leona Graham, MD, Addiction Psychiatry Training Program, University of Kansas School of Medicine
  • Vishesh Agarwal, MD, Psychiatry Residency, Einstein Medical Center, Philadelphia, Pennsylvania
  • Stacie Solt, MD,  Stanford Addiction Medicine Fellowship Program, Stanford, California
  • Erin Lorencz, MD, OB-GYN Residency, Mountain Area Health Education Center, Asheville, North Carolina
  • Lindsay Abcunas, MD, OB-GYN Residency, Northwestern University, Chicago, Illinois
  • Katherine Ann McKay, MD, Psychiatry Residency, McMaster University, Ontario, Canada
  • Alexandra Bright, MD, Addiction Psychiatry Fellow, University of Washington Medical Center, Seattle, Washington

Scholarships provide fellows and residents with complimentary Med-Sci Conference registration, as well as flight and hotel costs. Recipients also receive three free years of ASAM membership. For recipients, this is a unique opportunity in their careers.

“I was very happy to hear I had won a scholarship to this year’s ASAM meeting. It’s my first ASAM meeting of my psychiatry residency, which is especially meaningful because I am focused on addiction psychiatry as my future specialization,” said Dr. Paterson. “In the future, I aim to build a private practice in addiction psychiatry, where I hope to be an innovative practitioner in several aspects, from diagnostic testing to medications and other treatment modalities. I believe that my years in research will help with respect to identifying novel treatments.”

Dr. Saha echoed her colleague’s sentiments.

“The scholarship provides me the opportunity to meet established and emerging leaders in addiction medicine, as well the mentorship that I will receive in spending time with the chair of the Ruth Fox Memorial Endowment Fund, committee, and board members during the conference,” Dr. Saha said. “I also am enthusiastic about networking with the other scholarship recipients and future colleagues to learn about their work and career trajectories, as I am always looking for new ways to learn about the evolving science in the field of addiction.”

Speakers to Debate Medication, Non-Medication Recovery Approaches

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Petros Levounis, MD, MA

In recent years, more medications for the treatment of addiction have been developed, but at the same time some addiction specialists and their patients have chosen to go down a different path by staying away from medications. Hear from supporters—both patients and physicians—of both approaches in an intriguing session Sunday.

Speakers at Symposium 13, “Medication vs. Non-Medication Approaches to Recovery,” will look at research data and clinical experiences from the different treatment methodologies from 10:15 am to 12:15 pm in Orange Ballroom D, Lower Level.

“This is a dynamic that has been very alive in the American Society of Addiction Medicine: To what extent maintenance medications are helpful and to what extent the non-medication approaches to recovery are preferable,” said Petros Levounis, MD, MA, FASAM, a session organizer.

“All of us have thought about this question, but we have not approached it in a formal way and we haven’t debated the pros and cons of medication versus non-medication approaches to recovery at an ASAM symposium until now,” said Dr. Levounis, Chair of the Department of Psychiatry at Rutgers New Jersey Medical School.

The session will feature Sharon Stancliff, MD, ABAM Diplomate, presenting recent research data about medication versus non-medication approaches in recovery. She is the Medical Director of the Harm Reduction Coalition.

Kenneth Thompson, MD, FASAM, ABAM Diplomate, will present treatment options based on non-medication, abstinence, and spiritual principles. He is Associate Professor of Psychiatry and Public Health at the University of Pittsburgh.

Two people in recovery will present their experiences—one who used medication and one who did not, Dr. Levounis said.

Leading off the session, the organizers, Dr. Levounis and Melvin Pohl, MD, FASAM, ABAM Diplomate, will discuss concepts of recovery as defined in mental health treatment systems versus addiction treatment, and experiences with non-medication addiction treatment. Dr. Pohl is Medical Director of Las Vegas Recovery Center.

Session to Explore Interdisciplinary Approach to Addiction Training

Even though various professional disciplines ultimately need to work together in addiction care and research, they are rarely trained to work together and communicate their different perspectives. A Sunday Symposium will highlight efforts to improve interdisciplinary training.

Symposium 12, “Interdisciplinary Models in Training the Next Generation of Addiction Professionals,” will show how the Department of Veterans Affairs and other institutions are implementing new training pathways to help develop professionals from all disciplines to lead clinical, educational, and research initiatives in addiction.

“The goal is to ensure that an appropriate interprofessional workforce is developed to meet the present and future needs for those with addiction and other substance abuse conditions,” said Lauren Broyles, PhD, RN.

Dr. Broyles is a Research Health Scientist at the Center for Health Equity Research and Promotion at the Veterans Administration (VA) Pittsburgh Healthcare System, and Assistant Professor at the University of Pittsburgh School of Medicine. She is one of the speakers at the session, which will be presented from 10:15 am to 12:15 Sunday in Orange Ballroom A, Lower Level. A second speaker is Adam Gordon, MD, MPH, FASAM, Associate Professor at the University of Pittsburgh School of Medicine.

They will discuss how they have used an Interprofessional Advanced Fellowship in Addiction Treatment from the VA Office of Academic Affiliations to support the development of change agents in addictions research, quality improvement, and care delivery. Dr. Broyles said.

“The VA, as the largest integrated health care system in the country, has made this a priority for its advanced training programs,” Dr. Broyles said. “We will give background on the need for interdisciplinary training and collaboration in addiction. We also talk about some of the challenges and impediments to doing interdisciplinary training, as well as some concrete and innovative ways to make interdisciplinary training work.”

Each year, the VA Pittsburgh program accepts one physician fellow and one fellow from an associated health discipline, such as nursing, social work, psychology, or public health. The first Fellow in the program has a master’s degree in applied psychological research and is focused on developing patient-centered care for individuals with substance use and mental health disorders. A second Fellow will start upon completion of a doctorate in public health, and has interests in tobacco cessation and innovative relapse prevention strategies that can be incorporated into primary care, she said.

“Fellows spend no more than 25 percent of their time in clinical work. We have a formal interdisciplinary collaboration curriculum that the fellows participate in, and the focus of the fellowship is on system change through research, quality improvement, or evidence-based practice translation,” Dr. Broyles said.

Symposium to Examine Issues Related to Marijuana Use

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Andrea Barthwell, MD

Policy issues regarding medical and recreational marijuana laws continue to stir debate among the general public, the media, and physicians, and many of these issues will be addressed during Symposium 11, “Marijuana: Addiction Physicians and the American Public 2014.”

The symposium, presented from 8 to 10 am Sunday in Orange Ballroom D, Lower Level, will examine circumstances leading to the current situation of medical marijuana use, explore scientific issues, develop recommendations to assist physicians, formulate policy recommendations, and use the uniquely qualified perspective of addiction medicine physicians to lead the debate. One of the organizers of the session is Andrea Barthwell, MD, FASAM, ABAM Diplomate, and Co-Chair of the ASAM Task Force on Medical Marijuana.

“I have found there are three points of view among physicians in the medical marijuana debate,” Dr. Barthwell said. “One group is the activist physicians who object to current drug policy and see participation in the so-called ‘medical marijuana’ activities as a way to object, or to protect from prosecution the people who are using marijuana. Second are those physicians who have patients who report feeling better with the use of marijuana and who do not feel a need to challenge that report for a host of reasons, including that they want their patients to feel better. The third group is those who are motivated by the financial gain.”

At the heart of the debate is determining whether the healing properties of the cannabinoid system can be achieved while minimizing the psychotropic effects of the drug, she said. Endocannabinoids are crucial to bioregulation. With scientific evidence suggesting they may help reduce inflammation, insulin sensitivity, and fat and energy metabolism, endocannabinoids could be a tool in reducing the prevalence of metabolic syndrome. Additionally, modulation of the endocannabinoid system may be a cure for more chronic neurologic and immune conditions. While many questions remain, further research promises to shed insight into the mechanisms of health and disease, and provide new therapeutic options.

“Unimpeachable preclinical research indicates that there are many ways in which the endocannabinoid system of the body can be manipulated to produce either cannabinoid agonist or antagonist actions,” Dr. Barthwell said.

Still, the hazards of medical marijuana use exist, including the harmful effects of smoked marijuana, the potential for abuse, the potential for recreational users seeking the “high,” and the lack of standardization with regard to contamination, she said.

A portion of the symposium will be devoted to ASAM’s official position on medical marijuana. ASAM has outlined a number of recommendations on the matter, two of which include the need for federal regulatory standards for drug approval and distribution, and rejecting a process where state and local ballot initiatives approve medicines. These ballot initiatives could be decided by individuals not qualified to make such decisions, Dr. Barthwell said.

“Ultimately, ASAM believes physicians should not issue a recommendation for medical marijuana use unless the physician has adequate information regarding the composition and dose of the cannabis product, and has adequate training in identifying substance abuse and addiction,” she said.