April 12

Stay Cool at the Ice Cream Novelties and Networking Reception

While education is the primary focus of Med-Sci, having a little fun at the largest gathering of physicians, psychiatrists and other health professionals dedicated to addiction medicine is also important.

Throughout the conference, there will be countless opportunities to network and collaborate with peers, but the “coolest” one will be the Ice Cream Novelties and Networking Reception, from 4 to 4:30 pm Saturday in the Exhibit Hall.

This first-time reception offers attendees the last chance to see exhibitors, poster presenters, fellow colleagues and friends in a festive and memorable setting. The reception will feature ice cream novelties to take the edge off the Florida sunshine while making the final tour of exhibits.

Reserve Your Seat at the Annual Awards Luncheon

ASAM’s Annual Awards Luncheon is a favorite at the 2014 Med-Sci Conference, and attendees are encouraged to reserve their spots early. Tickets for the Saturday event are $75 per person and can be purchased at Registration. The luncheon runs from noon to 2 pm, and is a celebration of the best and brightest in the field of addiction medicine.

The plated Annual Awards Luncheon hails the accomplishments of rising stars and distinguished leaders. The setting provides a much-anticipated opportunity to network with colleagues, draw inspiration from outstanding accomplishments, and welcome new Fellows.

During the luncheon, ASAM will present a number of awards, including the John P. McGovern Award, ASAM’s Annual Award, the 2014 Young Investigator Award, the ASAM Medical-Scientific Program Committee Award, the Public Policy Award, the Annual Media Award, the ASAM/Millennium Labs Medical Scientific Program Committee Award, and the ASAM/Millennium Research Institute Fellowship Award.

Also during the luncheon,  ASAM will present certificates to members who have earned the FASAM title and are now Fellows of the American Society of Addiction Medicine. These individuals were selected for completing rigorous criteria, including significant service to the society and considerable contributions in certain areas.

Attendees can use the conference registration form to purchase tickets to the event.

Misuse of ADHD Medications Linked to Other Drug Issues

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Amelia Arria, PhD

The pressure to excel academically in college has led many students and their families to link low grades to Attention Deficit Hyperactivity Disorder (ADHD) and seek stimulants as a treatment. A Saturday Symposium will examine the issues related to stimulant misuse among adolescents and college students, including sharing and/or selling prescribed stimulants.

“Many clinicians are looking for guidance on the management of individuals with ADHD who may be at risk for diverting their medications. We will talk about how to detect individuals who may be at risk for diversion, and we will urge physicians to have that discussion with their patients about diversion and its risks,” said Amelia Arria, PhD.

Dr. Arria is one of the presenters at Symposium 7, “Prescription Stimulant Use and Misuse Among Youth: Review and Practice Implications,” which will be presented from 2 to 4 pm Saturday in Orange Ballroom A, Lower Level.

Speakers will discuss the epidemiology and risk factors associated with prescription stimulant misuse, the pharmacology and efficacy evidence of stimulants for the treatment of ADHD in youths and young adults, potential risks and negative consequences of the misuse of stimulants, the utility of stimulant medication for substance-abusing ADHD populations, and clinical strategies to prevent and minimize diversion and misuse.

There are two concerns when patients divert their medications—it disrupts the patient’s ADHD treatment and the person receiving the medication without a physician’s guidance can be problematic, said Dr. Arria, Associate Professor of Public Health and Director of the Center on Young Adult Health and Development, both at the University of Maryland.

“Nonmedical use of prescription drugs is a serious problem and has become part of the drug landscape for young people,” she said. “But
we have made progress. It does not look like the nonmedical use of prescription stimulants is rising. It appears to be falling in every group other than high school seniors.

“Through our research, we found that one of the purported motives for using these prescription stimulants is to improve academic performance—to improve focus, to stay awake longer to study. But use does not result in better academic performance. It’s not a ‘smart drug.’”

When prescribed by a physician, stimulants are effective for the treatment of ADHD, but nonmedical use of prescription stimulants is problematic.

“When you look at nonmedical users, what you find is a higher likelihood of a history of excessive drinking and other drug involvement, in particular marijuana,” Dr. Arria said. “What has probably led to a decrease in academic performance is the use of other drugs, not sleeping, and not going to class. Students are staying up, trying to cram, and as a result of their declining academic performance they might be using prescription stimulants as a shortcut to compensate for that behavior.”

Another speaker, Timothy Wilens, MD, will talk about his experiences managing students with ADHD. He is an Associate Professor of Psychiatry at Harvard Medical School and Director of Substance Abuse Services in Pediatric Psychopharmacology and the Center for Addiction Medicine, both at Massachusetts General Hospital.

Drug testing is good clinical practice for students who are prescribed ADHD medications because you want to rule out that their attention problems might be related to other drug use.

“On the flip side, if a student not previously diagnosed with ADHD is asking for prescription stimulants, a comprehensive assessment is required  to find out whether there are signs of academic performance difficulties, and the extent of drinking and other drug use. In that way, the physician is better informed when making clinical decisions about how to best help their patients.”

President’s Symposium Panelists to Discuss Current Topics

Get up to speed on some of the hottest topics in addiction medicine and health care by attending the President’s Symposium, “Addiction Medicine Today,” from 10 am to noon Saturday in Orange Ballroom A, Lower Level.

The symposium will feature ASAM President Stuart Gitlow, MD, MPH, MBA, and two leaders in the field—one from government and one from academia—discussing a variety of issues in a panel setting. Joining Dr. Gitlow will be Elinore F. McCance-Katz, MD, PhD, Chief Medical Officer for SAMHSA, and Chad D. Kollas, MD, Medical Director of Palliative and Supportive Care at the University of Florida Health Cancer Center.

“This is our chance to bring in speakers to discuss current event and current policy approaches,” Dr. Gitlow said. “These are good speakers who are exciting and will tell us what is going on up to the minute on different issues in government and the pain medicine side of things.

“This session is designed to give the speakers the opportunity to talk off-the-cuff on what interests them and what they think will be of interest to our audience. It is different from the usual approach we take.”

Dr. Kollas will discuss the opioid prescribing epidemic, as well as pain management issues related to prescribing opioids, explained Dr. Gitlow.

Other topics that may be discussed in the free-form discussion are expected to include the overlap between addiction and pain, future pharmacologic directions, the interface of government and addiction, and applying guidelines to practice.

The goal of the session is to develop fresh insights on the critical strategic questions addiction professionals must confront as they lead the field into the next decade and beyond, Dr. Gitlow said.

MRI Fellowship Awarded for Toxicology Screening Research

Sarah Bagley, M.D., is this year’s ASAM Millennium Research Institute (MRI) Fellowship Award winner. Dr. Bagley, who also is the recipient of a 2014 Ruth Fox Award, is a Fellow in Addiction Medicine in the Section of General Internal Medicine at Boston University Medical Center.

Dr. Bagley’s research submission on urine toxicology screening (UTS) in clinical practice earned her the MRI honor. The study examines discrepancies between self-reported patient drug use and UTS results in patients being treated for opioid use disorder with buprenorphine in an urban primary-care based program. In some countries, these patients only have UTS at the start of treatment, but in the United States patients are often monitored using UTS.

Researchers hypothesize that there is a subset of patients who do not disclose use but are found to have illicit substances in their urinalysis results. This study will identify and describe those patients, which is critical as they may require enhanced substance abuse treatment, Dr. Bagley said.

“The evidence base for the value of UTS in clinical practice is surprisingly limited,” she said. “For example, scant evidence exists about the consistency between patient self-reporting of drug use and urine toxicology results in patients maintained on buprenorphine, or how well urine toxicology results predict treatment outcomes.”

The award, which will be presented at the ASAM Awards Luncheon from noon to 2 pm Saturday, encourages Fellows to understand and research medication monitoring and drug testing in the early phases of their addiction medicine careers. The winning Fellow receives one year of research financial support. The Millennium database includes drug testing results identified in patient specimens from pain, primary care, and addiction practice settings tested at Millennium Laboratories. To conduct this research, fellowship applicants can access the database of medication monitoring test results available through MRI and/or collaborating with MRI researchers to draft the research topic. Many of the specimens have both immunoassay results and LC-MS/MS results. Winners must be in a two-year addiction medicine fellowship program with the recommendation and agreement of his/her training program director and institution.

“To have the financial support of the MRI Fellowship Award is critically important to the success of the research,” Dr. Bagley said. “It goes beyond just having a good idea. As researchers, we must have the infrastructure to do the work.

“The clinical significance of an unacknowledged urine toxicology result—when urine toxicology is discrepant from self-report—is not clear. Patients who have unexpected UTS results early in treatment may have a worse prognosis. If differences exist between treatment outcomes, based on the acknowledgment of UTS results, this may in fact inform future clinical care, such as the need for enhancing clinical services.”

Dr. Bagley said she is honored that her proposed research was selected from all award submissions and is fortunate to have the backing of Boston University Medical Center.

“I come from a program with great support and mentorship—one that is nationally recognized,” Dr. Bagley said. “There are still a lot of unanswered questions in addiction medicine, so the MRI Fellowship Award contributes to the future of the field.”

Ticket prices for the Annual ASAM Awards Luncheon are $75 per person. The event provides professionals with an opportunity to network with colleagues, draw inspiration from outstanding accomplishments, and welcome new Fellows.

ASAM Leading Development of Practice Standards, Performance Measures

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Component Session 3, presented Thursday night, addressed the establishment of practice standards and performance measures for addiction physicians.

In 2014, U.S. health care professionals are increasingly expected to meet standards of care and measure patient outcomes to gain optimal reimbursement from government and private payers. ASAM is taking a lead role in establishing standards and measures for addiction medicine to meet these demands.

An overview of the recently published Standards of Care for Addiction Specialist Physician and a look at the work on developing performance measures was presented Thursday during Component Session 3, “Quality Improvement: Improving Patient Care with Standards, Performance Measures and Guidelines.”

“ASAM, with support of SAMHSA and other federal agencies, is trying to move addiction medicine into the area of quality measurement, which is where the rest of medicine is,” said Michael Miller, MD, FASAM, ABAM Diplomate, Chair of the Practice Improvement and Performance Measurement Action Group (PIPMAG) overseeing the work. “In all of medicine there is a real push for accountability and demonstration of results. To say a treatment works or that you are a good provider is not enough; you have to show evidence that it works and that you are a good provider.”

The first step was to establish standards of practice, an effort that has been led by Margaret Jarvis, MD, FASAM, ABAM Diplomate, Medical Director of Marworth Treatment Center, Waverly, Pennsylvania. Work on writing those standards started in late 2012, and they were published on the ASAM website in March.

“We were charged with describing the most basic behaviors that an addiction physician would do with a patient,” she said. ‘There is language in the standards that says these are the basics you have to meet to do a competent job. We describe what physicians would do from the moment they see a patient, how to begin to assess them, how you go about assessing them, what needs to go into treatment planning, and what needs to go into care transitions.”

The practice standards have five modules that detail the work of an addiction physician across all types of practices in all types of settings.

“We tried to be mindful that this is not a guideline,” Dr. Jarvis said. “In a guideline, you get specific recommendations for specific situations. A standard is not intended to be that. This piece needed to describe behavior from a mile-high view and not get into the weeds with it. There are a few places where it was necessary to spell things out—as in the assessment piece about what needs to happen in taking a history and conducting an examination of the patient. That is a comprehensive list.”

The standards of practice provide the foundation for a second PIPMAG group that is working to define domains for performance measures. That group is led by R. Corey Waller, MD, MS, Director of the Center for Integrative Medicine at Spectrum Health, Grand Rapids, Michigan.

“Creating performance measures, quality measures and standards of care allows us to know that the patient and the system are both getting really good value for the service, if someone is meeting all of these performance and quality measures.” Dr. Waller said.

“It also allows us a way to determine and monitor certain behaviors we know lead to improved care,” he said. “Adopting these standards of care not only allows us to monitor physician performance, but allows us to explain the value proposition of what we do.”

The component session also addressed ASAM’s work with SAMHSA to steward measures of physician performance until they are adopted by public entities in health care that measure quality, such as the Centers for Medicare and Medicaid Services and the National Quality Forum.

“There is a performance measure that has been drafted, and ASAM has not drafted it, but we have been asked to steward the measure so it could be widely adopted. Only a specialty society can do that,” said Dr. Miller, Medical Director of the Herrington Recovery Center, Rogers Memorial Hospital, Oconomowoc, Wisconsin.

“We are going to steward, or shepherd, this measure for SAMHSA, and later there may be other measures developed by other entities, such as academic institutions or governmental institutions, so that ASAM may develop expertise in measures stewardship that we could then offer to others in the field,” he said. “The measure we are going to steward for SAMHSA is a composite measure that all together, at once, allows health systems to screen for unhealthy drinking, nonmedical use of prescription drugs, and tobacco use—which is never healthy.”

Symposium to Examine Latest Treatments for Alcohol Withdrawal

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Michael Fingerhood, MD

The latest information on current medical treatments for alcohol withdrawal syndrome and a look ahead at how genetic information could help drive treatments will be presented Saturday during Symposium 8, “Evidence-Based Approaches to Alcohol Detoxification and Treatment.”

Three speakers during the session, presented from 4:30 to 6:30 pm in Orange Ballroom A, Lower Level, will look at managing patients, counseling options, and the latest evidence for the use of medications, said Michael Fingerhood, MD, Associate Professor of Medicine at The Johns Hopkins University, and a symposium organizer and speaker.

Darius Rastegar, MD, Associate Professor of Medicine at Johns Hopkins, will discuss how to manage a patient through alcohol withdrawal.

“He will examine the evidence for different types of medications because there are a lot of options besides benzodiazepines for managing withdrawal,” Dr. Fingerhood said. “People, particularly primary care physicians, may wonder if they can do this safely in an outpatient setting, and when they should admit someone as an inpatent. What is a person’s risk for withdrawal?

“They may ask, ‘Do I just help people take this every X number of hours or do I do this symptom-driven, where I decide how to treat based on specific symptoms?’

Kenneth B. Stoller, MD, Assistant Professor at Johns Hopkins Psychiatry and Behavioral Sciences, will review literature about counseling patients going through alcohol withdrawal.

“He will take an evidence-based look at counseling, and Alcoholics Anonymous as a modality for ongoing alcohol use disorder treatment. How effective is it? We are going to look at the actual evidence for Alcoholics Anonymous,” Dr. Fingerhood said.

Dr. Fingerhood will review the latest evidence about medication for alcohol use disorder when counseling fails.

“Three medications are approved for use, and there will be a discussion of additional medications that have recently been in the literature for treatment of alcohol use disorder to try to reduce drinking or prevent relapse,” Dr. Fingerhood said. “Preventing relapse has been frustrating because most studies show a limited effect on preventing relapse.”

Those recent publications focus on groundbreaking research such as genetic-based treatment and anticonvulsant medications.

“There is some recent literature looking at the fact that alcohol-use disorder isn’t the same in all people,” Dr. Fingerhood said. “The idea of pharmacotherapy for alcohol-use disorder may be based on some genetic testing to predict which medications will work.

“One paper I will discuss was ePublished in the last month. Some papers deal with predicting who will respond to a particular medication, and others focus on the side effects and effectiveness of anticonvulsant medications.”

ASAM Criteria Offers a Look at What’s New and How to Apply It

Applying the principles of ASAM Criteria in daily practice was the focus of Thursday’s “ASAM Criteria Book and Software Live Course.” The course provided attendees with an opportunity to study the most widely used and comprehensive set of guidelines for placement, continued stay, and transfer/discharge of patients with addiction and co-occurring conditions.

“The course provided clinicians with resources they can apply to their practices upon their return home,” said David Mee-Lee, MD, ABAM Diplomate, Chief Editor of The ASAM Criteria and Senior Vice President of The Change Companies, Carson City, Nevada. “We reviewed a number of new updates and changes, beginning with a new title—The ASAM Criteria: Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions. We’re shifting away from the term ‘placement’ criteria to ‘treatment’ criteria, as it’s more than just ‘placement.’”

Dr. Mee-Lee and David Gastfriend, MD, ABAM Diplomate, were the course’s co-chairs.

A short list of what’s new, according to Dr. Mee-Lee, includes changing Diagnostic Admission Criteria terminology to be compatible with DSM-5, the addition of a section on working with managed care, restructuring the table of contents, highlighting adolescent-specific issues and criteria, shifting terminology from “detoxification” to “withdrawal management,” and opioid use disorder specialized services. The ASAM Criteria, he said, unifies the addiction field around a single set of criteria.

The workshop should help participants apply the criteria across a variety of settings with different populations—older adults, criminal justice settings, parents with children, and persons in safety-sensitive occupations. Speakers discussed how to use the criteria and software in working effectively with managed care and payers.

Dr. Gastfriend, Senior Advisor at Treatment Research Institute, Philadelphia, and President and CEO of RecoverySearch, Inc., Newton, Massachusetts, led a portion of the session on The ASAM Criteria Software.

 “ASAM is on the verge of launching a new era in patient intake, assessment, and treatment planning. The new ASAM Criteria Software is poised to unify the evaluation of patients. There is no reason in our modern world someone has to get a different evaluation in Peoria than in Poughkeepsie. It makes no sense for the luck of the draw to subject one patient to a novice counselor when another can end up with an expert,” Dr. Gastfriend said. “The knowledge base needs to be the same for all. Managed care expects no less from us, and the same should be true for patients and their families. This course provided the strong foundation for understanding the criteria and the software and how they work together.”

As the chief architect for the software, Dr. Gastfriend reviewed its purpose, use, and the history of research that led to its validation for national adoption. He also described how SAMHSA has sponsored the development of this latest version, and using it to lead the field of addiction medicine forward. The ASAM Criteria Software is currently undergoing a National Demonstration Phase with more than 20 sites using the software before its commercial launch later this year.

ASAM Movie Night Features Special Screening of The Anonymous People

0412_AnonymousPplNew to the Med-Sci Conference is ASAM Movie Night. The featured film, The Anonymous People, is already turning heads in the field of addiction medicine.

A special screening of The Anonymous People will be presented from 8 to 9:30 pm Saturday in Orange Ballroom D, Lower Level. The film’s writer and director, Greg Williams, MA, will be at the screening to introduce the film, and field questions and comments afterward. Williams also is this year’s recipient of the ASAM Media Award.

“I’ve received amazing feedback, and I’m humbled that the film earned an award from a prestigious, professional organization like ASAM,” Williams said. “For providers, the film has become an important new tool in the toolbox.”

The Anonymous People is a documentary about the 23 million Americans living in long-term recovery from addiction. The film explores the cultural understanding of addiction and the deeply entrenched social stigma that has kept recovery voices silent and faces hidden for decades. The moving story of this population is told through the faces and voices of citizens, leaders, volunteers, corporate executives, public figures, and celebrities who are laying it all on the line to save the lives of others just like them. Such individuals include NBA star Chris Herren, award-winning actress Kristen Johnston, Miss USA 2006 Tara Conner, and former congressman Patrick Kennedy, among others.

0412_AnonymousPpl2“There is an emerging new public recovery movement that aims to transform public opinion, engage communities and elected officials, and finally shift problematic policy toward lasting solutions,” Williams said. “By solely reporting and highlighting people in active addiction, the media often sensationalizes the dysfunctional side of what is a preventable and treatable health condition. Just like women with breast cancer, or people with HIV/AIDS, a grassroots social justice movement is emerging. Courageous addiction recovery advocates have come out of the shadows and are organizing to end discrimination and move toward recovery-based solutions.”

Williams, 30, has been in long-term recovery from addiction since the age of 17. His film tries to answer the question of why society treats people with addiction so differently from people with any other chronic illness. Much of it begins with inappropriate language—“loaded words”—that negatively impact treatment and recovery, he said.

0412_AnonymousPpl3The addiction recovery advocacy movement questions the approach the U.S. has taken toward the illness—criminalizing a health condition, marginalizing those who impacted, and giving superficial treatment to the chronic illness of addiction, Williams said. This failure has resulted in a price tag of more than $350 billion, lost lives, and disrupted families and communities.

“This film is fueling a changing conversation and community activism. I hope it continues to be an important step in the right direction with great utility for the professionals working in the addiction field,” he said.

The film can be licensed for Public Performance Rights to use in treatment and recovery programs through Alive Mind Cinema, Williams said. For details please visit the “Screenings” tab at manyfaces1voice.org. The Anonymous People opened theatrically in Los Angeles on Friday and is available for individual home video ownership both on DVD and digitally through manyfaces1voice.org.

Educating Prescribers a Key in Reducing Opioid Addiction, Overdose

Addiction physicians are increasingly being asked to help stem the rising tide of opioid addiction and overdose in their local communities. A special workshop Saturday has been developed to share strategies in this effort.

“Addressing the Opioid Addiction and Overdose Epidemic: Targeting the Prescriber,” a Collaborative Workshop developed by the Association for Medical Education and Research in Substance Abuse (AMERSA), will be presented from 4:30 to 6:30 pm in Orlando Ballroom IV, Lower Level.

“We are going to talk about strategies to get opioid prescribers both in primary care and addiction treatment settings engaged in addressing the opioid overdose crisis. We will look at it in three different ways,” said Alexander Y. Walley, MD, MSc, ABAM Diplomate, a session organizer and speaker.

Daniel P. Alford, MD, MPH, FASAM, ABAM Diplomate, will discuss national efforts to educate physicians about how to safely prescribe opioids. He will discuss Boston University’s Safe and Competent Opioid Prescribing Education program (www.scopeofpain.com). This program was developed to satisfy the extended-release/long-acting Risk Evaluation and Mitigation Strategy (REMS) education requirements issued by the Food and Drug Administration. He is an Associate Professor of Medicine at Boston University School of Medicine.

“This educational effort is not for the purpose of eliminating opioid prescribing, but really making it safe,” Dr. Walley said. “The SCOPE of Pain online and live programs focus on using a risk-benefit framework when making decisions to initiate, modify, continue, or discontinue opioids when managing patients with severe chronic pain.”

Hillary Kunins, MD, MPH, MS, Acting Executive Deputy Commissioner for Mental Hygiene, New York Department of Health and Mental Hygiene, will review its efforts to proactively educate prescribers.

“Using overdose mortality, opioid prescribing data, and expert input, the department developed opioid prescribing guidelines for general use. In addition, they developed a targeted approach for prescribers in Staten Island, the New York borough with the highest opioid-analgesic involved overdose mortality rates and the highest rates and doses of prescribed opioids,” Dr. Walley said. Dr. Kunins also will share the department’s guidance for addressing risky drug use identified in the prescription-monitoring database.

Dr. Walley, Assistant Professor of Medicine at Boston University School of Medicine, will address the role of physicians in patient education.

“I will focus on educating patients to prevent opioid overdoses and how to manage them when they happen so they are not fatal,” he said. “I will talk about how to prescribe naloxone rescue kits.”

The speakers will start their presentations by talking about opioids prescribed for pain, but also discuss opioids prescribed for the treatment of addiction.

“This is a relevant public health issue because it is not just overdoses, it is addiction and it is connected to prescribing of opioids,” Dr. Walley said. “But it is more complicated than that. There has been more information coming out about the transition of patients from prescription opioids to heroin, and heroin overdoses. Communities are concerned about this issue.”

And when local communities want help addressing those concerns, they most likely will turn to addiction physicians.

“ASAM doctors are the local experts on addiction who people often turn to when they want to understand the prescription opioid problem,” Dr. Walley said. “We are going to explain what is being done at national and state levels, and what can be done in municipalities and communities to address this problem.”