2015 Conference News

Plan to Attend 2016 Annual Conference

Save The Date LogoMark the date for the next ASAM Annual Conference.

The Annual Conference will take place April 14-17, 2016, at the Hilton Baltimore, Baltimore, Maryland.

Baltimore and its historic Inner Harbor offer a world of attractions to experience before or after the Annual Conference, so make your plans now to attend.

 

Millennium Award Supports Research of Medication Monitoring, Drug Testing

Fellows who research medication monitoring and drug testing were recognized Saturday during the Annual Awards Luncheon and in a poster submission by the 2014 award winner.

Ahmed N. Hassan, MD, FRCPC, Dip. ABPN, is the 2015 ASAM-Millennium Research Institute Research Fellowship Award recipient. His research project, to be conducted this year, is “Effectiveness of Opioid Therapy on Adherence to Psychotropic Medications.”

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Sarah Bagley, MD

The 2014 award recipient, Sarah Bagley, MD, presented her research project, “Urine Drug Testing for Patients on Buprenorphine—Examining Self-Reported Cocaine Use,” as a poster.

The award was created to recognize and provide financial support for research by addiction medicine fellows and to encourage them to understand and research medication monitoring and drug testing in the early phases of their careers. The award winner receives $15,000 for salary support, and complimentary registration, hotel reservations, and airline travel to attend the ASAM Annual Conference.

Dr. Bagley, an Addiction Medicine Fellow at Boston University, designed a retrospective cohort study comparing the agreement of urine drug testing with patient self-reporting to monitor cocaine use in patients treated with buprenorphine for opioid use disorders.

“We looked at patients who had cocaine-positive urine and whether they disclosed cocaine use to a nurse in their visits,” Dr. Bagley said. “In 192 patients with 2,498 urine drug test samples that occurred during nursing visits, we found that only 5 percent tested positive for cocaine, which is not very high. We did find that, in the times when there was a positive urine cocaine drug test, 60 percent of the time cocaine use was not disclosed to the nurse.”

The next step is to determine what the results mean, she said. Questions include: Is a person who tests positive for cocaine doing worse in treatment? Are too many drug tests ordered?

“In an era of thinking about efficiency and why we are ordering tests, it is important that we understand if there is something in the patient profile that helps identify who is going to have a positive urine test because that would help direct our testing,” Dr. Bagley said. “That may help us be smarter about how we order urine drug tests.”

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Ahmed N. Hassan, MD, FRCPC, Dip. ABPN

Dr. Hassan, a Clinical Fellow in Psychiatry at the Center for Addiction and Mental Health at the University of Toronto, Toronto, Canada, is planning a retrospective study using data from the Millennium Research Institute.

The study will compare the adherence of patients using psychiatric medication before and after the use of opioid therapies, specifically methadone and buprenorphine. The study also will compare which drug is more effective in helping patients adhere to their psychotropic medications.

“To the best of our knowledge, this is the first study that will evaluate the influence of opioid treatment on psychotropic medication,” he said. “There has been research on the effect of opioid treatment on adherence to HIV medication, but it has never been done on psychotropic medication.

“This is important because a lot of physicians—specifically psychiatrists—prefer sequential treatment rather than integrated treatment, which might be a better option for some patients. Hopefully, this will provide evidence that integrating opioid treatment with mental illness treatment will reduce substance use and allow adherence to other medications. It is an important step to advocate the importance of integration treatment between both medications.”

To learn more about the Millennium Research Institute Research Fellowship Award, including eligibility and the application process, visit ASAM’s website.

New e-Learning Center Improves Online Education Options

114x76 bannerASAM has upgraded the online education options for its members with the launch of the e-Learning Center (e-LC), which replaces the e-Live Learning Center. At the end of the Annual Conference, the new e-Learning Center will have more than 340 hours of content, and more content in different formats will be added later.

The e-Learning Center provides 24/7 access to continuing medical education (CME) courses. All courses are self-paced so you can view them at home or at work when you have time. The new e-LC also is compatible with mobile devices, re-sizing to fit the smaller screens of tablets and smartphones.

In addition, the e-LC is easier to navigate and is organized to help users find topics of interest, providing content in different formats, and archiving CME credits so they are easier to access when needed.

If you had an account on the e-Live Learning Center, you automatically have an account on the e-LC. If you did not have an account on the e-Live learning Center, you can easily create a new account.

Logging on to use the e-LC is easy:

  1. Go to the ASAM e-Learning Center
  2. Logon name: This is the same as your CME logon.
  3. Password: Enter your last name in all lowercase letters.

When you log on for the first time, be sure to complete your profile, which includes interest categories. Based on that, the e-LC system can recommend sessions of interest or that would benefit your practice. To search for content on the site, content options can be sorted by conference, categories, or what is recommended to you.

The e-LC content includes all conference content developed since September 2012 in the form of PowerPoint presentations and synchronized audio from the presentation sessions. To see sessions available at no cost, go to “Free Sessions” under the Education Catalog tab. The new system also allows ASAM to add podcasts and videos, including some videos from the 2015 ASAM Annual Conference.

When users view session presentations online for CME, they will need to complete a quiz at the end of the session to confirm they listened to the entire session.

How to Access the e-Learning Center, View Slides and Claim CME:

Go directly to the e-Learning Center, or go the ASAM home page and click on the e-Learning Center button.

Full Registrants-Annual Conference and Pain and Addiction

  1. Select Dashboard from the left menu
  2. Select the conference registered for-Check out slides
  3. Select the sessions attended-For CME
  4. Enter verification code when prompted-For CME:
  • For ASAM Annual Conference: ANNUAL2015
  • For Pain and Addiction: Common Threads XVI: PAIN2015

 

Cultural Competence Growing in Importance in Addiction Treatment

The Affordable Care Act has helped drive addiction medicine more into the mainstream of health care, and with that has come a broader spectrum of patient subsets and management challenges. A Sunday session is designed to improve the management of those patients.

“Cultural Competence in the Delivery of Addiction Treatment Services” will be presented from 8 to 9:30 am Sunday in Governors Ballroom B, Fourth Floor. Four speakers will identify challenges and present approaches taken to meet those challenges, especially in two subsets of patients.

“For a long time, the addiction field has not done a good job of dealing with cultural competence. It is not necessarily the field’s fault,” said session speaker Constance Weisner, DrPH, LCSW. “We had not been mainstreamed until the ACA happened. The public programs have not had the resources. For health care in general, and our field in particular, this has been an issue.”

The session will open with a review of the newest regulations and expectations for health systems and substance use treatment related to cultural competency, presented by the session moderator Deidra Y. Roach, MD. Dr. Roach is Medical Project Officer for the National Institute on Alcohol Abuse and Alcoholism, and her presentation will set the stage for Dr. Weisner.

“Dr. Weisner is not only well-versed in the literature of culturally competent health care, but has the lived experience of participating in the implementation of federal standards for cultural competence in health care in a very large HMO,” Dr. Roach said. “Her presentation will be foundational, providing the general platform upon which the other speakers will build their presentations focusing on specific populations.”

The Director of Faculty Development, Division of Research, Kaiser Permanente, University of California, San Francisco, Dr. Weisner will discuss steps Kaiser has taken to address the needs of some patient subsets. Those include making information available in multiple languages and in creative, interactive formats using information technology.

“In primary care, an innovation could be that if someone has been screened for a drinking problem, a physician could have a regional person on tap through a video consult who is from the same cultural group as the patient,” Dr. Weisner said. “It is a step forward that involves more than language. There are some exciting things people are developing for patient portals on prevention, such as treatment modules presented by virtual people that can be matched to the age, gender, or ethnicity of the patient.”

Other speakers at the session are Kamilla Venner, PhD, Assistant Professor at the University of New Mexico, Albuquerque, and Denis Antoine II, MD, Assistant Professor at Johns Hopkins University School of Medicine, Baltimore. Dr. Venner will discuss best approaches to adapting evidence-based treatments in American Indian/Alaska Native populations. Highlights of her presentation will include the importance of acculturation, spirituality, and cultural values in developing treatments that are appropriate for use in these communities. Dr. Antoine will provide an overview of the socio-political landscape that has impacted substance abuse treatment in the African-American community and highlight culturally relevant barriers to treatment access. He also will emphasize the importance of staff diversity and maintenance of cultural competence through regular training and program evaluation.

Updated Buprenorphine Course Combines Online, Live Case-Based Learning

ASAM is updating the eight-hour course physicians must complete to obtain a waiver to prescribe buprenorphine. The new course, which will be rolled out in July, will be a flipped classroom format blending four hours of online self-study and four hours of live interactive case-based presentations.

BMC Internal Medicine 2013

Daniel P. Alford, MD, MPH

“We are dividing the content in a way that makes sense for adult learners. The online part will be the essential knowledge content—the neurobiology of opioid use disorders, the Drug Addiction Treatment Act of 2000, opioid pharmacology and the efficacy and safety of pharmacotherapy – all things people can study on their own,” said Daniel P. Alford, MD, MPH. “We will focus the live session on clinical and office management procedures and case-based discussions. Much of the content presented during the four hours of live presentations will focus on the clinical application of the content covered in the online program.”

Besides the change in format, the course content also is being updated, said Dr. Alford who is the Chair of the ASAM Buprenorphine Course for Office-Based Treatment of Opioid Use Disorders Program Planning Committee and Associate Professor of Medicine at Boston University School of Medicine.

“We are taking a fresh look at the previous training content and updating it with the most recent evidence,” he said. “There has been a lot of clinical research published in the past few years. We are moving away from the need to talk about basic science research and expert recommendations and moving toward evidence-based clinical practice.”

The course’s revised content will be broke into four modules:

  1. Science and the Drug Addiction Treatment Act of 2000, covering topics such as the neurobiology of addiction; epidemiology of opioid use disorders; opioid pharmacology; and the efficacy and safety of pharmacotherapy medications beyond bupreneorphine and their efficacy and safety
  2. Implementation Science of office-based opioid treatment; how to assess patients and manage medications; the role of nonpharmacological treatment; how to monitor and educate patients for safety and benefit; and office management issues, such as agreements, billing and collaborative care.
  3. Special Populations, which will examine specific groups, such as women of child-bearing age; women who are pregnant or breast feeding;; adolescents and young adults; patients with acute and chronic pain; perioperative management issues; patients with medical and psychiatric comorbidities; and health professionals with opioid use disorders.
  4. Clinical Cases, the live section of the course, will review cases that address patient assessment; managing polysubstance use; induction and maintenance procedures; dealing with aberrant medication-taking behavior; acute pain; perioperative management; and pregnancy and breastfeeding.

The online portion will include slides with audio narration provided by faculty members, Dr. Alford said.

“For the online content, we assigned topics to faculty members with expertise in specific aspects of this field,” he said. “The live part of the course will be very interactive, with a summary and review to remind people of the major points from the online modules before we move to the case discussions.”

Managing Sedative Dependency: A Challenging Problem

Sedatives have long been known to be a difficult class of drugs to manage because most patients become dependent on them. A Sunday session, “Updates in Treating Sedative Dependency in Addiction and Chronic Pain,” will address how to tackle this challenge.

“The reason for this workshop has to do with the fact that making patients free from sedatives—and I mean discontinuing them—is very, very difficult,” said Herbert L. Malinoff, MD, FACP, FASAM, session organizer. “Once initiated, they produce dependency in virtually all people who take them regularly. It is a tenacious problem, and most doctors don’t know how to do this, including doctors who prescribe them.”

Presented from 8 to 9:30 am Sunday in Governor’s Ballroom A, Fourth Floor, the session will feature Dr. Malinoff and two other speakers discussing how sedatives work, how people react to them, the mechanism of withdrawing from sedative use, and how best to manage the problem that led to sedatives being prescribed.

“I will present a recital of what sedatives are, what they do to the brain, why they cause dependency, what are the prescribed sedatives on the market, what happens to people who take these sedatives, and why they are bad,” said Dr. Malinoff, Clinical Assistant Professor in the Department of Anesthesiology, University of Michigan, Ann Arbor.

Three common problems will be reviewed: cognitive impairment, visuospatial discoordination, and how all benzodiazepines are central nervous system depressants.

“Patients become clumsy, they fall and spill, and they become depressed,” Dr. Malinoff said. “This has been described as a downward spiral of worsening function and decreasing pain perception in people with chronic pain problems. If you put people who have chronic pain problems on sedatives, almost universally they do poorly.”

Mark A. Weiner, MD, Medical Director at Pain Recovery Solutions, Ypsilanti, Michigan, will discuss the challenge of stopping the use of sedatives.

“You have to be adept at using medications that can take the place of sedatives, which in themselves are not sedating, and that prevents anyone from emerging without a sedative withdrawal syndrome,” Dr. Malinoff said. “Sedative withdrawal syndrome occurs because these drugs produce dependency, and the withdrawal syndrome is the opposite of sedation, which is excitation.”

Melvin Pohl, MD, FASAM, Medical Director at the Las Vegas Recovery Center, will discuss how to handle the management of the initial problem that led to sedatives being prescribed for the patient, Dr. Malinoff said, adding, “Dr. Pohl is an expert at non-pharmacologic coping mechanisms.”

“Sedative use is very common,” he said. “There are multiple problems with this class of drugs, and in most patients they are not indicated. Sadly, in patients who have used them for any period of time, it is very difficult to subtly discontinue these medications. One has to be adept in using adjunctive medications and procedures to discontinue these medications.”

REMS Course Focuses on Appropriate Use of ER/LA Opioids

Physicians, as well as all health care professionals who prescribe extended-release/long-acting opioids (ER/LA), can learn about the safe and effective use of ER/LA through a three-hour REMS course that can be scheduled through ASAM.

The general REMS course on ER/LA opioids was developed by CO*RE (Collaborative for REMS Education) and is presented by ASAM and other organizations using the same content. Approved by the Food and Drug Administration (FDA), it has six modules whose content explains details about the appropriate and effective use of extended-release opioids and how to prevent bad outcomes, such as overdoses and overdose deaths.

Edwin A. Salsitz, MD, FASAM, DABAM

Edwin A. Salsitz, MD, FASAM, DABAM

“The ASAM version of the course is different from other REMS courses because it includes a seventh module dealing with addiction issues and chronic opioid use,” said Edwin A. Salsitz, MD, FASAM, DABAM, Chair of the ASAM REMS Program Planning Committee.

REMS, the acronym for Risk Evaluation and Mitigation Strategy, is linked to a consortium organized by the 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.

“Because ASAM is the American Society of Addiction Medicine, we thought it was appropriate for us to have a module that dealt with how often people become addicted, how you can tell if they are addicted, what you should do if they are addicted, and other issues around addiction and problematic behavior. We think the ASAM version providing that extra module really adds something to the overall course,” Dr. Salsitz said. He is an attending physician at Mount Sinai Beth Israel Medical Center, Division of Chemical Dependency, and an Assistant Professor of Medicine at the Icahn School of Medicine at Mount Sinai, New York.

The first six modules address subjects such as assessment of patients; which screening tools to use to assess the risk of problematic behavior while people are on chronic opioids; how to taper and withdraw patients from opioids; how to work with caregivers and family members when counseling is needed; and the safe storage of opioids.

“We go over each of these long-acting opioids in some detail, mentioning specific issues, such as metabolic or drug-to-drug interactions and indications,” Dr. Salsitz said. “Anyone who is prescribing opioids would benefit from the course either in terms of getting new education or having a refresher, kind of an Opioid 101.”

Go to the ASAM website for information and a full list of resources, or to attend or schedule a course. ASAM is looking for organizations that would like to host a session of 75 or more prescribers. Attendees earn three hours of continuing education credits.

“We provide faculty members who are certified to present the REMS course,” Dr. Salsitz said. “The course is appropriate for all medical specialties and subspecialties, including primary care physicians, pain physicians, and addiction physicians. We welcome nurses, physician assistants, and counselors. There is no group for which the course would not be appropriate.”

Session to Examine Definition of Addiction as One Disease

ASAM’s definition of addiction, as a primary chronic disease of brain reward, motivation, memory, and related circuitry, will be the focus of “Addiction is Addiction: Clinical Perspectives from Definition to Practice” from 10 to 11:30 am Sunday in Governor’s Ballroom B, Fourth Floor.

Raju Hajela, MD, MPH, FCFP, FASAM, DABAM

Raju Hajela, MD, MPH, FCFP, FASAM, DABAM

“The implications of that definition are profound because it encapsulates that addiction is one disease as opposed to ‘addictions,’ which is what a lot of people talk about,” said the session organizer, Raju Hajela, MD, MPH, FCFP, FASAM, DABAM. “Certainly in the psychiatric nomenclature, substance use disorders are identified and classified separately.

“Our definition defines the disease as a brain disease. Because of that advance, we have been able to synthesize all the research that has gone on over the previous decades that we want to share with membership and other attendees to help them understand what it is, where it came from, and how to implement it.”

One of the goals of the definition, developed through the work of ASAM’s Descriptive and Diagnostic Terminology Action Group (DDTAG), is to develop a holistic approach to care. Currently, many physicians focus on treating a substance abuse or behavior in isolation, said Dr. Hajela, President and Medical Director of Health Upwardly Mobile Inc., Calgary, Alberta, Canada.

Speakers at the session are:

  • ASAM President Stuart Gitlow, MD, MPH, MBA, DFAPA, who will highlight the development of the definition and how ASAM plans to have it more widely accepted.
  • Hajela, who will review the work of DDTAG and the need for physicians to cover the spectrum of addiction medicine, and not just one area.
  • Howard Wetsman, MD, FASAM, DABAM, who will address the growth of the idea that addiction is a unitary disease. He is Chief Medical Officer of Townsend, New Orleans, Louisiana.

“We will cover the practical aspects of the theory,” Dr. Hajela said. “We will not be going into the neurobiology, but we will reference it. The irony is that despite the fact neurobiology says addiction is all one disease, in practice people get caught up in treating opioid dependence or alcohol use disorder or cocaine use disorder. That is the problem we want to address.

“I have encountered many patients who were treated for one aspect of the disease while another aspect of the disease was left untouched. People want to try to intervene in one area and not give holistic treatment, and the other aspects of the disease get worse.”

The session also will address the challenges to more widespread acceptance of this ASAM definition of addiction, Dr. Hajela said.

“The takeaway is that we would like to have as many come as possible,” he said. “This is a very important workshop. This is truly the future of where addiction medicine will go.”

Urine Drug Testing Workshop to Focus on Physician-Patient Partnership

A two-part, four-hour workshop on Sunday will help participants increase their knowledge and confidence about using patient-centered urine drug tests in clinical practice.

Part one of “Urine Drug Testing ‘for’ your Patient not ‘to’ your Patient,” will be devoted to knowledge- and confidence-building, so urine drug testing can be applied appropriately to prevent, detect, and treat substance use disorders. Presenters will cover the basic science of urine drug testing by reviewing different methodologies, such as qualitative and quantitative urine drug testing; how to set up urine drug testing protocols in the clinical setting; and how to select a testing laboratory.

Part one will be from 8 to 9:30 am and part two from 10 to 11:30 am. Both sessions will be in Governor’s Ballroom C, Fourth Floor.

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Howard Heit, MD, FACP, FASAM

“The emphasis throughout the workshop will be on using urine drug tests for your patient’s benefit rather than as a punishment or as a trap for catching patients,” said workshop organizer Howard Heit, MD, FACP, FASAM, Assistant Clinical Professor at Georgetown University. Washington, DC. “Urine drug tests are a vastly underused, misunderstood, and misinterpreted modality.”

He will be a presenter at both sessions along with Michael Sprintz, DO, Founder and Chief Medical Officer at the Sprintz Center for Pain and Dependency, the Woodlands, Texas, and Gary M. Reisfield, MD, Assistant Professor at the University of Florida College of Medicine, Orange Park.

It’s vital that physicians become educated about how to approach patients, said Dr. Heit, who is a board-certified gastroenterologist and hepatologist.

“A patient could say, ‘What if I don’t want to do a urine drug test? Do you think I have addiction? Is that why you’re doing a urine drug test?’ How do you approach this patient in a patient-centered fashion? In urine drug testing, you must know the questions that you want to ask. Doing a urine drug test is for the benefit of the patient to help improve clinical care and your communication with the patient,” Dr. Heit said.

He cautioned that physicians need to understand the sophistication levels and limitations of urine drug tests, and that interpreting the results beyond their scientific capability could result in poor patient care and medical-legal problems.

“With any diagnostic test, you need to document why you ordered the test, the results, and what you are going to do with the test results,” he said.

Part two of the workshop will focus on clinical applications and skill-building. Through the use of role-play and case studies, presenters will demonstrate how to approach common clinical challenges. This session will highlight constructive communication with patients—communication that maintains therapeutic relationships without sacrificing treatment goals. Presenters also will use case studies to review the basic and applied science of urine drug tests and emphasize the appropriate tests to use, correct test interpretation, and next steps.

For example, presenters will describe how to respond in a nonpunitive but therapeutic way to an unexpected urine drug test result, including how to use the results to aid in a diagnosis and treatment plan to encourage positive behavior.

“You can’t do addiction medicine and pain medicine unless there is honesty on both sides,” Dr. Heit said. “Patients have a responsibility to give me the information that I need and the information that is in their past histories as best they can.

“I have a responsibility to my patients to give informed consent for what I’m doing and to provide them with the best medical care that I possibly can. It’s a bidirectional relationship. If it’s not bidirectional, you will not get the optimal results no matter what you do.”

ASAM’s Drug Testing White Paper is available online. During the ASAM board meeting on Wednesday, the Board voted to approve a subsequent “Statement of Consensus on the Proper Utilization of Urine Testing in Identifying and Treating Substance Use Disorders.” This final report will be published online next month and distributed through ASAM’s weekly electronic newsletter, ASAM Weekly. Click here to subscribe to ASAM Weekly.

Experts to Examine Use of Cannabinoids as Medicine

From science to politics to social media, one of the most-discussed topics is the legalization of marijuana and its use as medicine. Sunday, a panel of experts will discuss the science of cannabinoids and their effect on medical treatment and public policy.

“Role of Cannabinoids in Medicine/Addiction Medicine/NIDA-ISAM-ASAM Collaboration,” will be presented from 10 to 11:30 am in Governor’s Ballroom A, Fourth Floor.

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Jag H. Khalsa, MS, PhD

“I use the term ‘medical marijuana’ even though I don’t believe in the term. It is being used by a lot of people, and even clinicians, to treat indications such as neuropathic pain, nausea, multiple sclerosis, epilepsy, and glaucoma even though there is no hard data from large clinical trials that the Food and Drug Administration will accept to approve the use of marijuana for medical purposes,” said Jag H. Khalsa, MS, PhD, the session organizer.

Dr. Khalsa, Chief of the Medical Consequences Branch with the Division of Pharmacotherapies and Medical Consequences of Drug Abuse, National Institute on Drug Abuse, National Institutes of Health, will discuss the role of cannabinoids in medicine. He will review the effect of chemicals on cannabinoid receptors CB1 and CB2.

“A chemical that works on these receptors is known as a cannabinoid. I am going to present a detailed review of the information from clinical studies,” he said. “I have reviewed 70-plus studies in the published literature that I will briefly summarize to show the effects of cannabis on neuropathic pain, multiple sclerosis, and epilepsy.

“I will present that evidence and let the audience make a judgment whether we have sufficient clinical evidence to use cannabis for treating any of these indications.”

Joining Dr. Khalsa for the session will be Robert L. DuPont, MD, FASAM, former Director of NIDA and currently President of the Institute for Behavior and Health, Inc., Rockville, Maryland, and Greg C. Bunt, MD, FASAM, President of DayTop, New York.

Dr. DuPont will discuss how scientific information about cannabinoids could affect public health policy and how clinicians can use that background. Dr. Bunt will present a summary of the status of medical marijuana and cannabinoids in the United States, as well as information from studies about their use in Netherlands and Spain.

“This is a topical subject, and so we will leave plenty of time for open discussion” Dr. Khalsa said. “We want this to be an interactive session so people can take away whether there is evidence for using cannabinoids in medicine.”