April 24, 2015

ASAM Board of Directors Meeting Actions

The ASAM Board of Directors met Wednesday and approved several actions.

Council and Committee Leadership Changes

The Board of Directors approved a slate of candidates to take over several Chair positions within the organization. Congratulations to:

  • Publication Council Chair: William F. Haning III, MD, FASAM, DFAPA
  • Finance Council and Committee Chair: Brian Hurley, MD, MBA
  • Legislative Advocacy Committee Chair: Corey Waller, MD, MS, FACEP
  • Membership Council and Committee Chair: Paul H. Earley, MD, FASAM
  • Physicians in Training Committee Chair: Todd Kammerzelt, MD
  • Nominations and Awards Council Chair: Stuart Gitlow, MD, MPH, MBA, DFAPA
  • Medical Education Council Chair: Mark P. Schwartz, MD, FASAM
  • Ethics Committee Chair: Louis E. Baxter Sr., MD, FASAM

FASAM Credential Changed for Members Certified by ABAM, ABPN

The Board voted to accept a proposal from the Membership Committee to change the current award designation of “Fellow” to a membership category to recognize members who are either board-certified in addiction medicine by the American Board of Addiction Medicine (ABAM) or members who are board-certified in addiction psychiatry by the American Board of Psychiatry and Neurology (ABPN). In addition, the individual must be a member of ASAM for at least two consecutive years before automatically being designated as FASAM upon renewal of a third year of membership.

Individuals who were awarded the FASAM designation to recognize their significant contributions to the organization will automatically be recognized as “Distinguished Fellow” with a designation DFASAM. The current “Fellow Awards” will continue under the name “Distinguished Fellow Awards.”

These changes will be effective with the 2016 membership year. More information about these changes will be provided later this year.

National Associate Membership a Permanent Category

In April 2013, the Board approved the implementation of an “Associate Member” category to begin in 2014 as a pilot program at the National level. The pilot program has concluded and will now be rolled out as a pilot program to the Chapter level beginning in 2016. Chapters that are not yet ready to accept Associate Members will have an option to opt out of the pilot program. More information will be available later this year.

Payer Relations Committee Created

At its August 2014 meeting, the ASAM Board of Directors selected the creation of a payer relations function as one of its top three priorities for the next three years. To support that effort, the Board created a Payer Relations Committee to respond to, and be proactive around, policies by public payers (e.g., Medicaid, Medicare, Tricare), private payers (e.g., national, regional, and local insurers), and purchasers of health care goods and services (e.g., employers, collective bargaining units) that limit patient access to quality addiction treatment. The Payer Relations Committee also will focus on the practice management needs (e.g., billing, coding, reimbursement) of addiction medicine specialty practices to assure that they can deliver optimal quality care for the patients they serve. H. Westley Clark, MD, JD, was appointed as Chair.

Board Seeks Clarification on Guideline

The ASAM National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use will soon be finalized. The accumulation of evidence through clinical trials significantly lags behind practice for the treatment of opioid addiction. Given this gap, ASAM retained Treatment Research Institute in 2014 to develop a national guideline using a structured consensus process. The Board reviewed the draft document at its meeting earlier this week, requested additional clarification, and will reconvene in the near future to vote on its acceptance.

Consensus Document and Marijuana Policy

  • The Board approved a consensus document on urine drug testing.
  • The Public Policy Committee was charged to update ASAM’s marijuana policy.

Thank You to Annual Conference Supporters

Thanks our Supporters

The Christopher D. Smithers Foundation Kaleo Dominion Diagnostics Center for Substance Abuse Treatments (CSAT/DANSHA) Substance Abuse and Mental Health Services Administration National Institute on Drug Abuse (NIDA) Millennium Health Indivior Gilead Sciences, Inc. Cenpatico biodelivery sciences orexo Alkermes

Stop by ASAM Central to Enter Raffle, Complete Membership Profile

Attendees get a look at the new e-Learning Center at the ASAM Central desk.

Attendees get a look at the new e-Learning Center at the ASAM Central desk.

When ASAM members pick up their Annual Conference registration materials, they are encouraged to also visit the ASAM Central Desk next to Registration to enter a raffle and complete their membership profiles.

During the conference, ASAM is giving away five complimentary 2016 ASAM memberships, but to be eligible, members must have completed their Membership Profile. ASAM also will seek feedback from members about the Annual Conference. At the end of the conference, ASAM will survey all meeting registrants to determine ways to improve future conferences and educational meetings.

ASAM staff will ask members to complete a two-minute survey using iPads to get feedback on communication preferences for late-breaking news, upcoming events, and educational opportunities. Some members prefer to receive printed material, while others prefer electronic communication, so the Society wants to ensure that it is meeting the needs of members.

In 2014, ASAM began accepting Associate Members, who are professionals who teach, conduct research, or provide clinical care for those at risk for substance use disorder or who have a substance use disorder.

An Associate Member Roundtable session, “What Keeps You Up at Night?” will allow these members to learn from each other by sharing challenges and successes. The session will be presented from 7:45 to 8:45 pm Friday in Governor’s Ballroom E, Fourth Floor. The session will include small group discussions with other addiction professionals to discuss shared topics and issues of interest.

ASAM Releases The ASAM Essentials of Addiction Medicine, 2nd Edition

During the ASAM Conference, attendees will have the exclusive opportunity to get their hands on a limited number of the new edition of The ASAM Essentials of Addiction Medicine, 2nd Edition, before it is published in May. Edited by Abigail J. Herron, DO, and Timothy Koehler Brennan, MD, MPH, The ASAM Essentials is a high-yield guide to addiction medicine, featuring new methods to provide care to patients, as well as definitive answers on how to assist those suffering from addiction with early intervention tactics. It is an essential study tool for anyone taking the board certifying examination in addiction medicine.

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Abigail J. Herron, DO

This companion resource, derived from The ASAM Principles of Addiction Medicine, 5th Edition, presents the collective wisdom of hundreds of esteemed authorities on the art and science of addiction medicine.

Previously updated in 2011, The ASAM Essentials features new content in a user-friendly format, said Dr. Herron, who also was an author for The ASAM Principles.

“While The ASAM Principles is designed to be a comprehensive text, The ASAM Essentials is a distilled guide that allows readers to pinpoint the most relevant information about a topic, and this new edition also includes study questions and suggested readings. It is an excellent resource for the practicing clinician as well as for those preparing for the addiction medicine exam,” said Dr. Herron, Director of Psychiatry at the Institute for Family Health and an Assistant Professor of Psychiatry at the Mount Sinai School of Medicine, New York.

Many chapter authors from The ASAM Principles wrote the summary chapters in The ASAM Essentials, highlighting the most relevant information for readers. The editors also were delighted to include voices of the next generation of addiction medicine clinicians as contributors, with fellows, residents, and medical students serving as authors for some of the chapters, Dr. Herron added.

She credits her co-editor, chapter authors, and ASAM staff for the yeoman’s work they put forth to produce the 700-page, 137-chapter book.

“This project was very large in scope. Tim was a fantastic collaborator, and invaluable to the process. The ASAM staff was incredibly helpful in coordinating this group of contributors,” Dr. Herron said.

The streamlined format appeals to specialists seeking a quick-access reference source:

  • Find the authoritative answers needed on everything from the pharmacology of addiction through diagnosis, assessment, and early intervention; various forms of addiction management; treatment of individual patient populations; management of intoxication and withdrawal; pharmacologic and behavioral interventions; recovery programs; medical disorders and complications; co-occurring addiction and psychiatric disorders; pain and addiction; children and adolescents; and ethical, legal, and liability issues.
  • Contribute to public health in the area of addiction with the aid of a special introductory chapter, “A Public Health Approach to Prevention: The Health Professional’s Role.”
  • Easily switch back and forth between The ASAM Essentials and The ASAM Principles, thanks to a parallel chapter organization.
  • Zero in on the most important, practical information through highly focused, efficient coverage.
  • Maximize understanding and retention of vital concepts with key point summaries, review questions, and suggested readings in each chapter.

Now with the print edition, enjoy the bundled interactive eBook edition, offering tablet, smartphone, or online access to:

  • Complete content with enhanced navigation
  • A powerful search tool that pulls results from content in the book, the reader’s notes, and even the Web
  • Cross-linked pages, references, and more for easy navigation
  • A highlighting tool for easier reference of key content throughout the text
  • Ability to take and share notes with friends and colleagues
  • Quick-reference tabbing to save favorite content for future use

See the inside front cover to find out how to access the eBook.

Book Signing with Abigail Herron, DO

The ASAM Essentials of Addiction Medicine

Available for pre-publication purchase

1-2 p.m. Friday

Austin Grand Ballroom, Exhibit Hall, 6th floor

Booth 311 and 313

Pain and Addiction Course Looks at Non-Opioid Management Options

A member of the audience asks a question Thursday during the Pain

A member of the audience asks a question Thursday during the “Pain and Addiction Common Threads” course.

The focus and format of one of ASAM’s long-standing education sessions, the “Pain and Addiction Common Threads” course, took a different path Thursday as it explored a variety of treatment pathways and used more speaker and audience interaction. Part of the course’s title was “A World Without Opioids?”

“This year, we changed a lot. In the past it had been focused on opioids or buprenorphine. This year, the title says a lot—a world without opioids,” said R. Corey Waller MD, MS, FACEP, DABAM, Chair of the course. “We went through a myriad evidence-based ways to treat pain in the setting of addiction or pain outside the setting of addiction with non-opioid treatment pathways. Some of those are medications, some are interventions, some are behavioral therapies, and some are physical therapies—and all were discussed.”

The course’s planners also looked at feedback from those who attended the course in the last few years and changed it from a series of didactic presentations to showing attendees how to interact with patients.

“Just hearing people tell you what they know does not always make it easy to translate into somebody’s daily practice,” said Dr. Waller, Director of the Center for Integrative Medicine at Spectrum Health, Grand Rapids, Michigan. “This year, we gave a short overview lecture followed by doctor-patient interaction on stage that allowed attendees to see how you get information from the patient and the best ways to explain to the patient that these are the best ways to do it.

“We did not just present theoretical cases. We actually got to see the back-and-forth interaction between a doctor and one of the other doctors who was playing a patient. This allowed those in the audience to see some of the possible pitfalls as well as tricks of the trade. That will allow them to be able to go back to the office to see a patient and do something differently.”

Another change was that throughout the day, staff and faculty collected questions from physicians about their own patients. Those questions were discussed by a panel of faculty members who directly answered the questions.

“This allowed us to use a real case-based approach instead of a theoretical case, and give them specific answers,” Dr. Waller said. “That allowed us to answer ‘I would use these medications at this dose for this length of time, followed by this physical therapy, and this behavioral therapy.’”

Faculty members also developed specific scenarios based on data from previous course attendees so the faculty could demonstrate how to deal with specific situations. Those scenarios involved motivational interviewing and helping a patient with headaches stop using opioids.

“We had a patient with headaches who we got off of opioids, and we talked through all of the other pathways we could use to treat them, and explained why,” Dr. Waller said. “We talked about a patient who had a real pain that may need opioids, but was unable to use them because they have significant addiction. We had a patient without pain who has addiction, and how you determine that, how you get buy-in from the patient, and what pathway you can use in that setting.”

The course did not end with attendees walking out of the ballroom at the end of the day. They were asked for feedback immediately and will receive emails in the next few weeks for more insights about the course. They also will be contacted within six months “to see if anything we did stuck,” he said.

Materials related to the course also are available at the new ASAM e-Learning Center. Materials include a frequently asked questions section and videos of the course edited into shorter modules.

Primary Care Physicians and Clinicians Gain Expertise at Fundamentals Course

Attendees were grouped at round tables to improve discussion Thursday during the Fundamentals Course.

Attendees were grouped at round tables to improve discussion Thursday during “The Fundamentals of Addiction Medicine” course.

Primary care professionals gained a wealth of education Thursday during “The Fundamentals of Addiction Medicine” course. The case-based program yielded guidance for how to provide the most effective prevention strategies and treatment of patients at risk for substance use disorders.

Expanding the role of primary care physicians and clinicians in treating addiction has gained interest, in part, because of the comorbidities among substance abuse patients.

Peter Selby,MBBS, FCFP, DABAM, course chair and curriculum director, noted that primary care professionals often treat the consequences of the substance use—high blood pressure, falls, family problems, and recurrent symptoms—but not the underlying cause.

“Our goal was to help attendees become much more confident in how they handle these patients coming into their clinics. Now they can actually treat the root causes and have patients who are satisfied, as well as improve the quality of care that they provide,” said Dr. Selby, Professor of Family and Community Medicine and Psychiatry, Center for Addiction and Mental Health at the University of Toronto, Ontario.

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

“We developed the course in a way where participants not only learned through thinking, but they learned through doing,” Dr. Selby said.

Speakers discussed clinical manifestations of the neurobiology of addictions; an introduction to addictive disorders; identifying unhealthy substance use; screening, brief intervention, and referral to treatment; motivational interviewing; diagnosing substance use disorders and developing an appropriate treatment plan; and treating substance use disorders with medication and counseling.

Planners looked to attendee feedback from 2014 to make course improvements, including revamping the medication prescribing section and adding information about leading 12-step meetings.

“We designed the course in such a way that experts also could take this course and run with it. By that I mean, it’s portable, and the sessions can be led as modules in a single day or over several days by an expert facilitator,” Dr. Selby said.

He advised ASAM members to take the lead in identifying teaching opportunities in their communities and regions.

“Being an addiction medicine specialist or becoming certified by the American Board of Addiction Medicine means you’re not just a medical expert. You’re also a communicator and a capacity builder in your community,” he said. “You have a bigger role, and ASAM is developing the resources for you to be able to have an impact. Not everyone in your community is going to be able to come to the Annual Conference, but you certainly can take the knowledge to where they are.”

Meet the Editors of the Journal of Addiction Medicine

Be sure to visit the Poster Sessions and meet with the editors of the Journal of Addiction Medicine (JAM) Friday. The Poster Sessions will take place from noon to 2 pm and 9:30 to 11 am Saturday, and the Meet the Editors Session is from noon to 1 pm, both in the Austin Grand Ballroom, Sixth Floor.

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Richard Saitz, MD, MPH, FASAM, FACP

The new JAM Senior Editor is Richard Saitz, MD, MPH, FASAM, FACP. The co-editors are Shannon C. Miller, MD, FASAM, DFAPA; Martha J. Wunsch, MD, FAAP, FASAM; and Frank J. Vocci, PhD.

The session is an opportunity for ASAM members and conference attendees to give the editors feedback about JAM and the content they find most useful, such as clinical case conferences, reviews, primary research articles, and pages from the society. It also is an opportunity for readers to learn about the editors’ goals for JAM.

“We want to hear from ASAM’s diverse membership. Some are primarily researchers, but that is not the majority,” Dr. Saitz said. “The majority of members are our readers contributing to and hearing the voice of addiction medicine. We want the research and reviews we publish to be useful in their teaching and practice.”

For those who are interested in submitting papers, the session is an opportunity to talk to the editors to better understand the publishing process.

“We are happy to talk about what kinds of papers we are looking for,” Dr. Saitz said. “We can talk about how to prepare a paper for submission and, once it’s submitted, what you should expect. Authors can learn tips on the do’s and don’ts of writing, submitting, revising, and even processes post-acceptance. People can even bring abstracts or papers if they want us to take a quick look at something to see if we would be interested in it.”

Dr. Saitz is Chair and Professor of Community Health Services at Boston University, and he became the JAM Senior Editor January 1, succeeding George Koob, MD. Dr. Miller is a Professor of Clinical Psychiatry at the University of Cincinnati; Dr. Wunsch is Director of Addiction Medicine for the Greater Southern Alameda Area, Kaiser Permanente Northern California; Dr. Vocci is President and Senior Research Scientist at Friends Research Institute, Baltimore, Maryland.

Journal of Addiction Medicine is ASAM’s official peer-reviewed journal. Published six-times a year as a member benefit, the journal’s mission is to promote excellence in the practice of addiction medicine and in clinical research. Learn more about the many benefits of being an ASAM member at www.asam.org/member-benefits.

Time: Noon to 1 pm

Location: Booth #311, Austin Grand Ballroom, Sixth Floor

Have you wondered how to prepare papers for submission or how to respond to reviews? Do you have questions about publishing research? Learn from the experts how to get published in Journal of Addiction Medicine.

Friday ABAM Events at the ASAM Annual Conference

Following are ABAM-related events that will be presented Friday during the ASAM Annual Conference.

  • Noon to 1 pm, ABAM Foundation Addiction Medicine Fellowship Networking Lunch, Room 602, Sixth Floor
  • Noon to 1 pm, ADM Fellowship Networking Lunch, Room 602, Sixth Floor
  • 12:15 to 1 pm, “ABAM: Status of Certification, Maintenance of Certification, Fellowships and ABMS Recognition,” Room 410, Fourth Floor
  • 1 to 1:45 pm, “All About ABAM Certification and the Exam,”  Room 410, Fourth Floor
  • 8 to 9:30 pm, “ABAM Foundation 2015-16 Next Generation Awards for Adolescent Substance Use Prevention,” Room 406, Fourth Floor

ABAM Reflects Growth of Addiction Medicine

The American Board of Addiction Medicine (ABAM) is continuing its efforts to secure the recognition of the subspecialty by the American Board of Medical Specialties (ABMS). These efforts are paying off as an increasing number of physicians are pursuing educational options and practice paths to ABAM certification, and medical schools and other institutions are adding addiction medicine fellowships.

To learn more about ABAM during the ASAM Annual Conference, plan to attend any of the ABAM-related events that will be presented Friday, as well as the Awards Luncheon on Saturday.

ABAM recently announced that the American Board of Preventive Medicine (ABPM) has begun the formal process to bring addiction medicine into the ABMS as a subspecialty available to diplomates of all ABMS boards, said Kevin Kunz, MD, ABAM Executive Vice President. With the backing of ASAM, ABAM was established as an independent medical board in 2007 with a goal of ABMS recognition.

“In February, ABPM sent the required Letter of Intent to ABMS beginning the rigorous application and review process that will take approximately 18 months. There are many details to be worked out, and much work to be done. Although this process is the responsibility of ABPM as the sponsoring board, ABAM will encourage and support the vital undertaking,” he said.

ABAM has certified 3,363 physicians with the recent addition of 650 ABAM Diplomates who passed the 2014 ABAM certification exam. Many of the new diplomates will be recognized at the ASAM Annual Awards Luncheon Saturday. Kenneth Warren, PhD, Deputy Director National Institute on Alcohol Abuse and Alcoholism will award certificates to diplomates at the recognition ceremony.

The ABAM certification exam was a biennial event, but has become an annual event beginning this year because of the growing number of physicians seeking certification. The exam will be given October 17 and 19, and the regular application deadline is April 30.

“The exam has been buffed up,” Dr. Kunz said. “It has been reviewed for clinical relevance, and the exam writers are from multiple disciplines. People who take the test say it is challenging, but a good experience, that it has brought them up to date and caused them to focus their studying, and that it gives them knowledge that makes them capable of better caring for their patients.”

“All About ABAM Certification and the Exam” will be presented from 1 to 1:45 pm Friday in Room 410, Fourth Floor. A course to help prepare for the exam, The ASAM Review Course in Addiction Medicine, will be presented July 30-August 1 in Orlando.

ABAM also offers a Maintenance of Certification program, required by all medical boards to ensure lifelong competency for addiction medicine specialists.

The growth of interest in addiction medicine as a subspecialty also can be seen in the increase in accredited fellowship programs at medical schools. Eight programs were added in 2014, for a total of 27 programs, and another 10 are now in development.

“Many institutions are interested in this, and most are driven by a local champion, often an ABAM Diplomate who wants to bring the training of other physicians into reality. Our goal is to have 65 accredited fellowships by 2020,” Dr. Kunz said.

The growth in the specialty is being driven by, among other reasons, the Mental Health Parity and Addiction Equity Act and the Affordable Care Act, which are bringing medical care to more people who need treatment for substance abuse and alcohol misuse, he said.

“There is a realization in society that this is a disease that negatively impacts families, work productivity, and social relationships,” Dr. Kunz said. “There is hardly a family that does not understand to some degree the consequences of this disease. Physicians and society are increasingly accepting the reality that evidenced-based prevention and treatment are now available. We need more physicians to bring the science into practice.

“The family of medicine has realized that it is ready to do something about this. Addiction medicine—ABAM and ASAM—are the voice within medicine helping to say it is time to get on with promoting the incorporation of prevention and treatment of addiction into routine medical care. It is a good time for this field.”

Anyone interested in learning more about ABAM can stop by the ABAM Booth (#100) in the Exhibit Hall to sign up for the ABAM newsletter and ABAM eblasts.

Session to Address Lack of Treatment for Opioid Use Disorder Among Incarcerated

One group of individuals is among those in the United States not receiving the necessary care to treat their opioid use disorders. Because these individuals are incarcerated, they do not have access to pharmacotherapy, including buprenorphine, methadone, and naltrexone.

A prisoner’s right to adequate medical care while incarcerated is founded in a landmark Supreme Court case. In 1976, Estelle v. Gamble held that prisoners have the right to access care, the right to care that is ordered, and the right to a professional medical judgment.

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Sarah E. Wakeman, MD

“They generally do not receive detoxification services, so they have to suffer and go through the pain of withdrawal. If there is available treatment for the opioid use disorder, it is based on peer support, psycho-education, or therapeutic communities. No one receives these medications that we know are life-saving,” said Sarah E. Wakeman, MD, Medical Director of the Massachusetts General Hospital Substance Use Disorder Initiative, Boston.

Dr. Wakeman will present “Treatment of Opioid Use Disorder within Correctional Facilities” from 2 to 3 pm Friday in Room 410. She will provide an overview of incarceration in the United Sates and the epidemiology of opioid use disorder among prisoners. She also will review national and international research and experiences with addiction treatment within correctional facilities, with a focus on the evidence for opioid agonist treatment for prisoners with opioid use disorders.

“This session is relevant because the vast majority of people who are inside correctional facilities are there because they have substance use disorders. They’ve been directly arrested for drug-related crimes, or they’ve committed a crime as a part of their actions related to their substance use,” said Dr. Wakeman, also an instructor in medicine at Harvard Medical School.

Although the prevalence of substance use disorder is as high as 85 percent in some facilities, the care inmates receive does not mirror what addiction specialists consider evidence-based standard of care in the community.

“There is at least the expectation that for all other chronic diseases the care while people are incarcerated should be identical to the care they would receive in the community,” Dr. Wakeman said.

She pointed to a number of promising U.S. and international research studies, which found that opioid agonist maintenance among prisoners reduces illicit opioid use, crime, recidivism, and cost. Yet, she said, there continues to be a stigma that medication treatments are merely replacement drugs, not in line with the punishment mindset of prisons, and an avenue for additional smuggling of drugs into prisons.

“We have this huge gap between the science and the practice showing that these medications are effective not just for treating disease but for actually preventing people from going back to prison,” Dr. Wakeman said.

Beyond the needed advocacy for these individuals, Dr. Wakeman noted that addiction medicine specialists would inherit these patients when they return to their communities.

“We know that 95 percent of people in prison eventually will be released, so we are missing this great opportunity to start treatment while they are incarcerated and then provide linkage to care once they get released,” she said.

Dr. Wakeman worked in a state prison during medical school and, since becoming a physician, has run a post-prison release clinic and oversees her organization’s resident rotation in prison health. That background makes her fully aware of the dual loyalty physicians are called upon to have when caring for prisoners.

“In general practice, our sole loyalty as a physician is to the patient and what is in his or her best interest. In working with incarcerated populations, there is this additional entity, which is the correctional facility,” she said. “The goals of incarceration often run counter to the goals of medical care or what would be therapeutic for the patient. As a physician, you find yourself caught between those loyalties.”

The session will conclude with a summary of international examples about how changes in drug policy impact substance use, morbidity, and cost.

“In many other countries, the standard of care is to provide medications while people are incarcerated. We’ll review how a country’s overall drug policy can have a profound effect on both addiction and the intersection between the criminal justice system and addiction,” Dr. Wakeman said. “We’ll present some examples as we think about what lessons can be learned and potentially be applied in America.”

ASAM itself has had a long-standing policy statement that recommends providing care for persons who are incarcerated in addition to advocating to address the needs of care planning around pre- and post-release for the incarcerated population.