2015 Conference News

Ruth Fox Scholars Track Growth From Attending Conference

Last year, 11 residents and medical students chosen as Ruth Fox Scholars were able to attend the ASAM conference through funding from the Ruth Fox Memorial Endowment Fund. But that scholarship can do more than punch a ticket to a meeting; it can open doors in a career.

“I think the Ruth Fox scholarship solidifies an interest many people have in working with addictive disorders,” said Brian Hurley, MD, MBA, a Ruth Fox Scholar. “It formalizes that interest within the context of addiction medicine. It goes from being an area of need you think about but don’t know how to address, to a field of medical practice with a body of knowledge and its own set of skills.”

Since being chosen as a Ruth Fox Scholar in 2004, Dr. Hurley has held numerous positions in ASAM and will be the Treasurer in 2015-17. He is a Veterans Affairs National Quality Scholar affiliated with the University of California, Los Angeles at the VA Greater Los Angeles Healthcare System.

Catherine Friedman, MD

Catherine Friedman, MD

Catherine Friedman, MD, was a Ruth Fox Scholar in 2007. Although she has attended every ASAM Annual Conference since, she still carries fond memories of that first meeting.

“Many medical societies have programs like this to bring trainees to their annual meetings. Ruth Fox could be an example to all such programs of how to do these in a way that engages the participants and pulls them into both the specialty area and the society,” said Dr. Friedman, an Assistant Professor (Clinical) at the Department of Psychiatry and Human Behavior at Alpert Medical School of Brown University.

“My involvement in ASAM has made me much more aware of general addiction issues,” she said. “I have specialized in perinatal and adolescent addictions, but being involved with ASAM has increased my awareness of the general field of addiction medicine and how issues in these subpopulations relate to addiction medicine as a whole.”

Dr. Friedman recalls being directed around the meeting by the late Max Schneider, MD, a former ASAM President and Chair of the Ruth Fox Memorial Endowment Fund.

“He was an amazing person. He said we were going to go to every single function that had to do with ASAM because ASAM brought us there,” Dr. Friedman said. “We had to get up and introduce ourselves many times, and the ASAM members were incredibly welcoming every single time. Every evening the scholars got together with Max, and he had us share what we learned during the day and what we enjoyed most about the day. It helped us get to know each other as a group and to create a community among the scholars.

“That led me into ASAM. I got involved with founding and then leading the Women in Substance Use Disorders Action Group. I also started to do presentations.”

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Brian Hurley, MD, MBA

Dr. Hurley agreed about the impact of the meeting on his career.

“This program gives you exposure so you learn how addiction medicine is practiced in a variety of contexts,” he said. “You see the breadth of addiction medical practice. I walked away with a lot of new ideas about how to practice addiction medicine. I learned there are all kinds of ways I could address the needs of patients with substance abuse that I hadn’t even previously considered. The only place you get that is the ASAM conference.”

More information about the scholarship program is available on ASAM’s website. This year, 10 Ruth Fox Scholars from around the nation will be attending the ASAM conference. Help continue to support this important foundational program, and help ASAM to carry forward activities aimed at improving the quality of addiction care with a generous donation to the Ruth Fox Memorial Endowment Fund.

A Promise to Keep: Ruth Fox Endowment Renews Commitment to Goal

The Ruth Fox Memorial Endowment Fund, established to secure the future of ASAM, is marking its 25th anniversary with a re-energized campaign drive—A Promise to Keep—and a reception to honor its first chair, the late Max Schneider, MD, FASAM, Saturday night.

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Andrea Barthwell, MD, FASAM, DABAM

“There is a double meaning to ‘A Promise to Keep,’ a promise to medicine that we will always be here to make sure physicians are capable and qualified to help people who suffer from this disorder and to keep our original promise to generate $10 million in the reserve fund to make sure ASAM has a sustained future to grow and expand,” said Andrea Barthwell, MD, FASAM, DABAM, Chair of the Ruth Fox Memorial Endowment Fund Committee.

When it was established, the Ruth Fox Memorial Endowment Fund’s goal was to ensure that ASAM always had adequate funding to better serve addiction medicine professionals, but the fundraising effort has plateaued about halfway to the goal. A Promise to Keep is refocusing the fundraising campaign. The endowment earnings are used to help medical students and residents attend the ASAM Annual Conference and to support other organizational priorities.

“A Promise to Keep is recognizing that we have done something, but we have not done enough,” Dr. Barthwell said. “It is recognizing that as a Society we are aging, and there are a lot of opportunities for us who have grown up in this Society to look back at our professional lives and make sure we are doing what we need to do as we wind down our careers—meaning those in my generation are making sure to take care of the Society that took care of us.”

The campaign establishes new tiers for donors, who will now be recognized as their donations grow and move to higher tiers to encourage continued giving by members. In addition, members of ASAM leadership are being asked to make financial commitments to demonstrate their support as they work with outside donors, she said.

Details of the campaign will be shared at the annual ASAM Donors/Ruth Fox Reception Saturday night (invitation-only event), when Dr. Schneider, who died last fall, will be honored. He was a Past President of ASAM and Chair of the Endowment for 22 years.

“Max was a leader in the field. He was very welcoming to all,” said Dr. Barthwell, a Past President of ASAM. “He was known for his tremendous sense of humor and his ability to be very graceful in asking for more money. He was very involved until the end of his life, and his passing was very sad.

“Max recruited me to take over, and it was quite an honor to have him ask and for the Board to appoint me to this position. I hope I can do a fraction of what he did. It is with that in mind that we have attacked with new vigor our activities to make sure our promise is kept. We have a lot of people who are trying to help us achieve our goals in carrying on the work that Max set in motion.”

Interest from the fund also is used to attract young physicians to the specialty through the Ruth Fox Scholars program, which offers scholarships to applicants to increase their opportunities to learn about the diagnosis and treatment of substance use disorders. See a related story about how being a Ruth Fox Scholar helped the careers of two ASAM members.

“Last year we doubled the number we were able to invite, and we want to continue to promote that because it is important for the growth and vitality of our Society that we attract young people to the meeting,” Dr. Barthwell said.

This year, 10 Ruth Fox Scholars are attending the Annual Conference and will be recognized during the Saturday night reception. The scholarship winners are:

  • Sarah Bur, MD
  • Jenna Butner, MD
  • Smita Das, MD, PhD, MPH
  • David Dayan-Rosenman, MD
  • Gibson George, MD
  • Aaron Greenblatt, MD
  • Michael Mirbaba, MD, PhD
  • Enrique Oviedo, MD
  • Wesley Ryan, MD
  • Zoe Weinstein, MD

 

Experts Build Case Against Marijuana Legalization

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The President’s Symposium, “Marijuana: Patient to Policy,” was a popular discussion about the legalization of marijuana.

The drive to legalize or decriminalize marijuana is gathering momentum despite growing evidence it is not a “safe intoxicant.” Fueling the drive is the money of those hoping to become “Big Tobacco 2.0,” according to speakers during Friday’s President’s Symposium, “Marijuana: Patient to Policy.”

Moderated by ASAM President Stuart Gitlow, MD, MPH, MBA, the session featured four speakers and a spirited dialog as speakers discussed questions from the audience. The interest was so great that the session was presented two times Friday.

“We are in an interesting setting where marijuana as medicine has paved the way for people to feel they have a safe intoxicant,” Dr. Gitlow said. “They see this new drug as being a safe intoxicant…without any repercussions.

“This is the work of two groups—those who want to make money off it and those who want to get stoned.”

Wilson M. Compton, MD, MPE, Deputy Director of the National Institute on Drug Abuse, reviewed research showing the growing use of marijuana, how it affects IQ, and how it may lead to addiction.

In 2013, 19.8 million people used marijuana, and 40 percent used it daily or almost daily. It also is not your father’s marijuana, he said, because today’s marijuana is three to four times more potent than it was in past decades.

While according to DSM-IV 9 percent of marijuana users become dependent, those who start using it in their teenage years or are heavy users are more likely to later be found dependent. Studies also show that an increasing number of teens are getting marijuana from other people’s prescriptions where medical marijuana is legal and through nonsmoking routes, such as edibles.

“Does it matter? This is where we begin to link public health issues with neuroscience,” Dr. Compton said. A study in New Zealand showed a drop in IQ in people followed from birth to their late 30s when they began smoking marijuana as teens and continued to smoke.

Other studies around the world have shown links between marijuana use and schizophrenia and an increase in suicide attempts in teen years. The U.S. is now developing a large-scale study of 10,000 children to understand brain growth and development in connection with marijuana, he said.

Kevin Sabet, PhD, Assistant Professor of Psychiatry and Director of the Drug Policy Institute at the University of Florida, and President of Smart Approaches to Marijuana, said that money is driving efforts to legalize marijuana. “We are on the way to creating Big Tobacco 2.0,” he said.

Today, there is a generational divide, where older people do not understand that teens are not smoking joints in the basement. They are getting marijuana in new forms, such as oils and food, Dr. Sabet said.

“The marijuana industry does not make money if some of you relive your glory days at Woodstock,” he said. “It is about people younger than me hooking new customers. That is the only way to stay in business in the addictive industry.”

The number of young people smoking marijuana daily has increased by a factor of seven since 1992, he said, adding, “It is incumbent upon you to stand for a sensible policy that niether demonizes nor legalizes marijuana.

Kevin M. Gray, MD, Associate Professor at the Medical University of South Carolina, Charleston, discussed the challenges of treating cannabis use disorder in youths.

“I noticed anecdotally that some patients were not doing as well as other patients (in mental health treatment clinics) and, lo and behold, most of those were marijuana users,” he said.

That led Dr. Gray to become more involved in marijuana-use studies, and today there is a growing understanding of the endocannabinoid system. Research has shown the effectiveness of N-acetylcysteine (NAC) to reduce drug-seeking in adolescents, but more study is needed, he said. Other studies have used cessation counseling and cash reinforcement for marijuana-negative urine samples from participants, which has been criticized, but effective.

The final speaker was Patrick J. Kennedy, Former U.S. Representative and Founder of the Kennedy Forum, who made brief remarks, adding that he was interested in having an interactive discussion with the audience. He was critical of drives to legalize marijuana, adding, “no one in Congress or in the White House is fighting this.”

 

Dr. Goldsmith Wants to Use Education Experience During Term as President

R. Jeffrey Goldsmith, MD, DLFAPA, FASAM

R. Jeffrey Goldsmith, MD, DLFAPA, FASAM

After serving on ASAM education committees over the last three decades, R. Jeffrey Goldsmith, MD, DLFAPA, FASAM, wants to use that experience during his term as ASAM President to help educate primary care providers and the public about addiction medicine and improve cooperation among health care professionals.

“Getting everybody involved, increasing public awareness, and increasing medical nonspecialist awareness is an important part of what my two years as president is aimed at. I want to focus on interprofessional collaboration as an important goal,” said Dr. Goldsmith, who will become President at the end of the Annual Conference.

“A lot of doctors are not always encouraged and taught to be collaborative with other professionals who have different roles, but who share responsibility for taking care of the same patient. How do we get to know each other, how do we get to know each other’s limitations, how do we get to know all of our strengths? What are the common, simple ways of communicating with each other in a common mission and in the same direction? That kind of coordination is going to be important,” he said.

Dr. Goldsmith worked with traumatic brain injury PTSD patients in residential and outpatient status at the VA Post-Traumatic Stress Clinic for four years and is now working in the Buprenorphine Treatment Clinic in Cincinnati. He joined ASAM in 1984 and immediately became part of the Continuing Medical Education Committee, eventually serving as its chair for nine years. He has served as co-chair of the Medical Education Council and was the expert liaison for ASAM in the development of an online education course about SBIRT.

In his two years as President-Elect, he has been learning more about other facets of the Society and chairing a task force that presented a new three-year strategic plan to the ASAM Board of Directors last summer.

Still, Dr. Goldsmith sees educating primary care professionals—part of the new strategic plan—as a key role for ASAM, in formats such as the Fundamentals Pre-Conference Course and by ASAM collaborating with other medical societies.

“ASAM has over 3,200 members, but there are tens of thousands of professionals in primary care, and if we can activate them, it will improve what we are doing,” Dr. Goldsmith said. “We are not in this alone. It is not us against them. We are trying to use that interdependence in a way that makes us stronger and more effective in our caring.”

There also are many other issues on the Society’s agenda for the next two years, Dr. Goldsmith said:

  • Improving the quality of care for patients being treated for substance abuse. The ASAM Board of Directors has approved new standards of care for addiction medicine, and those standards can become broadly accepted.
  • Establishing basic clinical care measures that can be implemented by ASAM and other national organizations.
  • Reducing the barriers to addiction treatment identified by the Patient Advocacy Task Force.
  • Advancing the recognition of addiction medicine as a subspecialty by the American Board of Medical Specialties.
  • Working with Congress and state legislatures on addiction care issues, such as removing barriers to buprenorphine or methadone treatments, or developing favorable public health details as states decriminalize or legalize medical marijuana.

“I am excited about the next two years,” Dr. Goldsmith said. “The adventure is getting to meet all the people I have not met before who are aware of what is going on but don’t know what the next step is. If ASAM can be there to say, ‘Here is the next step and we can help you take it,’ it will be helpful and strengthen the national health care team to work on a joint mission where we all are doing our parts to take care of this complicated situation with addiction.”

Policy Plenary to Look at Buprenorphine Prescribing Limits

The increase in opioid addiction and overdose deaths has led to public officials looking for ways to reverse the trend. The ASAM Policy Plenary, “Consequence of Changing the Buprenorphine Prescribing Limit,” will discuss suggested options.

H. Westley Clark, MD, JD, MPH

H. Westley Clark, MD, JD, MPH

“There is an inadequate number of doctors prescribing buprenorphine, and therefore the argument that we should eliminate the cap does not address the problem that the issue of opioid misuse is much larger than the number of practitioners who are prescribing,” said the presenter at the session, H. Westley Clark, MD, JD, MPH, CAS, FASAM.

Dr. Clark was Director of the Center for Substance Abuse Treatment, part of the Substance Abuse and Mental Health Services Administration, when Congress passed legislation limiting the number of patients that physicians could treat with buprenorphine. Now the Dean’s Executive Professor of the Public Health Sciences Program at Santa Clara University, he has the experience and gravitas needed to discuss several issues related to buprenorphine prescribing limits during the plenary, presented from 8 to 9:30 am Saturday in Governor’s Ballroom A-C, Fourth Floor.

“I was with the government and we were responding to the field,” he said of the era when prescription limits were set. “One of the things we were tracking was not just the concerns clinicians were raising on the issue of limits, but also a countermovement on concerns about diversion and misuse of buprenorphine. No one has come up with a reasonable strategy to help address those issues.”

That countermovement continues, with some members of Congress coming out against the use of medication-assisted treatment in substance abuse, claiming it lacks adequate evidence of success, Dr. Clark said, adding that he will address some of those other concerns, including:

  • The lack of clear clinical goals and objectives being articulated to the public, as evidenced by a flurry of media coverage
  • Diversion of buprenorphine from treatment into street use
  • The pushback from public officials, including some in law enforcement, who believe recovery should only be drug-free and not include opioid-maintenance treatment
  • The CDC’s argument that opioids are bad for women of child-bearing age because of studies linking a twofold increase in neural tube defects to opioid use
  • Some state limitations on the dose and length of time a person can get Medicaid payments for buprenorphine
  • A few physicians who have been accused of price gouging or misbehavior with regard to buprenorphine
  • Other physicians who have been accused of ignoring psychosocial function in favor of simply dosing with buprenorphine

“Clearly on some of those issues I’m not going to take a pro/con position. I do believe the issue of buprenorphine treatment has been elevated in the political consciousness, with Representative Murphy coming out at his hearing, taking the position of being anti-medication-assisted treatment,” Dr. Clark said of Representative Tim Murphy (R-Pennsylvania), chair of the House Oversight and Investigations Subcommittee, which recently had a hearing on opiate and heroin addiction. “How far that opinion goes will be something addiction medicine specialists will have to deal with.

“This topic is front and center. We need to have a better idea of how we monitor and track, and the outcomes of our interventions because people are raising those concerns. We need to make it clear that if we are dealing with a chronic disease, that it is justifiable to use buprenorphine or methadone or naltrexone to help stabilize a person. We should think in terms of addressing psychosocial decrements of function, not just ideological phenomena.”

New Guideline Consolidates Addiction Treatments, Strategies

The ASAM Board of Directors Wednesday delayed a final vote on the publication of the National Clinical Guideline, featuring recommendations for the treatment of addiction involving opioid use, with a focus on pharmacotherapy and psychosocial interventions.

The Board reviewed a draft document and requested additional clarification. It will reconvene in the near future to vote on the acceptance of the proposed guideline.

A PCSS-MAT session, “Implementing the National Clinical Guideline: Improving Quality of Care in Addiction Medicine,” will look at content in the new document from 4 to 5 pm Saturday in Governor’s Ballroom D, Fourth Floor. Speakers will include the chairs of the ASAM Guideline Committee and the ASAM Quality Improvement Council.

“There are a lot of guidelines for various medications. This one brings together all the medications that are used for the treatment of opiate dependence,” said Kyle M. Kampman, MD, Chairman of the ASAM Guideline Committee. “It also includes special populations that have not been looked at before—chronic pain patients, pregnant patients, adolescents, and criminal justice populations. It is a comprehensive guideline, and to my knowledge there is nothing exactly like it out there.”

Calls for a comprehensive guideline have increased in recent years, and the Guideline Committee began its work about a year ago. It worked with the Treatment Research Institute, Philadelphia, which conducted literature searches of guidelines for several medications.

“We started by focusing mainly on guidelines that had been published by different organizations for various medications, and we started synthesizing that,” said Dr. Kampman, Professor of Psychiatry at the Perelman School of Medicine, Philadelphia. “We put together a list of ‘hypotheticals.’ These were statements of practices, and ultimately we developed almost 300. The committee then rated these hypotheticals based on two things—appropriateness and necessity.”

A draft of the guideline went through rounds of review before it was approved by the ASAM Board of Directors. The publication also goes beyond presenting existing guidelines to include consensus statements when literature is lacking, Dr. Kampman said.

“There have been advancements in the use of all of these medications. This is pretty comprehensive, and we have a lot more options than we did a few years ago,” he said. “But there is a lack of direct literature on some of these things. What we especially lack are direct comparisons between the different medications. In many cases we just did not have that, and we note that in the guideline. Some things are merely presented as a consensus when there was no literature to report.”

Margaret Jarvis, MD, FASAM, Chair of the ASAM Quality Improvement Council (QIC), said the guideline is needed because of the increasing number of primary care practitioners recognizing the epidemic of addiction, but unfamiliar with how to deal with it.

“There are people out there prescribing some of these medications, and there has been a great deal of variability in how well that is done,” said Dr. Jarvis, Medical Director at Marworth, Waverly, Pennsylvania. “There are a lot of questions with a lot of practices about how carefully this is being done—how carefully the diagnoses are being made, how well people are being monitored while on these medications, and whether the appropriate referrals for psychosocial treatment are being made.”

Other concerns focused on processes, the use of adjunct services, making treatment cost-effective and ethical, and keeping medications off the street, she said.

The QIC now will oversee the next steps by determining how the guideline will be distributed. “There are a lot of cool and fun ideas ASAM staff have come up with to roll this out,” Dr. Jarvis said.

One of the first steps may be to publish it online so it is quickly available to educate physicians or as a reference when working with policymakers, she said. Eventually, it could be available in user-friendly formats such as a mobile app or a small handout. Talks about the guideline could be presented to other medical societies.

“It is not news to anyone that we have a hideous national problem with opiate use disorder and overdose deaths as a result of that,” Dr. Jarvis said. “Trying to get effective safe treatment to a large number of people is helped by having guides that describe how to use those medications in a safe and effective way. That’s why this is important.”

Continuum, the ASAM Criteria Decision Engine, to Be Launched in Grand Ballroom Foyer

D2-Continuum Mock-Up

Continuum, the ASAM Criteria software, will be launched Saturday in the Exhibit Hall.

The national launch of Continuum, The ASAM Criteria Decision Engine™, is the focus of a special presentation from 10 to 10:30 am Saturday in the Austin Grand Ballroom Foyer, on the Sixth Floor outside of the Exhibit Hall.

ASAM Criteria Chief Editor David Mee-Lee, MD, DABAM, will make a presentation on the nature of software and the strategy for having it recognized as the national standard of care for evaluation and treatment in addiction medicine, said David Gastfriend, MD, DABAM, the chief architect of Continuum.

D2-Continuum Logo“This is a revolutionary event for the field of addiction treatment. This is the first time a single evidence-based national standard has been produced. This is for the end-user counselor for routine assessment and reassessment of patients at all levels of care,” said Dr. Gastfriend, CEO of the Treatment Research Institute, Philadelphia.

Following the presentation, attendees will be able to demo Continuum™ with the event sponsors: Compulink and Stratus EMR on tablets. The sponsors, Compulink and Stratus EMR have been offering demos at their booths, numbers #107 and #410 respectively, during exhibit hall hours. Both companies took initiative to be the first to offer Continuum™ to the public.

“This is the likely standard that can replace all managed-care prior authorization and utilization review programs,” Dr. Gastfriend said. “Because it guides the clinician to conduct an in-depth evidence-based interview and outputs the diagnostic criteria of DSM-IV and DSM-5, quantitative withdrawal scores, and the Addiction Severity Index composite scores, it provides a rich body of biopsychosocial information.”

ASAM Criteria was first tested in Norway and over the past three years in 20 treatment systems across the United States, and it had a high rate of acceptance and satisfaction from clinicians and patients, he said. Many states, cities, and managed care companies are now interested in migrating to Continuum™ for all placements, prior authorizations, and utilization review.

The clinical decision software will be launched through third-party distributors, including companies that sell electronic health record (EHR) systems and large addiction treatment systems. More than two dozen EHR developers have signed agreements with ASAM to launch the product, Dr. Gastfriend said. The names of those distributors, and any distributors to sign up later, will be posted on the ASAM website.

Those interested in seeing information about Continuum™ and signing up to receive updates on the product are invited to visit www.ASAMContinuum.org. The website features some archived product demos and mock interviews using the assessment tool. Authorized resellers will also be listed on the site.

Dr. Gitlow Looks Back and Forward as Presidency Ends

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Stuart Gitlow, MD, MPH, MBA

After serving almost four years as ASAM President, Stuart Gitlow, MD, MPH, MBA, will hand the leadership of the Society to President-Elect R. Jeffrey Goldsmith, MD, DLFAPA, FASAM, at the end of the Annual Conference. It is a transition he has been preparing for, but with mixed emotions.

“The experience has been wonderful. I have had a great time. I would not put anybody through it, but I would be happy to do a couple more years of it,” Dr. Gitlow said with a laugh as he reflected on his time in office. “It’s been a fascinating experience, but one I enjoyed. I hope the organization enjoyed my experience as well.”

To smooth the transition, Dr. Gitlow has tried to involve Dr. Goldsmith and the incoming President-Elect, Kelly Clark, MD, MBA, FASAM, in ASAM governance, but he also recognizes they will need to put their imprints on the organization during their terms in office. (See related story.)

“In any job, the mark of a good leader is not only to lead, but to make sure the organization is prepared and the next leader is prepared for the transition. Mentorship is a critical part of any leader’s activities,” Dr. Gitlow said. “I have worked closely with Jeff and Kelly to ensure they are strong and able to carry out all the duties that are involved in leading the organization. Both have wonderful strengths and superb ideas they will be implementing in the coming years. I think the Society will be in excellent hands.”

Although the President is the face of ASAM, its direction is set by the Board of Directors, which develops a strategic plan.

“The president’s role is to carry out that plan with the help of a strong staff, officers, board, and chapter leadership,” Dr. Gitlow said. “What the president’s own opinions are become somewhat subdued. The president’s role is to carry out the will of the board, and ultimately the membership.

“If everything were perfect, no one would know the presidents had changed because the will of the organization continues to get carried out. In truth, it’s a mixture. Each person tends to focus on areas they know best or think are most important.”

Dr. Gitlow said his focus has been on public policy issues—eliminating the cap on buprenorphine use, stressing ASAM’s positions on marijuana, and taking public positions on the use of alcohol and tobacco.

“Jeff has a wonderful background in terms of educational approaches, and I think he will draw upon that. That is a great opportunity,” Dr. Gitlow said. “We have done a lot to transition from an old school approach in medical education, and now we are starting to open doors to new approaches. I think we will see Jeff’s mark on many of those activities.

“Kelly is quite different from Jeff and me. She, too, will pick different areas of focus. The order of things in going from the last president to me, to Jeff, and to Kelly is great because all of us have different outlooks and opinions that we will be utilizing.”

Looking back on his time in office, Dr. Gitlow said ASAM has had many “front-page” issues to contend with, such as the opioid epidemic, the push to legalize marijuana, and the move to team approaches to care driven by the Affordable Care Act.

“The need for greater attention to this particular medical specialty is key,” he said. “We are opening our doors to nonphysician clinicians. That has been a transition for us and the country. We are looking forward to the opportunity to bring information from the medical specialty to non-physician clinicians more strongly than in the past. That transition has been one the organization is going through. Jeff coming in as president is perfect timing on that front because of the educational need and opportunity.”

Addiction Medicine on Path Toward a New Era

Three of the most visible proponents of developing modern, scientific approaches to the management of addiction received standing ovations from a standing-room-only crowd during the Opening Scientific Plenary of the ASAM Annual Conference Friday.

Discussing government approaches toward a national drug control policy, the reaction of the brain to drug use, and the goals of the Mental Health Parity and Addiction Equity Act were Michael P. Botticelli, George F. Koob, PhD, and Patrick J. Kennedy. Botticelli is the Director of the Office of National Drug Control Policy (ONDCP), Dr. Koob is the Director of the National Institute on Alcohol Abuse and Alcoholism, and Kennedy is a former U.S. Representative and Founder of the Kennedy Forum.

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Michael P. Botticelli

Botticelli reviewed the ONDCP National Drug Control Strategy, which addresses plans to reform the response to substance use, focusing on overdose prevention, medication-assisted treatment, and criminal justice reform.

“There are 23 million people in recovery and we want to support them. This is a disease…a health problem,” he said, adding that the health care community and third-party payers need to recognize the need to transition to a treatment model that sees addiction as a chronic condition.

“We have an obligation to make sure we change our language as it relates to addiction,” Botticelli said, adding that only 19 percent of those with addictions are receiving treatment. “We put the locus on the patient to get treatment. We need to put that responsibility on the system, not the patient.”

In response, government spending on drug control and treatment of addiction is increasing, and the science of addiction treatment is moving into a new era—slowly, he said.

“I wish we did not have a divide between abstinence-based care and medication-assisted care,” Botticelli said. “I hate the terms we use. It undermines treatment in general when we talk along these lines.”

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George F. Koob, PhD

Dr. Koob, former Editor-in-Chief of the Journal of Addiction Medicine, received the R. Brinkley Smithers Distinguished Scientist Award and presented “Reward, Stress and Addiction: Two Faces of Janus.” He discussed how the reward and stress neurocircuitry of the brain changes during the course of the addiction cycle, resulting in compulsive drug-seeking behavior.

The brain goes through three stages in reaction to the use of drugs, he said:

  • The Binge Intoxication Stage is characterized by a compulsion to seek and take drugs, which causes the system to change. This is a time when habits are formed.
  • The Withdrawal/Negative Affect Stage is when there is a loss of control in limiting intake. Researchers have traced this process in the brain and are trying to develop a drug to reverse that process.
  • The Preoccupational/Anticipation (Craving) Stage is a key element of relapse in humans, and it defines addiction as a chronic relapsing disorder. It most strongly affects the frontal cortex, and defects in the frontal cortex may drive addiction problems.

Moving forward, a key part of this ongoing research is to develop a better understanding of how neurotransmitters work, Dr. Koob said.

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Patrick J. Kennedy

Kennedy, who is in long-term recovery from addiction, discussed the importance of the Mental Health Parity Act, how it could be enforced, and the role of addiction medicine in the nation’s health care system.

The son of the late Senator Ted Kennedy, Patrick Kennedy took a much lighter approach toward discussing addiction by joking about his iconic family before moving on to the effects of political assassinations and alcoholism on his upbringing, and his addiction.

That background led Kennedy to be the primary sponsor of the Mental Health Parity Act in Congress, when he was “in and out of treatment,” at a time when addiction was treated as an acute rather than a chronic condition. The Mental Health Parity Act is changing that debate, Kennedy said.

“We are at the most exciting period of time…where we will treat the whole person,” Kennedy said, adding that means better medicines for treatment, improved research, and a stronger addiction community.

“At the end of the day, we all are in this together. Why is addiction treatment not reimbursed by insurance companies? That is something that has to be changed,” he said. “We have to make real the promise of the Parity Act—that we treat addiction and mental health the same way as any other physical illness.”

 

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.