Friday Conference News

NIDA Blending Conference Joins ASAM Conference

Mary Ellen Michel, Ph.D., Deputy Director of NIDA's Center for Clinical Trials Network, (left) and Geetha Subramaniam, M.D., Medical Officer, NIDA Center for Clinical Trials.

Mary Ellen Michel, Ph.D., Deputy Director of NIDA’s Center for Clinical Trials Network, (left) and Geetha Subramaniam, M.D., Medical Officer, NIDA Center for Clinical Trials.

The National Institute on Drug Abuse (NIDA) brought its annual Blending Initiative Knowledge Exchange Meeting Thursday directly to ASAM attendees for the first time. Leading addiction medicine specialists focused on four key areas with a new hands-on workshop style.

“We at NIDA convened a planning committee that included Gavin Bart, M.D., FACP, FASAM, as the ASAM representative and sought to create program content that was an interactive, bidirectional, hands-on, and practice-based learning opportunity for the attendees, very different from most passive lecture-format sessions,” says committee chair Geetha Subramaniam, M.D., Medical Officer, NIDA Center for Clinical Trials.

This was the first time the Blending Conference was held at the ASAM Medical-Scientific meeting; in the past, NIDA conducted this as a standalone conference, says committee member Mary Ellen Michel, Ph.D., Deputy Director of NIDA’s Center for Clinical Trials Network.

“We wanted a forum for practitioners to ask questions, to share cases, and to talk about their real-life experiences in implementing different approaches to addiction medicine,” she says. “This is information clinicians can begin to apply the first day they are back at their practices.”

Two plenary sessions addressed the issue of addiction as a chronic illness from different perspectives. A. Thomas McLellan, Ph.D., M.S., Chief Executive Officer, the Treatment Research Institute, Philadelphia, took a policy perspective. He discussed the opportunities presented for integrating addiction treatment with general medical settings in the emerging health care system of medical-centered homes.

Robert Califf, M.D., Director of the Duke Translational Medicine Institute, Duke University Medical Center, Durham, N.C., took a clinical perspective. He offered insights into how clinical trials for addiction and other chronic illnesses could be innovative in adapting to and accommodating the challenges of the evolving landscape of the health care system.

The highlight of the Blending Conference was concurrent interactive workshop sessions, led mostly by physician experts, focusing on four topic areas, Dr. Subramaniam says. These included motivational interviewing; new pharmacological treatments; screening, brief intervention, and referral; and rapid HIV testing.

“Motivational interviewing is very well known and is highly efficacious,” Dr. Michel says. “But actually implementing it, creating that neutral atmosphere for the client, is more difficult than many people appreciate. The workshop ‘Making Motivational Interviewing Techniques Accessible to Primary Care’ offered practical tips on putting this important technique to work in real practices with real patients.”

Session video recordings and copies of support materials from Thursday’s Blending Initiative Knowledge Exchange Meeting are available at NIDA’s Center for the Clinical Trials Network Dissemination Library.

Medication-Assisted Treatments
Physicians and non-physician clinicians are always looking for tips on implementing and/or addressing challenges in pharmacologic treatments for patients with substance use disorders. The Blending Conference did not disappoint.

In the intermediate-level workshop,”Medication-Assisted Treatment,” leaders provided a quick overview of the latest evidence for opioid dependence using buprenorphine and extended-release naltrexone. They elicited and shared strategies to adopt medicine-assisted treatment into clinical practice, reviewed the available training and mentoring programs, and discussed strategies to deal with challenges resulting from integrating these treatments into either general medical settings or counseling-focused treatment settings.

“We at the NIDA Center for Clinical Trials Network just finished a trial with buprenorphine in prescription opioid addiction,” Dr. Michel says. “This is an important population in whom it can be an effective treatment.”

SBIRT 
ASAM members are familiar with Screening, Brief Intervention, and Referral for Treatment (SBIRT), but few outside the addiction specialist community recognize either the acronym or the concept. NIDA wants to close that knowledge gap.

“We are very concerned about bringing SBIRT to as wide an audience as possible,” Dr. Michel says. “Presenting two sessions on the topic at ASAM might seem counterintuitive, but we see substance abuse physicians as an ideal vehicle to reach out to more traditional primary care settings, emergency departments, and general physician offices. This notion of screening, a brief intervention, and an appropriate referral for treatment can reach many, many more people with substance abuse problems and help educate other providers.”

One workshop focused on ways to work more closely with emergency departments, she says. They discussed how to successfully refer and link higher severity patients to specialty and higher levels of addiction treatment. The other workshop looked at ways to shape the emerging workforce by training medical students, residents, and non-physician practitioners that ASAM members work with on a regular basis.

“If you want to bring SBIRT into your own practice, connecting with other practitioners is a very good way to do it,” she says.

Rapid HIV Testing
Rapid HIV testing has emerged as a new frontier for substance abuse. Rapid testing can provide almost-instant results in the office setting, Dr. Michel says.

“The workshop presented how rapid HIV testing can be introduced into substance abuse treatment practices,” she says, “including approaches to positive results, including giving the individual information, confirming results, referring them for treatment, and so on.”

ABAM: Residencies Key to Establishing Addiction Specialty

To become a recognized, certified specialty similar to addiction psychiatry, addiction medicine must receive approval by both the American Board of Medical Specialties (ABMS) and the Accreditation Council for Graduate Medical Education (ACGME). Meeting those standards has been no easy task, but the specialty is well on its way.

The American Board of Addiction Medicine (ABAM) and ASAM are working together to move the field forward, setting standards and processes that will eventually meet ACGME and ABMS requirements, says ABAM President Jeffrey Samet, M.D., M.P.H. Among the tasks the specialty must accomplish, none is more important than establishing and securing long-term funding for 20 to 25 ABAM Foundation-accredited addiction medicine residency programs.

“If we, as a board, want to become ABMS-blessed, then we need to establish an extensive list of accredited residency programs,” he says. “The desired number is somewhere between 20 and 25 programs, but that, of course, is a means to an end.”

Thursday’s Component Session 1, “The American Board of Addiction Medicine (ABAM), and The ABAM Foundation: The Development and Accredita­tion of Addiction Medicine Residency Training Programs, and the Recognition of Addiction Medicine as a Medical Specialty by the American Board of Medical Specialties (ABMS),” discussed this pathway at length, featuring ABAM Foundation Board Member and Training and Accreditation Committee Chair Richard D. Blondell, M.D.

“We’ve developed a standardized national curriculum for all of these programs to follow,” Dr. Blondell says. “There were fellowship programs that existed in addiction medicine prior to the national curriculum, but now we are moving forward and have also developed a set of core competencies that trainees are required to possess at the end of their training. From there, we began integrating that program into the existing structure at several medical schools and teaching hospitals around the country.”

Dr. Blondell says that the March 19 announcement that The ABAM Foundation had accredited the Addiction Medicine Fellowship  Program at  NYU School of Medicine signaled a big win for the specialty.

“That was a major watershed moment for  ASAM and ABAM because it brought the total number of accredited programs to 10,” he says. “In the next year, we would like to get 10 or more programs up and running because we will need at least 20 programs to move forward. This is an important step for our specialty because, right now, only psychiatrists can specialize in addiction psychiatry, and it is imperative that we open this up to physicians who are certified by other primary medical specialty boards.”

In addition to the NYU School of Medicine, the following programs have been accredited by the ABAM Foundation:

  • Addiction Institute of New York Fellowship in Addiction Medicine; St. Luke’s and Roosevelt Hospitals
  • Boston University Medical Center Addiction Medicine Residency
  • Cincinnati Addiction Medicine Fellowship; University of Cincinnati College of Medicine
  • Geisinger Addiction Medicine Residency at Marworth
  • Minnesota Addiction Medicine Residency Program: UM-HCMC-VA; University of Minnesota Medical School
  • University at Buffalo Addiction Medicine Fellowship
  • University of Florida Addiction Medicine Program
  • University of Maryland—Sheppard Pratt Training Program; University of Maryland Medical System
  • University of Wisconsin  Program; University of Wisconsin School of Medicine and Public Health

All of the programs are modeled on the ABAM Foundation’s national guideline, The Program Requirements for Graduate Medical Education in Addiction Medicine, which was released in March 2011.

Dr. Samet says that with addiction medicine maturing—residencies coming on line, a core set of documents describing the field in hand, a plan to train physicians, and a means to accredit programs and certify physicians—it is beginning to establish itself formally. It also provides assurances to the medical establishment, as well as health care organizations and patients, that a standard of excellence has been set.

Dr. Samet says that Course 7 “Setting Up an Addiction Medicine Fellowship,” from 2 to 4 p.m. Saturday in Rooms 204-205, will provide a solid nuts-and-bolts primer for attendees interested in learning more about the process behind creating a residency program. The course is led by Petros Levounis, M.D., ASAM Director-at-Large, ASAM Medical Education Council Member, Director of The Addiction Institute of New York, and Chief of Addiction Psychiatry at St. Luke’s and Roosevelt Hospitals, New York.

Dr. Levounis says the format should prove interesting because it will include a panel of physicians from his own fellowship program at The Addiction Institute of New York answering questions from a physician, Launette Rieb, M.Sc., M.D., CCFP, FCFP, who is in the middle of establishing her own residency program.

“We will have three presentations from the faculty here, but also we’re going to have an interactive segment based on a structured dialogue with Dr. Rieb about her own experience, and the challenges and opportunities that she has encountered,” he says. “So it won’t just be talking heads in a room, but instead I hope that both the presenters and the participants will engage in an open discussion with someone who has been facing the obstacles—and inevitable frustrations—that come with putting together a fellowship. So in a very real sense, she will keep us honest.”

This is a ground-up session that will explain how to build a residency program from The ABAM Foundation’s perspective.

“We are trying to get attendees at the meeting to understand what it might take to do this because they are the ones who are going to eventually realize that with some help, they can really put together a program and fill this need,” Dr. Samet says. “So we are taking out the guesswork, showing them what’s really involved, and what the standards for building a training program really are.”

Dr. Samet says that while he has enjoyed watching the existing residencies take shape, he is even more excited to watch the growth the overall program is beginning to see as the individual programs begin to collaborate and share ideas with another.

“It has been fairly remarkable to look at the progress we’ve made over the past few years,” he says. “Now it is all about establishing and feeding a body that helps newer programs get on board. As these existing programs continue to learn from one another, they can share what they’ve learned with the programs coming up behind them and cut the time-to-accreditation considerably.”

Substance Use in Women Raises Reproductive Health Risks

Pregnancy and substance use clearly do not mix, and the Workshop “Women and Substance Use: Emerging Research and Clinical Topics,” shines the spotlight on this issue from 3 to 5 p.m. today in Rooms 204-205.

The workshop, led by Catherine Friedman, M.D., provides a review of contemporary topics of clinical and research interest related to this segment of the addiction community. Dr. Friedman is Assistant Clinical Professor in the Department of Psychiatry and Human Behavior at Alpert Medical School of Brown University, and Attending Psychiatrist at the Center for Women’s Behavioral Health, Women and Infants Hospital, Providence, RI. She notes that pregnancy and prevention among women diagnosed with substance use disorders is a chief concern of addiction specialists, as well as primary care physicians who treat women and children.

“Nationwide, more than 7,000 babies are born to opioid-dependent women each year. And in many localities, this number is increasing,” Dr. Friedman says. “For example, at Magee Hospital in Pittsburgh, 176 babies were born to opioid-dependent women in 2009, and that’s up from 25 babies in 2002.”

The workshop will feature presentations on “Reproductive Counseling as a Prevention Tool in Substance Abuse Treatment,” “Integrating SBIRT into Prenatal Care,” “Methamphetamine and Pregnancy,” “Methadone Induction in Pregnancy—Inpatient vs. Outpatient,” and “A Comprehensive Women-Centered Approach to Reducing Drug Use and Preventing HIV: Emerging Evidence from a Southern-African Intervention for Methamphetamine-Addicted Pregnant Women.” This last presentation, she notes, is a substitution for another topic previously listed in ASAM’s conference materials.

During the session, Dr. Friedman will discuss the benefits and drawbacks of methadone induction in pregnancy in both the inpatient and outpatient settings, as well as the systemic difficulties in implementing changes in local practice. In various states, she says, custom and availability of services dictates whether a pregnant woman is started on methadone on an inpatient or outpatient basis. Little research exists on which setting is the better option.

“Both the stage of pregnancy and social factors likely influence the optimal setting for methadone induction during pregnancy, and this may vary from woman to woman,” Dr. Friedman says. “But there are options to introduce both inpatient and outpatient induction, even in settings where only one option currently exists.”

In her presentation, “Reproductive Counseling as a Prevention Tool in Substance Abuse Treatment,” Jacquelyn Starer, M.D., FACOG, FASAM, will discuss dual prevention strategies to reduce the number of drug-exposed pregnancies by focusing on pregnancy planning in addition to screening and treatment of substance use disorders in women of reproductive age.

“The most important takeaway from this is to understand that a thorough reproductive history and reproductive counseling in treatment settings is a critical tool to prevent unplanned pregnancies in women with substance use disorders,” Dr. Starer says. “Reproductive issues are the primary concern of young women. If not properly counseled, an unplanned pregnancy can negatively impact the woman’s recovery and harm the fetus.”

Dr. Starer is Chair of ASAM’s Women and Substance Use Disorders Action Group, Coordinator of the Division of Opioid Dependent Pregnant Women at Community Substance Abuse Centers in Chelsea, Mass., and Associate Attending Physician at Faulkner Hospital Addiction Recovery Program in Boston. The Women and Substance Use Disorders Action Group has accomplished much during the last year, including the development of joint publication with the American Congress of Obstetricians and Gynecologists (ACOG) on opioid abuse, dependence, and addiction during pregnancy.

“We are delighted to have partnered with ACOG to create the Joint Committee Opinion, ‘Opioid Abuse, Dependence, and Addiction In Pregnancy,’ and we expect that the Committee Opinion will have a great impact on the care for pregnant women suffering from addiction when its released later this month.”

In all, Dr. Friedman says she hopes the workshop will expand the health care community’s discussion of substance use in women and how it is complicated by pregnancy and potential pregnancy.

“There are many compelling, unanswered clinical and research questions on how best to evaluate and treat reproductive-age or pregnant women who use substances,” she says. “Social and political factors also affect the care available to this population.”

ASAM Welcomes NAADAC to 2012 Med-Sci Conference

Cynthia Moreno Tuohy, NCAC II, CCDC III, SAP

Cynthia Moreno Tuohy, NCAC II, CCDC III, SAP

Addiction medicine specialists will spot a familiar presence in the 2012 Medical-Scientific Conference Exhibit Hall with NAADAC, the Association for Addiction Professionals. The association will showcase its education and training tools and provide attendees with information about the organization’s mission and objectives.

ASAM and NAADAC have worked together on advocacy issues over the years and served as leaders in the field of addiction medicine. Long regarded as a respected partner with ASAM, NAADAC, like ASAM, provides its members with education, professional development, legislative advocacy, certifications, and membership services.

“NAADAC and ASAM are alike on many levels, from training and education to certification and advocacy,” says Cynthia Moreno Tuohy, NCAC II, CCDC III, SAP, Executive Director of NAADAC. “Both our organizations are focused on making a difference in the current discussion and perception of addiction issues, including the Affordable Care Act.”

The association was founded in 1974 as the National Alcohol Counselors and became NAADAC some years later after adding drug counselors. NAADAC represents the professional interests of more than 75,000 addiction counselors, educators, and other addiction-focused health care professionals in the United States, Canada, and abroad, with affiliates in 44 states, 10 territories, and other countries. Its 8,000 members provide services across all health care settings and specialize in addiction prevention, intervention, treatment, recovery support, and education.

NAADAC was founded on the belief that addiction is a brain disease, and as such, supports continued research and policies that improve addiction awareness, prevention, and treatment, and recovery support, Moreno Touhy notes. NAADAC and ASAM are members of the Addiction Leadership Group, advocating for changes in insurance coverage for individuals diagnosed with addiction disorders. The group includes addiction-focused associations with representation in Washington, D.C., and meets monthly to coordinate its legislative agendas and other initiatives of mutual interest.

Because addiction is a global problem, Moreno Tuohy says NAADAC’s efforts are worldwide, providing training and certification and other support to a host of countries. To date, NAADAC has credentialed more than 15,000 counselors in the United States and abroad. Among its certification programs are the National Certified Addiction Counselor, the Nicotine Dependence Specialist credential, and the Masters Addiction Counselor designations. The Master’s Addiction Counselor credential was recently recognized by the Association for Behavioral Health and Wellness (ABHW) as the credential most used by managed health care third-party reimbursement.

“We facilitate certification internationally and help build professional development systems for governments beyond the United States,” says Moreno Tuohy. “I like to say we teach them how to fish and then they go fish.”

In its role to promote excellence in care, evidence-based services, and the well-being of the public, NAADAC created a Code of Ethics for the addiction field. Written to govern the conduct of its members and considered the accepted standard of conduct for addiction professionals, NAADAC’s Code of Ethics reflects the organization’s ideals and that of its members and other professionals in the addiction field. As such, when an ethics complaint is filed with NAADAC, it is evaluated by consulting the NAADAC Code of Ethics. The NAADAC Code of Ethics is designed to represent the values of the profession and to be used as a guide for making clinical decisions. State certification boards and educational institutions use NAADAC’s code to evaluate the behavior of addiction professionals and to guide the certification process.

Make plans to attend the  NAADAC National Conference August 12-15 in Indianapolis, which will showcase the association’s services, products, programs, and principles. Visit the NAADAC website for more information.

State and Regional Chapters Want Your Energy and Involvement

Several ASAM state and regional chapters reactivated in 2011 with new leaders ready to start working on local issues affecting addiction medicine and treatment. Some of the new or reactivated chapters include the Northern New England chapter (comprising Maine, New Hampshire, and Vermont), the Kentucky chapter, and the Texas chapter. Others, including Alabama, Nevada, and the Midwest chapter (comprising Kansas, Missouri, and Nebraska) are working towards reactivation.

Regardless of whether a chapter is reactivating or existed for a while, chapter leaders always look for members interested in getting involved. Here are some of the ways members may become involved:

Help voice opposition to state limitations on third-party reimbursement policies for medication-assisted treatments. This has been a hot topic recently, with activity in many different states as governors and legislatures are slashing budgets to cut costs. Mark Publicker, M.D., FSAM, President of the Northern New England Society of Addiction Medicine, and ASAM Patient Advocacy Task Force Chair Mark L. Kraus, M.D., FASAM are leading Component Session 5 “State Medicaid Limitations on Buprenorphine: How to Fight Back” from 10 a.m. to noon Saturday in Grand Salon West, Salon E. Dr. Publicker will share some resources and lessons learned from his recent work to stop limitations in Maine.

Start an online discussion on an important topic in your state through ASAM’s new website, and the Groups functions. Groups allow chapter members to share ideas, network, and create discussion forums and blogs. (To access the content for your chapter, log in to www.asam.or, select “Membership” and “State Chapters.)

  • Serve on a planning committee for an upcoming state chapter conference.
  • Volunteer to speak on an issue to a community group, or through an upcoming state conference.
  • Run for office in your chapter. State Board positions usually require minimal time commitments.
  • Volunteer to help encourage members to renew their membership, or lead a recruitment campaign to show prospective members all the benefits of membership. Contact the ASAM national office for more information.

Regardless of where you jump in to participate, the point is to get involved. ASAM state and regional chapters, and ASAM itself, need your involvement and energies to maintain a vibrant, effective specialty society. Contact the ASAM national office for more information, www.asam.org/contact-us.

Ruth Fox Course Planned to Offer Latest Research Findings on Effects of Addiction in Women

Margaret A. E. Jarvis, M.D., FASAM

Margaret A. E. Jarvis, M.D., FASAM

In planning a useful and thought-provoking 2012 Ruth Fox Course for Physicians, course directors sought to focus on how women are uniquely affected by addictive diseases and invited women to be course speakers, with one exception. The result was a symposium with the theme “Improving the Health of Women” that brought new research and insights to the forefront.

“Our speakers included a number of ASAM members who are quite successful, who have served this organization, or served at the national level in various government agencies,” says Margaret A. E. Jarvis, M.D., FASAM, Co-Director of the Ruth Fox Course for Physicians.

“There are gender differences in how this disease manifests and how to treat it,” Dr. Jarvis says. “Over the last three to four years, we’ve done a lot of thinking about how to do things so that the Ruth Fox Course is useful. This is one aspect of addiction disease and treatment that needs to be addressed.”

Dr. Jarvis notes that the progress of researching the gender difference in addiction manifestation and treatment is analogous to that of women and heart disease.

“It seems to run a decade behind, and we saw that in the area of heart disease and women,” she says. “There are nuances in treatment based on gender that we need to incorporate into practice.”

The speakers at this year’s Ruth Fox Course highlighted recent research that is focused on women and addiction.

“We always have Stanley Gitlow, M.D., begin this course, because he remembers Ruth Fox so well and shares his insights and memories of her exceptional work and commitment to this,” Dr. Jarvis says.

Research on women and addiction, such as that presented at the Ruth Fox Course, is relatively new.

“We looked at doing things differently in research involving women,” Dr. Jarvis says. “Historically, research in this area has ignored the fact that there are women with addictions, and we’re ignorant regarding how best to treat them.”

For example, that recent research shows that women may be more genetically vulnerable to addictions than men, and these new findings have the potential to change the way people with addictions are treated, she says.

“It’s still very new,” Dr. Jarvis says. “We have to begin to incorporate these nuances into practice.”

More ASAM members can now access the information presented during the Ruth Fox Course, thanks to the uploading of the course to the ASAM e-Live Learning Center.

“A perennial quandary for those at this meeting has been that the Ruth Fox Course and the Pain & Addiction Course are opposite each other, and there’s so much information to absorb,” she says. “But this year, I’d encourage everyone to take advantage of the ASAM e-Live Learning Center and get access to all the information that’s available.”

The Ruth Fox Course for Physicians will be available through the e-Live Learning Center at the end of May. Find the e-Live Learning Center at the ASAM website, under the “Education” tab.

Ruth Fox Identifies Telescoping as a Challenge in Dealing with Addiction Problems Among Women

Andrea Barthwell, M.D., FASAM

Andrea Barthwell, M.D., FASAM

Telescoping occurs much more frequently in women than men and therefore places them at increased risk for substance use disorders. So concludes one of the many speakers for Thursday’s Ruth Fox Course for Physicians, Andrea Barthwell, M.D., FASAM, who was interviewed before the ASAM Annual Medical Science Conference.

Dedicated to the Founding President of ASAM, speakers of this year’s Ruth Fox Course for Physicians focused on “Improving the Health of Women” by providing new directions and concepts in clinical practice, as well as updates on research and practical applications and a review of important and timely issues in addiction medicine.

Penelope P. Ziegler, M.D., FASAM

Penelope P. Ziegler, M.D., FASAM

For her presentation, “Substance Use and Women’s Health,” Dr. Barthwell presented her work from the last 30 years with women and summarized a recent publication of the same title. The former Deputy Director for Demand Reduction at the Office of National Drug Control Policy under President George W. Bush, Dr. Barthwell defined telescoping as the rapid progression toward alcoholism and drug dependence and an earlier onset of consequences by using the same, or similar, quantity of the substance compared to patients who do not experience this phenomenon. Telescoping and alcohol-related, alcohol-caused diseases in women are unique or occur at rates greater than in men. Dr. Barthwell advocates different approaches to assessment for alcohol, tobacco, and other drug use in women.

Penelope P. Ziegler, M.D., FASAM”With educational objectives aimed at changing a physician’s behavior, we intend to help ASAM practitioners identify and intervene in women’s substance abuse much earlier so that women experience fewer consequences in the future,” she says. “We hope to change how ASAM physicians interview and approach women in their practices in order to improve women’s health through earlier intervention and women-sensitive treatment.”

As an example of the difference between men and women, the American Cancer Society reveals a sobering fact about women and tobacco use.

“While women start smoking later in life than men, they experience health consequences earlier,” Dr. Barthwell says. “When dealing with a woman, we teach physicians to modify their screening techniques.”

Dr. Barthwell says the same is true for alcohol abuse. “Women need intervention earlier because liver disease develops at a lower cirrhotic threshold and earlier than in men,” she says. “With regard to alcohol, clear physiological differences exist between women and men because the critical enzyme in women, alcohol dehydrogenase, is less effective in breaking down alcohol than the one in a man’s stomach and small intestine. If a woman drinks the same amount as a man, her organs are bathed in a higher volume of alcohol at similar consumption rates, and the clearance of alcohol is delayed due to differences in the volume of distribution in women when compared to men.”

In another pre-Med-Sci Conference interview, Martha Wunsch, M.D., FAAP, FASAM, of Blacksburg, Va., discusses her presentation, “Addiction and Adolescent Girls,” noting that addiction often begins with use of tobacco, cannabis, and alcohol in the pediatric age group.

“Girls are catching up with boys in use and abuse of drugs, particularly in mid-adolescence,” she says. “We are familiar with some factors that are protective, as well as those that place a young girl at increased risk for abuse.”

Dr. Wunsch says that it is important to increase physicians’ familiarity, and comfort level, with teens and substance use disorders.

“There are very few pediatricians who focus on addiction medicine, and so the addiction medicine specialist must be prepared to provide care to the adolescent,” she says. “Teens in general are greatly underserved. I will present skills that are helpful when working with this patient population. I hope to attract more physicians to focus their talents here.”

Still another pre-conference interview gleaned insights from Penelope P. Ziegler, M.D., FASAM, Medical Director of the Virginia Health Practitioners’ Monitoring Program , on “Addiction in Women Physicians.” She makes the point that not only are women different from men across the board when it comes to addiction, but women physicians also differ from their male counterparts.

“The fact of the matter is that there is very little information available with regard to addicted women in medicine,” she says. “If you take a look at various sources, very few women are being included in these monitoring studies. While the numbers of addicted women are similar to men, it is a mystery why there are so few women in these peer-assistance programs.”

She says that it would be easy to assume that fewer women get addicted than men, but data show that is not the case.

“It is possible the system is enabling women to go undetected and fewer are reported to monitoring programs because people are less comfortable with reporting women,” she says. “It is less likely for a woman to be suspected of abuse, often because women are more private in their drug abuse, and they may be more clever in the ways they go about avoiding detection.”

Pain & Addiction Course: Common Threads XIII Set its Focus on Physician Opioid Addiction, Rx Drug Abuse

Herbert Malinoff, M.D., FACP, FASAM

Herbert Malinoff, M.D., FACP, FASAM

When leaders planned Thursday’s day-long Pain & Addiction Course: Common Threads XIII — Healing the Healer, they ensured that presentations addressed the latest research on treatment strategies for physicians with opioid addiction and the profession’s response to the epidemic of prescription drug abuse. The course succeeded on both fronts in featuring leaders in these fields presenting the latest advances and insights on these important issues.

Speakers presented successful strategies for treating physicians with addictions, and participants learned much from this experience that could benefit all people who are addicted to opioids, says Herbert Malinoff, M.D., FACP, FASAM, Chair of the Pain & Addiction Course Planning Committee.

Edwin A. Salsitz, M.D., FASAM

Edwin A. Salsitz, M.D., FASAM

“The experts in the field reviewed how physicians with addictions are treated successfully, but the real issue is how to extrapolate that to others who aren’t physicians,” says Dr. Malinoff. “The treatment physicians can access can be a template or paradigm for treating all people with that illness. The problems are that our health care delivery system is not set up to deliver that kind of care to those who need it and, even if it were, there are not enough professionals to provide that kind of treatment.”

Dr. Malinoff says that he appreciates the location of the 2012 ASAM Medical-Scientific Conference in Atlanta because it is home to many government agencies, including the Centers for Disease Control and Prevention, and that many government officials attended the course. These are government thought leaders who could take information they learned and discuss important issues surrounding the delivery of care for addiction.

During the course, ASAM Board of Director-at-Large Paul H. Earley, M.D., FASAM, Earley Consultancy, LLC, Atlanta, presented the latest data on physician addiction and treatment, what is known about who has the disease, how they recover, and how licensure boards and physician health programs become involved with treatment decisions.

“Outcome studies of addicted physicians would naturally affect decisions on their treatment,” says Edwin A. Salsitz, M.D., FASAM, Co-Chair of the course.

Prescription drug abuse has received recent attention in the media, and Dr. Malinoff says that it truly is an epidemic.

“There is a lot of overdosing going on, and the epidemiology of this is depressing,” he says. “The problem is not just doctors writing too many prescriptions, it’s that the prescribed drugs are getting into the hands of college students, high school students, older people, and others.”

Dr. Salsitz notes that the focus of this portion of the course was led effectively by experts in the field.

“We had a distinguished group of speakers on this topic, led by Andrew J. Kolodny, M.D., the President of Physicians for Responsible Opioid Prescribing (PROP),” says Dr. Salsitz. “Almost all physicians prescribe these drugs, so how to do this properly is most important. The entire symposium on opioid prescriptions should lead to a more enlightened prescribing approach among attendees.”

Dr. Malinoff found the concluding panel discussion invigorating and observed that his fellow attendees found this portion of the program enlightening as well.

“I think the best part was the case discussions that took place,” he says. “One can hear how experts handled these cases, and the audience could interact with them and ask questions. It was very valuable.”

Pain and Addiction Course Addresses Physician Addiction Issues, Increase in Overdose Deaths

Leonard J. Paulozzi, M.D., M.P.H.

Leonard J. Paulozzi, M.D., M.P.H.

While it is bad news that physician addiction is disconcertingly real and dangerous, perhaps the good news is that recovering physicians are also more inclined to adhere to treatment than other patient populations. This was one of many issues addressed during Thursday’s Pain and Addiction Course: Common Threads XIII – Healing the Healer.

In its entirety, the Pain and Addiction Course featured leading experts in addiction medicine who outlined the scope of the impaired physician problem in the United States, reviewing the current data with regard to treating addicted physicians, and defining the epidemiology of the prescription opioid epidemic. The program also outlined the increase in overdose deaths related to increased opioid prescribing and dosage level, and offered up a Universal Precautions paradigm to guide opioid prescribing practices.

Doctors with Opioid Addiction
Paul H. Earley, M.D., FASAM, of Earley Consultancy, Atlanta, shared insights and perspective about his presentation, “Physician Health: Doctors with Opioid Addiction,” during an interview before the ASAM Annual Medical-Science Conference. He focuses on what is currently known regarding who has the disease, as well as defining what is known about how those with the disease recover, and a host of other topics.

“It is bad that these doctors are addicted, and it is bad that it is so easy for them to become so,” he says. “But it is also true that treatment is very good. The long-term prognosis is high — data shows 80 percent of doctors who went through treatment and were followed two to five years afterward were doing very well, with no relapse.”

Physicians do develop addictions as commonly as any other patient cohort, Dr. Earley noted. The difference is, he says, “doctors tend to become more addicted because of their often unfettered access to the drugs. It is that simple, they have a higher rate of opiate addiction because they can get the drugs easier.”

CDC Presents Epidemiology and Public Health Role
In another pre-Med-Sci Conference interview, speaker Leonard J. Paulozzi, M.D., M.P.H., shared insights about his scheduled topic of presentation, “Epidemiology of the Epidemic.” He is a Medical Epidemiologist in the Division of Unintentional Injury Prevention within the National Center for Injury Prevention and Control at the Centers for Disease Control and Prevention (CDC) in Atlanta, GA.

“This issue has been around for more than two decades, and awareness of the problem has grown over the last dozen or so years,” Dr. Paulozzi says. “Of course, the role of opioid analgesics in this problem has come into sharper focus in the last year or two. The problem has gone from being a local issue to one where overdose deaths have been steadily increasing nationally, with no resolution to the problem in sight.”

The increase in fatalities has not led to effective efforts to check the spread of the problem, he says. There are some encouraging signs in some states, “but we haven’t bent the curve down nationally yet, so we need to do more,” Dr. Paulozzi adds.

Dr. Paulozzi says there are a number of strategies that could prove efficacious in dealing with this trend. One is improving how opioids are tracked throughout the system.

“Doctors should be able to get data on their patients’ use of controlled substances incorporated into their daily workflow.  They should be able to access a list of all prescriptions given their patients and see whether the patients are visiting multiple providers and picking up prescriptions from multiple pharmacies.”

With that information, it is much easier to coordinate the care of patients and avoid extremely high doses and drug interactions. “It becomes easier to identify patients with high usage rates with regard to controlled drugs, particularly opioids,” Dr. Paulozzi says. “We would like to see more of a wide-scale attempt by state programs such as Medicaid to coordinate the care of patients in this way.”

In addition, state laws and regulations pertaining to access to scheduled drugs need to be in place to take action against illegal activity perpetrated by both prescribers and patients, Dr. Paulozzi says.

“We need to use these drugs much more carefully if we are to reduce their abuse,” he says. “And at the same time, we need to improve access to treatment for addicted patients.”

Chapter President Offers Warm Georgia Greeting

Daniel (Ray) Gaskin Jr., M.D.

Daniel (Ray) Gaskin Jr., M.D.

Georgia Society of Addiction Medicine (GSAM) President Daniel (Ray) Gaskin Jr., M.D., extends a warm welcome to addition medicine specialists who are converging on his home state for the 43rd ASAM Medical-Scientific Conference.

“Atlanta is a vibrant, modern city with warm elements of the deep South and Southern hospitality,” he says. “In preparing for the Med-Sci, GSAM has actively promoted the conference to addiction medicine specialists and psychiatrists, faculty, residents, and students of medical schools, specifically Emory University, Mercer University, and the Medical College of Georgia. We hosted the Welcome Reception Thursday, along with ASAM leaders and state chapter meetings.”

GSAM will host its chapter meeting at 10:30 a.m. today in Room 201 and will highlight its accomplishments for the year. The chapter provided strong advocacy for a Georgia law passed to enable development of the Physicians Health Program (PHP) and then the subsequent formation of the Georgia Professional Health Program, Inc. This nonprofit group of ASAM providers and other addiction treatment providers advocates the appropriate treatment of professionals with addictive disorders. GSAM also promoted passage of the law establishing the Prescription Drug Monitoring Program (PDMP) in Georgia, and ASAM-certified addictionists will work on the implementation and oversight of this program.

“We are concerned about an epidemic of prescription drug abuse problems and addiction,” Dr. Gaskin says. “We are particularly concerned about making sure that opioid pain medications can be used properly to treat those with chronic pain and that people who develop addictive disorders also receive prompt identification and appropriate treatment.”

Additionally, GSAM supports the continued drive for the American Board of Medical Specialties to recognize the American Board of Addiction Medicine (ABAM) in providing board certification to addiction medicine specialists, which would improve credentialing and respectability for the specialty in the medical community. GSAM supports education among physicians of all specialties, residents, and medical students in the safe prescribing of opioids and potentially addictive medications. “One of my personal goals is for an ABAM-certified addictionist to be available within one hour’s drive of any person in Georgia,” Dr. Gaskin says. “Another personal goal of mine is to see that all medical students and medical residents in Georgia have training by ABAM-certified physicians in addictive disorders and have attended community Alcoholics Anonymous/Narcotics Anonymous 12-step recovery meetings with follow-up and discussion of 12-step recovery techniques.”

Dr. Gaskin would like to encourage all ASAM members to attend the GSAM 2012 Summer Conference, co-sponsored with the South Carolina Society of Addiction Medicine. The conference is June 29 and 30 in Charleston, S.C. “This GSAM/SCSAM conference is a wonderful blend of addiction science, history, and addiction psychotherapy, a unique learning opportunity for everyone with an interest in the disease of addiction,” he says. Information is available on the GSAM website, www.georgiaasam.org.

In addition to its chapter meeting at the 43rd ASAM Medical-Scientific Conference, GSAM conducted a drawing at this morning’s ASAM Annual Business Meeting for dinner to an Atlanta restaurant. GSAM also has arranged special discounts for conference participants to GSAM members’ favorite restaurants and attractions.

“We are additionally making sure that onsite recovery support meetings are taking place,” Dr. Gaskin says. “It always has been a special pleasure to welcome recovering individuals and physicians to our meetings and to recognize the value of 12-step recovery in addiction treatment.”

The convenience of this year’s Medical-Scientific Conference in Atlanta offers many Georgia member and non-member addiction medicine specialists an opportunity to see what an extensive program the conference offers and what activities GSAM engages in on the behalf of the specialty.

“When they arrive in Georgia, ASAM members will immediately notice that Addiction Medicine is alive and vibrant in Georgia,” he says. “We hope they will come forward and be part of our movement. We need volunteers, and we are happy to share our knowledge and our fellowship. In the 12 years that I have been attending this conference, I have observed and been privileged to participate in revolutionary advances in the understanding and effective treatment of those suffering from addictive disorders. ASAM is a dynamic society. Welcome to the conference and join with us to learn more about treating addiction and saving lives.”

ASAM Debuts Patient Placement Criteria Products

David Mee-Lee, M.D.

David Mee-Lee, M.D.

ASAM’s recent success in advancing the use and understanding of its Patient Placement Criteria through a new strategic partnership benefits addiction professionals and clinicians alike. In fact, when ASAM and The Change Companies partnered last fall, ASAM made huge strides in expanding access to and improving the quality of addiction treatment by introducing a host of new assessment tools and treatment guides.

Likewise, The Change Companies, with its expertise in international publishing, consulting, training, and multimedia, brings to the partnership a rich history of work with experts in the field of behavior change to develop effective and evidence-based prevention, treatment, and recovery resources. Together, the two have introduced a new level of support resources designed to aid clinical decision making for addiction treatment.

Paul Earley, M.D., FASAM

Paul Earley, M.D., FASAM

“The interactive journals and eLearning courses we created as a result of this partnership are designed to make it easy to implement ASAM’s Patient Placement Criteria for addiction assessment and treatment, even for those professionals who are outside the addiction treatment field,” says David Mee-Lee, M.D., Senior Vice President of The Change Companies and editor of the ASAM Patient Placement Criteria. “The result is an array of resources now available to professionals that combines the assessment, service planning, and treatment guidelines ASAM established.”

By defining one national set of criteria for providing outcome-orientated and results-based care in the treatment of addiction, ASAM’s Patient Placement Criteria is the most widely used and comprehensive set of guidelines for placement. Its new suite of participant interactive journals and eLearning modules will be on display at The Change Companies booth (No. 6) during the conference.

ASAM Board of Director-at-Large Paul Earley, M.D., FASAM, Earley Consultancy, LLC, Atlanta, has participated in the production of ASAM’s Patient Placement Criteria since its first edition. Dr. Earley was tasked with reviewing each of the products developed by The Change Companies to ensure they met ASAM’s high standards, language, and vision for addiction treatment.

“First and foremost, it was important that the products developed by The Change Companies reflected the integrity of, and aligned with, ASAM’s vision for assessment and addiction treatment,” Dr. Earley says. “Our biggest challenge was to make sure the language used in the products, from the workbooks to the website and eLearning modules, matched the language we believe is best used to communicate with patients and train addiction professionals and clinicians.”

The two ASAM Criteria-specific patient journals and two eLearning courses are now available for purchase, Dr. Earley notes, and the ASAM Criteria-specific journals are co-branded. All of the products interface with the ASAM Criteria, Second Edition Revised and ASAM Patient Placement Criteria: Supplement on Pharmacotherapies for Alcohol Use Disorders, which may be ordered at the ASAM Booth in the exhibit hall. The Change Companies CEO Joyce Conley, Ph.D., says the two organizations collaborated to produce thorough and accurate materials.

“Our teams have worked together to create and extensively revise products that address every angle of initial assessment through service planning and continued care,” Dr. Conley says. “We have joined the Patient Placement Criteria with application-focused resources and behavior-change tools and are just beginning to realize the true value such an integration has to offer.”

Additionally, ASAM will conduct a Component Session 9 Town Meeting on the ASAM Criteria Revision (PPC) from 10 a.m. to noon Sunday in Grand Salon East, Salon B, to discuss revisions to the ASAM Criteria. The meeting will address new terminology and updates to the implementation of the ASAM Criteria and the Diagnostic Admission Criteria to keep it compatible with DSM-V of the American Psychiatric Association that will be released in 2013.

“These are some great products that we want everyone to use and be happy with,” Dr. Earley says. “Still, we will continue to screen the products to keep them up to date and effective for the addiction treatment community.”

Dr. Gitlow Highlights ASAM Progress Since Last Year’s Med-Sci Conference

Stuart Gitlow, M.D.

Stuart Gitlow, M.D.

ASAM Acting President Stuart Gitlow, M.D., welcomes you to Atlanta and takes this occasion of the Medical-Scientific Conference as an opportunity to highlight major accomplishments of the society during the past year, to address challenges to addiction medicine, and to discuss a future of great potential.

One particularly enormous accomplishment recently involved the release of ASAM’s definition of addiction. “The media really picked up on it, and the definition received widespread newspaper and television coverage,” Dr. Gitlow says. “It was very well received by both the addiction medicine community and the broader medical community. Now it is time for us to build on that recognition. My goal for ASAM is for it to become the leader in the field in terms of addiction definitions and diagnostic terminology.”

He also praised the development of the new ASAM  task force to address “the considerable discrimination against patients with addiction in receiving coverage for appropriate pharmacologic treatment.” Problems range from limits on how long coverage is available to the amount of medication covered. The task force will coordinate ASAM’s response to these barriers by investigating policies state-by-state and sending teams of individuals to those states. These teams will educate legislators about how denying appropriate pharmacotherapy and treatment costs more than providing effective medication.

ASAM’s development of a marijuana policy is also a major priority for Dr. Gitlow. Last year, ASAM developed a white paper, “The Role of the Physician in ‘Medical Marijuana,'” that concluded there is currently no good reason for the use of marijuana for any medical condition.

“We recognize the need for, and encourage, further study,” he says. “We essentially are working on the second part of our marijuana policy at a time when some states are moving in a direction of legalizing marijuana to some extent. It is a big challenge for us to come up with a consensus as a national organization.”

Dr. Gitlow also praises ASAM’s updated website, as one of the society’s greatest accomplishments of the past year, offering critical information to addiction medicine specialists and the public across the country. Particularly useful is the new integrated functionality with the President’s Blog, where members and other stakeholders may interact with ASAM leadership and receive immediate feedback, as well as keep up to date on crucial research, treatment, diagnosis, and policy issues in addiction medicine. Additionally, state chapters of ASAM may readily set up their own pages within the ASAM website or place links to state chapters’ established websites, all with the intent to foster communication directly with members.

“Our website will become extremely important in the coming years as people begin to enter into the maintenance of certification process for their addiction medicine certificate through the American Board of Addition Medicine (ABAM),” Dr. Gitlow says. “Our updated website makes it easy for them to obtain CME online through review and other courses in addiction medicine. We are hopeful members will be active participants in the ASAM website and provide us feedback so we can be better and faster in responding to their needs.”

ASAM will conduct its major elections this year. Dr. Gitlow encourages ASAM members to review the information coming out this fall about candidates and consider which candidates would best serve ASAM. He also encourages members to consider running for ASAM leadership positions themselves.

“We want people to be excited about the issues involved,” he says. “We want there to be a constant vibrancy to the organization that you can only get when leaders at the top change from term to term.”

In addition to accomplishments, ASAM also faced challenges. Perhaps the greatest is the need to grow the specialty of addiction medicine itself. Money is available to fund treatment for addiction, but not nearly enough doctors are available who understand this disease, he notes. Non-physicians are entering the addiction treatment arena, and he predicts that in a decade, thousands of nurses and physician assistants will treat addictive disease “but not necessarily correctly. We have to move forward forcefully, but cautiously, in terms of finding our way through this new era.”

Another challenge involves a contentious political climate where half the nation supports the Affordable Health Care Act (ACA), while the other half does not. ASAM must move cautiously here as well to determine the best course of action for ASAM members and their patients in advocacy efforts. At the same time, ASAM is awaiting the final regulations for the Parity legislation passed in 2008 and how they will be integrated into the details of the ACA.

“Our future holds enormous potential,” Dr. Gitlow says. “With the formation of the American Board of Addiction Medicine in 2007, we are in a wonderful position to continue on the path of being the de facto addiction medicine physician specialty organization. I am proud that we are moving in the direction of an American Board of Medical Specialties’ board certification. I am thrilled to think that addiction medicine will soon be on the same level as other specialties. That means that patients with addictive disease will no longer be puzzled about whom they should seek for addiction treatment.”