Take a peek at this year’s workshops and papers! Posters coming soon.

Workshops

A1: Management of Persons Who Inject Drugs (PWID) in the General Medical Setting

David Marcovitz, MD, Vanderbilt University Medical Center; Joji Suzuki, MD, Brigham and Women’s Hospital; Mariah Smith, MD, Vanderbilt University Medical Center; Alex Sidelink, MD, NYU Langone Health

Learn about the challenges and opportunities of managing the growing population of persons who inject drugs (PWID) in integrated medical settings and to help prepare participants to manage this unique and high-risk population in this workshop. From convincing hospital administrators to support such models financially to addressing system-wide stigma, laying the groundwork alone for such efforts abounds with opportunity and challenges.

A2: Attention-Deficit Hyperactivity Disorder (ADHD) in Individuals with Addiction

Kristopher Kast, MD, Vanderbilt University of Medical Center; Timothy Wilens, MD, Massachusetts General Hospital; Frances Levin, MD, Columbia University Irving Medical Center/New York State Psychiatric Institute; Amy Yule, MD, Boston Medical Center; Vinod Rao, MD, PhD, MGH/Harvard Medical School

Among treatment-seeking individuals with SUD, the prevalence of ADHD is 19-27%. This workshop will explore how effective ADHD pharmacotherapy offers an opportunity to reduce ADHD symptom burden and improve SUD-related outcomes. We’ll also talk about the significant diagnostic and therapeutic challenges when diagnosing such a patient and how ADHD pharmacotherapy may be an important intervention for individuals engaging in addiction treatment.

A3: Build Your Motivational Interviewing Effectiveness by Practicing Strategic Listening

Carla Marienfeld, MD, University of California San Diego; Brian Hurley, MD, MBA, DFASAM, Los Angeles County Department of Health Services; Florence Chanut, MD, FRCPC, Universite de Montreal; Jeffrey DeVido, MD, MTS, Marin County Department of Health and Human Services; Petros Levounis, MD, MA, Rutgers New Jersey Medical School

Increase your competence using motivational interviewing, gain a greater knowledge of the concepts and terminology, and improve your performance working with patients trying to change behaviors in this interactive workshop.

A4: Benzodiazepines: A Crisis Hidden in Plain Sight

Steven Wright, MD, The Alliance for Benzodiazepine Best Practices; Anna Lembke, MD, Stanford University School of Medicine; Christy Huff, MD, Benzodiazepine Information Coalition

Benzodiazepine receptor agonists are a class of substances that includes the classical benzodiazepines and the so-called Z-drug hypnotics, whose clinical effects may involve anxiolysis, sedation, myorelaxation, and anticonvulsant activity. Many clinicians prescribe these agents for far longer than recommended. In addition, discontinuation can be very challenging. This workshop will discuss evidence-based use of benzodiazepines and the potential dangers of with prescribing “off label.”

A5: Addiction in Native American Youth During COVID-19

Jeena Kar, PGY-1, University of Florida; Kristie Brooks, MS, LPC, University of Saskatchewan; Sara Jo Nixon, PhD, University of Florida; Pamela Jumper Thurman, PhD, Colorado State University

Join a dynamic and interactive discussion about addiction in Native American youth. Did you know the Navajo Nation has the highest coronavirus infections per capita in the United States, ahead of even New York and New Jersey? Furthermore, their numbers are considered grossly underestimated due to misclassification of Native Americans under the category “Other” on coronavirus census reporting. This presentation will help you be aware of this health disparity and encourage you to get involved in health policy advocacy that may rectify this.

B1: Substance Use Disorders and the Legal System

Elie Aoun, MD, PC, Columbia University College of Physicians and Surgeons - Division of Law, Ethics, and Psychiatry; Debra Pinals, MD, University of Michigan, Director, Program in Psychiatry, Law, and Ethics; Laurence Westreich, MD, New York University of Medicine

Anyone who treats people with substance use disorders knows that their patients interact the legal system (quite often!) via incarceration, DUIs, child custody disputes, employment issues, court-ordered drug testing, and in many other venues. Learn practical, up-to-date information on the relevant aspects of addiction in the legal system and how you can best assist your patients or think through issues in any matters where legal questions might arise.

B2: Outpatient Low-Threshold Clinical Care Models For Patients With Substance Use Disorders

Christoforos Giakoumatos, MD, MGH/Harvard Medical School; David Marcovitz, MD, Vanderbilt University Medical Center; Laura Kehoe, MD, MGH/Harvard Medical School; Jessica Gray, MD, MGH/Harvard Medical School; Vinod Rao, MD, PhD, MGH/Harvard Medical School

Learn about four unique models of care designed to meet the needs of complex dual-diagnosis. Let’s spark some conversations and creativity so you can return to your practice with tangible ideas for care innovation for your patients with active psychiatric illness and substance use disorders.

B3: Telepsychiatry with Youth in the Days of COVID

David Atkinson, MD, Teen Recovery Program at Children’s Health; Lisa Williams, LPC, Children’s Health; Emily Tejani, MD, UCSF

During the coronavirus pandemic, health systems have been challenged, disrupted or thrown into chaos. Let’s change your discomfort working with telepsychiatry and help identify solutions to common problems: technological, logistic, and interpersonal that can occur from doing telepsychiatry work.

B4: My brain Seeking Reward: Neuroscience Applications in Clinical Practice

Ellen Edens, MD, MPE, Yale School of Medicine; Anahita Bassir Nia, MD, Yale School of Medicine; Ashley Walker, MD, Oklahoma University School of Medicine; Adrienne Hicks, MD, Yale School of Medicine; Gretchen Hermes, MD, PhD, Yale School of Medicine

Get ready to role play! The disparity between overwhelming human need and overwhelming resistance to medical intervention relates in part to stigmatization of individuals with addiction. In this workshop, we model brain changes associated with reward processing and habit formation in order to illustrate how neuroscience can improve patient care.

B5: Meth 2.0: New Wave of a Known Threat

Alena Balasanova, MD, Nebraska Medicine/University of Nebraska Medical Center; Michelle Davids, DO, Broadlawns Outpatient Mental Health; Larissa Mooney, MD, UCLA/Department of Veteran’s Affairs

In this workshop, an interactive session using case studies of patients with methamphetamine use disorder will be provided followed by a question and answer session to facilitate additional discussion and identify resources for clinicians. Learn about the most recent evidence for treatment and tools for the practicing clinician using interactive case discussions as a platform.

B6: Best Practices in Managing Patients with OUD who use Kratom

Cornel Stanciu, MD, MRO, FASAM, FAPA, Dartmouth-Hitchcock Medical Center, New Hampshire; Thomas Penders, MD, Brody School of Medicine at East Carolina University

Learn all about kratom through lecture and case studies in this workshop. Since this area represents a huge unmet practice gap, here we aim to merge evidence from literature with clinical practice in efforts to guide the development of a consensus standard of care.

C1: Outcome Measures in Addiction Psychiatry

David Marcovitz, MD, Vanderbilt University Medical Center; Dominick DePhilippis, PhD, Department of Veterans Affairs, Philadelphia CESATE; Mannesh Gopaldas, MD, Vanderbilt University Medical Center; Sanchit Maruti, MD, MS, University of Vermont Addiction Treatment Program; Arthur Robin Williams, MD, MBE, Columbia University Department of Psychiatry

Collecting outcome measures for patients with substance use disorders and co-morbid behavioral health disorders is a challenge for clinicians. In this workshop we’ll discuss how a focus on measurement-based care and routine outcomes monitoring can enhance your individual and group practices. Then we’ll break up into small groups for an interactive activity in which you’ll troubleshoot an implementation challenge at your home institution related to collection of outcome measures.

C2: Addiction Consult Services: The Role of Psychiatry

Alena Balasanova, MD, Nebraska Medicine/University of Nebraska Medical Center; Joji Suzuki, MD, Brigham and Women’s Hospital; Kelsey Priest, PhD, MPH, School of Medicine, Oregon Health & Science University

Learn how hospital-based addictions care is an innovative way to improve care and outcomes for patients with substance use disorders. Given the prevalence of SUDs among patients admitted to the medical and surgical wards, hospitalization appears to be an opportune time to initiate SUD treatment and other co-occurring psychiatric conditions. Here we’ll present opportunities for psychiatrists to enhance hospital-based addictions interventions within your local healthcare systems.

C3: Group Based Opioid Treatment (GBOT) Implementation

Matthew Stohs, MD, Medical College of Wisconsin, Froedtert Hospital, Zablocki VAMC, Milwaukee; Jim Berry, DO, West Virginia University; Stephen Forman, MD, PhD, University of Pittsburgh/VA Pittsburgh; Brad Hoffman, PharmD, VA Medical Center, Marion IL; Mary-Anne Kowol, MD, Medical College of Wisconsin/VA Milwaukee; Lisa McCutchen, MD, VA Medical Center, Marion IL; Randi Sokol, MD, MPH, MMedEd, Cambridge Health Alliance (Tufts/Harvard)

Learn how to implement Group-based Opioid Treatment (GBOT) with buprenorphine into your practice. Coupling of buprenorphine with group psychotherapy holds promise to increase access to care for patients, mitigate provider burnout, and sustain clinical productivity.

C4: Making the Invisible Visible: Exploring Bias Through Art

Zoe Adams, Medical Student, Yale School of Medicine; Anna Reisman, MD, Yale School of Medicine; Joana Andoh, BA, Yale School of Medicine; Sydney Green, BA, Yale School of Medicine; Kenneth Morford, MD, Yale School of Medicine; Nientara Anderson, MD, MHS, Yale School of Medicine

In this workshop, we will demonstrate how art observation can be a means of entry into discussion and education on issues of bias in medicine, including bias directed towards individuals with substance use disorders. The ultimate goal of the session is to develop comfort in describing the inherent assumptions and biases embedded in western culture as well as their influence on personal and professional interactions.

C5: From In-Person Group Treatment to Digital Therapies: How to Help Women with Substance Use Disorders

Dawn Sugarman, PhD, McLean Hospital; Shelly F. Greenfield, MD, MPH, McLean Hospital/Harvard Medical School

This workshop will familiarize attendees to the Women’s Recovery Group, a 12-session, empirically supported, gender-specific relapse prevention group therapy that utilizes a cognitive-behavioral approach. This interactive session will provide an opportunity for participants to learn how to implement the WRG in person, and how digital technology could be used to deliver gender-specific care to women with SUDs.

D1: Should Addiction Psychiatrists Recommend Sublingual Buprenorphine to Chronic Pain Patients on High-Dose, Long-Term Opioid Therapy?

Dustin Patil, MD, Tufts Medical Center; Joji Suzuki, MD, Brigham and Women’s Hospital; Claire Twark, MD, Brigham and Women’s Hospital; Claire Twark, MD, Brigham and Women’s Hospital; Claudia Rodriguez, MD, Brigham and Women’s Hospital; Mohammed Issa, MD, Brigham and Women’s Hospital

Join us for an interactive discussion on treating patients on high-dose, long-term opioid therapy (LTOT) in an era of widespread concern regarding opioid safety. LTOT is associated with adverse events including opioid use disorder (OUD), hyperalgesia, overdose death, and diversion. However, newer studies demonstrate significant patient-related harms that may result from opioid dose reduction or discontinuation. Is buprenorphine a viable alternative for patients on LTOT who do not meet criteria for OUD?

D2: The Apple May Not Fall Close to the Tree: Reducing Incident SUD in the Next Generation through Parental Support and Early Intervention

Emily Tejani, MD, UCSF; Martha Ignaszewski, MD, British Columbia Children’s Hospital/Vancouver General Hospital; David Atkinson, MD, UT Southwestern

This workshop aims to enhance participants’ familiarity with evidence-based approaches to preventing youth SUD, with a particular focus on effective ways to partner with parents toward the goal of reducing youth substance use and substance use disorder onset. The workshop will also feature a pilot program of a family intervention for parents with SUD that involves collaboration with those parents’ children.

D3: Internet Gaming Disorder – Should Psychiatrists Screen for Screen-Time?

James Sherer, MD, Rutgers New Jersey Medical School; Klaus Woelfling, PhD, Department for Psychosomatic Medicine and Psychotherapy of the University Medical Center of the Joha; Meredith Gansner, MD, Harvard Medical School; Michael Hsu, MD, Brigham and Women’s Hospital; Rober Aziz, MD, Rutgers New Jersey Medical School; Petros Levounis, MD, Rutgers New Jersey Medical School; Robert Rymowicz, DO, UCLA, David Geffen School of Medicine; Timothy Fong, MD, Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA

Making extensive use of video clips, this workshop will highlight the similarities and differences between Internet Gaming Disorder and Gambling Disorder. The videogame industry has overtaken the film and television industries with regards to profits, and the COVID pandemic led to a spike in game playing while people are sequestered at home. This presentation aims to familiarize participants with this novel topic and summarize potential avenues for treatment which may be recommended to patients and their families.

D4: Trials and Tribulations in Optimizing mHealth Interventions in Addictions

Susan Murphy, PhD, Harvard University; Stephanie Carpenter, PhD, University of Michigan; David Wetter, PhD, University of Utah; Shea Lemley, PhD, Dartmouth College; Maureen Walton, PhD, University of Michigan

Through a combination of presentations and guided discussion with interactive polling exercises, this workshop will close these gaps in knowledge and enhance clinical treatment of substance use disorders by describing challenges and solutions in the development and conduct of three original Micro-Randomized Trials.

D5: Awakening and Recovery

Michael McGee, MD, WellMind; Bryon Adinoff, MD, University of Colorado School of Medicine

Given the challenges our profession faces with addictions treatment outcomes, augmenting our clinical work with responsible, spiritually informed interventions holds promise for enhancing treatment outcomes. This workshop will present a practical and clinically sound approach to nurturing spiritual growth based on literature on mindfulness practices, loving kindness practices, and tenants of Acceptance Commitment therapy.

D6: Management of Alcohol Use Disorders in Liver Transplant Patients

Sidarth Wakhlu, MD, UT Southwestern Medical School; Arjmand Mufti, MD, UT Southwestern Medical Center; Devin Dunatov, MD, UT Southwestern Medical Center

We need to change our clinical focus from predicting risk factors to actively engaging patients in substance use treatment post orthotopic liver transplant (OLT). Too many patients die while awaiting an OLT because of the obscure 6 month abstinence rule. This workshop will discuss how to increase the survival rate of patients with alcohol liver disorder.

Papers

 

P1: Boston University Psychiatry Evaluation of Minority Addiction Treatment (BUPE-MAT) Study: A qualitative analysis on barriers to buprenorphine treatment for racial/ethnic minorities

Jawad Husain, MD, Boston Medical Center; Emma Fitzelle-Jones, BS, Boston Medical Center; Devin Cromartie, MD, MPH, Boston Medical Center; Rohit Abraham, MD, MPH, Boston Medical Center; Annelise Brochier, MPH, Boston Medical Center; Cristina Montalvo, MD, MBS, MAT VA Boston Healthcare Systems, West Roxbury Campus

Since 1999, deaths from opioid use disorder (OUD) have surpassed nearly half a million. The opioid overdose mortality rate is rising fastest in the non-Hispanic black population compared to other racial/ethnic groups in the U.S. Clinical guidelines strongly recommend buprenorphine as a first-line treatment for OUD. However, racial/ethnic minorities are less likely to initiate or to be retained in buprenorphine treatment compared to non-Hispanic white individuals. This qualitative study seeks to further our understanding of how knowledge, culture, racism and stigma overlap to affect buprenorphine treatment initiation and retention in order to improve access to care and to provide education to providers to improve patient outcomes and to devise strategies to improve racial/ethnic minority engagement in buprenorphine treatment to curb the rapidly rising opioid-related mortality in these populations.

P2: Cannabis Use is Associated with Depressive Symptoms among Pregnant Women Receiving Buprenorphine for Opioid Use Disorder

Abigail Richison, MD, University of Arkansas for Medical Sciences; Andrew James, PhD, University of Arkansas for Medical Sciences; Hannah Williams, MD, University of Arkansas for Medical Sciences; Jessica Coker, MD, University of Arkansas for Medical Sciences; Shona Ray-Griffith, MD, University of Arkansas for Medical Sciences; Zachary Stowe, MD, University of Wisconsin School of Medicine and Public Health; Erin Bider, MD, University of Arkansas for Medical Sciences

As more states are legalizing medical marijuana, cannabis use is increasing with risk perception decreasing. Previous studies have evaluated various effects of cannabis use in different populations; however, to date, there is no research focused on pregnant women with opioid use disorder (OUD) enrolled in opioid agonist therapy (OAT). In this study, we examined the associations between cannabis use and depression in pregnant women with OUD and how these variables affect OAT treatment outcomes. Our hope is to help empower physicians and patients to start an evidence-based conversation about possible risks associated with perinatal cannabis use.

P3: Correlates of Opioid Abstinence after Randomization to Buprenorphine-Naloxone versus Injectable Naltrexone in a Multi-Site Trial.

Miranda Greiner, MD, MPH, Columbia University Irving Medical Center/New York State Psychiatric Institute; Aimee Campbell, PhD, Columbia University Irving Medical Center/New York State Psychiatric Institute; Edward Nunes, MD, Columbia University Irving Medical Center/New York State Psychiatric Institute; Martina Pavlicova, PhD, Columbia University Mailman School of Public Health, Department of Biostatistics; John Rotrosen, MD, New York University Grossman School of Medicine; Matisyahu Shulman, MD, Columbia University Irving Medical Center/New York State Psychiatric Institute; Jennifer Scodes, MS, Columbia University Mailman School of Public Health, Department of Biostatistics, CUIMC/NYSPI; Joshua D. Lee, MD, MSc, NYU School of Medicine and Director of the NYU Fellowship in Addiction Medicine; Patricia Novo, MPA, MPH, New York University Grossman School of Medicine; Tse-Hwei Choo, MS, MPH, Columbia University of Mailman School of Public Health, Department of Biostatistics

Opioid use disorder (OUD) is associated with substantial mortality. Despite effective treatments, many patients that successfully initiate OUD pharmacotherapy will discontinue treatment within the first few weeks or months. Upon treatment discontinuation, patients are at risk for relapse and overdose, however, not all patients relapse. This paper presentation is on a secondary analysis of factors associated with opioid abstinence three months following the treatment trial. While abstinence is not required for improvement in opioid use outcomes, there is a need to better understand predictors of relapse and abstinence after medication discontinuation in order to better advise patients that may discontinue medications. Barriers to treatment retention and sustained abstinence are factors generally considered to be proxies for greater disease severity. Better understanding of factors associated with sustained abstinence can inform efforts to facilitate stable recovery for opioid-dependent individuals.

P4: Opioid Overdose Prevention and Response Training for First Year Medical Students: Are Improvements Maintained after a Year?

Tabitha Moses, MS, Wayne State University School of Medicine; Rafael Ramos, MS, Wayne State of University School of Medicine; Eva Waimeo, MD, Wayne State University School of Medicine; Mark Greenwald, PhD, Wayne State University School of Medicine; Jessica Moreno, PharmD, Psychiatric Clinical Pharmacy Specialist; May Chammaa, BA, Wayne State University School of Medicine

The current opioid overdose crisis has led to calls for improvements in undergraduate medical education as well as increased training focused on overdose prevention and harm reduction. Initial data indicate that these trainings have a positive effect on student knowledge of and attitudes towards responding to opioid overdose; however, there is little data on whether these changes are maintained over time and how the training may impact student behavior. This study demonstrated that, 1 year later, most improvements seen after a single 1-hr training were maintained compared to baseline; however, there were significant decreases compared to immediately post-training. This study provides the first evidence to suggest that training may have long-lasting effects on knowledge of and attitudes towards opioid overdose and naloxone use.

P5: Patient Satisfaction with Shared Medical Appointments Among Patients with Opioid Use Disorder Attending an Urban Buprenorphine Clinic

Serra Akyar, MD, MPH, Northwell Health’s Staten Island University Hospital; Stephanie Ruthberg, BA, MA, Rutgers New Jersey Medical School; Kristyn Lao, BA, Rutgers New Jersey Medical School; Amesika Nyaku, MD, MS, Rutgers New Jersey Medical School; Erin Zerbo, MD, Rutgers New Jersey Medical School

Current literature on share medical appointments (SMA) for OUD remains limited but studies have shown that it is highly acceptable and has comparable or better retention in care rates with buprenorphine as compared to individual appointments. In this study, we conducted patient satisfaction surveys among patients with OUD attending an urban buprenorphine clinic to determine their level of satisfaction with SMAs. We found that patients in a predominantly Black/African American and Hispanic/Latinx community with co-occurring mental illness and other substance use reported overall satisfaction with SMAs and would recommend this modality to other patients. This study adds to the literature about the acceptability of SMAs for OUD and confirms that SMAs are acceptable in an urban and racial/ethnic minority population. In the exploratory analysis, satisfaction with SMAs was associated with older age, being a retiree or being on disability. This positive signal may suggest that SMAs may serve a role in providing differentiated care for certain subpopulations with OUD that may be prone to isolation.

P6: Pharmacological Treatment of Pain Among Persons with Opioid Addiction: A Systematic Review and Meta-Analysis with Implications for Drug Development

Joao De Aquino, MD, Yale University; Peggy Compton, RN, PhD, Clinical Instructor; Jose Flores, MD, PhD, Yale School of Medicine; Mehmet Sofuoglu, MD, PhD, Yale School of Medicine; Victor Avila-Quintero, MD, Yale School of Medicine

The clinical features and neurobiology of chronic pain and opioid use disorder (OUD) are inextricably linked. Despite emerging evidence supporting the negative impact of chronic pain in the treatment of OUD, the pharmacological management of pain in the presence of OUD has received limited attention. We systematically reviewed the studies investigating pharmacological interventions for pain among persons with OUD. Our results highlight early signals for drugs with GABAergic and glutamatergic mechanisms of action, which warrant further exploration. Our review also underscores the need for methodological improvements and broader treatment targets in future studies. Various biological systems play crucial roles in modulating pain- and addiction-related behavior – which are heavily influenced by multifaceted factors such as affect and cognitive state. A greater mechanistic understanding of these systems suggests promising future treatments for OUD and chronic pain. Whilst much has been achieved in the fields of pain and OUD within the past few decades, there is a pressing need for conceptual and methodological integration, so that the clinical potential of biological systems modulating pain and addictive behavior can be fully realized, improving patients’ lives along both domains.

P7: Pharmacotherapy for attention-deficit hyperactivity disorder (ADHD) and long-term retention in outpatient addiction treatment: a retrospective cohort study

Kristopher Kast, MD, Vanderbilt University Medical Center; Timothy Wilens, MD, Massachusetts General Hospital; Vinod Rao, MD, PhD, MGH/Harvard Medical School

ADHD often co-occurs with addiction and is associated with a more complicated course and early drop-out. We examined the relationship between ADHD pharmacotherapy and retention in outpatient addiction treatment in a clinically-diagnosed sample. The presentation will review this retrospective cohort study and its main finding of increased long-term retention in outpatient addiction treatment for individuals with comorbid ADHD and addiction who received ADHD pharmacotherapy. Clinically-relevant issues around diagnosis, timing of treatment relative to abstinence states, and measures to reduce risk of nonmedical use of prescribed stimulants will be reviewed. ADHD pharmacotherapy is associated with increased long-term retention in outpatient addiction treatment. In view of the evidence for worsened outcomes among individuals with comorbid ADHD, judicious use of targeted pharmacotherapy may be an important component of treatment-planning. Future studies should address risk and NNH associated with ADHD pharmacotherapy.

P8: Strategies to Increase Medication Assisted Treatment for Substance Use Disorders and their Outcomes: Data from 140 Quality Improvement Programs Affecting Over 12,000 Individuals

Eric Hermes, MD, Yale University School of Medicine; Shari Rogal, MD, MPH, University of Pittsburgh Department of Medicine; Ilse Weichers, MD, MPP, MHS, VA Office of Mental Health and Suicide Prevention; Roni Hoff, PhD, MPH, VA Office of Mental Health and Suicide Prevention

Medication assisted treatment (MAT) diminishes cravings, lessens substance use, and improves abstinence for opioid use disorder (OUD) and alcohol use disorder (AUD). Despite strong evidence supporting MAT, these treatments are underutilized. Quality improvement (QI) programs are needed to increase MAT use within healthcare systems such as the Veterans Health Administration (VHA). The objective of this research is to understand characteristics of successful QI programs to increase MAT within VHA. Little is known about QI program characteristics to increase MAT within healthcare systems. This is the first study to describe MAT QI programs within a healthcare system and associate program characteristics with outcomes. While this study provides guidance to organizations undertaking similar efforts, more research is needed to better characterize MAT QI programs. Clearer links between barriers encountered, strategies used, level of effort delivered, and resultant outcomes must be identified.