North Carolina’s Addiction Medicine Conference

I had a great weekend.

I went to the annual NC Addiction Medicine Conference, held in April each year, in Asheville. This year, I took an extra day off work and went to the pre-conference workshops, which I haven’t done in the past, because of poor planning on my part.

I went to the workshop titled “Treating Women for Substance Use Disorder During the Perinatal Periods: Integrated Medical and Behavioral Health.” It was fantastic. Hendree Jones, PhD., lead author or the MOTHER study, was one of the main speakers. I’ve heard her talk before, and not only does she present information in a straightforward way, she epitomizes the empathy that providers should have towards their patients. Dr. Mishka Terplan, MD, was the other presenter, and was equally eloquent and gifted lecturer. During the workshop, we broke into small groups to interact with other participants about topics.

Here are the latest ideas I heard: it’s ok – really, it is ok – to treat pregnant women with buprenorphine/naloxone combination products. We don’t have to switch them to the monoproduct. I already knew a pregnant woman shouldn’t be switched from methadone to buprenorphine, but I learned a pregnant woman shouldn’t be switched from buprenorphine to methadone, either.

I learned the depressing news that screening and brief intervention for substance use disorders are less likely to be done in women than men, and when their screen is positive, women are less likely to receive any intervention. Also, physicians aren’t good at diagnosing substance use disorders in women who are on either end of the age spectrum.

I learned about the social determinants of health that influence the outcome of pregnancies and substance use disorders the same as they influence all of health.

I learned that split dosing in pregnancy can be helpful with buprenorphine, same as it is with methadone. I have been splitting the dose of pregnant patients on buprenorphine nearing the end of their pregnancies, but wasn’t sure there was data or expert opinion that supported doing this. There is.

These lecturers talked specifically about the Bell study – that pesky study out of Tennessee that concluded taper of medication-assisted treatment during pregnancy was a reasonable idea. Even Bell’s own data didn’t support that conclusion, since the incidence of neonatal abstinence wasn’t decreased with a taper (or cold turkey withdrawal in jail). Reduction of NAS is the main reason Tennessee physicians in TN and elsewhere taper the dose of buprenorphine/methadone during pregnancy.

I already knew these facts, but since I deal with some obstetricians who don’t approve of the use of buprenorphine/methadone for the treatment of pregnant women with opioid use disorder, it was nice to confirm my approach is based in facts and data. After so much resistance from local OBs, I start doubting myself, wondering if I’ve got it wrong because after all, I’m not an obstetrician. It’s a great feeling to have what I’ve been recommending confirmed by the experts.

The whole conference was great. On the day of the main conference, I gave a thirty-minute presentation about the state laws passed around opioid and buprenorphine prescribing. I think it went well. I was well-prepared, since I’d spent hours researching, then hours rehearsing my presentation. I hate speaking in public, and have jitters about it. The more I practice, the more confident I feel. I felt a flood of relief when it was over, and pleased I’d gathered the courage to do this.

Then I went to an outstanding presentation on LGBTQ patients. I learned a lot, and feel more confident that I can treat this population in a culturally competent way. That presentation was followed by one on peer support specialists. This is not necessarily a completely new idea, but now there’s funding available for such personnel. I know how valuable peer support specialists can be, since we have several who work with our patients. They can be a godsend.

It went on like this for the rest of the day and the next too. All the speakers I heard were outstanding.

At this (and similar) conferences, it’s not just the information I get, or the credit hours that I need to remain licensed. There’s also a delight in being around people with the same passion to help people with substance use disorders. Sometimes we argue. I don’t think a group of three hundred doctors will ever agree on everything. But we remember we have more in common than the few points about which we have disagreements.

It’s nice, being among providers who understand the joys and tribulations of caring for our patients.

Any provider interested in joining North Carolina’s Society of Addiction Medicine should go to these websites:

http://www.ncsam-asam.org/

https://governorsinstitute.org/

The advantages of joining the state chapter of Society of Addiction Medicine (and also the national organization, called American Society of Addiction Medicine, or ASAM) include reduced rates on conferences, access to other physicians interested in treating patients with substance use disorders, and access to online CME hours (ASAM).

And support. Lots and lots of support, because we have a job that can be challenging.

Additional resources for physicians include the Provider Clinical Support System (PCSS)

https://pcssnow.org/

Providers in North Carolina who want more data about providing office-based treatment of opioid use disorder using buprenorphine can join ECHO UNC, a program of weekly teleconferences that can be accessed by computer or by phone. This is free, and participants can get CME hours. The format is a case presentation, followed by questions and commentary about management options, then a short didactic session. Then the session wraps up with a second case presentation. It lasts 2 hours, and participants can join for all or part of the weekly conference. It’s held each Wednesday from 12:30-2:15 or so.

Interested providers can go to: https://echo.unc.edu/ to learn more and to sign up to participate.

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3 responses to this post.

  1. Dr. Burson, your presentation was the most outstanding in the entire conference!

    Reply

  2. Posted by Narinder saini on May 1, 2018 at 9:03 pm

    Thanks for sharing your visit to the conference Would like to attend it next year Narinder

    Sent from my iPhone

    >

    Reply

  3. Posted by Theodore D Fifer MD FACS on May 1, 2018 at 9:10 pm

    Excellent and thank you for sharing this information. Can you give us a reference for the safety of buprenorphine/naloxone in pregnant women ?

    Reply

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