Conference Season

Each spring we have several addiction medicine conferences. This year was the same; we had our regional North Carolina Society of Addiction Medicine Conference, followed closely by the national AATOD (American Association of Treatment for Opioid Dependence) meeting. Next week is the national ASAM (American Society of Addiction Medicine) conference.

This year, all of them were/are virtual.

I learned a great deal from the first two conferences and look forward to the third as well.

For a regional meeting, this year’s NC spring Addiction Medicine conference was impressive. I wasn’t expecting too much from the virtual meeting, so I was surprised at the ease of access to the sessions, and the graphics for the conference. This conference is supported by the NC Governor’s Institute on Drug Abuse, along with the state’s Department of Health and Human Services. They have been able to get speakers of prominence from the state and national levels. For example, Dr. Paul Earley, current president of ASAM, gave one of the opening keynote addresses.

Federal and state updates on various topics were given, and I particularly enjoyed several talks given by our state’s public health experts on overdose data in our state. We had excellent presentations by several of the most prominent psychiatrists in our state, which is always informative. Dr. Anthony Dekker, renowned for his work with Native American populations, gave interesting updates on the populations he treats.

Every other year, this conference recognizes outstanding work in the field of Addiction Medicine at the state level by giving the Frederick B. Glaser award. It’s awarded to people who have shown ongoing commitment and effort in our field in the areas of treatment, education, research, and leadership.

I (probably along with many other people) nominated Dr. Eric Morse, and was pleased that he won, in addition to Dr. Blake Fagan

I’ve worked most with Dr. Morse, who is tireless at providing advice and guidance to physicians and others working in our field. He chairs our regular OTP physicians meeting, among other activities.

We’ve had teleconference monthly meetings starting around 2008. This last year, due to COVID uncertainties and physicians’ demands, the meeting was held weekly. Dr. Morse moderated all of them. That’s a big commitment of time, especially in the middle of a workday. I find these sessions very helpful, but some weeks I’m too busy with patients to attend. Some weeks I tune in for at least a half hour. Anyway, I really appreciate Dr. Morse’s consistent efforts.

He also started a handful of opioid treatment programs in our state. Many people won’t recognize what a financial challenge this is. With all the regulations around the operation of an opioid treatment program, it usually takes more than a year to get through the approval process to open. Most physicians don’t have the capital to make this happen, but somehow Dr. Morse has been smart and savvy enough to open a handful of OTPs.

This means his OTPs are truly run by a physician, instead of a corporation.

Don’t get me wrong. I work for a for-profit corporation, and the state is fortunate to have these OTPs, because otherwise we couldn’t come close to meeting the needs of patients with opioid use disorders. But I really like the idea of a physician-owned & operated opioid treatment program.

But I digress.

I don’t know Dr. Blake Fagan quite as well, since he doesn’t work at an opioid treatment program but rather as a family physician in the Mountain Area Health Education Center (MAHEC) in Asheville, NC. He is a professor in the Department of Family Medicine at the University of North Carolina and has taught many residents in primary care fields about opioid use disorder and its treatment with medications. This is so important, because it ensures a fresh army of medical workers to help with the opioid use epidemic. He’s educated new providers about how to treat patients in office-based settings with buprenorphine products.

Both physicians richly deserved the award and I’m happy they both won.

The AATOD conference was a little different. I found it to be more difficult to navigate the online meetings; it was a little daunting for me, but I’m not very tech-savvy. It took me some time to figure out how the sessions worked; sessions were pre-recorded, and participants needed to view these presentations, then join a live question and answer session with the presenters. I also had to account for the three-hour time difference, but I made it to all of the plenary sessions in the mornings, and a fair number of the pre-recorded sessions in the afternoons (evenings for those of us on the east coast).

The AATOD plenary sessions are by their nature more about the big picture of opioid use disorder, and AATOD had some great speakers. I was interested in the talk given by Anja Busse, from the United Nations Office on Drugs and Crime. We can sometimes forget that the opioid epidemic taking place in the U.S. isn’t the only thing going on in the world of substance use disorders.

The AATOD meeting had speakers talk about the intersection of the justice system and opioid use disorder treatment, which appears to be a hot topic at present. They had a Justice from the Nevada supreme court and Nevada’s governor Steve Sisolak spoke as well.

With the attention now focused on inmate health, I am hopeful that soon we’ll see incarcerated patients have access to treatment medications for opioid use disorders.

The individual sessions were interesting. I particularly loved being inspired by Dr. Loretta Finnigan, who did the pioneering work on treatment for pregnant women with opioid use disorders, about the compassionate and effective treatment of women with opioid use disorder, followed by Dr. Mishka Terplan, with focused information. I’ve heard them both speak before, and always find it rewarding to hear them.

One of the most interesting sessions was about the changes in the privacy standards for patients getting care at opioid treatment programs. There’s been many people pushing to allow opioid treatment programs enter data about their patients to their state’s prescription monitoring program. Indeed, I’ve blogged about this before (see my blog on September 2, 2020). Presenters made great points. Their best argument against easing confidentiality standards was that prospective patients may be discouraged from seeking help for opioid use disorder if they know their information will be made available to anyone with access to the prescription monitoring program. In some states, law enforcement can access this data, and some states have loose controls around this. The potential for misuse of that information is worrisome.

Next week is the national ASAM meeting, and I’m anticipating it too.

Virtual meetings are great in some ways, not so great is other ways. I appreciate the convenience and cost savings of virtual meetings, aside from reducing the risk of COVID transmission. And I can work on my craft projects while listening to presenters. But a great deal of the “feeling” (for lack of a better word), is lost. I miss that sense of comradery and common purpose I get sitting in a room of my peers, all dedicated to improving our knowledge and skills to better treat our patients. That feeling isn’t reproduced virtually, for me.

I believe that next year we will be back to actual meetings, and I vow not to take that for granted.

2 responses to this post.

  1. Posted by npcz83 on April 19, 2021 at 7:41 pm

    I always enjoy hearing/reading your perspective, doctor Burson! Has anyone at these conferences mentioned anything about possibly keeping the extra COVID take homes in place even after the pandemic restrictions are no longer in place? My understanding is that, generally, most patients have responsibly handled their extra take homes, but I’m also sure it’s by state rather than a blanket federal deal. But I’m curious if the people at the top are at least considering something like this. For example here in PA Max take homes is 6 (ugh), so it would be AMAZING if someone like myself—fully compliant for 4 years—could stay at 13 take homes instead of having to go back to 6, when I’ve shown I have been responsible with 13. Maybe these things will be considered at the clinic-by-clinic level? Would love any insight if you have it. Thanks!

    Reply

    • No I didn’t hear anything about actual federal plans or recommendations, which surprised me. I will keep my ears open during the national ASAM meeting later this week.
      I think you’re right – OTPs must abide by whichever system which is most restrictive, federal vs state. For example, I was thinking about submitting exceptions for some patients who use THC and have positives for this to remain at advanced levels if they did well over the past year. But we were told explicitly NOT to submit such exception requests because they would not be approved, which is disappointing.
      It’s crazy for one week to be the maximum take home level – very restrictive.

      Reply

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