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Biography and Statement - Miriam Komaromy, MD, FACP, FASAM

Candidate for Region VIII: Regional Director

komaromy-asam-election

1. What are your greatest contributions to ASAM and the field of addiction medicine?

I serve ASAM in a number of different capacities. I am a member of ASAM’s national Medical Education Council. I am co-chair of the Fundamentals of Addiction Medicine Course (which has been offered as an 8-hour pre-course at the ASAM Annual Meeting), and I lead the Fundamentals of Addiction Medicine teleECHO (FAME) program that is part of ASAM’s new Fundamentals Recognition Program. I am also President-elect of the newly formed New Mexico ASAM Chapter.

As co-chair of the Fundamentals of Addiction Medicine Course, I have worked closely with Dr. Peter Selby, who chairs the course, to transform it into a highly interactive day-long workshop which is being streamlined to allow the course to be offered by small teams of ASAM members who will serve as faculty in continuing education venues around North America. This will make the course more accessible and will allow primary care providers around the US and Canada to gain access to high-quality training in treatment of SUDs. It will also offer an opportunity for ASAM specialists to share their expertise with PCPs in their region and to establish mentoring relationships. We have also developed the new ASAM Fundamentals of Addiction Medicine Recognition Program, which provides trainees who participated in the Fundamentals day-long course with the opportunity to complete a 40 hour course of study in additional addiction medicine topics in order to receive official recognition of their extended training from ASAM.

As part of the implementation of this new Recognition program, I have obtained funding from the federal Center for Substance Abuse Treatment (CSAT) to develop a teleECHO clinic that is designed specifically for participants in the Recognition program. (As explained in my brief biography, ECHO is a model for training PCPs to care for common complex diseases such as hepatitis C, rheumatologic disorders, and SUDs. ECHO uses video conferencing technology to connect multiple PCPs with a team of specialists at a central hub, which is typically an academic medical center, for weekly video conferences. PCPs present cases from their own practices, and receive mentorship and guidance from the specialists. Over time this results in the development of confidence and expertise, and PCPs become able to offer treatment in their own communities.) Although ECHO programs are typically statewide, this pilot ECHO clinic is international in scope, in the location of both trainees and specialists, since multiple ASAM members are joining by video to offer their expertise from around the continent.

In NM I have played a significant role in shaping health policy in relation to treatment for SUDs. I was instrumental in obtaining Medicaid coverage for buprenorphine and methadone for treatment of opioid use disorder, and for the removal of prior authorization requirements and limitations in treatment duration. I have drafted legislation that has been introduced to provide incentives for physicians to treat opioid use disorder, and contributed to the bill that authorizes pharmacists to dispense naloxone without a prescription. I am frequently called to testify on substance use issues before the state legislature, and have served on committees at all levels to try to improve access to high quality treatment.

Through the ECHO Institute I have participated in providing OBOT training to nearly 500 NM physicians to allow them to obtain the federal waiver (in collaboration with ASAM, AAAP, and other organizations). During the decade that we have been providing this training NM has greatly increased the number of buprenorphine-waivered physicians statewide and particularly in traditionally-underserved areas. I lead a weekly teleECHO clinic that offers NM PCPs a forum for ongoing case-based learning about treatment of SUDs. On average more than 140 PCPs participate in the teleECHO clinic each year, and more than 650 PCPs have participated in the past 5 years.

I am frequently invited to speak locally and nationally about addiction medicine, including a presentation at the 2015 Buprenorphine Summit sponsored by SAMHSA and NIDA, and during the past year a National Governors’ Association health policy roundtable on how to address the opioid epidemic in the rural US, a presentation at a recent SAMHSA conference on the use of telehealth in promoting the use of pharmacotherapy for SUDs, and meetings with the Secretary of Agriculture, Tom Vilsack, and Michael Botticelli, Director of the White House Office of National Drug Control Policy (ONDCP) to discuss approaches to the opioid epidemic.

Finally, I am very involved in health services research related to SUDs and feel strongly that we need more funding and opportunities to evaluate strategies to meet clinical, educational, and workforce needs in the field of Addiction Medicine. I will be receiving the 2016 AMERSA award for the best program/curriculum abstract.

2. How would your election benefit ASAM and the field of addiction medicine?

As the leading addiction medicine specialty society in the US, ASAM is in a tremendous position to provide national leadership in developing solutions to the epidemic of opioid use disorder (OUD) that is devastating the country, as well as the longstanding challenges of alcohol and tobacco use disorders and substance use disorders in general.

It is unlikely that there will ever be enough addiction medicine specialists to provide treatment to all North Americans who need it. Instead, we can play a critical role by sharing our expertise to train PCPs to provide this care in the majority of cases, while we continue to play an essential clinical role in caring for the most complex patients. We have the ability to train and support a primary care workforce that can provide massive expansion of access to treatment for OUD and other SUDs, and we can guide and shape this treatment in order to ensure that it is high-quality and evidence-based so that it can be as effective as possible.

I have learned a great deal from my work on ASAM committees and development of our local chapter. The Fundamentals of Addiction Medicine course and extended Recognition program are examples of ways that ASAM members can provide tremendous local benefit to their communities, by offering training and support to PCPs in their areas to promote primary-care-based treatment of SUDs. I will work to expand this program, and to develop new tools to help ASAM members influence and improve the treatment environment in their communities.

Providing this type of training to primary care teams has been the focus of my work in NM for much of the past decade. I would like to extend this focus to the national level, and help to develop solutions that can catalyze workforce expansion and access to treatment for SUDs nationally and internationally by harnessing and promoting the expertise of ASAM addiction medicine specialists.

I will also advocate for and promote research on clinical and health-care delivery strategies to maximize the impact of Addiction Medicine for the benefit of our field, and most of all, for the patients whom we serve.

Biographical Sketch

I am a 53 year old Internist and Addiction specialist, practicing at the University of New Mexico (UNM) in Albuquerque. I grew up in Albuquerque, but did all of my training in the Bay Area at UCSF. I became interested in addiction medicine as an intern at San Francisco General Hospital, when my clinical practice was filled with impoverished young men who were dying of AIDS and were addicted to a number of different substances. Getting to know them as they tried to make peace with their illness and impending death gave me a window into a reality that I had never understood: addiction can happen to anyone, and wonderful, warm, talented people can fall victim to this disease. I returned to New Mexico 12 years ago and practiced in several community-based settings before coming to the University full time. These settings included an FQHC where I established an OBOT practice, the state-funded addiction-treatment hospital where I was medical director, and Albuquerque Health Care for the Homeless, where I established a large program to provide buprenorphine treatment, counseling, and case management for individuals with opioid use disorder who were being released from incarceration.

Since returning to NM 12 years ago I have held a part-time position with Project ECHO at UNM, and 3 years ago I came to the ECHO Institute at UNM full time and became Associate Director. ECHO is a model for training PCPs to care for common complex diseases such as hepatitis C, rheumatologic disorders, and SUDs. ECHO uses video conferencing technology to connect multiple PCPs with a team of specialists at a central hub, which is typically an academic medical center, for weekly video conferences. PCPs then present cases from their own practice, and receive mentorship and practice guidance from the specialists. Over time this results in the development of confidence and expertise, and PCPs become able to offer treatment in their own communities. I established at Integrated Addictions and Psychiatry teleECHO clinic at UNM 11 years ago, and since that time I and colleagues have hosted a weekly 2-hour session to help PCPs learn to treat SUDs. We have also been responsible for offering the buprenorphine waiver training to approximately 400 NM physicians (in collaboration with ASAM, AAAP, etc). Since becoming Associate Director at Project ECHO my primary focus has continued to be on the treatment of SUDs, including a pilot national addiction treatment teleECHO that I am conducting in collaboration with ASAM for trainees who have completed the ASAM one-day Fundamentals of Addiction Medicine live course. This exciting teleECHO clinic is bringing together PCPs from around the country who want to increase their addiction medicine skills and a number of ASAM members who have been contributing their expertise to help with case discussions and addiction medicine updates. The Center for Substance Abuse Treatment has generously provided me with support for this pilot project. I also focus my efforts on supporting other groups around the world who are using the ECHO model to treat a wide variety of diseases, and it has been very exciting to see a number of groups begin to use this approach to provide training and support for PCPs who are interested in treatment of SUDs.