President's Blog

  • CARE

    by R. Jeffrey Goldsmith, MD,DLFAPA, FASAM | June 12, 2015

    People are dying daily from illegal prescription drug use. Physicians are involved in this complicated scenario--what I describe as a three-ring circus sometimes. One ring is the family and network of the dead person; one ring is the medical professionals’ commitment to treat pain as the fifth vital sign; and one ring is the group of individuals whose addiction drives them to maneuver people to get more drugs, over and over again.

    This is not entertaining, as our hearts tell us. ASAM is committed to “bringing better care” to people suffering from addiction. This can happen in many different ways. As a far-reaching cadre of healthcare specialists, ASAM has noticed that many physicians do not pay much attention to addictive disorders. For many at ASAM, we have seen this go on for decades. Those of us in academic settings have worked hard to make this awareness in training more substantial, putting ourselves on the line. But the measureable outcomes are still limited, and younger physicians are not eagerly aware of addiction despite it being a common chronic illness.

    ASAM has linked up with several groups this year to make significant progress. The Hazelden Betty Ford Foundation worked with the Treatment Research Institute (TRI) and made an agreement with ASAM to provide experts to create teaching modules that medical schools across the US can subscribe to each year. This is being done through MedU, which has created much-used cases in pediatrics through CLIPP, family medicine through fmCASES, internal medicine through SIMPLE, and others. Hazelden Betty Ford Foundation, TRI, ASAM and MedU together have developed clinical vignettes and 14 lecture modules on a variety of addiction knowledge topics, by bona fide international experts. It is named CARE, Course on Addiction and Recovery Education.

    Last year the collaborative group integrated addiction recognition, addiction knowledge and addiction management skills, for all physicians, into three vignettes. This year we included addiction problems into three additional vignettes. We now have six different addiction vignettes that can be used by any medical school that wants to incorporate this new technology into their teaching program for medical students. This can be adapted for residency training, or even faculty training for new teachers.

    This enhances two of ASAM’s three strategic priorities: quality of care and the expansion of training for primary care clinicians. This does not oblige medical schools to use these products. Whatever we can do to enhance medical school awareness that addiction is common and chronic in nature, will help these strategic interventions succeed. Greater awareness will also help physicians expand access to treatment, knowing that there is some kind of treatment for their/our patients. We are all in this together.

    Here is the website and press release on CARE; check them out when you have a moment. You can try the modules free for 30 days, with this offer being shown on the CARE site below:

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  • President’s Blog: Envisioning the Future - Today

    by R. Jeffrey Goldsmith, MD, DLFAPA, FASAM | February 13, 2015

    In August the Board of Directors (BOD) met to set the strategic priorities for ASAM for the next three years, 2015-2018. These priorities do not replace the work ASAM is already doing in the areas of membership, education and advocacy. Instead, these selected priorities will help focus the organization’s work and assure that we make progress in these important strategic areas.

    We are proud of the many members and other stakeholders who provided input to help with the Board’s decision making. We received member feedback at last year’s business meeting, chapter leadership input and conducted interviews with more than 20 external organizations to identify many needs in the addiction field.

    After significant deliberation, the BOD by consensus selected three strategic priorities which reflect member needs, that respond to our external environment and which will strengthen ASAM’s mission. A strong theme across all of these priorities is how they will support patient access to quality treatment – a core tenant of ASAM’s mission.

    Each priority requires ASAM resources, which do have limits - money, people and time – but these are challenges we are willing to overcome.

    So what are these three areas?

    The first focuses on advocacy with public and private payers to assure access to treatment. Payer policies that affect patient access to all kinds of addiction treatment are an ongoing issue. Especially as Medicaid coverage expands, more addiction patients have Medicare coverage, and members have further experience with health plans on the exchanges. Our headquarters staff receive calls and emails from members on a regular basis about a range of payer related issues, including prior authorization policies, restrictive coverage and network inclusion policies to name just a few. Expanding our resources to respond to these issues is critical to assure patient access.

    The second area focuses on quality improvement. Developing standards, performance measures and guidelines, keeping these resources current, and driving their application in practice require a long-term commitment to quality improvement. ASAM has recently updated The ASAM Criteria which is being adopted in the public and private sectors. We are developing a range of associated products such as an electronic clinical decision tool that will standardize the use of The ASAM Criteria. ASAM’s Quality Improvement Council has also been working recently on standards, guidelines and performance measures and now has the organization’s commitment to grow and expand this important work.

    The third priority area involves expanding the Fundamentals of Addiction Medicine curriculum to provide an effective way to increase the knowledge and competency of primary care providers in treating addiction. Last year, ASAM launched a live course component of this curriculum. Over the next three years, the curriculum will be expanded to include a range of online and competency-based trainings whose completion will result in recognition for learners’ completion.

    The Fundamentals of Addiction Medicine curriculum is designed to change attitudes, expand skills – and ultimately to improve patient care. I believe in the Culture of Denial, part of the standard culture of America. It has kept physicians from being aware of the ubiquity of substance use disorders and their important role in responding to the presence of problems. We have plenty of research evidence that early recognition encourages earlier behavior changes and better long-term outcome.

    Expanding the skills of the thousands of primary care professionals will help to expand access to treatment by providing early screening, early interventions and early referrals for expert treatment by addiction specialists. It will also create more public awareness, health care awareness and ongoing dialogue at home and in the physician’s office.

    The BOD’s priority setting process was titled “Envisioning the Future.” With our plans of action in place, we’d welcome your involvement and feedback in the comments below on how to make these priorities a vision for today.

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  • Associate Membership Presents New Opportunity

    by Herb Malinoff, MD, FACP, FASAM | September 20, 2013

    With the approval of an Associate Membership Category by ASAM's Board of Directors, ASAM joins many other medical societies by including nonphysician clinicians and scientists in their membership.

    Associate Membership presents a new opportunity to impact the quality of addiction care for patients dealing with addiction. The new Associate Member category will allow select non-physicians to join ASAM in its mission to improve the quality of addiction treatment.

    ASAM is committed to your needs as a physician in addiction medicine. The Associate Member category will not alter or dilute ASAM’s mission – it will strengthen it. To demonstrate ASAM’s dedication to serving our physician members, Associate Members will be part of a non-voting Section (structured like a committee) and the Section Council will report to the ASAM Board of Directors. Furthermore, eligible professionals applying for Associate Membership must be sponsored by an ASAM Member in good standing. Help secure the future of addiction medicine by welcoming the contributions of your associate colleagues.

    Physician members remain ASAM’s top priority and focus, however the Associate Member Category will help advance the field and continue to improve the quality of care for our patients. Many ASAM members currently work with non-physician colleagues and have already experienced how those eligible for Associate Membership contribute to addiction medicine and treatment in many ways. This is a major step for ASAM that will provide new opportunities for current members to share knowledge, discuss research and hone treatments with other dedicated professionals working in addiction medicine.

    Physicians serve as the leaders of interdisciplinary teams caring for patients—help advance the quality of addiction treatment at all levels and bolster ASAM’s position as the preeminent organization dedicated to addiction medicine. Recruit non-physician colleagues to join ASAM.

    I look forward to your continued support of ASAM and its mission.

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  • AMA House of Delegates Meeting Wrap-up

    by Stuart Gitlow, MD | June 24, 2013

    Our ASAM team met with success at the American Medical Association’s annual meeting last week. The AMA accepted new policy that we had proposed which states that the organization opposes any limitation to patient access to medically necessary pharmacologic therapies for opioid use disorder. This new policy applies both to opioid treatment programs or to office based practices; it covers federal, state, and third-party restrictions on duration of treatment, medication dosage or level of care. Although the resolution met with some mild push-back from one of the Blues, it swept through both reference committee and the House of Delegates unscathed.

    We were also successful at stopping the California Medical Association’s efforts to reschedule what they referred to as “medical cannabis” and to decriminalize “medical use of cannabis.” ASAM testified once again that there remains no such thing as either medical cannabis or appropriate medical use of cannabis. We noted that salicylates can be synthesized from willow bark, but that physicians do not, to our knowledge, recommend that patients obtain their aspirin in that manner. ASAM supports moving marijuana out of Schedule I, but does not support placing it in the other existing DEA Schedules. Rather, we support implementation of a newly devised Schedule that would permit appropriate research to take place without indicating that there are medical applications for the plant. Schedules II and up would suggest this, and although small-scale studies suggest potential medical use for cannabinoids, as of yet there is no evidence that marijuana itself would meet the typical requirements of a medication. 

    We were unsuccessful in our effort to see the AMA support hydrocodone combination products being rescheduled from Schedule III to Schedule II. We based our proposal on the scientific fact that hydrocodone combination products have no less addiction potential than other narcotics, nearly all of which are in Schedule II. This effort met with enormous and rather overwhelming disagreement from pain/palliative care physicians as well as from the surgical caucus; these groups want to retain the ability to easily call in prescriptions for narcotics or to write refills where appropriate. They felt that hydrocodone combination products remain the only real choice in such situations where phone orders are necessary. Not only did our proposal fail, but ultimately, the AMA adopted policy that promotes keeping hydrocodone combination products in Schedule III.

    Our Alternate Delegate, Ilse Levin, DO, was re-elected to the AMA’s Council on Science and Public Health by unanimous consent of the House. Dr. Levin will have four additional years on the Council as a result.

    Specialty societies are evaluated every five years to determine if they should retain their delegate seat in the AMA House. This was our year for review and we successfully accomplished our goal here. The next AMA meeting takes place in National Harbor, Maryland, in November. All our ASAM members who are also members of the AMA are most welcome to join with our delegation at the meeting.

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  • Call to Action: Unite the Addiction Field

    by Stuart Gitlow, MD | February 15, 2013

    As the Chairman of ASAM's Board, I have the privilege of sitting on the Board of the National Council on Alcoholism and Drug Dependence. Founded by Marty Mann and with over 100 affiliates throughout the US, NCADD has played a key role in the development of the addiction treatment community. NCADD has a policy development group, a medical-scientific committee, and an annual meeting. Interestingly, though, other than my presence on the Board, there is no formal relationship between ASAM and NCADD, which act in parallel with very similar goals. I have taken the first step toward mending this breach by offering the NCADD Board a chance to assign a liaison to participate in our Board meetings. Since that offer was made, NCADD has already participated in a recent ASAM Board teleconference. I view this as a significant step forward, but I believe there is much more that we can accomplish.

    This past week, I had the chance to meet with the Executive Director of NASADAD, the National Association of State Alcohol/Drug Abuse Directors. They too have an annual meeting, and their basic purpose is to "foster and support the development of effective alcohol and other drug abuse prevention and treatment programs throughout every State." NASADAD's bylaws specifically encourage a promotion of training within the field, a focus on translating research and knowledge into practice, and attention to shaping public policy positions that advance the state of addiction treatment. As I flew home from Washington after that meeting, I sat next to a group of people who had just attended the CADCA meeting. Thousands of attendees had been at the National Leadership Forum. But what is CADCA, I asked.

    CADCA is the Community Anti-Drug Coalitions of America, a group that for 20 years has been representing the interests of more than 5000 community coalitions throughout the country, and which now terms itself the nation's leading drug abuse prevention organization. And although there is an MD on CADCA's Board of Directors, there is no formal relationship between CADCA and the addiction medicine community.

    I could go on, noting the presence of Faces and Voices of Recovery, NAADAC, AATOD, AMERSA, AAAP, and the International Nurses Society on Addictions as further examples. The latter group is holding its 37th annual conference later this year. Missing in action, however, has been a true public face in the addiction world. Gary Mendell aims to correct that oversight, as he addressed the Clinton Foundation's 2013 Health Matters Conference recently with respect to his goals with www.Brianswish.org.

    But at the end of the day we still have an illness that directly impacts well over 15% of our population and with the direction things are going with marijuana it is likely to have an even greater health and economic impact upon our society than ever before. And we have a dozen or two large organizations with overlapping missions and visions. While many of these groups cooperate informally and formally through coalitions on policy issues such as parity and ACA, there have been no regular meetings of Board Chairs. There have been no world congresses on addiction where we all get together at one time.

    I'd like to see this oversight fixed. I want to reach out to my counterparts at the other groups and begin the discussions. But I'd prefer to do this with a major goal in mind. What I'm picturing, is putting the building blocks in place to hold a US Congress on Addiction sometime in the next four to five years.  This Congress would be, a single conference that would include and incorporate the annual meetings of major groups in the field, that would bring all the players together at one time to discuss policy, to hold educational sessions, to work on terminology, to address turf issues, and to respond to the growing problems with as much of a single voice as we can muster. We would include the scientific, medical, research, payer, recovery, and both public and private communities and related organizations. While there are many logistical, business and other details to sort out, we need to set our sights high.

    ASAM has had some big goals over the past few years, among which have been parity and board certification. I raised another, a diagnostic manual, last time. And here is one more - the concept of bringing the entire field together to achieve a true working relationship, improved outreach, and a genuine network for the benefit of our patients with addiction.

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