SUBSTANCE USE DISORDERS: A Comprehensive Review and Update 2019

Transcription

1 SUBSTANCE USE DISORDERS: A Comprehensive Review and Update 2019 Sunday Wednesday February 17-20, 2019 Disney s Grand Floridian Resort & Spa Course Directors: John F. Kelly, PhD Founder and Director, Recovery Research Institute Program Director, Addiction Recovery Management Service (ARMS) Associate Director, Center for Addiction Medicine Elizabeth R. Spallin Associate Professor of Psychiatry in Addiction Medicine Harvard Medical School David H. Rubin, MD Executive Director, Psychiatry Academy Director of Child and Adolescent Psychiatry Residency Training Christopher J. Shaw, RN, ANP, PMHNP-BC, CARN-AP Nursing Director, Substance Use Disorders Timothy E. Wilens, MD Chief, Division of Child and Adolescent Psychiatry Co-Director, Center for Addiction Medicine Professor of Psychiatry Harvard Medical School

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3 Substance Use Disorders: A Comprehensive Review and Update 2019 Sunday Wednesday February 17-20, 2019 Disney s Grand Floridian Resort & Spa WELCOME On behalf of the Department of Psychiatry, we are proud to welcome you to our annual conference Substance Use Disorders: A Comprehensive Review and Update. This conference provides a broad update across assessment and treatment of substance use disorders (SUD). Our sessions and panel discussions touch on many complex topics. This includes treating addiction as a chronic disease, treating medical and psychiatric comorbidities, and misuse of many different substances. These issues challenge even experienced health care professionals. That is why in every session, our faculty share their diverse experience and help you find the best strategies to care for your patients who struggle with SUD. We know these patients are seen across all practice settings, so our goal is to share knowledge that is helpful whether you work in primary care, psychiatry, social work, psychology, nursing and more. Please ask all your questions. Get feedback on your challenging cases. And find the guidance you need to improve outcomes for your patients with SUD. Thank you for joining us at this important conference! TARGET AUDIENCE This program is intended for psychiatrists, psychologists, general and family practice physicians, nurses, physician assistants, nurse practitioners and social workers. COMPLIMENTARY BREAKFAST, LUNCH, AND COFFEE BREAKS Complimentary breakfast, lunch and coffee breaks will be available to course participants. EVALUATION FORMS/CME/CEU CERTIFICATES Every participant needs to complete the activity evaluation online to claim CME/CEU credits for this course. Please refer to the Evaluation and CME Information document in this syllabus for more information. We strongly encourage you to complete the evaluation, even if you do not require a certificate. Your comments are important to us as we plan future programs. The link to claim credit is as follows: QUESTIONS Opportunity for questions will be provided at the end of each module during the panel discussion. Please write your questions on the index cards provided. Cards will be collected during the last 15 minutes of the lecture prior to the start of the panel discussion. Experience has shown that this method is preferable to that of spontaneous questions. COPYRIGHT The course materials and PowerPoint presentations are copyright protected by, Department of Psychiatry, Division of Postgraduate Education, the faculty members and the appropriate authors. Videotaping and audiotaping are not allowed. Thank you for your cooperation.

4 CELLULAR TELEPHONES & PAGERS During the lectures, we ask that you turn your cell phones and pagers to vibrate or off. We also ask that you do not talk on your cell phones inside the meeting room. Thank you for your cooperation. CONTACT INFORMATION For questions or comments, please contact MGH Psychiatry Academy member services at or LEARNING OBJECTIVES At the end of this educational activity, participants should be able to: Determine the best practices for treatment of substance use disorders Evaluate how to properly screen and diagnose substance use disorders Identify rational, evidence based pharmacologic and non-pharmacologic therapies for patients with substance use disorders Assess relative utility and strengths of recovery-oriented models of care Analyze the progression of the disease from childhood through adolescence Assess and treat patients with co-morbid substance use, mood disorders, anxiety disorders, ADHD, pain, and infectious diseases Determine how to manage complicated withdrawal Implement motivational interviewing, CBT and contingency management techniques when working with patients suffering from substance use disorders Analyze the effects of and interventions for marijuana and synthetics Identify the different approaches and challenges associated with opioid, alcohol and nicotine treatment ACCREDITATION This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of McLean Hospital and. McLean Hospital is accredited by the ACCME to provide continuing medical education for physicians. McLean Hospital designates this live activity for a maximum of AMA PRA Category 1 Credits. Physicians should only claim credit commensurate with the extent of their participation in the activity. Please Note: The Buprenorphine (MAT) Waiver Training on Sunday, February 17 is not included the accreditation provided through the joint providership of McLean Hospital and. AMA PRA Category 1 Credit and continuing education credit are not offered for the waiver training. PSYCHOLOGISTS The Department of Psychiatry is approved by the American Psychological Association to sponsor continuing education (CE) for psychologists. The Department of Psychiatry maintains responsibility for this program and its content. This offering meets the criteria for Continuing Education (CE) credits for psychologists. REGISTERED NURSES This program meets the requirements of the Massachusetts Board of Registration in Nursing (244 CMR 5.00) for contact hours of nursing continuing education credit. Advance practice nurses, please note: Educational activities which meet the requirements of the ACCME (such as this activity) count towards 50% of the nursing requirement for ANCC accreditation.

5 SOCIAL WORKERS This program has been approved for Social Work Continuing Education hours for relicensure, in accordance with 258 CMR. Collaborative of NASW and the Boston College and Simmons Schools of Social Work Authorization Number D AMERICAN ACADEMY OF FAMILY PHYSICAINS (AAFP) This Live activity, Substance Use Disorders: A Comprehensive Review and Update 2019, with a beginning date of 02/17/2019, has been reviewed and is acceptable for up to Prescribed credit(s) by the American Academy of Family Physicians. Physicians should claim only the credit commensurate with the extent of their participation in the activity. AMERICAN BOARD OF PSYCHIATRY & NEUROLOGY MOC PROGRAM The American Board of Psychiatry and Neurology Has Reviewed the Substance Use Disorders: A Comprehensive Review and Update 2019 conference and has approved this program as part of a comprehensive program, which is mandated by the ABMS as a necessary component of maintenance of certification. This program is approved as an ABPN Maintenance of Certification program. It awards up to AMA PRA Category 1 Credits. Other CE Licenses: Other Providers can claim a Participation Certificate upon successful completion of this course. Participation Certificates will specify the title, location, type of activity, date of activity, and number of AMA PRA Category 1 Credits associated with the activity. Providers should check with their regulatory agencies to determine ways in which AMA PRA Category 1 Credits may or may not fulfill continuing education requirements. Providers should also consider saving copies of brochures, agenda, and other supporting documents.

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7 AGENDA SUNDAY, FEBRUARY 17, :00 6:00 PM Buprenorphine (MAT) Waiver Training Laura G. Kehoe, MD, MPH, FASAM THIS IS A TICKETED EVENT, NO CME CREDIT. MONDAY, FEBRUARY 18, :00 8:00 AM Registration & Continental Breakfast 8:00 8:10 AM Welcome & Introduction David H. Rubin, MD MODULE TOPIC 1: EMPIRICALLY BASED METHODOLOGIES 8:10 8:30 AM Motivational Interviewing John F. Kelly, PhD 8:30 8:50 AM CBT John F. Kelly, PhD 8:50 9:10 AM Harm Reduction Christopher J. Shaw, RN, ANP, PMHNP-BC, CARN-AP 9:10 9:50 AM Panel Discussion Moderator: Timothy E. Wilens, MD Panelists: John F. Kelly, PhD, Christopher J. Shaw, RN, ANP, PMHNP-BC, CARN-AP 9:50 10:10 AM Coffee Break MODULE TOPIC 2: RECOVERY ORIENTED 10:10 10:30 AM Self-Help Treatments John F. Kelly, PhD 10:30 10:50 AM Screening Christopher J. Shaw, RN, ANP, PMHNP-BC, CARN-AP 10:50 11:10 AM Treating Addiction as a Chronic Disease Colleen T. LaBelle MSN, RN-BC, CARN 11:10 11:30 AM Nursing Clinical Care: The MGH Model Christopher J. Shaw, RN, ANP, PMHNP-BC, CARN-AP 11:30 12:10 PM Panel Discussion Moderator: Timothy E. Wilens, MD Panelists: John F. Kelly, PhD, Colleen T. LaBelle MSN, RN-BC, CARN, Christopher J. Shaw, RN, ANP, PMHNP-BC, CARN-AP 12:10 1:10 PM Lunch

8 MODULE TOPIC 3: PHARMACOTHERAPY I 1:10 1:30 PM Alcohol Laura G. Kehoe, MD, MPH, FASAM 1:30 1:50 PM Methamphetamine, Cocaine, Stimulants Timothy E. Wilens, MD 1:50 2:20 PM Panel Discussion Moderator: John F. Kelly, PhD Panelists: Laura G. Kehoe, MD, MPH, FASAM, Timothy E. Wilens, MD 2:20 2:40 PM Coffee Break MODULE TOPIC 4: OPIOID 2:40 3:00 PM Overview of Opioid Use Disorder Colleen T. LaBelle MSN, RN-BC, CARN 3:00 3:20 PM Buprenorphine 101 Laura G. Kehoe, MD, MPH, FASAM 3:20 3:40 PM Naltrexone Intramuscular & Methadone Laura G. Kehoe, MD, MPH, FASAM 3:40 4:20 PM Panel Discussion Moderator: Timothy E. Wilens, MD Panelists: Laura G. Kehoe, MD, MPH, FASAM, Colleen T. LaBelle MSN, RN-BC, CARN 4:20 PM Adjourn

9 TUESDAY, FEBRUARY 19, :00 8:00 AM Continental Breakfast 7:00-8:00 AM Ask the Expert Breakfast Session Timothy E. Wilens, MD THIS IS A TICKETED EVENT, NO CME CREDIT. 8:00 8:10 AM Introduction Timothy E. Wilens, MD MODULE TOPIC 5: NEUROSCIENCE 8:10 8:30 AM Neurobiology of Addiction Timothy E. Wilens, MD 8:30-8:50 AM Genetics of Substance Use Disorders Robert R. Althoff, MD, PhD 8:50 9:20 AM Panel Discussion Moderator: David H. Rubin, MD Panelists: Timothy E. Wilens, MD, Robert R. Althoff, MD, PhD MODULE TOPIC 6: DEVELOPMENTAL PERSPECTIVES 9:20 9:40 AM Childhood Precursors Robert R. Althoff, MD, PhD 9:40-10:00 AM Adolescence Timothy E. Wilens, MD 10:00 10:30 AM Panel Discussion Moderator: David H. Rubin, MD Panelists: Robert R. Althoff, MD, PhD, Timothy E. Wilens, MD 10:30 10:50 AM Coffee Break MODULE TOPIC 7: MARIJUANA, SYNTHETICS AND TRIPLE C-LEGAL AND ILLEGAL 10:50 11:10 AM Medical Marijuana Timothy E. Wilens, MD 11:10 11:30 AM Contingency Management in Marijuana Addiction Robert R. Althoff, MD, PhD 11:30 11:50 AM OTC: Synthetics and Triple C Timothy E. Wilens, MD 11:50 12:30 PM Panel Discussion Moderator: Laura G. Kehoe, MD, MPH, FASAM Panelists: Timothy E. Wilens, MD, Robert R. Althoff, MD, PhD 12:30 1:30 PM Lunch

10 MODULE TOPIC 8: COMORBIDITY I 1:30 1:50 PM ADHD Timothy E. Wilens, MD 1:50 2:10 PM Pain Laura G. Kehoe, MD, MPH, FASAM 2:10 2:30 PM Pregnancy Colleen T. LaBelle, MSN, RN-BC, CARN 2:30 3:00 PM Panel Discussion Moderator: David H. Rubin, MD Panelists: Timothy E. Wilens, MD, Laura G. Kehoe, MD, MPH, FASAM, Colleen T. LaBelle, MSN, RN-BC, CARN 3:00 PM Adjourn

11 WEDNESDAY, FEBRUARY 20, :00 8:00 AM Continental Breakfast 8:00 8:10 AM Introduction David H. Rubin, MD MODULE TOPIC 9: COMORBIDITY II 8:10 8:30 AM Mood Disorders Shamim H. Nejad, MD 8:30 8:50 AM Anxiety Disorders Shamim H. Nejad, MD 8:50 9:10 AM Question & Answer Session Shamim H. Nejad, MD MODULE TOPIC 10: PHARMACOTHERAPY II 9:10 9:30 AM Withdrawal Management Dawn Williamson, RN, DNP, PMHCNS-BC, CARN-AP 9:30 9:50 AM Nicotine Shamim H. Nejad, MD 9:50 10:10 AM Sedatives and Hypnotics David H. Rubin, MD 10:10 10:40 AM Panel Discussion Moderator: David H. Rubin, MD Panelists: Shamim H. Nejad, MD, Dawn Williamson, RN, DNP, PMHCNS-BC, CARN-AP 10:40 AM Adjourn

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13 FACULTY Planners: John F. Kelly, PhD (Course Director) Founder and Director, Recovery Research Institute Program Director, Addiction Recovery Management Service (ARMS) Associate Director, Center for Addiction Medicine Elizabeth R. Spallin Associate Professor of Psychiatry in Addiction Medicine Harvard Medical School David H. Rubin, MD (Reviewer, Course Director) Director, Child and Adolescent Psychiatry Residency Training and McLean Hospital Director, Postgraduate Medical Education, Department of Psychiatry Executive Director, Psychiatry Academy Christopher J. Shaw, RN, ANP, PMHNP-BC, CARN-AP (Course Director) Nursing Director, Substance Use Disorders Timothy E. Wilens, MD (Course Director) Chief, Division of Child and Adolescent Psychiatry Co-Director, Center for Addiction Medicine Professor of Psychiatry Harvard Medical School James Althoff, MD (Reviewer) Family Physician Rural Family Medicine Associates Diplomate of the American Board of Family Medicine Jane Pimental, MPH Managing Director Psychiatry Academy Susan Sprich, PhD (Psychologist Reviewer) Director, Postgraduate Psychology Education Director, Cognitive Behavioral Therapy Program Assistant Professor of Psychology Harvard Medical School Faculty: Robert R. Althoff, MD, PhD Associate Professor of Psychiatry, Psychology and Pediatrics Director, Adirondack Division, Department of Psychiatry University of Vermont College of Medicine Laura G. Kehoe, MD, MPH, FASAM Medical Director, Substance Use Disorder Bridge Clinic Assistant Professor of Medicine, Harvard Medical School John F. Kelly, PhD (Course Director) Founder and Director, Recovery Research Institute Program Director, Addiction Recovery Management Service (ARMS) Associate Director, Center for Addiction Medicine Elizabeth R. Spallin Associate Professor of Psychiatry in Addiction Medicine Harvard Medical School Colleen T. LaBelle, MSN, RN-BC, CARN Program Director, Office Based Addiction Treatment Director, State Technical Assistance Treatment Expansion Office Based Opioid Treatment with Buprenorphine (STATE OBAT) Boston Medical Center

14 Shamim H. Nejad, MD Medical Director, Division of Psychosocial Oncology Swedish Cancer Institute Swedish Medical Center David H. Rubin, MD (Reviewer, Course Director) Director, Child and Adolescent Psychiatry Residency Training and McLean Hospital Director, Postgraduate Medical Education, Department of Psychiatry Executive Director, Psychiatry Academy Timothy E. Wilens, MD (Course Director) Chief, Division of Child and Adolescent Psychiatry Co-Director, Center for Addiction Medicine Professor of Psychiatry Harvard Medical School Dawn Williamson, RN, DNP, PMHCNS-BC, CARN-AP Addiction Specialist, Emergency Department Christopher J. Shaw, RN, ANP, PMHNP-BC, CARN-AP Nursing Director, Substance Use Disorders

15 FACULTY DISCLOSURE STATEMENTS FACULTY DISCLOSURE STATEMENTS In accord with the disclosure policy of McLean Hospital as well as guidelines set forth by the Accreditation Council on Continuing Medical Education, all people in control of educational content, including speakers, course directors, planners, and reviewers, have been asked to disclose all relevant financial relationships with commercial interests of both themselves and their spouses/partners over the past 12 months, as defined below: Commercial Interest The ACCME defines a commercial interest as any entity producing, marketing, re-selling, or distributing health care goods or services, used on, or consumed by, patients. The ACCME does not consider providers of clinical service directly to patients to be commercial interests. For more information, visit Financial relationships Financial relationships are those relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit. Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, speaking and teaching, membership on advisory committees or review panels, board membership, and other activities from which remuneration is received, or expected. ACCME considers relationships of the person involved in the CME activity to include financial relationships of a spouse or partner. Relevant financial relationships ACCME focuses on financial relationships with commercial interests in the 12-month period preceding the time that the individual is being asked to assume a role controlling content of the CME activity. ACCME has not set a minimal dollar amount for relationships to be significant. Inherent in any amount is the incentive to maintain or increase the value of the relationship. The ACCME defines relevant financial relationships as financial relationships in any amount occurring within the past 12 months that create a conflict of interest. Conflict of Interest Circumstances create a conflict of interest when an individual has an opportunity to affect CME content about products or services of a commercial interest with which he/she has a financial relationship. The following planners, speakers, and content reviewers, on behalf of themselves and their spouse or partner, have reported financial relationships with an entity producing, marketing, re-selling, or distributing health care goods or services (relevant to the content of this activity) consumed by, or used on, patients: Speakers & Planners: NAME COMPANY RELATIONSHIP Robert R. Althoff, MD, PhD NIMH, NIDA Research Funds, (Investigator) Klingenstein Third Generation Foundation WISER Systems, LLC Grant Funds (Medical Student Training Program Faculty Sponsor and PI) Ownership Equity (Partner) Timothy E. Wilens, MD NIH (NIDA) Grant Support (Investigator) Alcobra, Neurovance/Otsuka, Ironshore, and KemPharm Guilford Press, Cambridge University Press, Elsevier, Ironshore US National Football League (ERM Associates), U.S. Minor/Major League Baseball; Phoenix/ Gavin House and Bay Cove Human Services Consulting Fees (Consultant) Royalties (Published author/ co-editor/co-owner of copyrighted diagnostic questionnaire, licensing agreement) Consulting Fees (Clinical Consultant) Susan Sprich, PhD (Psychologist Reviewer) Oxford University Press Royalties, for co-authoring treatment manual and client workbook Springer Royalties for editing book All other individuals including course directors, planners, reviewers, faculty, staff, etc., who are in a position to control the content of this educational activity have, on behalf of themselves and their spouse or partner, reported no financial relationships related to the content of this activity.

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17 PLEASE NOTE THAT THIS IS NOT THE OFFICIAL PROGRAM EVALUATION Substance Use Disorders: A Comprehensive Review and Update 2019 Use this page to take notes on the speakers for their presentations. Evaluations will be available for completion online at mghcme.org/substanceuse Rating scale 1 = Strongly Disagree, 2 = Disagree, 3 = Agree, 4 = Strongly Agree. Talk Time and Speaker Rating Notes The quality of the following presentations met or exceeded my expectations: SUNDAY, FEBRUARY 17, 2019 MONDAY, FEBRUARY 18, 2019

18 TUESDAY, FEBRUARY 19, 2019

19 WEDNESDAY, FEBRUARY 20, 2019 Complete the course evaluation online at mghcme.org/substanceuse

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21 Three Steps to Claiming your CME Credit : Visit and click on the orange Register button. 2: Enter your Academy Login username and password then click the Login button. If you have forgotten your password, please click the Reset Your Password? button. Once logged in, select your certificate type. Substance Use Disorder: A Comprehensive Review and Update : Click on the Evaluation button. Once you have completed your evaluation, and attested to the number of sessions you attended, your certificate will be generated. You should claim only the credit commensurate with the extent of your participation in the activity. Complete the evaluation and claim your credit by: March 22, 2019.

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23 How to Reset Your Password Please visit and enter the address that you used to set up your account, and then click Submit. You will receive an with instructions to reset your password. The will also include your username. If you do not receive an within a few minutes, please check your Spam/Junk Mail folder. After resetting your password, enter your username and your new password to access and complete the evaluation and claim your credit. MY USERNAME IS:

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25 MASSACHUSETTS GENERAL HOSPITAL VISITING mghcme.org/visiting World Renowned. Locally Accessible. We are pleased to announce our one-of-a-kind Visiting program that allows our extraordinary Mass General clinicians to work directly with your health care facility. Mitigate Physician Shortages Meet Expanded Patient Demand Raise Quality of Care Launch New Service Lines Provide Clinical Education How can your organization collaborate with Mass General Psychiatrists or Psychologists? Provisional Clinical Services On-site clinical staff for a psychiatry department, hospital or unit Length of assignment term customized to your needs Our staff can help treat & manage patients, supervise medical students & more TeleHealth Meet patient care demands for a psychiatry department, hospital or unit Our faculty can treat & manage patients and provide doctor to doctor consults Dedicated teams from Mass General for short and long-term needs Interim Leadership Interim clinical or non-clinical leadership for a psychiatry department, hospital or unit On-site and remote leadership schedule Consult on clinical rotations, didactic curricula and content, grant writing, research collaboration and more may also be combined with this service Clinical Consultation Focus on improving quality of care for a psychiatry department, hospital or health system On-site or telehealth/remote guidance Build collaborative care team models in your community to meet patient demand Launch new service lines, position for grants, launch QI initiatives & more For more information contact: Shauna Futch, (617) , sfutch@mgh.harvard.edu

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