Addiction Education News


Online medical education course on addiction released by TRI and MedU



Online Course on Addiction Released by Treatment Research Institute and MedU

The Treatment Research Institute (TRI) has partnered with MedU, an experienced developer of online medical education, as well as the American Society of Addiction Medicine (ASAM) and the Betty Ford-Hazelden Foundation (HBFF) to produce a Course on Addiction and Recovery Education (CARE) for use in medical schools. The project was conceived and directed by TRI’s A. Thomas McLellan, Ph.D., and supported by a grant from the Scaife Foundation. The new course has several components:

Online Course. The web-based course includes 12 video modules, each 25 to 40 minutes in length, on topics such as the pharmacology of alcohol, treatment of opioid withdrawal, and short- and long-term effects of cocaine on brain function. Each module employs engaging graphics and reference materials and is presented by an expert in the field. The modules are designed to be used together as a single course or can be used separately as part of existing courses in multiple departments.

Clinical Case Scenarios. Three interactive virtual patient cases illustrate the modules by presenting common clinical scenarios: a pregnant woman who continues to drink; a chronic pain patient who regularly uses more opioid medication than prescribed; and an adolescent male under treatment for asthma who also smokes marijuana.

Faculty Training. To prepare faculty to deliver the course, TRI and MedU are developing an immersion education experience for medical school faculty in partnership with the Betty Ford-Hazelden Foundation, which is modifying its Summer Internship for Medical Students (SIMS) program to serve as a rapid and efficient method of educating mid-level medical school faculty in essential elements of clinical care for addicted patients.

SIMS is a one-week immersion education program that has been completed by more than 2,000 students from over 100 medical schools during its 10-year history. Because medical school faculty will need additional instruction to enable them to serve as mentors for the MedU course, the SIMS program is being supplemented with experiential and academic information that will better prepare teaching faculty for mentoring students in this topic. To this end, a new manual has been developed and additional sessions with Betty Ford physicians have been included to offer the kind of peer-to-peer instruction and guidance necessary to make the visiting faculty comfortable in mentoring the second year students in the planned course.

Availability. The full course, with all supplemental teaching materials, was completed and released in time for the 2014-2015 academic year. It is available by subscription from MedU, a major provider of web-based medical education materials. For more information, visit the MedU website at http://www.med-u.org/.

AAMC Accepting Applications for Innovation Awards

The Association of American Medical Colleges is accepting applications for its Clinical Care Innovation Challenge Awards, which recognize AAMC-member medical schools and teaching hospitals that have implemented or are developing programs to address clinical care innovations, including new delivery, payment, and training models.

The awards, which range from $5,000 to $10,000, recognize successfully implemented programs or support one-year pilot projects. Pilot sites will  participate in a learning collaborative to support their implementation efforts.

AAMC is accepting applications through November 24, 2014, at 5:00 p.m. Eastern time. To receive updates or for more information, email your name and contact information to innovationchallenge@aamc.org or go to https://www.aamc.org/initiatives/quality/354304/clinicalcareinnovationandchallenge.html.

AACOM Adopts New Strategic Plan to Advance Osteopathic Medical Education

In announcing a new Strategic Plan for the American Association of Colleges of Osteopathic Medicine, AACOM President Stephen C. Shannon, D.O., M.P.H., writes that “The new framework includes many changes that will affect all levels of our profession: The scope of our mission has been enlarged, our goals for accomplishing that mission are bigger, and our objectives for achieving those goals go beyond where we have gone before. We believe that achieving these goals will make us more aligned from the inside out, more operationally efficient, better able to measure progress against goals, and will help to differentiate us more completely from other associations in the medical education space.”

The following strategic goals are enumerated in the plan:

1. Position osteopathic medicine as an effective solution to the nation’s health care needs and assure the continuous flow of resources and recognition for osteopathic medical education by serving as the collective voice of the colleges of osteopathic medicine and associated osteopathic medical education programs.

2. Promote osteopathic medical education as a preferred pathway for future physicians in order to satisfy the need for sufficient numbers of qualified physicians to meet U.S. health care needs.

3. Support member schools in preparing osteopathic physicians who are ready to meet the evolving health care needs of America by promoting excellence, innovation and a culture of lifelong learning throughout medical education.

4. Demonstrate the distinctive value and approach of osteopathic medical education by providing opportunities for collaborative research and scholarship.

5. Operate as an efficient and fiscally responsible organization working in support of its mission and its members.

For a comprehensive discussion of the Strategic Plan, see Dr. Shannon’s message at http://www.aacom.org/resources/e-news/ome/2014-05/Pages/president.aspx.



Screening pregnant women for drug use



Medical Groups Say All Pregnant Women Should be Screened for Drug Use

The American Congress of Obstetricians and Gynecologists (ACOG) has joined other medical organizations in calling for all pregnant women to be screened for drug use, with a follow-up urine test if necessary, to reduce the growing number of infants born with neonatal abstinence syndrome (NAS), which is caused by maternal opioid use during pregnancy. The American Medical Association (AMA) and the Association of State and Territorial Health Officials (ASTHO) also have adopted policies calling for universal screening of pregnant women.

A 2012 study published in the Journal of the American Medical Association found that every hour, an infant is born in the United States with symptoms of NAS, which is marked by constant high-pitched crying, vomiting, diarrhea, low-grade fever, seizures and tremors. Premature infants with NAS may experience respiratory distress and need to be placed on ventilators.

Specifically, the new ACOG policy supports the idea of a “screening dialogue” with pregnant women. The group says urine drug tests should be used only to confirm suspected or reported drug use, and conducted only with the patient’s consent. Physicians also should inform women of any legal consequences of a positive drug test, such as the need to alert child protective services.

Source: American Congress of Obstetricians and Gynecologists. Pregnant women & prescription drug abuse, dependence and addiction. Toolkit on State Legislation. ACOG: 2014.

Even More Illness Caused by Smoking than Previously Estimated

In a newly published report, CDC researchers estimate that 14 million U.S. adults experienced at least one major medical condition attributable to smoking in the year 2009. The researchers based their estimate on two existing national datasets—the National Health Interview Survey (for a general estimate of all smoking-related diseases) and the National Health and Nutritional Examination Survey (NHANES) (to account for underreporting of COPD).

Pointing out that cigarette smoking harms nearly every organ and organ system in the body, the report’s authors also estimated that smoking is linked to 2.3 million cases of heart attack, 1.3 million cases of cancer, 1.2 million cases of stroke, and 1.8 million cases of diabetes. They add that, for each annual death, there are 15 to 20 persons living with major disease caused by smoking,” said senior author Terry Pechacek of the CDC. He added: “Smoking not only will kill you, it will damage your health and make your life worse.”

Source: Rostron BL, Chang CM & Pechacek PF. Estimation of cigarette-smoking attributable mortality in the United States. JAMA Internal Medicine. 2014 Oct 13 [Epub ahead of print].

Heroin Overdose Deaths Rise as Prescription Opioid Overdose Deaths Fall

The death rate from heroin overdoses doubled from 2010 to 2012, according to a new study from the Centers for Disease Control and Prevention (CDC). However, as overdose deaths associated with heroin rose, those involving  prescription opioids declined. The study’s authors speculate that some individuals may have switched from prescription medications to illicit drugs in response to laws aimed at reducing prescription drug abuse.

Between 1999 and 2011, overdose deaths involving prescription opioids quadrupled, from 4,030 to 16,917. However, in 2012 the number of such deaths declined by 5 percent, to 16,007. However, overdose deaths associated with heroin increased by 35 percent between 2011 and 2012, from 4,397 to 5,927.  The largest increase in heroin overdose deaths occurred in the New England states, followed by the South.

The study also found that 75 percent of heroin users in opioid treatment programs who started using heroin after 2000 say they first abused prescription opioids but later switched to heroin. Many said they made the switch because heroin was easier to obtain, less expensive and more potent than the prescription opioids they had been using. In contrast, more than 80 percent of subjects who began using heroin in the 1960s reported that they did not begin by abusing another drug.

Source: Rudd RA, Paulozzi LJ, Bauer MJ et al. Increases in heroin overdose deaths — 28 States, 2010 to 2012. MMWR. 2014 Oct 3;63(39);849-854.



ASAM’s Medication Initiative, More



ASAM Focuses on Improving Access to Anti-Addiction Medications

The American Society of Addiction Medicine (ASAM) unveiled a new initiative, Advancing Access to Addiction Medications (AAAM) at a June meeting and press conference that was attended by more than 100 representatives of organizations focused on addiction prevention, treatment, recovery, and education. The event was designed to draw attention to the multiple obstacles patients face in accessing treatment with FDA-approved anti-addiction medications.

Following opening remarks by U.S. Representative Paul Tonko and ASAM President Stuart Gitlow, M.D., M.P.H., MBA, researchers from The Avisa Group and the Treatment Research Institute (TRI) presented results of studies commissioned by ASAM that examined all 50 state Medicaid programs as well as 30 private insurers. They reported finding a large number of policies among both public and private sector insurers that amount to de facto denial of coverage of FDA-approved medications such as methadone, buprenorphine, and naltrexone. The researchers also shared the results of their review of more than 350 research reports that document the clinical efficacy and cost-effectiveness of such pharmacologic therapies.

Michael Botticelli, Deputy Director of the White House Office of National Drug Control Policy, led the panel discussion with a presentation on access to treatment as a component of ONDCP’s National Drug Control Strategy. He lauded programs that have adopted innovative and effective methods of delivering such services, such as the “hub and spoke” delivery system created by the Vermont Department of Health.

In the small-group discussions that followed, participants considered how their organizations could contribute to education and outreach efforts to promote access to effective treatments. Meeting co-chairs Mark L. Krause, M.D., FASAM, and Richard Soper, M.D., J.D., applauded the participants’ commitment to “come together as a field to educate policymakers, health care practitioners, patients and the public about the value of these medications.”

A report of the meeting and supporting documents (including the Avisa Group and TRI studies) can be accessed at http://www.asam.org/advocacy/aaam.

AAMC Panel Proposes Common Taxonomy for Physician Competencies

In its August 2013 issue, Academic Medicine, journal of the Association of American Medical Colleges, published a report* proposing a common taxonomy to describe domains of competence and specific competencies for physicians and other health professionals, including competencies in addiction medicine.

The report describes the goals and processes of the AAMC-sponsored initiative as follows: “Although health professions worldwide are shifting to competency-based education, no common taxonomy for domains of competence and specific competencies currently exists. In this article, the authors describe their work to (1) identify domains of competence that could accommodate any health care profession and (2) extract a common set of competencies for physicians from existing health professions’ competency frameworks that would be robust enough to provide a single, relevant infrastructure for curricular resources in the Association of American Medical Colleges’ (AAMC’s) MedEdPORTAL and Curriculum Inventory and Reports (CIR) sites.

“The authors hope that researchers and educators within medicine and other health professions will consider using this reference list when applicable to move toward a common taxonomy of competencies.”

Source: Englander R, Cameron T, Ballard AJ, Dodge J, Bull J, Aschenbrener CA. Toward a common taxonomy of competency domains for the health professions and competencies for physicians. Academic Medicine. 2013 Aug;88(8):1088-1094.

The full report and an addendum listing competencies for various specialty areas, including addiction, can be accessed at: http://journals.lww.com/academicmedicine/
Fulltext/2013/08000/Toward_a_Common_Taxonomy_of_Competency_Domains_for.21.aspx

AACOM Welcomes New Osteopathic Medical School

The American Association of Colleges of Osteopathic Medicine (AACOM) has announced that Liberty University College of Osteopathic Medicine (LUCOM) has become the association’s newest member college.

LUCOM will be housed in Liberty University’s planned Center for Medical and Health Sciences in Lynchburg, Virginia. With Founding Dean Ronnie B. Martin, D.O., R.Ph., at the helm, the medical school will open its doors to its inaugural class of students in Fall 2014.

With the addition of LUCOM, the United States now has 30 colleges of osteopathic medicine (COMs) in 28 states. AACOM President and CEO Stephen C. Shannon, D.O., M.P.H., welcomed LUCOM, noting that “Osteopathic medicine is playing an increasingly important role in the nation’s health care workforce, ensuring that the physicians graduating from our schools are well-equipped to handle the current and future health care needs of the American public and capable of providing exceptional leadership in the evolving landscape of the United States health care system.”



Residents Dissatisfied with Training About Addiction



Survey: Residents Are Dissatisfied withTheir Training About Substance Use Disorders

A new survey has found that medical residents at one of the nation’s leading teaching hospitals are dissatisfied with the quality of their training about substance use disorders, and that many feel unprepared to diagnose or treat such problems in their patients. This is significant because persons with substance use disorders are likely to seek medical care from their primary care physician, often for health problems caused or exacerbated by use of alcohol, tobacco or other drugs.

Survey Design. The survey of residents at Massachusetts General Hospital (MGH) was designed to assess residents’ basic knowledge of substance use disorders, how they evaluated the training they had received, and how prepared they felt to diagnose and treat addiction to alcohol or drugs. In May 2012, the survey was emailed to all MGH residents in internal medicine and primary care, as well as those in a joint medicine/pediatrics residency, for a total of 184 recipients. All were informed that their participation in the survey was voluntary and anonymous. Of the group who received the survey, 101 residents (55%) completed and returned it.

The survey report, published in the journal Substance Abuse shows that a significant number of respondents reported feeling unprepared to diagnose or treat substance use disorders. Specifically, 25% of respondents said they felt unprepared to diagnose addiction, while 62% said they felt unprepared to treat it. Further, 72% of respondents rated their addiction training in the outpatient setting as “fair” to “poor,” while 56% rated their addiction training in inpatient settings as “fair” to “poor.” In contrast, 95% of participants in the primary care addiction rotation rated it as “good” or “excellent.”

Assessment of Knowledge. The survey also asked six questions to evaluate residents’ knowledge about diagnosing and treating substance use disorders. Although residents’ answers to questions about diagnosis were more accurate than their answers about treatment options, none of the respondents answered all six questions correctly, and only 6% gave correct answers to the three questions about pharmacologic treatments for addiction, including available FDA-approved medications. There were no significant differences in the accuracy of the residents’ responses across PGY levels.

Sara Wakeman, M.D., chief medical resident at MGH and lead author of the article, commented that the results represent “a tremendous disparity between the burden of disease and the success of our current model of training.” She added that “our residents estimated that one in four hospital inpatients has a substance use disorder, which matches what other studies have found and represents a disease
prevalence similar to that of diabetes.”

At the time the survey was administered, formal addiction training for most residents at MGH was confined to a single noontime conference on alcohol withdrawal and three highly-rated lectures on addiction-related topics during ambulatory rotations. The primary care residency included an intensive two-week outpatient rotation in addiction, which was available to other residents as an elective.

Parallels with Earlier Studies. Previous studies of residency training programs have found deficiencies in addiction education of residents, with some programs offering none at all. Dr. Wakeman noted that “Our findings are in line with previous data from training programs that reported limited addictions training and with studies of medical residents showing low satisfaction in caring for addicted patients. It is unlikely that MGH is unique in this educational deficiency, but rather these findings may demonstrate a critical failure in medical education as a whole.”

James Morrill, M.D., Ph.D., an MGH internist and core faculty member of the outpatient addiction elective rotation, commented that the survey results demonstrate that “it’s time to bring the level of addictions education in elite medical training programs like MGH’s up to the same high level that residents receive in areas such as cardiology. We need to help our residents recognize the great potential of primary care to stem the tide of morbidity and mortality due to addiction and keep addicted patients in treatment and out of the hospital.”

Michael Bierer, M.D., an MGH internist specializing in addiction treatment, commented that “Addictions are highly prevalent. They affect general health and health care, break up families and cause suffering that extends beyond the patients themselves. But they are highly treatable. Ignoring these problems doesn’t make sense from any perspective, and doing the right thing at the right time is not hard. Treating addictions well is certainly no more complex than some of the sophisticated skills our residents typically master.”

Changes at MGH. In response to the survey’s findings, MGH has added 10 noontime conferences for residents and included addiction case histories in 25% of ambulatory intern reports. Drs. Wakeman, Morrill, and Bierer have formed a group with several other faculty members that meets monthly to discuss additional educational needs in addiction medicine and how to develop more resources for MGH residents.

Dr. Wakeman and her co-authors plan to repeat the survey to assess the impact of these changes. They also hope to expand the survey to a national sample of residents to determine whether their findings can be broadly applied to programs nationwide.

Source: Wakeman S, Baggett M, Pham-Kanter G, Campbell E. Internal medicine residents’ training in substance use disorders; A survey of the quality of instruction and resident self-perceived preparedness to diagnose and treat addiction. Substance Abuse. 2013 Sept. [Epub ahead of print]



Opioid Overdose Toolkit; Online Courses on Safe Opioid Prescribing



PCSS-O to Offer Webinars on Pain Management in September, October and November 2013

The Prescriber Clinical Support System for Opioids (PCSS-O) and the Boston University School of Medicine will co-sponsor three free monthly webinars on “Scope of Pain: Safe and Competent Opioid Prescribing.”

The first monthly webinar is scheduled for Wednesday, September 25, 2013, from noon to 1:00 p.m. Eastern time. To receive CME credit, individuals must participate in all three webinars (September, October, and November), then go online to www.scopeofpain.com to complete a post-test and evaluation. Detailed instructions will be provided at the time of registration.

To register for the webinars, which were organized by the American Academy of Osteopathic Addiction Medicine (AACOM), go to https://events.r20.constantcontact.com/register/. Support for the PCSS-O and the webinars is provided by the Substance Abuse and Mental Health Services Administration of the U.S. Department of Health and Human Services.

SAMHSA Toolkit Focuses on Preventing and Treating Opioid Overdose

The Substance Abuse and Mental Health Services Administration (SAMHSA) has released an Opioid Overdose Toolkit to educate first responders, physicians, patients, overdose survivors and family members, and community leaders on ways to prevent and treat opioid overdoses and prevent overdose-related deaths.

The Toolkit responds to the fact that both prescription and illicit opioids are involved in a growing number of overdoses, which were responsible for almost 17,000 U.S. deaths in 2012.

The toolkit contains five separate booklets, each designed for a specific audience:

  • First Responders will find five steps to use in responding to opioid overdose, including how to use naloxone and provide other life-saving assistance.
  • Prescribers will find information on how to assess a patient‘s risk for opioid overdose, as well as clinically sound strategies for prescribing opioids and educating and monitoring patients so as to prevent overdose.
  • Patients will learn how to use prescribed opioids safely so as to minimize the risk of opioid overdose.
  • Survivors and Family Members will find insights and support through the information provided, including available resources for information and support.
  • Community Members can learn about opioid overdose as a foundation for creating policies that help prevent opioid ovedoses and related deaths.

The toolkit can be viewed at or downloaded from SAMHSA’s website at: http://store.samhsa.gov/product/Opioid-Overdose-Prevention-Toolkit/All-New-Products/SMA13-4742.

NIAAA Offers Online Course on Screening Youth for Alcohol Problems

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) has created a new online course to help physicians learn to conduct fast, evidence-based alcohol screening and brief intervention with young people.

“Just in time for back-to-school physicals, physicians, physician assistants, and nurses can learn how to use a simple youth alcohol screening tool and earn up to 2.5 continuing education credits or contact hours,” said Kenneth R. Warren, Ph.D., acting director of NIAAA. “This new course joins NIAAA’s family of evidence-based, user-friendly products to help clinicians identify patients of all ages who are at risk for alcohol-related problems, and to intervene early, when we have the best chance to prevent problems.”

NIAAA produced the course in collaboration with MedScape. For more information or to access the course, go to http://www.nih.gov/news/health/aug2013/niaaa-12.htm.

BU Launches New Online Course Modules on Safe Opioid Prescribing

The Boston University School of Medicine has launched two new course modules — on “Complex Conversations” and “Using the PDMP” — as part of its online series on “Safe and Effective Opioid Prescribing for Chronic Pain.”

Developed with support from the federal Substance Abuse and Mental Health Services Administration (SAMHSA) and the Massachusetts Board of Registration in Medicine, the series is directed by BU’s Daniel P. Alford, M.D., M.P.H., FACP. The series offers primary care physicians and other health care professionals the knowledge they need to care for patients who are living with chronic pain, including learning how to define chronic pain, how to manage its treatment, the tools available to assess pain, the risks involved in prescribing opioids, and how to discontinue opioid treatment when necessary.

Currently available modules include:

  • Module 1: Opioid Efficacy and Safety / Assessment and Monitoring Tools
  • Module 2: Communicating with Patients / Managing Patients with Psychiatric Comorbidities
  • Module 2a: Exit Strategies
  • Module 3: Case Study
  • Module 4: In Practice: Applying Principles of Safe Opioid Prescribing
  • Module 5: [NEW] In Practice: Complex Conversations
  • Module 6: [NEW] In Practice: Using the Prescription Drug Monitoring Program (PDMP)

Each of the modules is approved for AMA PRA Category 1 credit. There is no charge to register for modules, which can be accessed at www.opioidprescribing.com. To date, more than 14,000 physicians and other health care professionals have completed at least one module in the series.

CDC Releases New HIV Screening Program

The HIV Screening: Standard Care program developed by the Centers for Disease Control and Prevention (CDC) gives primary care providers new tools to help ensure that all patients are tested for HIV at least once. Of the estimated 1.1 million HIV-positive persons living in the U.S., about 20% are unaware of their HIV status.

HIV Screening: Standard Care offers a variety of resources for providers—as well as materials for their patients—to explain and encourage universal testing. For questions about the HIV Screening: Standard Care program or to order a free resource kit, e-mail screenforHIV@cdc.gov.



Addiction Education News



COPE’s e-newsletter, Addiction Education News, is on summer sabbatical. Publication will resume in September 2013, when the first issue of the new academic year will be emailed to all COPE members and posted on the COPE website.

Addiction Education News reports on current developments in government and the private sector that affect medical education about substance use disorders, as well as new journal articles, other publications and related resources available to teaching faculty. The newsletter also features links to other sources of useful information.

Addiction Education News welcomes contributions from COPE members and other interested parties. Send inquiries, letters to the editor, and other contributions to COPE Executive Director Bonnie Wilford at MedEdGroup@aol.com.


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