November 13th, 2017

Progress continues to be made in understanding and treating people suffering with the disease of addiction. That was evident to those attending the November 11th annual meeting of the Maryland-DC Society of Addiction Medicine – the regional chapter of the American Society of Addiction Medicine. Here are some items from the meeting that I found interesting:

  • Government assistance
    • Federal funds from the 21st Century Cures Act, passed under the Obama-Biden administration, have become available to support addiction treatment in Maryland.
    • Patient access to buprenorphine has been enhanced by increasing the number of patients who can be treated by an individual physician. Furthermore, nurse practitioners (NP) and physician assistants (PA) are now allowed to prescribe it due to The Comprehensive Addiction and Recovery Act, also passed under the previous administration. As a result, over 43,000 practitioners have now received the prescription waiver, including over 4,000 in the NP and PA category.
    • The Maryland Behavioral Health Administration will be providing funds to pay for the treatment of gambling addiction by private treatment programs, such as Kolmac.
  • Treatment
    • The newly available Maryland Prescription Drug Monitoring Program is designed to prevent people from getting opioid prescriptions from multiple prescribers. Increasingly sophisticated urine drug testing is available to detect the presence of addictive substances. Presentations on both of these topics focused on how clinicians can use these tools to increase communication with patients rather than misusing them in a punitive direction and fall into the trap of becoming a policeman rather than a healer.
    • Technology provides a new world of potential tools to enhance treatment. Telemedicine is probably the one with the widest application thus far now that administrative barriers regarding billing and regulations as well as privacy issues are being resolved. Patient acceptance is growing, especially when the telemedicine services are used to supplement rather than replace traditional in-person services.
  • Research
    • The most striking conclusion from new studies looking at direct comparisons between buprenorphine, methadone, and injectable long-term naltrexone is how well all of them can work. These studies involve random assignment to one of these medications. What is needed next are studies that study which medications are best for which patients.

I had the opportunity to make one of the presentations, describing a new alcohol withdrawal treatment protocol that reduces or eliminates the use of benzodiazepines, which have been the standard of care for almost 50 years. The breakthrough is the recognition that alcohol withdrawal triggers the same hyperactivity in the sympathetic “fight/flight” system that occurs with opioid withdrawal. Adding alpha-2 adrenergic agonist medication, such as guanfacine or clonidine, to a medication such as gabapentin, allows even severe alcohol withdrawal syndromes to be treated safely and effectively.

Our geographic region has an unusually large number of knowledgeable and engaged medical addiction specialists and I feel fortunate to be able to interact with so many of them at events such as this. We are looking to grow our MDDCSAM chapter, which now welcomes non-medical clinicians as associate members. If you have interest in joining, please contact the American Society of Addiction Medicine.

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