Category Archives: cms

About Addiction

Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.

Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.

Links to articles worth reading

Determination of Genotype Combinations That Can Predict the Outcome of the Treatment of Alcohol Dependence Using the 5-HT3 Antagonist Ondansetron

CME

The 2013 TnSAM Addiction Medicine Conference was August 29th and 39th, 2013

Powerpoint slides are now available as enduring CME.

TSAM Addiction Medicine

Co-occurring disorders and DSM 5

Opiates and Pregnancy rev-1

Addiction Talking Points part one          Addiction Talking Points part two

Neurobiology of Addiction part one        Neurobiology of Addiction part two

Counseling Skills DBT Lite

MedBriefPsyTx 8 28 13

The University of Tennessee College of Medicine, together with the American Society of Addiction Medicine and the Tennessee Society of Addiction Medicine, presented a 2-day conference on addiction medicine.  130 people registered and attended. The first three-hour conference (8:30 -12 Noon 8/29/13) was an ASAM-sponsored risk evaluation mitigation strategy conference about opiate prescribing.  Titled ER/LA Opioid REMS: Achieving Safe Use While Improving Patient Care, this session addressed our most pressing health problem of prescription drug abuse, was designed in association with the FDA and ASAM, and was offered to everyone at no charge (Free CME!) thanks to a grant.

The remaining day and a half (12 Noon – 4:45 pm 8/29/13 and 8:30 am – 4:45 pm 8/30/13) was sponsored by TnSAM and accredited by the UT College of Medicine (AMA PRA Category 1 Credits for doctors), received Prescribed CME credits form AAFP, and was NAADAC approved for counselors by TAADAS. The conference provided important information on addiction topics, with an outstanding array of topics and speakers:

12:00-1:00 PM  Hooked But Not Hopeless – Sherry Hoppe, Ed.D and Sylvia Yates

1:15-2:15 PM  Tennessee Department of Health and TMA Response to Tennessee’s Prescription Drug Abuse Epidemic – Mitch Mutter, M.D.

2:30-3:30 PM  Dual Diagnoses: Management of co-occurring disorders in Addicted Patients – Terry Holmes, M.D.

3:30-4:30 PM  Opiate Dependency in Pregnancy – Tom Cable, M.D.

8:30-9:30 AM Addiction Medicine Talking Points – John Standridge, M.D.

9:30-10:30 AM  Evidenced-Based Behavioral Treatments for Addiction – James Finch, M.D.

10:45-11:45 AM  The Neurobiology of Reward and Addiction – John Standridge, M.D.

11:45 AM-12:45 PM  Lunch and Learn with Faculty

1:00-4:15 PM  Counseling Skills Workshop: Motivational Interviewing, Cognitive Behavioral Therapy, and Mindfulness – James Finch, M.D. and Jane Finch, L.C.S.W.

The conference was held at the University of Tennessee at Chattanooga on August 29 and 30, 2013.

Faculty
John Standridge, M.D., F.A.A.F.P., F.A.S.A.M., has practiced in addiction medicine since 1979. He serves as Medical Director of the Council for Alcohol and Drug Abuse Services Inc. (CADAS) in Chattanooga, Tennessee. He is serving a two-year term, 2013-2014, as president of the Tennessee Society of Addiction Medicine. He actively teaches geriatrics to internal medicine residents as Clinical Professor of Internal Medicine and was Professor and Program Director of a geriatric medicine fellowship in the department of Family Medicine, both at the University of Tennessee College of Medicine Chattanooga. He practices family medicine in a deliberately small office called “Personal Medicine LLC”.
Sherry Hoppe, Ed.D. After almost 20 years as a college and university president, Dr. Sherry Lee Hoppe retired as president from Austin Peay State University (TN) in 2007. Today, she works fulltime writing. Staying clean takes commitment and determination.  Dr. Sherry Hoppe and her sister Sylvia Yates wrote Hooked But Not Hopeless to reveal how an average person can be caught in the far-reaching and unrelenting tentacles of substance abuse.

Mitch Mutter, M.D. serves as Medical Director for Special Projects for the Tennessee Department of Health. Dr. Mutter is board-certified in cardiology and is former president of the Hamilton County Medical Society, the Tennessee Heart Association, the Hamilton County Medical Foundation, and president of the Tennessee Board of Medical Examiners. He also founded the Children’s Nutrition Program of Haiti, an effort he established after his first trip to that country in 1988 to provide medical services and develop a grassroots nutrition program.

Tom Cable, M.D. is Medical Director at Volunteer Treatment Center in Chattanooga, a facility that provides medically supervised methadone and buprenorphine maintenance treatment. Dr. Cable is a board-certified family physician with a twenty-one year career in academic medicine prior to his establishment of a private practice at the Optimal Health Institute, which includes buprenorphine maintenance treatment. He is currently a Clinical Professor of Family Medicine with the University of Tennessee College of Medicine Chattanooga.

Terry Holmes, M.D. is Director, Clinical Services, at Moccasin Bend Mental Health Institute and serves as the consulting psychiatrist for the Council for Alcohol and Drug Abuse Services Inc. (CADAS) in Chattanooga, Tennessee.

James Finch, M.D. has over 20 years of experience as a specialist in Addiction Medicine, and is the past-president of the North Carolina Society of Addiction Medicine. He is a national speaker on addiction medicine topics. He and his wife, Jane B. Finch, LCSW, provide a wide range of complementary behavioral interventions through the group practice called Changes by Choice: Broad-Based Options for Recovery.

Jane B. Finch, MSSW, LCSW is a clinical social worker in private practice who has specialized in the treatment of addictive disorders for over 15 years. Jane uses her training in Dialectical Behavior Therapy and Trauma Reprocessing Therapy (EMDR) to help clients manage stress and reduce disturbances associated with underlying traumas. She is certified in Critical Incident Stress Management The ultimate aim is “to create a life worth living,” as Dialectical Behavior Therapy (DBT) would put it. She utilizes DBT, Cognitive Behavioral Therapy, Motivational Enhancement, Imago Relationship Therapy, Eye Movement Desensitization Reprocessing (EMDR) and Existential Psychotherapy to help clients achieve their goals.

About TNSAM

The Tennessee Society of Addiction Medicine represents a small but dedicated group of physicians, who seek to improve the health and well-being of those who suffer from the disease of addiction. The mission of the Tennessee Society of Addiction Medicine, a state chapter of the American Society of Addiction Medicine, is to improve the care and treatment of people with the disease of addiction and advance the practice of Addiction Medicine.

Our goals include:

  • Increasing access to and improving the quality of addiction treatment;
  • Educating physicians (including students, primary care, addiction specialists and other specialists), other health care providers, legislators and the public;
  • Supporting research and prevention;
  • Promoting the appropriate role of the physician in the care of patients with addiction;
  • Establishing addiction medicine as a specialty recognized by professional organizations, governments, physicians, purchasers and consumers of health care services, and the general public

Listings

Current Officers

President   2015-2016
Alexander Zotos, M.D
President-elect   2015-2016
To be elected in April at ASAM conf
Secretary-Treasurer
Ralph Thomas Reach, M.D.

Past Presidents

2013-2014
John Standridge, M.D., F.A.A.F.P., F.A.S.A.M.
2011-2012
Michael J, Baron, M.D., M.P.H., F.A.S.A.M.
2009-2010
Darrell Arnett, M.D.
2007-2008
Richard Soper, M.D., J.D., M.S., F.A.S.A.M.
Board of Directors
         Serving 2013-2017
John Standridge, M.D., F.A.A.F.P., F.A.S.A.M.  (Chairman)
Alexander Zotos, M.D.
Ralph Thomas Reach, M.D.
         Serving 2013-2015
Richard Soper, M.D., J.D., M.S., F.A.S.A.M.
Michael J, Baron, M.D., M.P.H., F.A.S.A.M.
Link

Our mission is to improve the care and treatment of people with the disease of addiction and advance the practice of Addiction Medicine.

Treatment decisions on the use of FDA-approved medications for addiction should be made only by skilled physicians.

Message from Our President
Greetings from TnSAM,
I hope everyone is enjoying their summer and taking some time off for family, friends, and personal endeavors.
It is an exciting time for addiction medicine.  More and more light is being shed on the opioid epidemic currently facing our communities.  The tides are turning on the liberal use of opiates for “chronic pain”.  Just recently the President of the AMA, Steven Stack, M.D. addressed the issue regarding the overprescribing of opiates and steps we should all follow to help curb the crisis.  In March of 2016, the CDC released new recommendations for the prescribing of opiates for chronic pain.  Furthermore, discussions have taken place in congress questioning the current practice of the CMS for coupling reimbursements to patient satisfaction scores in regards to pain control.    As this all comes to light, prescribing practices will change and help reduce the excessive use of opiates for pain control, inadvertently leading some down the vicious cycle of addiction.
However, this in itself does not directly impact our current crisis of opiate dependent patients.  Recently, the HHS announced an increase of 275 patients that can be prescribed buprenorphine, for certain qualified physicians, mainly boarded physicians and certified treatment facilities.  This is definitely a step in the right direction yet there are people on both sides of the fences in regards to whom should be qualified to do this.  There are many non boarded physicians whom do an outstanding job that could definitely see more than a 100 patients.  On the other hand, there are some boarded physicians whom do not practice quality addiction medicine and simply write for buprenorphine. They do not spend time with their patients or provide counseling or therapy for them.  Time and time again patients will tell us how another provider did not even take the time to listen to them or show interest.  Poor providers beware, your patients tell on you!!!
Over time, I have changed my view as to the necessity of some regulation and oversight.  If it serves to improve the care of the patient then so be it.  Simply writing medication and taking payment for it without providing insight and solutions to the disease of addiction is simply wrong.  My belief is that over time the “bad apples” will go away and the law of economics will bring about the highest quality care at a reasonable cost for the patient.
Furthermore, TnSAM must support to fight for reimbursement from insurance companies and increase access to care.  It is my hope that one day we all can simply bill insurance and be reimbursed at a “fair and reasonable” level just like any other specialty.  We can not say we want to be regarded as a specialty and not practice billing the way they do.  On this, we have a long way to go…….
Most of us in the field keep up with the regulations and standards in regards to medication assisted therapy.    However, some do not.  Thus I wanted to summarize to anyone who may not be aware of current policies and regulations that will go into effect soon in Tennessee.  Tennessee will be placing all practices under one of two regulatory agencies.  If you are a solo practitioner and see up to 150 patients then you will fall under the Department of Health, Division of Health Related Boards. i.e. the medical board.  If you are seeing 150 or more patients, whether a solo, group practice, or clinic, you will fall under the Department of Mental Health and will be a licensed facility and have to meet certain guidelines.   This will include regulatory fees, meeting certain criteria, and monitoring to ensure the highest quality standards are met.  These regulations are being adopted due to the concerns of many groups including state legislators, law enforcement agencies, health care providers, and certain concerned citizens in Tennessee.  This came out of necessity invariably due to a few providers whom practice out of the standard of care, and may not have their patient’s best interest at hand.
Please continue to do what you do best and that is to provide your patients with the best quality care possible.  I do not know of many other fields where patients thank you on a daily basis for saving their lives.  Addiction medicine is truly a rewarding specialty.
Sincerely,
Alexander Zotos, M.D.
President, Tennessee Society of Addiction Medicine

ABMS RECOGNIZES ABAM AS THE NEWEST MEDICAL SUBSPECIALTY!!!!!

Drs. Sokol and O’Connor said it eloquently in their letter of this announcement to all ABAM diplomates:

As we all celebrate this occasion, we hope that you will take a moment and reflect with pride on your own contributions to our newly recognized field. As ABAM diplomates you have been at the forefront in the care of patients with substance use disorders. Your work has been driven by the will to care for patients and families, and to improve their lives and the health of your community. You have stood up to stigma, ignorance and to outdated policies and practices that accompanied this most challenging of all diseases. You have had many successes with patients and colleagues along the way and have set the stage for medicine’s response to addiction. You have pioneered this new era in American medicine and healthcare. Thank you, and savor the moment.

 

Happy New Year!!!!

We will be having our annual meeting at the ASAM national conference in April on Friday April 15th between 4-5 pm.  I hope all will participate if you’re going to attend the conference.  An agenda will go out which will outline various topics we will be discussing.  Please feel free to suggest additions to the agenda if you wish to discuss specific topics.

The opioid epidemic continues to be at the forefront of issues facing Tennesseans as well as nationally.  We will continue to advocate for treatment, the most important aspect for change.  This includes increasing medication assisted therapy.  Currently there continues to be various legislative and regulatory proposals which will shape how we practice as addiction specialists.  Please do your part by contacting your local representatives at both the state and national level. The most effective role is to help educate our legislators on standards of care and effectiveness of treatment.  Another important aspect is to convey that treatment and prevention saves money in the long run and there is research to prove it.

Additionally, neonatal abstinence continues to be a hot topic in our state.  We must do our part and educate our fellow physicians, including obstetricians and pediatricians, of the benefits of working together for positive outcomes.  Recently many high risk obstetricians and neonatal intensivists have expressed an interest in developing multi-disciplinary teams. In Chattanooga, the high risk obstetrical group has asked to form a team which will help to improve outcomes.  If there is a need in your community, I urge you to do the same in assisting the opiate dependent mothers.

I also want to inform you of a study which has begun which will be looking at neonatal abstinence syndrome and the variability in symptom severity.  Genetic testing will be carried out to assess whether certain genotypes are more at risk than others.  Our esteemed colleague, Dr. John Standridge, is the principle investigator. Feel free to contact him with your interest in participating in this research project.  Participation is encouraged. Dr. Standridge will be presenting his research to the International Conference on Opioids in June, 2016, at Harvard Medical School in Boston.

Lastly, I have been informed that TnSAM will be joining with the North Carolina Chapter at the April North Carolina Conference (April 22-24th) in Asheville, N.C. in a collaborative effort. More to follow.

Thank you for all you do…..

Dr. Zotos

ANNOUNCEMENT OF ANNUAL MEETING — APRIL 15, 2016 at 4:00 p.m., BALTIMORE, MD

As required by our bylaws, “there shall be an Annual Meeting of the Society. The time and place of such Annual Meeting shall be determined by the Board of Directors, and will by tradition coincide with the annual Med-Sci Meeting of ASAM. Written notice thereof shall be given to all members, by mail or e-mail to the address of the record with the Society or other address supplied by the member for that purpose. All notices shall be sent not less than thirty (30) day prior to each meeting. Additional notices shall be posted on the official Society website…”

AGENDA ITEMS WILL INCLUDE ELECTION OF OFFICERS AND BOARD MEMBERS.

The Annual Meeting shall be chaired by the President of the Society, Dr. Alex Zotos, and shall be for the purpose of disseminating information to the membership and conducting any other necessary business. Officers shall be recognized and introduced to the membership along with incoming directors at the beginning of each Annual Business Meeting.

Read and Recommended (New Feature):

Read Senator Edward J. Markey’s bill to remove limits from the numbers of patients a provider (physician/ANP/PA) can treat with buprenorphine.

The Development and Maintenance of Drug Addiction (Neuropsychopharmacology)

Read Governor Shumlin’s 2014 State of the State Address, dedicated to heroin and other opiate addiction in Vermont.

Read the letter to the editor of the New York Times. titled Treatment of Addiction, by Thomas Farley, departing Commissioner of Health in New York City.

The TnSAM Constitution and Bylaws were ratified by TnSAM members on November 22, 2013.

One of the great minds and original thinkers in TnSAM is a former Tennessee president, Rich Soper, T.M.I.A.H.N.T.L.H. (Too many initials after his name to list here).  Rich has a special column, listed below as Soper’s Soapbox.  In this section his free flow of random thoughts (which he calls “Liquid Soap”) is published as we receive them. These also fall in the read and recommended categories.  Please avail yourself of his insights and wisdom. In an article titled “Legislating Limited Treatment Will Worsen Outcomes”, he discusses — BRILLIANTLY — the unintended consequence of learned helplessness that derives from legislated mandates of inadequate, thus failed, treatments. In another he is the scholar, describing process addiction.  Tennessee may not be the biggest or richest chapter, but we have the beauty.  Avail yourself.

Items of Interest for TNSAM Members

TNSAM’s Agenda (PEACE):

  1. Parity – equality in access, benefits, coverage, respect, and treatment
  2. Education – of public, legislators, physicians in training and those in practice
  3. Advocacy – advancing the stature and recognition of the specialty
  4. Communication – facilitating the spread of ideas among members and the public
  5. Evidence-based practice – improve the quality of addiction treatment through research and education

ASAM Issues Policy Statement on Patient Access to Addiction Medications

Read the full report

News on Parity — On November 8, 2013, the Departments of Treasury, Labor, and Health and Human Services (collectively, the “Departments”) jointly issued final regulations under the Mental Health Parity and Addiction Equity Act of 2008 (the “MHPAEA”). In general, the MHPAEA requires that group health plans offering mental health/substance use disorder benefits that apply any financial requirements or treatment limitations to these benefits cannot apply requirements or limitations that are more restrictive than the requirements or limitations applied to medical/surgical benefits.

Effective Date

The final regulations apply to group health plans for plan years beginning on or after July 1, 2014 (i.e., January 1, 2015 for calendar year plans). Until that time, plans and issuers must continue to comply with the interim final regulations, which were effective for plan years beginning on or after July 1, 2010.

Background

The MHPAEA requires parity between mental health/substance use disorder benefits and medical/surgical benefits with respect to financial requirements and treatment limitations. Plans providing mental health/substance use disorder benefits generally may impose financial requirements (such as deductibles, copayments, coinsurance and out-of-pocket limitations) or quantitative treatment limitations (such as frequency of treatment, number of visits, days of coverage or other similar limits on the scope or duration of treatment) on mental health/substance use disorder benefits, as long as the requirements or limitations are on par with those imposed on medical/surgical benefits. Specifically, the requirements or limitations can be no more restrictive than the “predominantfinancial requirements or treatment limitations applied to “substantially all” medical/surgical benefits.

As previously announced in the interim final regulations, the “predominant/substantially all” test applies on a classification-by-classification basis, based on six classifications of benefits: (i) inpatient, in-network; (ii) inpatient, out-of-network; (iii) outpatient, in-network; (iv) outpatient, out-of-network; (v) emergency care; and (vi) prescription drugs. The final regulations provide that office visits can be split out as a subclassification separate from outpatient services. The final regulations specifically prohibit subclassifications for generalists and specialists.

See the News from Maryland’s new parity initiatives.

Editorials

  • 2013-08-03 – New Feature! Editorials may be found here. Editorials may be provided by any member of TnSAM. Please submit by email to the president of TnSAM. Submissions that are overly long or inflammatory may be returned for re-writing.

Old News

The 2013 TnSAM Addiction Medicine Conference held in Chattanooga, TN, August 29th and 30th, 2013, was highly successful. One hundred-thirty people from many different professions registered.  The ER/LA Opioid REMS: Achieving Safe Use While Improving Patient Care session addressed our most pressing health problem of prescription drug abuse. Ninety-one people attended this session, the vast majority being prescribers for whom the course was intended. Thank you to all who attended this important conference, and thanks for all you do!

Only those who regard healing as the ultimate goal of their efforts can, therefore, be designated as physicians.— Rudolf Virchow