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  • February 06, 2024 10:51 AM | Judy Pfeiffer (Administrator)

    Negative Impacts of High Potency THC on the Developing Brain and Mental Health This Is NOT "Medicine"

    Elizabeth 'Libby' Stuyt, MD

    Register Now - On-demand

    Cannabis (marijuana) use is increasing, with growing commercialization facilitating new trends in cannabis consumption - more daily use and use of higher potency forms of the drug (high % THC or 9-tetrahydrocannabinol, the key psychoactive cannabinoid in cannabis). Acutely, cannabis produces euphoria, relaxation, reduces stress, but it can also impair cognitive function, coordination and engender anxiety and psychosis. With ongoing use, these adverse effects may be compounded by the development of cannabis use disorder (CUD) and other neuropsychiatric symptoms or disorders. The magnitude of adverse consequences and their persistence are associated with dose, use frequency, duration, and age of onset of use. Compared with adult onset, credible evidence has revealed that adolescent-onset and ongoing cannabis use confers a heightened risk of developing addiction, psychosis, cognitive impairment, depression, anxiety, suicidality, with some effects emerging during adulthood. Adolescent vulnerability during this critical phase of adolescent neurodevelopment is foreseeable, as the endogenous endocannabinoid signaling system continues to evolve and contribute to shaping brain architecture. In competing with endocannabinoid agonists at the cannabinoid receptor 1 (CBR1), THC interposes in these exquisitely controlled processes to dysregulate endocannabinoid signaling, triggering incompletely understood neuroadaptive changes. Recent trends of daily use and/or consumption of high potency cannabis products conceivably amplify the overall risks for adolescents, and also in the developing fetal brain. This presentation will describe:

    Recent trends in cannabis use among youth, new and more potent forms of cannabis, and delivery systems, cannabis risks for the developing fetal and adolescent brain and how this information can be used.

    At the conclusion of this seminar, attendees will know and be able to counsel patients on:
    1. Trends in THC Potency and Delivery Systems
    2. Trends in THC Potency and Delivery
    3. Marijuana Risks for Developing Fetal Brain Systems
    4. Marijuana Risks for Developing Adolescent Brain
    5. What you can do with this information...

    CME: This webinar has been approved for a maximum 1, AOA Category 1-A CME credits. Physicians should claim only the credit commensurate with the extent of the extent of their participation.

    This webinar is free to AOAAM members.
    Non-members - $35.


  • January 31, 2024 4:00 PM | Judy Pfeiffer (Administrator)

    Linked is a joint letter of support for the Substance Use Disorder Workforce Act, H.R 7050 signed by the American Osteopathic Association (AOA) and the American Osteopathic Academy of Addiction Medicine (AOAAM). In short, the legislation would add an additional 1,000 Medicare GME supported residency positions in addiction medicine, addiction psychiatry, or pain medicine. Our belief is grounded in the necessity of increasing the number of residents specializing in these specialties, ultimately ensuring broader patient access to better and more effective care.

    The AOAAM remains steadfast in our commitment to supporting legislation that advances care for individuals struggling with the disease of addiction. We will keep you informed on about updates related to the Substance Use Disorder Workforce Act, as well as other legislative relative to patient care and the practice of addiction medicine.

    Read the Letter

  • January 17, 2024 4:30 PM | Judy Pfeiffer (Administrator)

    Today, FDA is announcing that Emergent BioSolutions is extending the shelf-life of newly manufactured NARCAN (naloxone hydrochloride) 4 milligram (mg) Nasal Spray products from 3-years to 4-years. This action was taken at the request of the FDA and is the latest of multiple steps the Agency has recently taken to prevent overdoses and reduce overdose-related deaths by expanding access to naloxone and other overdose reversal agents.

    Naloxone is a medication that rapidly reverses the effects of opioid overdose and is the proven standard treatment for opioid overdose as it is a medicine with no abuse potential, and it is not a controlled substance. NARCAN nasal spray was first approved by the FDA in 2015 as a prescription drug. In March 2023, FDA approved NARCAN 4 mg nasal spray, as the first naloxone product approved for over-the-counter, nonprescription use. The Agency also approved an initial shelf-life extension for NARCAN 4 mg nasal spray in August 2020 which extended the original product’s shelf-life from 2-years to 3-years. 

    This shelf-life extension applies only to NARCAN (4 mg) nasal spray products produced following today. The shelf-life of products that were produced and distributed prior to this announcement is not affected and remains unchanged. Prescribers, patients, and caregivers are advised to continue to abide by the expiration date printed on each product’s packaging and within the product’s labeling.

    “Naloxone is an important tool in addressing opioid overdoses. Today’s shelf-life extension of newly manufactured lots of Narcan 4 mg nasal spray supports the FDA’s Overdose Prevention Framework and efforts to ensure more OTC naloxone products remain available to the public,” said Marta Sokolowska, Ph.D., deputy center director for Substance Use and Behavioral Health in FDA’s Center for Drug Evaluation and Research.

    FDA’s request for this shelf-life extension is a testament to the Agency’s continuing progress towards implementing the FDA Overdose Prevention Framework, which provides our vision to undertake impactful, creative actions to encourage harm reduction and innovation in reducing controlled substance-related overdoses and deaths. As we move forward in executing that vision, we remain focused on responding to all facets of substance use, misuse, overdose, and death through the four priorities of the framework, including: supporting primary prevention by eliminating unnecessary initial prescription drug exposure and inappropriate prolonged prescribing; encouraging harm reduction through innovation and education; advancing development of evidence-based treatments for substance use disorders; and protecting the public from unapproved, diverted, or counterfeit drugs presenting overdose risks.

    Additional Resources: 



  • January 10, 2024 10:57 AM | Judy Pfeiffer (Administrator)

    Cannabis and Adolescent Brain Development

    Bertha Madras, PhD (The Honorable)

    Register Now - On-demand

    Cannabis (marijuana) use is increasing, with growing commercialization facilitating new trends in cannabis consumption - more daily use and use of higher potency forms of the drug (high % THC or 9-tetrahydrocannabinol, the key psychoactive cannabinoid in cannabis). Acutely, cannabis produces euphoria, relaxation, reduces stress, but it can also impair cognitive function, coordination and engender anxiety and psychosis. With ongoing use, these adverse effects may be compounded by the development of cannabis use disorder (CUD) and other neuropsychiatric symptoms or disorders. The magnitude of adverse consequences and their persistence are associated with dose, use frequency, duration, and age of onset of use. Compared with adult onset, credible evidence has revealed that adolescent-onset and ongoing cannabis use confers a heightened risk of developing addiction, psychosis, cognitive impairment, depression, anxiety, suicidality, with some effects emerging during adulthood. Adolescent vulnerability during this critical phase of adolescent neurodevelopment is foreseeable, as the endogenous endocannabinoid signaling system continues to evolve and contribute to shaping brain architecture. In competing with endocannabinoid agonists at the cannabinoid receptor 1 (CBR1), THC interposes in these exquisitely controlled processes to dysregulate endocannabinoid signaling, triggering incompletely understood neuroadaptive changes. Recent trends of daily use and/or consumption of high potency cannabis products conceivably amplify the overall risks for adolescents, and also in the developing fetal brain. This presentation will describe:

    Recent trends in cannabis use among youth, new and more potent forms of cannabis, and delivery systems, cannabis risks for the developing fetal and adolescent brain and how this information can be used.

    At the conclusion of this seminar, attendees will know and be able to counsel patients on:
    1. Trends in THC Potency and Delivery Systems
    2. Trends in THC Potency and Delivery
    3. Marijuana Risks for Developing Fetal Brain Systems
    4. Marijuana Risks for Developing Adolescent Brain
    5. What you can do with this information...

    CME: This webinar has been approved for a maximum 1, AOA Category 1-A CME credits. Physicians should claim only the credit commensurate with the extent of the extent of their participation.

    This webinar is free to AOAAM members.
    Non-members - $35.


  • November 15, 2023 11:04 AM | Judy Pfeiffer (Administrator)

    BAD MEDICINE: Mental Health and What the Opioid Epidemic Can Teach Us About Cannabis

    James H. Berry, DO

    Register Now - On-Demand

    Over the past two decades, the number of people using cannabis has skyrocketed, along with individual and public health harms such as addiction, psychosis, and suicide. Concerning parallels exist between today's industry driven cannabis market and the prescription opioid pain pill industry which fueled our nation's addiction epidemic. This talk will review the current evidence regarding potential harms, equip participants to consider what products should be labeled a "medicine" and to reasonably discuss risks with patients, peers, media and legislators.

    At the conclusion of this seminar, attendees will be able to:

    1. Review the impact of cannabis on mental health
    2. Articulate what is meant by a ""medicine""
    3. Recognize the similarities between the history of our opioid crisis and the current cannabis landscape

    CME: This webinar has been approved for a maximum 1, AOA Category 1-A CME credits. Physicians should claim only the credit commensurate with the extent of the extent of their participation.

    This webinar is free to AOAAM members.
    Non-members - $35.



  • October 24, 2023 11:09 AM | Judy Pfeiffer (Administrator)

    Public Health Implications of Expanded Marijuana Programs
    Kenneth Finn, MD

    Register Now - On-Demand

    Many states have expanded their marijuana programs for a variety of reasons, for both medical and recreational purposes. Over time our drug crisis has worsened under the banner of legalization despite one platform to legalize is curbing our crisis. Other health impacts have worsened during this time, including increased use during pregnancy with known harms of in utero exposure, increased health care utilization, addiction across many age groups, increased potency with known harms including suicide and psychosis. Other impacts to the brain and other organs are documented as well.

    At the conclusion of this seminar, attendees will be able to:

    1. Review the endocannabinoid system and how it is related to the opioid system
    2. Explain what impact expanded marijuana programs have had on public health
    3. Improve the ability to educate and communicate with patients who may have questions about marijuana

    CME: This webinar has been approved for a maximum 1, AOA Category 1-A CME credits. Physicians should claim only the credit commensurate with the extent of the extent of their participation.

    This webinar is free to AOAAM members.
    Non-members - $35.


  • September 25, 2023 5:00 PM | Judy Pfeiffer (Administrator)

    NIH - National Institute on Drug Abuse
    New guides available to help communities respond to the opioid overdose crisis

    SAMHSA, in collaboration with RTI International, has released two important resources intended to aid community practitioners in the ongoing work to end the overdose crisis. These products will equip public health practitioners, coalitions, nonprofits, and other groups working to prevent opioid-related deaths in their local communities with knowledge and best practices. 

    With support from NIH, SAMHSA commissioned RTI International to develop the guides in collaboration with a technical expert panel. The guides are based on insights and tools from the ongoing National Institutes of Health (NIH) HEALing Communities Study.  The HEALing Communities Study was launched in 2019 by the NIH and SAMHSA. The multi-site implementation research study is designed to test the impact of an integrated set of evidence-based practices across healthcare, behavioral health, justice, and other community-based settings. The study aims to prevent and treat opioid use disorder and reduce opioid-related overdose deaths in 67 communities across four states: Kentucky, Massachusetts, New York, and Ohio.

    Opioid-Overdose Reduction Continuum of Care Approach (ORCCA) Practice Guide 2023

    The guide includes evidence-based strategies for reducing opioid overdose deaths. The strategies include: opioid overdose education and naloxone distribution, medication for treatment of opioid use disorder, and safer opioid prescribing and disposal.
    View Practice Guide


    Engaging Community Coalitions to Decrease Opioid Overdose Deaths Practice Guide 2023

    This resource provides guidance on building and maintaining community coalitions that focus on the opioid crisis, as well as approaches for assessing how well coalitions are functioning.
    View the Practice Guide


  • June 21, 2023 5:18 PM | Judy Pfeiffer (Administrator)

    About the author: Adam D. Scioli, D.O., DFAPA, FASAM, FAOAAM is the Medical Director and Head of Psychiatry at Caron Treatment Centers.

    For 30 years, we’ve been chasing a panacea for mental health, trying to find the right prescription or the right mix of medications as a substitute for comprehensive treatment. More and more, doctors prescribe medication alone, even though such medications should be supported by counseling.

    The lack of qualified therapists is compounded by insurance companies making it even more difficult. It’s perceived that the pharmaceutical approach is less costly and more efficient. It’s easier to measure costs than quality.

    We keep seeking the magic pill for behavioral and mental health — and there is no magic pill. The focus has swung too far towards stabilizing patients rather than getting them well. Getting well – having a good quality of life, being engaged in the community, maintaining strong relationships and, above all, finding meaning and purpose – requires time and effort.

    Still, we keep looking for that labor-saving device. It’s not working. It’s getting worse. People are unhoused, living on the fringes, and dying of what have become known as the diseases of despair.

    Here’s why we need to take a more comprehensive approach to behavioral health.

    People cannot find or afford the help they need

    Despite epidemic levels of psychological distress left in the wake of the pandemic, our mental health system has never been more difficult to access.

    While it’s now law that health care insurance provides coverage for mental health care on par with more traditional medical health care, that’s not a reality for most people. They find their insurance plans only have a few behavioral health care providers in-network, so many people seeking care end up paying the full cost themselves or delay getting help.

    Small wonder many people don’t seek counseling. Even for those willing to pay out of pocket, there are months-long waiting lists for an appointment. There are simply not enough psychiatrists, psychologists and other qualified mental healthcare workers to meet the demand.

    There are huge gaps in how we educate and train health care practitioners on behavioral health

    There is a disconnect among medical professionals in general, who often fail to consider behavioral health when working with patients.

    Outside of those of us who work in the fields of mental health and addiction medicine, there are not enough providers who fully understand the implications of mental health, substance use disorder (SUD) or the combination of the two.

    In my own work in SUD, I often see a lack of comfort among other specialties in caring for people with this disease. If the wrong drugs are used for anesthesia, for example, something as simple as a colonoscopy can risk reactivating someone in recovery. However, few anesthesiologists are trained to consider this as a factor in their preoperative evaluations.

    This is a blind spot that can be easily rectified with a consult.

    We emphasize stability over wellness, limiting the length of treatment

    Compare this to the care we provide for an emergent disease like cancer. There’s an intensive period of evaluation and treatment for cancer, and then patients start on a treatment protocol that, in most cases, lasts several years, with surveillance for up to five years afterwards before a person is considered “cured.”

    When we look at behavioral health care, instead of that comprehensive, intensive approach, we first jump to the least expensive and lowest level of care. Complete patient assessments and diagnostic testing are often limited and based solely on patient-reported symptoms without fully understanding the underlying pathology. This can lead to an incomplete or misdiagnosis, complicating further treatment. Only when someone “fails” that treatment do they graduate to more intensive care. Perhaps it’s the level of care that is failing the patients, not the patients who are failing.

    There are no quick fixes.

    We have siloed treatment of mental health and SUD

    Substance use and mental health disorders are closely linked. Of the estimated 20 million adults in the U.S. with SUD, almost 40% also suffer from some form of co-occurring mental illness. The reverse relationship is also true, with nearly 20% of adults with a mental illness also having a co-occurring SUD.........

    Read more


  • June 21, 2023 2:26 PM | Judy Pfeiffer (Administrator)

    Managing Difficult Encounters

    R. Gregory R. Lande, DO, COL (Ret.), FACN, FAOAAM

    Abstract:

    Difficult doctor-patient relationships are a recognized aspect of modern healthcare, but the actual incidence, risk factors, ethical issues, and management strategies are less well-known. The author queried PubMed, ScienceDirect, and the Education Resources Information Center. The inclusion criteria consisted of the free-text terms “difficult patient” and “difficult client” and the Medical Subject Heading terms “patient participation” and “professional-patient relations” with searches further refined by focusing on adults, management, screening, and incidence among review and research articles published in academic journals in English. The author excluded articles focused on children, adolescents, and anger management. This study condenses a body of research spanning two decades and can help clinicians understand factors that contribute to difficult encounters, employ simple screening instruments, and implement management approaches that can minimize difficult encounters and maximize their successful resolutions. Based on the collected evidence, most doctor-patient relationships are trouble-free, but some, ranging between 10% and 20%, are dominated by difficulties of varying degrees and types.

    Read the article.


  • May 09, 2023 11:47 AM | Judy Pfeiffer (Administrator)

    The Drug Enforcement Agency, jointly with the Substance Abuse and Mental Health Services Administration (SAMHSA), is issuing a temporary rule to extend certain exceptions granted to existing DEA regulations in March 2020 as a result of the COVID19 Public Health Emergency (COVID-19 PHE), in order to avoid lapses in care for patients.

    The full set of telemedicine flexibilities regarding prescription of controlled medications as were in place during the COVID-19 PHE will remain in place through November 11, 2023.

    If a patient and a practitioner have established a telemedicine relationship on or before November 11, 2023, the same telemedicine flexibilities that have governed the relationship to that point are permitted until November 11, 2024.

    According to the rule, ultimately, there will be a final set of regulations permitting the practice of telemedicine under circumstances that are consistent with public health, safety, and effective controls against diversion. 

    Read SAMHSA's release here.

    Read entire rule here.



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