Substance Abuse and Mental Health Services Administration
December 11, 2023

OVERVIEW

On December 11, 2023, the Substance Abuse and Mental Health Services Administration (SAMHSA), in partnership with the U.S. Food and Drug Administration (FDA) and the National Institute on Drug Abuse (NIDA), hosted a listening session to discuss the medical need, emerging data, and barriers to accessing higher doses of buprenorphine in the context of high potency synthetic opioid (HPSO) exposure. The meeting focused on gathering quantitative and qualitative data on the need for, effectiveness of, and safety of “high dose” buprenorphine (defined as > 24 mg of buprenorphine per day) in the treatment of opioid use disorders (OUD), to inform federal guidelines and policies. This document summarizes the recommendations and opinions of the participants and does not reflect an official position, policy, or set of recommendations from any federal or state agency.

More than 300 individuals registered for the virtual listening session, with over 200 attending the Zoom meeting. Participants represented a wide range of disciplines related to OUD services, including providers, academics, researchers, and those with lived experience. The meeting was structured around four panels:

• Setting the Context: The Current Landscape, Guidance, and Use of High Dose Buprenorphine
• New and Original Data on the Use of High Dose Buprenorphine
• Qualitative Data and Implementation Insights
• Identifying Barriers to Accessing High Dose Buprenorphine and Potential Solutions

Read the report.

AOAAM Board Member Jan Widerman, DO, FAOAAM is featured in The DO

Understanding the connection between ADHD and substance use disorder

Pediatrician Jan Widerman, DO, FAOAAM discusses ADHD and SUD in children and adults and shares guidance on treatment and medication.

Throughout his 43 years as a pediatrician and 17 years as an addiction specialist, Jan Widerman, DO, has come across many patients who might have avoided developing a substance use disorder (SUD) had they been diagnosed and treated for attention deficit/hyperactivity disorder (ADHD) as children. As a mostly genetic disorder, ADHD is typically diagnosed before the patient is 12 years old and affects around 5-12% of the population.

“Seventy to 80% of these patients do not outgrow the diagnosis,” said Dr. Widerman. “If untreated, it can lead to higher rates of SUD, as well as accidents and problems in work, relationships and life.”

Dr. Widerman recently spoke at OMED 2024 about the correlation between ADHD and SUD. He shared information to help DOs feel better-equipped to diagnose ADHD in adults, understand how ADHD affects patients’ lives, differentiate ADHD from other comorbidities and determine proper dosing of medications to treat ADHD.

Read the Full article.

NARRATIVE MEDICINE

Nerve Pain

Jon Lepley, DO, FAOAAM
Medical Director of Addiction Medicine
Penn Medicine Lancaster General Health

Lisa was a real thorn in my side as a patient in the Philadelphia jail 10 years ago. She was a twentysomething- year-old, mostly healthy female who somehow entered my chronic medical care clinic within a day of entering the jail. Urgent appointments in the chronic care clinic were typically reserved for someone with insulin-dependent diabetes or severe asthma. Lisa was placed on my schedule for “nerve pain.”

Although all detainees met with a nurse within four hours of entering the jail to identify urgent problems and continue existing medications, physician evaluations for chronic illnesses were routinely scheduled to occur three weeks after a person entered the jail. This timeframe provided a crucial advantage. The jail system routinely processed more than 30,000 people a year,1 but at least half were released within two weeks. Seeing every incarcerated person with a health problem before then was unfeasible.

Sometimes, persistence trumped procedure at the jail in the face of vociferous patients, no matter how minor the complaint. Bearing prominent and protruding brown eyes against a gaunt face — I initially wondered if she had a thyroid problem — Lisa confidently strode into the exam room. She offered to make the appointment easy for me.

She said, “You just need to prescribe me Pamelor, and then after I try that for four weeks, I will come back, and you can give me my Neurontin.” I was the one who prolonged the interaction by asking where she had pain, for how long, and how the problem was initially diagnosed. She helpfully pointed out that I had many patients to see and could get on to more meaningful work by following her lead and prescribing a low dose of nortriptyline.

I was the one who prolonged the interaction by asking where she had pain, for how long, and how the problem was initially diagnosed. She helpfully pointed out that I had many patients to see and could get on to more meaningful work by following her lead and prescribing a low dose of nortriptyline.

A noticeable cacophony of gripes from many older patients outside the exam room door waiting to see me validated Lisa’s observation. I was swamped and obliged, hoping she would follow the probabilities and leave within two weeks. The odds did not play out that way.

Lisa returned to my clinic after four weeks with a chief complaint of “nerve pain.” Her eyes were less prominent, and her face was fuller. Read more....

R. Gregory Lande, DO, COL (Ret) FACN, FAOAAM is a past president of the AOAAM and a prior board member. Dr. Lande retired from the US Army Medical Corps in recognition for which he received the Legion of Merit award. Dr. Lande then assumed a variety of administrative, clinical, academic, and research positions. Currently, Dr. Lande is a clinical supervisor, Editor-in-Chief of the Journal of Addictive Diseases, and a clinical professor at the Orlando College of Osteopathic Medicine. He is the author of over 100 articles, chapters, and books on a wide variety of medical and medical history subjects. 

United States Military Justice in the Civil War: Court-Martial Practices and Administration (SKU: 9781476695846) is a book by R. Gregory Lande that was first published on September 19, 2024. The book discusses the role of military justice in the Civil War, which was important for maintaining discipline in the Union military.

Despite its relative invisibility to the public, the administration of military justice during the Civil War played a vital role in maintaining the discipline necessary for Union military success. While some scholars have criticized the Union military courts as arbitrary and excessively harsh, others have defended it as a necessary means of maintaining order in the face of unprecedented challenges faced by the Union. Drawing on extensive primary research, this history presents a compelling narrative based on a statistical analysis of 5,000 Union military trials, court records, historical legal publications, and insights from contemporary historians. This work analyzes the relationship between alcohol misuse and misconduct, covers the differing approaches to sexual misconduct across the services, and exposes the uneven and sometimes unfair application of military justice. Offering a balanced perspective on the struggle between maintaining discipline and protecting the legal rights of service members, this history is the first of its kind.

Link to Dr. Lande's books on Amazon: https://www.amazon.com/Books-R-Gregory-Lande/s?rh=n%3A283155%2Cp_27%3AR.+Gregory+Lande

Congratulations To AOAAM Board Member
Adam Scioli, DO, FAOAAM

Wernersville, PA – May 20, 2024 – Caron Treatment Centers, a nonprofit behavioral healthcare leader for almost 70 years dedicated to transforming lives through treatment, research, prevention and addiction medical education, announced the appointment of Adam Scioli, D.O., DFAPA, FASAM, FAOAAM, to Chief Medical Officer (CMO). Dr. Scioli will serve on Caron’s Executive Leadership Team, reporting directly to Caron Chief Executive Officer John Driscoll.

As Chief Medical Officer, Dr. Scioli will oversee all medical services at Caron, including psychiatry, psychology and neuropsychology as well as Caron’s expanded neurocognitive services. Caron currently operates two addiction-focused medical centers – The Carol and Ray Neag Center in Pennsylvania and The Keele Center in Florida. Dr. Scioli also oversees Caron’s research program at the Fran and Doug Tieman Center for Research, as well as the Addiction Medicine Fellowship program and Caron’s medical education efforts. In addition to these efforts, Dr. Scioli is a leader on Caron’s interdisciplinary Neurorestorative Health Program which focuses on optimizing and restoring brain health functionality compromised by substance use and issues such as trauma, anxiety and depression.

“While this promotion is a well-deserved recognition of Adam’s significant contributions at Caron, it also demonstrates our commitment to treating the disease of substance use disorder (SUD) as the brain disease it is,” said John Driscoll, CEO of Caron. “The role of Chief Medical Officer has a long history at Caron, reflecting our dedication to healthcare and ensuring consistency of medical philosophy and care throughout the Caron continuum. Adam’s leadership will enable Caron to continue implementing evidence-based and medically appropriate treatments for their substance use and behavioral health disorders, while helping us to advance the treatment of these diseases at its root – the brain. With individuals presenting in treatment with more complex and co-morbid conditions at a greater rate than before, the medical sophistication that Adam and his team provide and their approach to these diseases are invaluable to providing this lifesaving, transformational healthcare.”

“We’re excited to elevate Adam to this important role,” continued Driscoll. “He’s already spearheading Caron’s brain health and neurorestorative care initiative which will transform addiction treatment.”

“I am honored by the opportunity to further advance the practice of addiction medicine, both here and throughout the treatment sector,” commented Dr. Scioli. “Substance Use Disorders are diseases, and they need to be treated as such. Medical research is rapidly advancing our understanding of these diseases and how they affect the brain, and Caron is committed to incorporating advances in medicine into clinical practice in the treatment of SUD.”

Dr. Scioli has been a medical leader at Caron Treatment Centers since July 2015, most recently serving as the corporate medical director and head of psychiatry at Caron.

Dr. Scioli is a graduate of the University of Pennsylvania and New York College of Osteopathic Medicine. He completed an internship at St. Barnabas Hospital in the Bronx, New York and later completed his psychiatry residency training at Einstein Medical Center in Philadelphia, where he was chief resident for two years and was conferred the title of Distinguished Laughlin Fellow for professional achievement, dedication and scholarship. Dr. Scioli simultaneously completed fellowship training through the Psychoanalytic Center of Philadelphia, where his work focused on the relationship between addiction and attachment.

Dr. Scioli is board-certified by the American Board of Psychiatry and Neurology and the American Osteopathic Board of Neurology and Psychiatry. Additionally, he is board-certified in addiction medicine through the American Board of Prevention Medicine and the American Osteopathic Board of Neurology and Psychiatry. Dr. Scioli is a distinguished fellow of the American Psychiatric Association and a fellow of both the American Society of Addiction Medicine and the American Osteopathic Academy of Addiction Medicine. He also serves as secretary/treasurer on the Board of Trustees of the American Osteopathic Academy of Addiction Medicine and as board chair of the International Doctors in Alcohol Anonymous.

Caron Treatment Centers

Caron Treatment Centers is an internationally recognized nonprofit dedicated to transforming lives through addiction and behavioral healthcare treatment, research, prevention and addiction medicine education. During our almost 70 years Caron has helped thousands of individuals struggling with behavioral health issues, including substance use disorder, begin to manage these brain diseases and find hope. Anchored by two medical centers on our Pennsylvania and Florida campuses and headquartered in Wernersville, Pennsylvania, Caron provides a comprehensive continuum of care that includes medical stabilization and detoxification, residential, partial hospitalization, intensive outpatient, and outpatient programs, as well as Recovery support, family and alumni services. Caron also provides concierge signature treatment for executives, healthcare professionals and older adults and offers Neurorestorative Health Care at our Keele Medical Center in Palm Beach County, Fl. In addition to our Pennsylvania and Florida campuses, Caron provides services in Wyomissing, Pa, Philadelphia, Washington, D.C., Atlanta, and New York City. Caron accepts several major insurance plans and provides financial assistance for those who qualify. For more information, please visit caron.org or @CaronTreatment.

Congratulations to
AOAAM Resident Board Member 
Mohit Chhatpar, DO

2024 Scientific Poster Presentation Winner
ACOFP Annual Convention

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

How 19th-century news coverage helped shape the early years of osteopathic medicine

The press played a pivotal role in broadcasting the new philosophy of holistic care and shaping the public perception and acceptance of osteopathic practices.

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

In the late 19th century, a new medical philosophy made its debut on the front pages of newspapers. After A.T. Still, DO, MD, unveiled his vision for osteopathic medicine in 1874, early mentions in the press mingled curiosity with controversy, mirroring the public’s perception.

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

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

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: 

• Information about Naloxone and Nalmefene
• FDA Overdose Prevention Framework
• Timeline of Selected FDA Activities and Significant Events Addressing Substance Use and Overdose Prevention