The AOA has approved as eligible for AOA Addiction Medicine subspecialty certification those osteopathic physicians who hold the following credentials:

1. Active AOA primary certification, current in OCC, if applicable; and
2. Active American Board of Addiction Medicine (ABAM) certification, current in ABAM MOC.

Applicants who meet these two requirements will be granted subspecialty/CAQ certification in Addiction Medicine, with a requirement that Diplomates maintain their certification through the AOA's Addiction Medicine Osteopathic Continuous Certification (OCC) process.  

Once certified, examination will occur at the appropriate interval based on the date of initial certification or re-certification by ABAM. Other OCC requirements will apply as adopted by the Bureau of Osteopathic Specialists (BOS). Please note that, at this time, the OCC process is under review by the BOS and AOA Board of Trustees (BOT). Details will be forthcoming.

The application fee is $295.

Apply at AOCCAM.ORG

You may also contact AOAAM's Executive Director, Nina Vidmer, at nvidmer@aoaam.org or 708-572-8006 if you have any questions.

The American Osteopathic Academy of Addiction Medicine (AOAAM) and the American Osteopathic Association (AOA) held a meeting on April 7, 2017 to discuss the mechanism to attain a subspecialty certification in addiction medicine. 

The meeting was a follow-up to the AOA resolution that was passed on April 12, 2016 that provides DOs who are ABAM diplomates with a process to attain an AOA subspecialty certification in addiction medicine.

Osteopathic physicians who are ABAM diplomates have 3 possibilities for certification in addiction medicine:

1. If you hold a current, primary AOA certificate, you should have been offered an automatic AOA certification in addiction medicine-. There is a $295 processing fee. Contact addictionmedicine@osteopathic.org for additional information.
2.  If you are a DO and hold a current ABMS certificate, you are eligible for the new ABMS certification examination being offered via the American Board of Preventive Medicine. As an ABAM diplomate, you will not need to list and have verified your practice experience, or provide a reference letter. Go to: www.theabpm.org
3.  If you do not hold a current AOA or ABMS certificate, your status as a current ABAM diplomate remains unchanged, if you are continually registered in the ABAM MOC program.

The AOA recognizes that the opioid epidemic has had a tremendous impact on families, and therefore they are considering a practice pathway for the future to allow for even more DOs to combat the increase of substance use disorder among our patients. 

Attached are slide sets from the AOA and ABAM that outline the pathway to certification. We will keep our members apprised of any news as it becomes available.

• Slides
• Chart

Fighting substance use disorders is a big challenge for American veterans and their communities.  AOAAM past President, Anthony Dekker, DO, was a recent contributor to the article in Media Planet, “Help is on the Way for Veterans Caught in the Opioid Crisis.”  Read the article.

Apr 17, 2017 Clinical Essentials from MMWR Morb Mortal Wkly Rep

Takeaway

• Fentanyl is involved in the majority of opioid overdose deaths in southeastern Massachusetts, according to the Morbidity and Mortality Weekly Report (MMWR).

• The majority of respondents who survived overdose had administered or observed administration of naloxone (Narcan).

Why this matters

• Health officials should expand existing overdose education programs to include fentanyl-specific messaging.

• Access to naloxone should be increased.

Study Design

• 196 overdose deaths were investigated in 3 counties with serious opioid overdoses in southeastern Massachusetts (2014-2016).

• Researchers also interviewed 64 adults who had used opioids in the last year and had observed or experienced an overdose in the past 6 mo.

•  Funding: Massachusetts Department of Public Health and US Centers for Disease Control and Prevention.

Key results

• Among 190 opioid overdose deaths, the proportion involving fentanyl increased from 32% during 2013-2014 to 74% in the first 6 mo of 2016.

• 82% of fentanyl-involved deaths were from illicitly manufactured fentanyl.

• 36% displayed evidence that overdose occurred within seconds or minutes.

•  7 5% of living respondents reported successful reversal of overdose with naloxone.

Limitations

• Because the study was restricted to 3 counties in southeastern Massachusetts, results may lack generalizability to other US counties.

References

Somerville NJ, O'Donnell J, Gladden RM, Zibbell JE, Green TC, Younkin M, Ruiz S, Babakhanlou­Chase H, Chan M, Callis BP, Kuramoto-Crawford J, Nields HM, Walley AY. Characteristics of Fentanyl Overdose - Massachusetts, 2014-2016. MMWR Morb Mortal Wkly Rep. 2017;66(14):382-386. doi: 10.15585/mmwr.mm6614a2. PMID: 28406883

Disclaimer

© 2016 Univadis International, Inc. All rights reserved.

 Psychological Consequences of the American Civil War

Author: R. Gregory Lande

The conclusion of America's Civil War set off an ongoing struggle as a fractured society suffered the psychological consequences of four years of destruction, deprivation and distrust. Veterans experienced climbing rates of depression, suicide, mental illness, crime, and alcohol and drug abuse. Survivors, leery of conventional medicine and traditional religion, sought out quacks and spiritualists as cult memberships grew. This book provides a comprehensive account of the war-weary fighting their mental demons.

Paperback: 256 pages / Publisher: McFarland (December 20, 2016) / Language: English

ISBN-10: 1476667373 / ISBN-13: 978-1476667379

Available at McFarland Books (http://www.mcfarlandbooks.com/), Amazon and many leading retailers.

Click here to view the October 2016 Addiction Education News - COPE

Click to view SAMHSA’s presentation on “Understanding the Buprenorphine Final Rule for a Patient Limit of 275”.

Physicians who have prescribed buprenorphine to 100 patients for at least one year can now increase their patient limits to 275 under new federal regulations. Read CSAT's Dear Colleague Letter (PDF | 234 KB) on the new rule.

The Understanding the Final Rule for a Patient Limit of 275 (PDF | 163 KB) guidance document will help you determine whether you are eligible to request the new, higher limit on the patients that you may treat based on your credentials or features of your practice setting. You may also review the final rule in the Federal Register for further information.

If you wish to be considered for the higher limit please complete the online Waiver Notification Form SMA-167. SAMHSA reviews applications within 45 days of receipt. For more information, send an email to info@buprenorphine.samhsa.gov  or call 866-BUP-CSAT (866-287-2728).

The Senate earlier this week passed the Comprehensive Addiction and Recovery Act (CARA). 

The bill, which focuses on treating substance use disorder as a chronic illness rather than a criminal offense, expands education and prevention efforts, strengthens prescription drug monitoring programs, and increases first responder access to naloxone. The bill also allows nurse practitioners and physician assistants to prescribe buprenorphine with some restrictions.

The Department of Health and Human Services (HHS) issued a final rule on July 6, 2016 to increase access to Medication Assisted Treatment (MAT) with buprenorphine. This Rule will become effective on August 5, 2016.  Below are key points that outlines which practitioners are eligible for an expanded patient limit of 275.  (To read the entire rule click here)

Who is Eligible for a Patient Limit of 275 Under the Final Rule?

Under routine conditions, a practitioner would qualify for the higher limit in one of two ways:

1. by possessing subspecialty certification in addiction medicine or addiction psychiatry, or
2. by practicing in a Qualified Practice Setting (QPS) as defined in the rule. In either case, practitioners with the higher limit would have to possess a waiver to treat 100 patients for at least 1 year in order to gain experience treating at a higher limit.

The purpose of offering the 275 patient limit to practitioners in these two categories is to recognize the benefit offered to patients through: the advanced training and maintenance of knowledge and skill associated with the acquisition of subspecialty certification; and; the higher level of direct service provision and care coordination envisioned in the qualified practice setting. 

In addition to ensuring higher quality of care, the criteria for the higher limit is intended to minimize the risk of diversion of controlled substances to illicit use and accidental exposure that could result from increased prescribing of buprenorphine.

Route 1 - Subspecialty Certification:
A practitioner with board certification in addiction would have the training and experience necessary to recognize and address behaviors associated with increased risk of diversion.

Route 2 – A Qualified Practice Setting (QPS)
The QPS is an alternative to advanced certification to acquire the new 275 patient limit. If you terminate your relationship with a QPS you return to the 100 patient limit.

What is a QPS?

1. the ability to offer patients professional coverage for medical emergencies during hours when the practitioner’s practice is closed; this does not need to involve another waivered practitioner, only that coverage be available for patients experiencing an emergency even when the office is closed;
2. the ability to ensure access to patient case-management services including behavioral health services;
3. health information technology (health IT) systems such as electronic health records, when practitioners are required to use it in the practice setting in which he or she practices;
4. participation in a prescription drug monitoring program (PDMP), where operational, and in accordance with State law.  PDMP means a statewide electronic database that collects designated data on substances dispensed in the State.  For practitioners providing care in their capacity as employees or contractors of a Federal government agency, participation in a PDMP would be required only when such participation is not restricted based on State law or regulation based on their State of licensure and is in accordance with Federal statutes and regulations; and
5. employment, or a contractual obligation to treat patients in a setting that has the ability to accept third-party payment for costs in providing health services, including written billing, credit and collection policies and procedures, or Federal health benefits. (100% cash only clinics are out by design because “pill mills" were cash only).

NOTE:
The Higher 275 patient limit must be applied for every 3 years.
Final documentation construction is pending and a form will be available at www.samhsa.gov.

The Higher 275 patient limit may be revoked if there are violation of good practices.
Under the new increase, if you are outside of the standard of care, action can be taken and you will lose the waiver for the new limit.

Besides numbers what is the difference between the lower limit and the higher limit?

• Practitioners approved to treat up to 275 patients will also be required to accept greater responsibility for providing behavioral health services and care coordination, and ensuring quality assurance and improvement practices, diversion control, and continuity of care in emergencies.
• The higher limit will also carry with it the duty to regularly reaffirm the practitioner’s ongoing eligibility and to participate in data reporting and monitoring as required by SAMHSA.