Best Practices for Improving SUD/OUD Treatment in the Fentanyl Era

The addition of fentanyl to the nation’s drug supply has dramatically escalated overdose deaths and required providers to urgently “step up” our collective efforts to treat SUD & OUD – requiring compassion, commitment, and innovation. This conference provides prescribers and their multi-professional teams the opportunity to hear from national speakers and their colleagues and explore innovative strategies to advance our treatment efforts. Join us to hear advances on the latest in practices to initiate buprenorphine and its new formulations, create contingency management programs to address stimulant use, implement peer services, partner with corrections, and more. Join your colleagues to explore how we can together step it up – it’s about saving lives.

 Maple Hill Farm Inn and Conference Center |  June 14, 2023  |  8:00AM- 4:00PM

CMEs and other contact hour offered. See the registration page or below for more information.

This activity includes topics recommended by the DEA and SAMHSA to satisfy 2023 MATE Act requirements. This activity qualifies for 3 credit(s) of the 3

 CME credit requirement for opioid medication education found in P.L. 2015, Chapter 488, Maine’s legislation to address the opioid drug crisis.

Master of Ceremony

Buprenorphine Initiations in the World of Fentanyl 

Presenter: Zoe Weinstein, MD, MS, Boston Chobanian & Advedisian School of Medicine

With the majority of the drug supply containing fentanyl, what are the strategies for high and low-dose initiations in the inpatient setting? Dr. Weinstein will explore ways to safely transition our patients onto buprenorphine, given the potential risks. She will highlight what we know and what are the directions of future research for inpatient and outpatient buprenorphine induction.

Contingency Management: Experiences with Implementation

Presenter: Marielle Baldwin, MD, MPHBoston Chobanian & Advedisian School of Medicine

Contingency Management (CM) is an evidence-based behavioral intervention using positive reinforcements to help people change their substance use patterns. CM has shown efficacy in reducing the use of a range of substances, including stimulants (cocaine and methamphetamine), alcohol, opioids, marijuana, and nicotine. Dr. Baldwin will: examine the principles of and evidence in support of contingency management as an effective treatment for a range of substance use disorders; highlight an example of CM in the treatment of stimulant use disorders specifically; discuss the basics of CM implementation, along with challenges of implementation. 

Full Sessions

Exploring the Opioid Clinical Committee’s (Opioid CAC) Guidance Documents

Panelists:  Rachel Solotaroff, MD,  Alane O’Connor, DNP and Kelley Harmon, DO

An exploration of two Opioid CAC Guidance documents to guide our practices by panelists.

  • Ensuring Access to Medications for Opioid Use Disorder (MOUD) in Hospital Settings
  • Draft Ambulatory withdrawal and care for OUD/AUD/Other SUD 

What We Do Matters: Addressing Stigma in Health Care Towards People Who Use Substances

This session will feature a documentary-style video to reveal the expressions and impact of stigma towards people with substance use disorders when they seek healthcare. A brief discussion will follow the video to promote further processing of the material presented.

Facilitator:  Kristen Silvia, MD



Workshop Descriptions

Please review the workshop descriptions below and select one workshop from each Session (Morning and Afternoon) to attend. Once you have selected the workshops that you would like to attend, you can register for the Step it Up Conference here:

Morning Session Workshops

Workshop A1: Addiction Recovery Support Services: Rationale and Science

Presenter: John Kelly, Ph.D. (pre-recorded video) and Reflective Panel

 Location: Gallery

During the past 50 years in the United States we have learned a great deal about the causes, prevalence, clinical course, and impact of alcohol and other drug use disorders, including that these disorders tend to have a long course. Even when individuals achieve initial remission, risk for recurrence of the disorder can remain elevated for several years.  This presentation will provide brief contextual overview of what has been learned during the past 50 years of addiction science which has led to the emergence and growth of new models of extended recovery support services that are demonstrating effectiveness and cost-effectiveness in facilitating long-term remission and stable recovery.

Workshop B1: Partnering with Corrections

Presenters: Alane O’Connor, DNP , Melissa Caminiti, MPH, RN & Elizabeth Simoni, JD

Location: Carriage House

Come learn about substance use disorder treatment in Maine jails and prisons. Presenters will review related literature as well as their own experience of successes and challenges in delivering SUD treatment in correctional settings. Presenters will also discuss successful diversion programs including pretrial/community corrections supervision rather than detention

Workshop C1: Ambulatory Withdrawal Management and Identifying Risk for Withdrawal

Presenter: Nicholas Piotrowski, MD, FASAM

Location: Gathering Place

Many patients can receive treatment for alcohol withdrawal safely in the community with the support of a primary care provider. This program will provide an overview of key elements and safety considerations of ambulatory alcohol withdrawal management programs. Consideration also will be given to the risk of other drugs including opioids in alcohol withdrawal management.

Afternoon Session Workshops

Workshop A2: Implementing Peer Recovery as Part of the Clinical Team

Presenter: Amanda Thompson

Location: Gallery

The integration of a peer support role within SUD treatment programs can have a profound positive effect on team dynamics and patient outcomes. In this session, we’ll discuss peer support model fidelity, role clarity, and strategies to successfully integrate the role on multidisciplinary teams, including supervision and communication recommendations.

Workshop B2: Treating Adolescents with Substance Use Disorders in Maine

Presenters: Deborah Hagler, MD,  Jonathan Fanburg, MD 

Location: Carriage House

Join Deborah Hagler, MD, and Jonathan Fanburg, MD, as they discuss an overview of what is currently happening regarding adolescent Substance Use Disorders (SUD) screening, prevention, and treatment in Maine, things to consider as an adult provider treating adolescents, and challenges that are specific to treating adolescents with a SUD in Maine (attention will be given to treatment of adolescents using opioids). There will be time at the end to ask questions and share challenges you might be facing when it comes to treating adolescents.

Workshop C2: Enhancing Access to Extended-Release Buprenorphine for Patients with Opioid Use Disorder (Opioid CAC Guidance Doc)

Presenter: Alane O’Connor, DNP,  Kristen Silvia, MD,  Anne Marie Toderico, PharmD

Location: Gathering Place

Come learn how to utilize extended-release buprenorphine (XRB) when caring for patients with OUD. We will discuss clinical indications including XRB dosing and administration, XRB operational considerations including REMS certification as well as ordering, storing, and billing for the medication. Finally, we will discuss Mainecare’s XRB clinical criteria and related suggested workflows.

Additional Workshop Session Faculty

Continuing Medical Education

This activity includes topics recommended by the DEA and SAMHSA to satisfy 2023 MATE Act requirements.

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the Maine Medical Education Trust and CCSME. The Maine Medical Education Trust is accredited by the Maine Medical Association Committee on Continuing Medical Education and Accreditation to provide continuing medical education for physicians.

The Maine Medical Education Trust designates this live in person activity for a maximum of 6.5 AMA PRA Category 1 Credit(s)TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

This activity qualifies for 3 credit(s) of the 3 CME credit requirement for opioid medication education found in P.L. 2015, Chapter 488, Maine’s legislation to address the opioid drug crisis.

Contact Hours

This program constitutes 6.5 hours of training through AdCare Educational Institute of Maine, Inc. for the following credentials:

  • AdCare Educational Institute is a National Association for Alcoholism and Drug Abuse Counselors (NAADAC) approved education provider. Provider #62201 6.5 Hours of Continuing Education.
  • AdCare Educational Institute, Inc. is approved by the American Psychological Association to sponsor continuing education for psychologists. AdCare Educational Institute, Inc. maintains responsibility for this program and its content. 6.5 hours of continuing education. Partial credit will not be issued.

Certified Prevention Specialists: This training is approved by the Maine Prevention Certification Board and meets the requirements for Prevention Specialist Certification in Maine. 6.5 hours of training for Certified Prevention Specialists: IC&RC Prevention Performance Domains: 6:.5 Professional Growth and Responsibility.

Social Workers: The Board of Social Workers Licensure does not pre-approve continuing education. Retain a copy of certificate issued and training agenda to provide to the Maine State Board of Social Workers. Provision of these two documents is necessary for the Board of Social Workers to issue continuing education credit.

Licensed Counselors: The Maine State Board of Counseling Professionals does not pre-approve continuing education. Retain a copy of certificate issued and training agenda to provide to the Maine State Board of Counseling Professionals. Provision of these two documents is necessary for the Board of Counseling Professionals to issue continuing education credit.

Deborah Hagler, MD

Deborah Hagler, MD, FAAP attended Duke University and Cornell Medical College and did her pediatric training at the Children’s Hospital of Philadelphia. Throughout her educational journey she has been involved in collaborative efforts to educate her community. As a resident in Philadelphia she worked with at risk youth in a local homeless shelter and helped organize a series of talks for residents to educate herself and colleagues about social determinants of health. For these efforts receiving the Nancy Barnhart Community Service Award and the Senior Resident Humanitarian award.

Dr. Hagler is an active member of the community serving as the school physician for many of years and working with many local organizations on issues pertinent to children’s health and wellbeing. She has been the recipient of several Community Builder Awards from the local United Way.

Dr. Hagler is currently a pediatrician and Director of the Community Health and Wellness Center at Mid Coast Hospital and is the immediate past President of the Maine Chapter of the American Academy of Pediatrics. She recently completed a Masters of Public Health at the Bloomberg School of Public Health at Johns Hopkins University focusing on child and adolescent mental health and is using many of her new skills to lead a multi stakeholder coalition to improve children’s mental health and spearheading the creation of a substance abuse treatment clinic for adolescents in the Mid Coast Region.

Nicholas Piotrowski, MD, is an addiction psychiatrist, Fellow of the American Society of Addiction Medicine, and Assistant Professor of Psychiatry at Tufts Medical School. Since 2020, Dr. Piotrowski has served as Medical Director of Addiction Psychiatry for Maine Behavioral Healthcare. He supervises medical treatment in four substance use treatment hubs in Southern and Coastal Maine and provides system leadership in substance use treatment at MaineHealth.

Rachel Solotaroff, MD, is the Executive Clinical Director of Substance Use Disorder Services at Penobscot Community Health Care, where she provides patient care, oversees substance use disorders care delivery in the outpatient setting, and providing medical direction for withdrawal management at New Horizons. Prior to moving to Maine, Rachel served as Chief Medical Officer and then CEO at Central City Concern in Portland, Oregon. Rachel’s interest lies in using a population health framework to address the complex intersection of homelessness and substance use disorders, often accompanied by trauma, social isolation, and mental illness. Rachel is a general internist with additional board certification in Addiction Medicine, and holds a Masters in Clinical Research.

Kristen Silvia, MD after attending UMASS Medical School in Worcester, completed her residency in Family Medicine at Maine Medical Center in 2006.  She worked as a family physician and clinical faculty member at Scarborough Family Medicine until 2016.  During her 10 years as a primary care provider, she treated many patients with opioid use disorder.  In 2016, she transitioned from primary care to being the Medical Director for the Maine Medical Partners outpatient Integrated Medication Assisted Treatment (IMAT) program.  She also serves as the Primary Care Director for the MaineHealth Substance Use Disorder Initiative, which developed a system-wide response to the opioid epidemic.  In 2018, Dr. Silvia earned board certification in Addiction Medicine.  She is currently the Program Director for Maine Medical Center’s Addiction Medicine Fellowship and the Chief of MMC’s Addiction Medicine Division.  She is also an Associate Clinical Professor at the Tufts School of Medicine.

Anne-Marie Toderico, PharmD is the Pharmacy Director for MaineCare, Maine’s Medicaid program. Prior to joining MaineCare, Anne-Marie was the program manager for Maine Center for Disease Control and Prevention’s contact tracing program.  Here she worked with a remote team of Maine citizens to trace COVID-19 exposures across the state.  Anne-Marie’s experiences before state government, include administrative roles as Director of Operations for a large physician owned practice and Director of Drug Use Policy for MaineHealth, a large, local health system.   She started in healthcare as an IT analyst and led the build for the nurse, physician and pharmacy portion of the health system’s electronic health record.  Anne-Marie has served as an executive on her state affiliate pharmacy association and for a local health system leadership alumni organization.  Her hidden talent is knitting and crochet; she can be found creating scarves and sweaters while procrastinating or avoiding outdoor chores.  

Amanda Thompson is employed by Maine Behavioral Healthcare as a Program Manager for Substance Use Peer Recovery Services. She is a Certified Intentional Peer Support Specialist and Recovery Coach Professional Facilitator. In her role she supports a team of Peer Recovery Partners working with individuals in substance use treatment, Emergency Departments and MaineMOM. Amanda is a person in long term recovery from Substance Use Disorder and believes that utilizing others with lived experience to support those struggling and navigating care is vital to enhancing access to services, improving patient outcomes and creating lasting change.

Melissa J. Caminiti, MPH, BSN, RN, is the Director of Recovery and Reentry Services with Wellpath, the medical vendor for the Maine Department of Corrections. She oversees the operationalization of substance use disorder treatment services for Maine’s six adult state prison facilities. Treatment services include medications for substance use disorder, education and implementation of harm reduction strategies, and the development of peer recovery networks. She also supports staff and clients in Adult Community Corrections (probation). Additionally, she oversees comprehensive discharge planning for residents releasing with high acuity somatic and behavioral health needs.

She received both her Bachelor of Science in Nursing and her Master of Public Health from the University of North Carolina in Chapel Hill. Her previous work experience includes the application of quality improvement science in rural hospital and nursing home settings, as well as health policy work focused on women, children and family systems impacted by substance use disorders

Jonathan T. Fanburg, MD, MPH is a Pediatrician and Adolescent Medicine specialist who has worked in Maine for over 20 years seeing children, adolescent, and young adults.  Presently, he is the Director of the Division of Adolescent and Young Adult Medicine at Maine Medical Center, and an Associate Medical Director of Primary Care at Maine Medical Partners.  Along with seeing patients aged 10-26, he works with school health, substance use, adolescent gynecology, eating disorders, and resident and attending education.  He recently stepped off of the executive committee for the Section on Adolescent Health for the American Academy of Pediatrics.

Alane O’Connor, DNP is the director of perinatal addiction medicine at Maine Medical Center and is the medical advisor of the Maine Maternal Opioid Misuse (MaineMOM) Initiative, a 5-year, $5 million federal grant to expand access to substance use treatment for pregnant and postpartum individuals in Maine. She also co-chairs Maine’s Opioid Response Clinical Advisory Committee, which advises the Governor’s opioid response director on clinical and public policy issues. Dr. O’Connor has more than 15 years of experience in addiction medicine in a variety of settings including the design and implementation of an extended-release buprenorphine pilot at Somerset County Jail, rapid access to substance use treatment in emergency departments through Maine Medical Association’s Project RISE, as well extensive experience caring for pregnant patients with substance use disorder in both the inpatient and outpatient settings. She lectures regionally and nationally and has trained more than 100 family medicine and obstetric resident physicians. She is a core faculty member of Maine’s only addiction medicine fellowship program. Finally, she has published numerous peer reviewed articles on maternal and infant outcomes of substance exposed pregnancies including the related child welfare implications as well as the care of incarcerated pregnant patients.

John Kelly, PhD During the past 50 years in the United States, we have learned a great deal about the causes, prevalence, clinical course, and impact of alcohol and other drug use disorders, including that these disorders tend to have a long course. Even when individuals achieve initial remission, the risk for recurrence of the disorder can remain elevated for several years. This presentation will provide a brief contextual overview of what has been learned during the past 50 years of addiction science, which has led to the emergence and growth of new models of extended recovery support services demonstrating effectiveness and cost-effectiveness in facilitating long-term remission and stable recovery. 

Marielle Baldwin, MD is an Assistant Professor of Family Medicine at Boston University Chobanian and Avedisian School of Medicine and works clinically with the Family Medicine Residency Program at Boston University Medical Center (BUMC). She completed her family medicine residency and chief residency at BUMC in 2017.

Since joining the BU Department of Family Medicine, Dr. Baldwin has catalyzed a number of clinical programs and quality improvement efforts. She is the Medical Director for the Stimulant Treatment and Recovery Team (START), an extension of BMC’s Office-Based Addiction Treatment (OBAT) Program and a clinic that uses evidence-based contingency management techniques to care for patients with stimulant use disorders. She is the Director of the Addiction Pathway for the BUMC Family Medicine Residency Program at South Boston Community Health Center and at Greater Roslindale Medical & Dental Center. 

Dr. Baldwin teaches and mentors residents and junior faculty. She is the recipient of the 2021 New Faculty Clinical Excellence Award from the Boston University Medical Group and the 2021 Barbara A. Rockett, MD Early Career Physician Leadership Award from the Massachusetts Medical Society.

Zoe M. Weinstein, MD, MS is an Assistant Professor at the Boston University Chobanian & Avedisian School of Medicine. She is a graduate of Boston University’s Addiction Medicine Fellowship and board certified in Internal Medicine and Addiction Medicine. She has been the Director of Boston Medical Center’s interdisciplinary addiction consult service since July 2016. She has been NIDA grant funded as a co-investigator on multiple studies to deliver training and technical assistance to interdisciplinary provider teams. She is currently site-PI of two NIDA Clinical Trial Network studies focused on inpatient addiction care. Her clinical and research work are also focused on long-term Office-Based Addiction Treatment (OBAT) with buprenorphine. She currently serves as Associate Director of Boston University’s Addiction Medicine Fellowship Program, a board member of AMERSA and is a site medical director of a local methadone clinic.