Video Resources

Objectives:

• • Identify pharmacology and pharmacokinetic properties of gabapentin that link to key clinical effects
  • Describe the prevalence and risk factors of non-prescribed gabapentin use
  • Detail clinical outcomes of non-prescribed gabapentin use

March 7, 2023 | Post-Acute and Long-Term Care Facilities: Prescribing and Managing OUD and AUD | Amelia Hersey, PA-C

Objectives:

• • Adapting outpatient practice to SNF/LTC Facilities
  • Basic review of protocols
  • Explore applications utilizing case examples

February 1, 2023 | How to Respond Proactively to Patient Behavior in MOUD and Chronic Pain Environments | Eric Haram, LADC

The patient’s journey towards stable management of their chronic pain and/or OUD is a landscape of challenges and opportunities that often exceed our patient’s ability to cope. Planning and responding proactively to behaviors that may impact the safety of the person, program and staff is critical.

Objectives:

• • Understand program policies, norms, and contracts that direct patient progress and safety
  • Understand the use of patient assessment
  • Discuss patient, staff, and program education
  • Identify ways to support and reinforce patient psychosocial skill development

December 21, 2022 | Substance Use and Co-occurring Infectious Diseases | Kinna Thakarar, DO, MPH

Learning objectives:

• • Recognize the interplay between Infectious Disease and Substance Use disorder epidemics
  • Identify opportunities to incorporate recommended screening into practice settings

Urine Toxicology Testing in Substance Use Disorder Treatment | December 12, 2022 | Dr. Alane O’Connor, DNP

Urine toxicology testing can be a useful tool in clinical decision making when caring for patients with substance use disorders. It is critical for providers to be familiar with the pros and cons of various types of testing and to be skilled in interpreting the results.

Objectives:

• • Review essential concepts in urine toxicology testing including testing methods, specimen validity measures, windows of detection and cut-off concentrations.
  • Discuss toxicology testing in the context of substance use disorder treatment including monitoring for prescription medication use and/or returns to use as well as how to talk with patients about drug testing.
  • Learn how to interpret urine toxicology results including unexpectedly positive/negative specimens.
  • Examine strategies for caring for special populations including those who are engaged with the child welfare and criminal justice systems.

Cannabis and Cannabis Use Disorder: Updates for Clinicians on a Complex Topic | December 6, 2022 | Kevin M. Gray, M.D., Professor of Psychiatry and Behavioral Sciences, Medical University of South Carolina

Dr. Gray will provide a general overview of the complex and evolving context for cannabis use. The talk will then focus on cannabis use disorder (CUD) and its clinical implications. An overview of evidence-based psychosocial strategies will be followed by a summary of findings to date on candidate pharmacotherapies for CUD. Dr. Gray will then provide perspective on the incorporation of evidence-based CUD treatment practices in challenging clinical scenarios, including co-occurring opioid use disorder and mental health disorders.

Objectives:

• • Summarize current knowledge regarding cannabis-related benefits and harms
  • Describe evidence-based psychosocial treatments for cannabis use disorder
  • Indicate candidate pharmacotherapies being examined for cannabis use disorder

Harm Reduction | November 30, 2022 | Kinna Thakarar

Learning objectives:

• • Review harm reduction approaches
  • Understand the roles of syringe service programs
  • Understand how to incorporate harm reduction principles in your current work with people who use drugs

What does this mean to ME: Legal Issues and Prescribing | November 14, 2022 | Ben Townsend and Elisabeth Fowlie Mock

This program will review current legal requirements for Maine opioid prescribers and the possible effects of current law enforcement activity

• • Objectives:
    Improve understanding and familiarity with documentation and other tools to manage legal risk in view of current law enforcement activity involving opioid prescribing practices.
  • Learn the basic requirements associated with Maine’s opioid prescribing statute and rules.
  • Learn the basic legal and regulatory requirements associated with Maine’s Prescription Monitoring Program.

Diagnosis and Treatment of ADHD in Adults with Substance Use Disorder: Applying Evidence to a Common Clinical Quandary | November 10, 2022 | Andrea Truncali, Lauren Moran, and Margaret Chaplin

Diagnosis and treatment of adult ADHD is on the rise. Patients with substance use disorder are thought to be disproportionately affected by ADHD but how safe is, and what impact does the pharmacologic treatment have? This session will bring together psychiatry and addiction medicine physicians to explore this clinical question. We will present clinical advice about diagnosis, review literature about pharmacologic treatment, and bring experience and evidence together to discuss common clinical questions on this topic.

Goals

1. Raise awareness of the complexity of ADHD dx

2. Understand evidence for treatment of adult ADHD alone and with SUD

3. Understand the harms of treatment of adult ADHD

Objectives

1. Identify considerations in enhancing specificity of making an ADHD diagnosis in adults

2. Describe the evidence for benefit of treatment of adult ADHD, and the limitations of that evidence

3. Outline potential harms of stimulant therapy

Universal Screening, Brief Intervention and Referral to Treatment: SBIRT within Primary Care | November 9, 2022 | Eric Haram, LADC

Universal screening and brief intervention and referral for substance misuse within primary care settings is a foundation activity soon to be required under PCPlus. This program will review the nuts and bolts to help providers implement this evidence-based practice. Screening tools to be highlighted include CRAFFT, DAST, AUDIT, 4Ps.

Objectives:

• • Describe screening and engagement
  • Identify strategies to engage individuals in care discussion
  • Discuss tips to support shared decision making

Methadone Transition to Bupenorphine | November 3, 2022 | Jonathan C Fellers, MD

Learning objectives:

• • Understand the pharmacologic differences between buprenorphine and methadone
  • Describe 2 strategies for switching between buprenorphine and methadone
  • Discuss informed consent and considerations for patients

When a Patient with Chronic Pain Loses their Provider: Compassionate, Evidence-Based Responses | November 2, 2022 | Elisabeth Mock, MD, MPH and Noah Nesin, MD

What are the best actions to take when patients with chronic pain in a community suddenly lose their provider?  Patients on high dose opioids often have difficulty finding new providers.  What resources are available to support prescribers in such a transition?

Cannabis Research: Complexities and Priorities| November 1, 2022 | Susan R.B. Weiss

The presenter will clarify cannabis, cannabinoids, and the endocannabinoid system. After examining the evolving landscape and the effects of long-term cannabis use, the public health impacts of cannabis will be discussed.

Objectives

• • Understand cannabis, cannabinoids, and the endocannabinoid system
  • Discuss the evolving landscape of cannabis use
  • Examine long term health effects of cannabis
  • Discuss the public health impact of cannabis

Illicit Drug Supply 2022: More potent methamphetamine forms and mixtures of fentanyl, and the “Xines” and “Xenes”| October 25, 2022 | Richard Rawson, PhD

An undeniable fact of the 2022 illegal drug supply is that it is changing rapidly and it is much more lethal.  Methamphetamine with far greater purity and potency and fentanyl mixed into “heroin” cocaine and meth, fentanyl pressed into a variety of pill forms, and potent drugs including xylazine (a veterinary tranquilizer) and isotonitazene a potent opioid are now part of the drug landscape.

Learning objectives:

• • Understand the new street drug supply to provide effective overdose care and treatment.

Contingency Management: An Essential Treatment Approach for Individuals with Stimulant Use Disorder | October 18, 2022 | Richard Rawson, PhD

Contingency Management (CM) is a powerful behavioral strategy that has repeatedly been demonstrated to reduce stimulant use by individuals with Stimulant Use Disorder.  Use of CM outside of the VA has been rare due to regulatory and funding obstacles.  However, CM is cited in the 2022 National Drug Plan as a priority treatment to address the treatment needs of individuals with cocaine and methamphetamine use disorder.  Delivery of an effective, evidence-based CM protocol that is in compliance with federal guidelines requires careful development of a training and implementation plan.  The presenter will present the steps and key components of the CM protocol and implementation plan being used in California in the first large scale implementation of CM outside the VA.

Ambulatory Alcohol Withdrawal Management | October 11, 2022 | Nick Piotrowski, MD, FASAM, Medical Director, Addiction Psychiatry, MBH

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.

Objectives:

• • Describe the role of ambulatory alcohol withdrawal management in the ASAM continuum of care.
  • Name 4 essential components of an ambulatory alcohol withdrawal management program.
  • Outline advantages and disadvantages of using benzodiazepines for ambulatory alcohol withdrawal management.

Medications and Treatment of Alcohol Use Disorders | October 4, 2022 | Sephanie Nichols, PharmD MPH and Eric Haram, LADC

Objectives:

• • Understand prescribing and treatment for Alcohol Use Disorder
  • Describe ways to engage with patients when discussing unexpected information

Update on 2022 PMP Enhancements | September 29, 2022 | Elisabeth Fowlie Mock, MD

Multiple enhancements to the Maine PMP in 2022 will further its mission “to promote the public health and welfare and to detect and prevent substance misuse.” Tune in to learn about PMP tools to enhance patient safety and how to ensure documentation of your compliance with the 2016 Chapter 488 law. Dr. Mock has been serving as the Clinical and Policy Advisor to the PMP since January 2022.

Objectives:

• • Use the PMP as a tool for patient safety
  • Evaluate PMP check workflows
  • Understand the ‘Overdose Risk Score’
  • Review new PMP functionalities

Medications for Youth with an OUD and Other Treatment/Recovery Considerations | September 20, 2022 | Amy Yule, MD

This presentation will discuss youth/adolescents with OUD and co-occurring mental health disorders, trauma, and/or ADHD, review the three types of MOUD that can be used for youth with a main focus on buprenorphine, and review developmental considerations and approaches to treatment and recovery.

Learning objectives:

• • describe the three FDA-approved medications for OUD, their actions, induction, and dosing in the youth/adolescent population
  • identify the developmental aspects of treatment and recovery approaches when caring for the youth/adolescent population
  • discuss trauma-informed care and the importance of addressing co-occurring psychiatric disorders when engaging with the youth/adolescent population.

Delivering XR Buprenorphine in Maine Practice | September 27, 2022 | Eva Quirion, NP, PhD

Explore the delivery of XR buprenorphine with a focus on practical issues. Challenges and successes of the use of the XR buprenorphine will be highlighted.

Learning objectives:

• • Assess patients for XR buprenorphine
  • Describe induction and delivery (practice tips on injection)
  • Name challenges and success with the use of XR buprenorphine

Complex Persistent Opioid Dependence | October 4, 2022 | Mark Sullivan

Learning Objectives:

• • Learn the prevalence of Opioid Use Disorder (OUD) in patients treated with long-term opioid therapy (LTOT) for chronic pain
  • Understand the difference between OUD and Complex Persistent Opioid Dependence among patients on LTOT
  • Learn how to manage Complex Persistent Opioid Dependence

Opioid Health Home (OHH) New Adopted Rule – MaineCare Services | September 14, 2022 | Kaley Boucher

The program will review the recent changes to the Opioid Health Home (OHH) model and regulation. The new updates provide increased flexibility and care coordination across programs. The changes will be highlighted and there will be opportunities for questions and answers.

Objectives:

• • Describe the various tiers of the Opioid Health Home model
  • Highlight changes from the previous MaineCare OHH regulations
  • Identify the advantages of value-based payment models

Comorbidities in Psychiatry: Prescribing Pearls | August 24, 2022 | Dr. Laurie Deerfield

This presentation will assist prescribers in their conceptualization and understanding of different diagnostic categories and ways psychiatric presentations may overlap to guide their choice of agents to treat complex medical psychiatric and substance issues appropriately without exacerbating other comorbid issues. Topics will include the how fentanyl influences those decisions, tips on reading confirmation substance testing, and ways to avoid precipitated withdrawal and the phenomenon known collectively as “restless leg syndrome.” Topics will include treating substance use disorders and anxiety, depression, and bipolar spectrums as well as depressive disorder sub types among others as time allows.

Buprenorphine and Pain | August 9, 2022 | Stephanie Nichols, PharmD, BCPS, BCPP, FCCP

This session will review the interface and nuances of the use of buprenorphine in a person with pain. We will review multiple angles, including both the treatment of acute and chronic pain in a person receiving buprenorphine for OUD and the use of buprenorphine to treat pain (with or without OUD).

Learning objectives: 

• • Compare and contrast the various formulations of buprenorphine including consideration of FDA indication, route of administration, and dose
  • Identify the clinical result of using buprenorphine in a person who is opioid naive and in a person who is currently using other medical or nonmedical opioids
  • Describe the efficacy and clinical pearls associated with the use of buprenorphine patch and transmucosal forms for analgesia in a person with and without OUD
  • Identify emerging and best practices regarding treatment of acute and chronic pain in a person receiving buprenorphine for OUD

Early Recovery: Shifts in Focus | July 27, 2022 | Todd Mandell, MD

The early recovery period is critical to supporting ongoing recovery efforts. There are many pitfalls, with continued disruption of sleep, mood fluctuations and changing ways to care for yourself. Dr. Mandell will explore these areas providing tips about when and what might be helpful for pharmacological and treatment considerations.

Learning objectives:

• • Participants will be able to assist patients with the identification of post-withdrawal symptoms and refer for management.
  • Participants will be able to provide patients with education and skills regarding affect management as it pertains to recovery.
  • Participants will be able to address within their scope of practice issues such as overall well-being and self-care including healthy nutrition and sleep hygiene.

Peer Support Roles in Primary Care: How does it work? | July 12, 2022 | Carol Squires, Dr. Kristine Silvia, Michael Niles, and Randy Morrison

Peer recovery partners in primary care foster connection, engagement, and support with self-directed recovery pathways. The panel will discuss their journey working together in primary care settings – what’s worked, lessons learned, how they collaborate as a team to support patients.  The panel will consist of a physician, clinician, and peer support staff who have created this type of partnership.

Learning objectives:

• • Discuss peer support roles in primary care settings.

Principles in Pain Care: Guiding Mood, Movement and Rest | June 29, 2022 | Eva Quirion, NP, PhD

How best to assess pain to offer non-opioid medication and non-medication treatments based upon the patient needs will be explored. Pertinent to this assessment is learning how to distinguish between peripheral pain and centralized pain.

Learning objectives:

• • Assess patients with chronic pain to offer non-opioid medications and non-medication treatments based on patient needs.
  • Distinguish between peripheral pain and centralized pain in order to identify treatments most likely to be helpful.

Changing the Risks of Benzodiazepines across the Lifespan | June 23, 2022 | Jonathan Fellers, MD

Learning objectives:

• • Explore the indications and treatment frame for the use of benzodiazepines
  • Understand the risks of benzodiazepines, including higher risk situations such as comorbidity
  • Discuss strategies for deprescribing benzodiazepines

New Strategies to Initiate Buprenorphine Therapy: Microdosing and Macrodosing | June 14, 2022 | Stephanie Nichols, PharmD, BCPS, BCPP

This session will review the initiation of buprenorphine for OUD using the microdosing and macrodosing approaches. We will review why these emerging approaches are preferable to traditional approaches, the supporting evidence, and the practical pearls for implementation.

Learning Objectives:

• • Describe microdosing and macrodosing approaches to buprenorphine initiation
  • Recall the evidence supporting each of these approaches
  • Discuss practical pearls regarding these approaches when applied to patient care

Best Practice of the Use of Extended-Release Buprenorphine and Naltrexone | May 4, 2022 | John Mariani, MD

The presenter will explore the promising and best practices on the use of XR Buprenorphine and naltrexone. The ways the medications can be delivered and practical issues of certification in the SUBLOCADE REMS program, storage, and administration will be discussed.

Learning objectives:

• • Assess which patients are appropriate for treatment with the extended release (XR) formulation of Buprenorphine and Naltrexone.
  • Familiarize with the induction and monitoring processes for XR Buprenorphine and XR Naltrexone. Familiarize with delivery, storage, and administration (including certification in the Sublocade REMS Program).

Data Collection: Assessing the Complex Patient | April 5, 2022 | Todd Mandell, MD, FASAP

The presenter will explore how to assess and use evidence based resources and tools to begin to identify the interrelations between SUD and psychiatric conditions to direct treatment approaches. Interactive case studies will be used for discussion.

Learning objectives:

• • Identify ways that SUD can mimic functional psychiatric conditions.
  • Complete an HPI with a focus on the reasons that brought the patient to seek treatment.
  • Identify a plan to utilize evidence based resources/tools as part of their assessment process.