Alcohol, Tobacco, and Other Drug Use Interest Group Agenda
SGIM 2022 Annual Meeting
Thursday April 7, 2022 12:00-1:00 pm
There was a large group in attendance. We acknowledged the passing of Dr. Richard Saitz and several group members mentioned the impact he had on SGIM, the ATOD interest group (including the group’s name change to emphasize less stigmatizing terminology), the field of addiction medicine, and personal reflections.
We then discussed the two remaining pathways for ABPM Addiction Medicine board certification. The practice pathway is open through 2025 (ABAM pathway closed). A few members had difficulty documenting clinical hours when they were enrolled in a general internal medicine fellowship, but it was recommended that having a supervisor give sufficient details about the clinical exposure should be sufficient. Most problems stem from insufficient detail about clinical practice. 2021 Exam: 626 passed the exam (an overall pass rate of 82%).
Group members recommended other scientific meetings
The ACGME will require all internal medicine programs to provide instruction on addiction in 2022. This should create opportunities for medical educators to develop and optimize educational interventions and experiences. There was also discussion of integrating medical students and residents into hospital-based addiction medicine consult services.
There was discussion of the National Academies of Science, Engineering, and Medicine’s workshop on federal regulations on methadone treatment. There is video on NASEM’s website and the commissioned papers were recommended. There is currently federal legislation proposed that would allow for office-based prescribing and pharmacy dispensing of methadone outside of licensed opioid treatment programs.
The US Department of Justice released guidance on how the Americans with Disabilities Act protects persons with opioid use disorder. The document includes examples of policies that would violate the ADA, such as skilled nursing facilities refusing to admit a person who takes prescribed medication for opioid use disorder (MOUD) or a jail that does not allow people to take MOUD that was initiated before detention. There is a US attorney in Massachusetts who is willing to speak about ADA violations based on MOUD access and availability.
For more information on the Civil Rights Division, please visit www.justice.gov/crt. For more information on the ADA, please call the department’s toll-free ADA Information Line at 800-514-0301 (TDD 800-514-0383) or visit www.ada.gov. Individuals who believe that they may have been victims of disability discrimination may file a complaint at www.ada.gov/complaint.
The DEA also released guidance on changes in the “3 day rule” regarding dispensing of methadone to treat withdrawal outside of an opioid treatment program.
- Previously under 21 CFR 1306.07(b), “a physician is authorized to administer narcotic drugs to a person for the purpose of relieving acute withdrawal symptoms when necessary while arrangements are being made for referral for treatment, even if that physician is not registered as a Narcotic Treatment Program (NTP). A limitation of this regulation includes that not more than one day’s medication may be administered to the person or for the person’s use at one time. Such emergency treatment may be carried out for not more than three days and may not be renewed or extended.”
- In an effort to decrease barriers to accessing treatment, the new rule allows DEA licensed providers at clinics, hospitals, or ERs to dispense a 3-day supply of OUD medications at one time, instead of a 1-day supply for 72 hours. Providers do not need to have an X-waiver for this but do need to be licensed by the DEA. For questions and to request an exception to the 1-day supply limitation by emailing ODLP@dea.gov with the subject line: “Request for Exception to Limitations on Dispensing for OUD”.
Other topics of interest: Should we develop working groups or sub-committees within the interest group?
- Implementation of addiction services into hospital systems – shared experiences, paying for services
- Telehealth programs
- Policy interest group - changes possible with state-level Medicaid waivers, will regulatory changes during the COVID-19 public health emergency become permanent (bupe telemedicine, OTPs – 14 or 28 days of take-home medication) continued after COVID-19
VA – pain substance use program at VA