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SYMPOSIA Session ISAM & CSAM-SMCA 2016 Montreal, Canada Oct 20-22, 2016 # Title S1 CRISM: Quebec/Maritimes Page Novel targets and models for effective interventions for drug misuse prevention and treatment: Julie Burneau A demonstration project to inform the adaptation of personality-targeted interventions for concurrent substance misuse among methadone maintenance therapy clients Sherry Stewart Evaluation of the perspective of participants from an overdose prevention and naloxone administration training program 12 Michel Perrault Aller plus loin PROFAN peer-oriented program for the prevention and reduction of overdoses and administration of Naloxone Guy Pierre Levesque Personality traits and methadone dose and compliance independently predict concurrent substance use in clients undergoing methadone maintenance treatment for opiate addiction S2 Ioan Tiberiu Mahu Gambling Disorder: a global update Criminal Activity in a large UK treatment seeking population of pathological gamblers Henrietta Bowden-Jones Proportion of revenue derived from pathological gambling: Clinical implications Nady el-Guebaly 17 A high prevalence of gambling disorder and associated factors in Japan Susumu Higuchi Comorbidity, family history and personality. A German study supporting the classification of pathological gambling as a behavioral addiction S3 Karl Mann Continuity of Care for Adolescent SUD and co-occurring disorders: an update Continuity of Care for Adolescent SUD Yifrah Kaminer Continuity of Care (COC) for adolescents with psychiatric disorders Robert Milin 21 Systems of care for adolescent SUD with co-occurring psychiatric disorders Marc Fishman Initiation of addiction treatment and access to services: Young Adults’ account of the help-seeking experiences Vincent Wanger 1|Page S4 Forensic Aspects of Addiction Medicine Criminal Justice reform for the addicted person Gregory Bunt An overview of Addiction Care in Canadian Prisons Leo Lanoie 24 Occupational Drug Testing Laurence Westreich S5 Anabolic-androgenic steroid and polysubstance use among inmates in Norwegian prisons Ingrid Amalia Havnes International Policies Understanding Evidence-based Public Health Policy & Public Health Approach as a basis for addiction policy, the Swiss model Riaz Khan People with a history of injecting drugs in Europe: comparative assessment of addiction and HCV treatment Nat Wright 28 Guiding principles on framework and support measures for opioid dependence treatment including the prescription of agonist medicines Simon Olivier Special Session of the UN General Assembly on the World Drug Problem April 19-21 Norman Wetterau S6 Capacity Building and Quality Assurance on Addiction Treatment in India: Models and approaches – Practice facets of India Incorporating addiction treatment training in medical curriculum Sudhir Khandelwal Specialized training programmes for health professionals Anju Dhawan 31 Online training: an innovative training method Atul Ambekar Evaluation of Quality Assurance and performance of OST centres – a dashboard index Alok Agrawal S7 Intervention for addiction and associated health risks: how to reach “hidden” populations Mental health and injection risk behaviors: cocaine users’ perspectives about their health needs. COSMO study Karine Bertrand Experiences of drug abuse among men who have sex with men: issues and challenges for the implementation of comprehensive services Jorge Flores-Aranda Motivational interviewing to reduce drug injection risks: lessons learned from a mixed methods study Elise Roy 2|Page 35 Gathering user’s perspective, clinicians’ and community stakeholders’ experiences to increase access to addiction services in men who have sex with men Mathieu Goyette S8 Canadian Research Initiative in Substance Misuse: a focus on prescription opioid misuse: OPTIMA Prescription opioid misuse Julie Bruneau Guideline for the Clinical Management of Opioid Addiction Keith Ahamad 38 OPTIMA trial protocol: optimizing patient centered care, a pragmatic randomized control trial comparing models of care in the management of prescription opioid misuse Didier Jutras-Aswad Prescription Opioid Crisis and Ancillary Studies for Optima Trial Ron Lim/Eugenia Socias S9 Behavioral Addictions: an update Profiling the Forensic gambler Henrietta Bowden-Jones Problematic Online gambling - Addiction or coping process? Daniel Kardefelt-Winther Why do you play online? Self-reported motives, in-game behaviors and addictive use of Massively Multi-player Online role Playing Games (MMORPG) Joel Billieux 41 How to engage patients with gambling problems into treatment Hannu Alho Social aspects of online-gambling: a latent class analysis Yasser Khazaal Neuroimaging of Dopamine Transporters in Disordered Gamblers Hermano Tavares S10 Therapeutic Communities around the globe Addiction Medicine and Integrated Therapeutic Communities Gregory Bunt Therapeutic Communities: a global perspective 46 Sushma Taylor Spirituality and Recovery in the Therapeutic Community Marc Galanter Social Model Recovery Systems: a Novel Approach to Addiction treatment Management Peter Vamos S11 Neurosciences Update 49 Impulsivity and compulsivity in chronic opioid dependence and short term abstinence Alex Baldacchino 3|Page Selective Dopamine D3 Receptor Antagonism attenduates a major drug addiction co-morbidity factor-stress-induced PTSD-like behavior Elliott Gardner Useful biomarker to identify hazardous drinking in Korean suicide attempters S12 Seongho Min Opioid Education Opioid abuse and dependence among patients with chronic non-cancer pain: a training challenge in pain management for Quebec family physicians Elise Roy 52 Why doctors have trouble saying “No”. Joel Bordman Waitlist management of opioid use disorder: a novel program incorporating interim methadone therapy delivered on a mobile unit John Fraser S13 Youth Issues The association between mental illness and tobacco use disorder: evidence from studies in adolescence Urvashi Prasad 55 PAUSE: a novel SBIRT Initiative for Alcohol or Marijuana Use targeting University students Catherine Munn Usefulness of cigarette per day (CPD), time to first cigarette (TTFC) and heaviness of smoking index (HIS) in assessing cigarette dependence in India Pratap Kumar Jena S14 Aboriginal Communities Hope and Despair – Culturally sensitive community led opiate maintenance programs in remote First Nations in Northwestern Ontario Mike Franklyn & Sharon Cirone S15 58 SALOME project Safety profile of injectable hydromorphone in a medically supervised treatment program for long term severe opioid use disorder in Vancouver Canada: Outcomes from a recent SALOME RCT Suzanne Brissette Non-inferiority of hydromorphone compared to diacetylmorphine for long term opioid dependence: a randomized clinical trial Eugenia Oveido-Joekes S16 59 Characteristics and response to treatment among Aboriginal people receiving injectable opioids for the treatment of long-term opioid dependence Heather Palis The taxonomy and concept of behavioral addictions: discussion of controversies and relevance to ICD-11 – Part I 62 The taxonomy and concept of behavioral addictions Susumu Higuchi Behavioral Addictions in the context of ICD-II development 4|Page Vladimir Poznyak Pathological Gambling in ICD 11: addiction or impulse control disorder Henrietta Bowden-Jones Behavioral and substance addictions: neurobiological and clinical considerations Marc Potenza S17 Tobacco Tobacco Addiction Treatment in patients with Concurrent addictions: an update Peter Selby 65 The Neuropsychiatric Safety of Smoking Cessation Medications (An Overview of the EAGLES Study) Milan Khara S18 Telemedicine & Hepatitis C Telemedicine and Clinical Management of Hepatitis C Virus Infection on Drug Abusers Jag Khalsa Prevention and Management of Hepatitis C Virus Infection in People Who Use Drugs Andrew Talal The changing paradigm for psychiatry in the treatment of Hepatitis C in those with a co-morbid substance use disorder Clewert Sylvester 67 Interferon-free direct acting antiviral hepatitis C therapy for people who inject drugs Jason Grebely Prevention of Hepatitis C among persons who inject drugs: challenges and opportunities Julie Bruneau S19 Education in Developing Countries Randomized control trials (RCTs) results and qualitative data demonstrate meaningful impacts of the NextGenU.org online training model on health workers, their patients and the health system Veronic Clair Extending capacity in health outcomes in addiction medicine and psychosocial interventions for community health workers Wiplove Lamba 69 Addiction/HIV Researchers Mentoring the Next Generation of Clinician Scientists Jan Klimas S20 International Neuroscience Altered resting state cortico-striatal connectivity in adolescents and adults with Internet gaming disorder Jung-Seok Choi 73 Auditory P300 event-related potential and dopaminergic polymorphisms of Internet gaming disorder Yeon Jin Kim Structural brain correlates of impulsive delated reward discounting in Alcohol and Nicotine use disorders Michael Amlung S21 Advances in Pharmacotherapy – I 76 5|Page Long-acting Formulations to Improve Substance Abuse Treatment Adherence Ivan Montoya Early Implementation of Probuphine REMS program Ole Snyder Slow Release oral Morphine (SROM): closing the gap between methadone and diacetylmorphine in OST Robert Haemmig S22 Behavioral Addictions WHO- ICD 11 – part II Risks associated with the development of diagnostic criteria for behavioral addictions: case of internet-related disorders Joel Billieux Concerns with ICD-11 proposal for gaming disorder – taking a rights-based, child-centered approach to minimize stigmatization and potential harm for regular gamers Daniel Kardfelt-Winther 78 Evaluation of the draft diagnostic guidelines for gaming disorder using clinical subjects Susumu Higuchi Contribution of different diagnostic criteria to the assessment of gaming disorder: What we can learn from the DSM-5 classification of IGD? Florian Rehbein S23 Marijuana, ISAM Physicians and Public Policy Marijuana – Decriminalization vs Legalization Gregory Bunt Cannabinoids as Medicine Jag Khalsa 82 Marihuana myths, facts & rise of Big Marihuana Kevin Sabet Cannabis, pain and Addiction: can we learn from the opioid crisis? Mark Ware Nora Volkow Marijuana research update S24 Medical Education (ISAM) – part I Medical Education in substance misuse/addictions: international perspectives and study results: State of the Art Alex Baldacchino An update: the full medical specialty in Addiction Medicine in Norway Bjorn-Magnus Simonsen 84 Pregraduate Teaching in Addiction Medicine in Switzerland Barbara Broers Addiction Medicine in Canada: a Multispecialty Subspecialty Nady el-Guebaly 6|Page Integrating addiction medicine in psychiatry training Cor De Jong S25 Capacity building of general physicians and linkage with Health services: Indian Experience Anju Dhawan Treatment with opioid pharmacotherapy: A diversity of approaches. A panel of presentations and discussion. Dr. Vladimir Poznyak, discussant Opioid Management in Diverse Settings Rick Rawson UAE: Clinical considerations for the use of Suboxone with a comprehensive treatment context Tarek Gawad 88 Lebanon: Rapid expansion of buprenorphine use in Beirut: treatment experiences and considerations about medication diversion Ramzi Haddad The organization of opioid treatment service into a hub and spoke system in Vermont USA John Brooklyn S26 Young Investigators Towards Improved Addiction management Services in a low resource country: staff regard and perceived facilitators for management of alcohol Use Disorders in Malawi Beatrice Mwagomba 90 Co-curricular Drug Abuse Treatment in a University: Implementation and Evaluation Abidemi Olubunmi Bello A graduated severity level approach to Food Addiction Classification Karren-Lee Raymond S27 Advances in Pharmacotherapy – II Pharmacokinetic evaluation of CAM2038 (buprenorphine FluidCrystal injection depot) q1w (once weekly) and q4w (once monthly) versus intravenous and sublingual buprenorphine in healthy volunteers Fredrik Tiberg A randomized, multiple dose opioid challenge study to assess blockade of subjective opioid effectsbyCAM2038 (buprenorphine FluidCrystal injection depot) q1w (once weekly) in adults with opioid use disorder Sharon Walsh Efficacy and safety of CAM2038 (buprenorphine FluidCrystal injection depot) q1W (once weekly) and q4w (once monthly) in adult outpatients with opioid use disorder: a randomized controlled trial Michelle Lofwall 93 Modeling the effectiveness of subdermally implanted buprenorphine, injectable naltrexone and sublingual buprenorphine for clinically stable adults with opioid dependence John Carter C-EDGE CO STAR: risk of reinfection following successful therapy with Elbasvir (EBR) and Grazoprevir (GZR) in persons who inject drugs (OPWID)receiving opioid agonist therapy (OAT) John Carter S28 Food Addictions: New Horizons 97 Introduction, Definition and Overview of Food Addictions 7|Page Gregory Bunt Neurochemical and neurophysiological Substrates of Food Addictions Nora Volkow Food, Sugar and Addiction Mark Gold S29 Food addiction: neurobiological findings and clinical and public health implications Marc Potenza Updates in the Treatment of Trauma, Post-Traumatic Stress Disorder and Addictions Treatment of Trauma, PTSD & Addiction Kathleen Brady 99 Implementing empirically-based trauma services: a challenge for community treatment providers Louise Haynes Update on psychotherapeutic approaches for the treatment of comorbid PTSD and SUD Therese Killeen S30 Medical Education (ISAM) – Part II How doctors can learn from each other: family physician meets addiction physician Mary Elizabeth Janssen Van Raay Evaluation of the addiction Medicine training in Indonesia: the ISCAN Shelly Iskander 101 The effect of Addiction Medicine Education on the attitude towards patients with addiction and the perception of addiction among medical students Astri Parawita Ayu Addiction Medicine training needs assessment (AMTNA): comparing Ireland, the Netherlands, Lithuania and Indonesia Jan Klimas S31 Aspects of Service Delivery Abstinence variations in paid versus free OST services Adrian Abagiu Abstinence variations in paid versus free OST services Joseph Eibl 105 Enhancing the adherence on psychotropic medications in patients with substance use disorders Ahmed Hassan Bringing Harm Reduction to the bedside in an Inner City Acute care Hospital Kathryn Dong S32 Alcohol Can Alcohol dependent patients return to reduced drinking levels? What do the data indicate? Karl Mann 108 Effect of GABA Extract of Black Sticky Rice with Giant Embryo on alcohol-related indices after acute alcohol intake in social drinkers 8|Page Sung-Gon Kim S33 Making outcome measurement meaningful: Development and implementation of the Visual ADOM-R© - an outcome measure for the Alcohol & Drug Sector Susanna Galea ASAM-ISAM Session: Recovery and Addiction: What is it and How can it be measured? Growth and Development in Recovery Jeff Goldsmith 110 Addiction and Recovery: A quality measurement dashboard Yngvild Olsen S34 A multidimensional Model of Recovery Kenison Roy III Moving beyond Motivational Interviewing: using motivational communication to facilitate behavior change to improve outcomes What is Motivational Communication and does it improve patient outcomes Building an effective relationship between the patient and provider to facilitate change Applying Motivational Communication skills and concepts to patients with addiction problems Practicing Motivational Communication skills with challenging patients: role play exercises S35 Melanie Willows Travis Campbell Kim Lavoie Aboriginal Communities – II 112 Simon Bacon Kim Corace Michael Valis Suicide and Harm Reduction in Aboriginal Communities, Hudson Bay, Northern Canada Arnold Hill 113 Evaluating impact of cocaine use in opioid agonist therapy in Northern and rural regions of Ontario Alexandra Franklyn S36 Substances & Psychiatric Disorders/Psychosis Distinguishing the Psychotic Features of Cannabis and Amphetamine-type Stimulants Fares Alharbi Cannabis induced psychotic disorder and cannabidiol’s purported antipsychotic properties: the state of the evidence Rob Tanguay 115 Efficacy of psychostimulant interventions for amphetamine and methamphetamine use disorders: a systematic review & meta-analysis Meha Bhatt S37 Examining the association between Psychiatric Disorders and Cocaine binge: results from the COSMO study Louis-Christophe Juteau Men who have sex with men: addressing substance misuse and sexual health Substance use and sexual risk behaviors profiles among men who have sex with men tested for HIV at SPOT, a community-based rapid testing intervention in Montreal Karine Bertrand Mon Buzz: an online brief intervention on substance use and sexual health with men who have sex with men – 9|Page 118 development and implementation process Mathieu Goyette & Jorge Flores-Aranda Addressing sexuality with gay/bisexual/queer men using crystal meth Vincent Francoeur Understanding syndemics and addiction in gay male populations Aaron Purdie S38 Opioid Prescribing education Improving opioid prescribing with an educational and self-monitoring strategy in primary care Pamela Leece 122 Improving opioid prescribing with an educational and self-monitoring strategy in primary care S39 Daniel Buchman Homelessness – Recovery & Prevention A Hepatitis C treatment program for homeless patients Pierre Lauzon Is substance use associated with lack of hygiene and prevention? Exploration of multi-risk behaviors in the French population Aurelie Mayet 124 Addiction treatment and recovery programming from patients perspectives: exploratory focus groups of homeless patients with addiction and mental health disorders Ashok Krishnamurthy S40 The Addiction Recovery and Community Health (ARCH) Team Patient, hospital and community stakeholder perspectives Elaine Hyshka Substance dependence and concurrent personality disorders: Phenomenology, Influence on treatment outcomes and evidence-based treatments Phenomenology and epidemiology of co-occurring personality disorders and addictive disorders Ronald Fraser 128 Evidence based treatments for concurrent personality disorders and substance dependence Kathryn Gill S41 Epidemiology, Drugs & Youth Non-Medical prescription opioid use among high school adolescents in Atlantic Canada Miroslava Kolajova 129 Prevalence and awareness of Novel Psychoactive Substances in a Northern Irish Student population Marty Gillian Prevalence and awareness of Novel Psychoactive Substances in a Northern Irish Student population Soheir ElGhonemy S42 Concurrent Disorders – International Aspects 132 Concurrent Substance Use Disorders and PTSD in an inpatient Addiction Treatment Program in Canada James MacKillop 10 | P a g e S43 Opioid Issues & Outcomes Understanding opioid use disorder: Highlighting the heterogeneity in patterns of use and methadone maintenance therapy outcomes Caroline Brunnelle A project to determine the spectrum of substance use severity, patterns of substance use, and readiness to change in an acute care hospital Keith Hansen 133 Development and early findings from the Homewood post-discharge outcome monitoring system in the Addiction Medicine service Sarah Sousa S44 Cannabis Regulating Cannabis: What do Physicians need to know about regulation Rebecca Jessman Synthetic Marijuana and Refractory Epileptogenicity Neil Patel 136 A cross-sectional study of cannabis use among opioid dependent patients maintained on buprenorphine in a community based drug treatment clinic Igam Bagra The Association between Cannabis Use and Methadone Maintenance Treatment (MMT) Outcomes: A systematic review Laura Zielinski 11 | P a g e S1: Canadian Research Initiative in Substance Misuse (CRISM): a national research consortium in substance misuse focused on translation and implementation. Julie Bruneau Authors & presenters:, Keith Ahamad, Eugenia Socsias, Evan Wood, Didier Jutras-Aswad, Ron Lim MD, Michel Perrault, Michel Perrault, Diana Milton, Chantale Perron, Carley Marshall, Ana Carolina Artunduaga, Guy-Pierre Lévesque, Sherry Stewart, Patricia Conrod, Tiberiu Mahu, Jennifer Swansung, Aïssata Sako Intervention for substance misuse is a pressing and complex health issue that requires evidence-based approaches, an understanding of the biological, psychosocial and social factors and an acknowledgement of the important impact of cultural and societal contexts in order to be truly effective. Over the past few decades, remarkable research advances have helped to identify novel targets and models for effective interventions for drug misuse prevention and treatment. However, the rate at which these innovations have reached persons living with substance misuse has been slow and erratic. The purpose of the CRISM research program is to enhance this process. Learning Objectives: The Québec-Maritimes node will host 2 symposiums,that will 1. highlighting research that has integrated implementation process evaluation and innovative practices tailored to the needs of PLWSM, service providers and communities 2. Providing a forum to discuss the strengths and challenges of intervention research. Over the course of 2 symposium sessions, different studies on: 1. Prescription opioid misuse (OPTIMA); 2. Naloxone and overdose intervention; 3. Polysubstance misuse and personality targeted intervention for methadone patients, will be presented. These symposiums will be an opportunity to reflect on the challenges and strengths of developing intervention research, regarding leadership, capacity-building, support strategies, resources allocated/used, compatibility of interdisciplinary and intersectorial visions, and satisfaction of knowledge users. A demonstration project to inform the adaptation of personality-targeted interventions for concurrent substance misuse among methadone maintenance therapy clients Author(s) Name : Sherry H. Stewart, Patricia J. Conrod, Sean P. Barrett, Ioan T. Mahu, Leah Jones, Jennifer Swansburg, Aissata Saiko, Flavie Laroque, Craig MacDonald, Olive Mana, Kristen Chafe Departments of Psychiatry and Psychology & Neuroscience, Dalhousie University c/o Department of Psychology and Neuroscience, PO Box 15000, 1355 Oxford Street, Halifax, Nova Scotia, Canada, B3H 4R2 Email [email protected] Objective: Given evidence that personality remains important in understanding substance use among methadone maintenance therapy (MMT) clients, personality-matched interventions demonstrated effective in other areas of substance misuse treatment (Conrod et al., 2000) may be effective within the MMT population. However, these interventions would need to be adapted to suit the needs of this clientele. This demonstration project seeks to clarify client and therapist 12 | P a g e perspectives that would inform intervention adaptation for use in this population. Additionally, we are collecting quantitative data on clients’ substance use patterns and motives for use in each personality type. Methods: We are collecting data on personality, motives and substance use patterns among methadone maintenance therapy (MMT) 120 clients in four clinics in Halifax and Montreal participating through the Quebec-Maritimes CRISM node. We are also conducting qualitative interviews with clients of each personality type, and focus groups with therapists at each clinic, to gain more insight into reasons/contexts for use and how interventions need to be adapted. Results: Preliminary results on 30 clients suggest theoretically expected associations between motives for use and most substances are observed in this population (e.g., primary motive for use of crack cocaine was enhancement; primary motive for misuse of prescription sedatives was anxiety coping). Once data collection is complete, statistical analyses will examine whether reasons for use of specific drugs differs by personality. We will share some qualitative data that will help inform intervention development. Conclusion: Collectively, our two studies suggest that personality-matched treatment should be adapted for use within MMT clients. References Conrod, P. J., Stewart, S. H., Pihl, R. O., Cote, S., Fontaine, V., & Dongier, M. (2000). Efficacy of brief coping skills interventions that match different personality profiles of female substance users. Psychology of Addictive Behaviours, 14, 231-242. Learning Objectives: 1. Attendees will learn about the rationale surrounding personality-targeted treatment for substance misuse and how this model applies to MMT clients. 2. Attendees will be exposed to stories shared by MMT clients of different personality traits about their experiences using drugs (i.e., patterns, motives, and contexts). Evaluation of the perspective of participants from an overdose prevention and naloxone administration training program Author(s): Michel Perreault, Diana Milton, Chantale Perron, Carley Marshall, Ana Carolina Artunduaga, Guy-Pierre Lévesque Douglas Mental Health University Institute, 6875, boul. LaSalle - Montréal (Québec) H4H 1R3 Email [email protected] 13 | P a g e Introduction: The PROFAN program trains drug users on how to detect and avoid overdose situations, as well as how to administer naloxone to reverse the effects of an opioid overdose. This program provides tools to persons who are in direct contact with other drug users, and in an ideal position to intervene. A unique aspect of PROFAN is that it is a group of peers who trains the other participants. As such, the assessment of the perspective of participants is central to evaluate the implementation and the effectiveness of this program. Objective: to evaluate the perspectives of peer-trainers and participants on the program and assess their knowledge acquisition. Methodology: Peer-trainers (n=5) and participants (n=113) were consulted through focus groups and selfadministered questionnaires on: 1) training received (what was appreciated; what could be improved) and 2) knowledge acquisition, by comparing results on overdose detection and the administration of naloxone before and after training. Results: Participants reported appreciating the training content, animation by peers and the potential to save lives. In terms of knowledge acquisition, there was improvement for all questions in the post-training questionnaires, namely questions on the administration and effects of naloxone and how to react in overdose situations. Conclusion: PROFAN provided an opportunity to develop and implement a peer-oriented training program to help intervene in overdose situations. The acceptability and feasibility of such a program, when provided by peer-trainers, appears high, as 118 participants were trained in 6 months. Additional training sessions are in development, including a condensed version. Learning Objectives: 1. To identify the elements of success, as well as the aspects which are less effective, for the development of overdose prevention and naloxone administration training programs. 2. To understand the benefits of involving peers in programs as trainers for other service users. Aller plus loin PROFAN peer-oriented program for the prevention and reduction of overdoses and administration of Naloxone Author(s): Guy Pierre Lévesque, Chantale Perron 2250 rue Florian, Montréal, Qc. H2K 2P5 Email [email protected] Introduction: In Canada, opioid use is increasingly prevalent, and the rise in use is among the highest in the world. A recent episode of severe drug overdoses and related deaths in Montreal highlighted an urgent need for intervention. The PROFAN program was implemented to help prevent overdose-related deaths by facilitating access to naloxone and providing knowledge and training on how to prevent overdoses. 14 | P a g e Objective: To develop and implement a training program administered by peers for current or former drug users on overdose prevention and naloxone administration. Methodology: PROFAN is aimed at clienteles who are most at risk for overdoses, namely current and former drug users, and their entourage. A unique aspect of the program is that a group of peers, trained by doctors and other health professionals, dispense the program to other participants. The training focuses on: 1) identifying overdose situations and symptoms, 2) administering naloxone, and 3) debunking myths surrounding overdoses. The training also includes a specialized cardiopulmonary resuscitation course. Participants can obtain their own naloxone kits from a nearby pharmacy upon completion of the training. Results: A total of 118 individuals (75 males; 43 females) received training from five peer-trainers within the PROFAN program between june-november 2015. Conclusion: A program on overdose prevention and naloxone administration intended for, and administered by peers, was implemented in Montreal. A total of 118 participants completed the training, and there is a waiting list for upcoming sessions in 2016. Due its popularity, a shortened version of the program has also been developed. Learning Objectives: 1. The participants will be able the identify the elements of success, as well as the aspects which are less effective, for the development of overdose prevention and naloxone administration training by peers. To understand the benefits of involving peers in programs as trainers for other service user Personality traits and methadone dose and compliance independently predict concurrent substance use in clients undergoing methadone maintenance treatment for opiate addiction Author(s): Ioan T. Mahu, Sean P. Barrett, Lacey R. Peters, Heather G. Fulton, & Sherry H. Stewart Dept of Psychology & Neuroscience, Dalhousie University, PO Box 15000, 1355 Oxford Street, Halifax, Nova Scotia, Canada, B3H 4R2 Email [email protected] Objective: This study aimed to examine the relationship of personality and methadone dose/compliance to concurrent substance use in a sample of methadone maintenance therapy (MMT) clients. Methodology: Sixty-eight clients (63.2% male; mean age = 38.5 years, SD = 9.8) were recruited from a lowthreshold MMT clinic in Halifax, Canada (mean methadone dose = 105.4 mg, SD = 41.1). Substance use was assessed using an adapted version of the Drug List Questionnaire (Barrett, Gross, Garand, & Pihl, 2005). Demographic variables and methadone dose/compliance were collected via self-report. Personality dimensions were measured using the Substance Use Risk Profile Scale (Woicik, Stewart, Pihl, & Conrod, 2009). Results: Prescription opioid misuse was predicted by lower methadone compliance (B = -.606, OR= .545, 95% CI [.342-.869], p = .01), higher hopelessness (B= .259, OR= 1.30, 95% CI [1-1.67], p = .048) and anxiety sensitivity (B= 15 | P a g e .568, OR= 1.77, 95% CI [1.13-2.75], p = .012). Injection drug use (n=51) was predicted by lower methadone dose (B= -.043, OR= .96, 95% CI [.93-.98], p =.003), higher impulsivity (B=.398, OR= 1.49, 95% CI [1.04-2.14], p = .031) and hopelessness (B=.426, OR= 1.53, 95% CI [1.04-2.25], p = .03). In contrast, neither personality nor methadone variables predicted alcohol, cannabis, cocaine or benzodiazepine use. Conclusion: In sum, methadone variables and personality independently predicted opiate use and injection drug use patterns within a clinical sample of clients at a later stage of addiction. Results caution that personality may be targeted in treatment as a supplement to MMT. References: Barrett, S. P., Gross, S. R., Garand, I., & Pihl, R. O. (2005). Patterns of simultaneous polysubstance use in Canadian rave attendees. Substance Use and Misuse, 40, 1525-1537. Woicik, P. A., Stewart, S. H., Pihl, R. O., & Conrod, P. J. (2009). The Substance Use Risk Profile Scale: A scale measuring traits linked to reinforcement-specific substance use profiles. Addictive Behaviors, 34, 1042-1055. Learning Objectives: 1. Attendees will learn about the link between personality and specific patterns of substance use generally and among methadone maintenance therapy clients in particular, with the latter suggesting that personality is also important at a later stage of addiction. 2. Attendees will also learn about the relation between methadone dose and compliance with certain forms of concurrent substance misuse during methadone maintenance therapy. 16 | P a g e S2: Gambling Disorder: A global update Dr Henrietta Bowden-Jones Email [email protected] Presentations within symposium and Author(s) Name : o Criminal activity in a large UK treatment seeking population of pathological gamblers. Dr. Henrietta BowdenJones ( National Problem gambling Clinic UK) o Proportion of revenue derived from pathological gamblers: A Canadian Study. Prof. Nady El-Guebaly ( Dept. of Psychiatry, university of Calgary, Research Director AGRI) o A High prevalence of gambling disorder and associated factors in Japan. Prof Susumu Higuchi_(National Hospital Organization Kurihama Medical and Addiction Center, Japan) o Comorbidity, family history and personality. A German study supporting the classification of pathological gambling as a behavioural addiction. Prof Karl Mann ( Mannheim University, Germany) Symposium Abstract This symposium focuses on the latest international perspectives on gambling disorder. In the first presentation a large cohort of treatment seeking problem gamblers form the National Problem Gambling Clinic in the UK is described and the severity of their forensic history is looked at in relation to severity of gambling presentation. The second presentation outlines the proportion of Canadian industry earnings which derives from pathological gambling expenditure. The third presentation outlines Japan’s significant problem gambling prevalence and looks at the associated factors that this presents with. Lastly, the German study attempts to identify clinical and demographc variables that will inform the future classification of pathological gambling as a behavioural addiction in the next edition of ICD11. Learning Objectives: 1. To bring the latest research on behavioural addictions to the symposium delegates 2 To continue in a smaller setting the roundtable discussion on the future classification of pathological gambling in ICD11. 17 | P a g e Revenue from Problem Gamblers: Clinical Implications Author(s): Nady el-Guebaly MD & Rob Williams PhD 1403 – 29 St NW, Calgary, AB T2N 2T9 Email [email protected] In the Western World, the exponential increase in gambling opportunities has not resulted in a related increase in the prevalence of problem gamblers. A major concern however remains the proportion of revenue derived from problem gamblers. Examples of the Pareto principle, the 20:80 rule in the business world, as it applies to the gambling world, as well as ingredients of the relative proportion of income derived from problem gamblers will be reviewed, such as the type of gambling, the specific jurisdiction and the time period. The relevance of this economic variable in clinical features includes the impact on stigma towards problem gamblers among the general population. It also affects the occurrence of mental health distress as identified in surveys of suicidality as well as relapse. Low risk gambling guidelines also address the proportion of income wagered. Financial management is a component of the recovery process for the gambler and family, and Gamblers Anonymous addresses it in their 12 steps. Learning Objectives: 1. Relevance of the economic dimension in problem gambling 2. Clinical implications on the course and management High prevalence of gambling disorder and its associated factors in Japan Author(s): Susumu Higuchi, Yoneatsu Osaki, Tomomi Tohyama National Hospital Organization Kurihama Medical and Addiction Center, 5-3-1 Nobi, Yokosuka, Kanagawa, 2390841, Japan Email: [email protected] Objective: According to a recent meta-analysis, the lifetime prevalence of gambling disorder (GD) among adults is 1.6%. Although the Japanese prevalence of GD was assumed to be high because of a unique cultural relationship to gambling, there has been scant investigation into its prevalence among subjects representative of the adult population in the country. 18 | P a g e Methods: We conducted two national surveys in 2008 and 2013. The number of subjects was 7,500 and 7,059, respectively, aged 20 years or more. Subjects were selected using a two-step random sampling protocol. In addition to questions relating to alcohol, tobacco, and Internet use and use disorders, the South Oaks Gambling Screen (SOGS) was included in the surveys. The cut-off score for GD was five points or more. Results: The prevalence of GD was 9.6% for men and 1.6% for women in 2008, which was far higher than that observed in other countries. A similar prevalence was found in the 2013 survey. No significant relationships between the rate of GD and education, marital status, occupation, or income level were seen. The vast majority of male pathological gamblers used pachinko as a gambling tool. Conclusions: The prevalence of GD was estimated to be high and was stable in Japan. Pachinko, a type of gambling, has a suggested association with this heightened prevalence. Learning Objectives: 1. To learn the magnitude of gambling problems in Japan and in other countries 2. To understand factors associated with gambling disorder Comorbidity, family history and personality traits in treatment seeking pathological gamblers compared with healthy controls Author(s): K. Mann, T. Leménager, F. Kiefer, M. Fauth-Bühler Central Institute of Mental Health, University of Heidelberg, Square J5, 68159 Mannheim/Germany Email: [email protected] K. Manna, T. Lemenagera, F. Kiefera, M. Fauth-Bühlera* Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim / Heidelberg University, Mannheim, Germany a Objective: Prevalence estimates of pathological gambling (PG) in Germany range from 0.2% to 0.6% (Brosowski et al., 2015). The reclassification of PG as an addictive disorder in DSM-5 is under debate within the ICD eleventh revision. Attendees of the presentation will learn about the potential of data on family history of psychiatric disorders, psychiatric comorbidity and personality variables and to what extent they can provide scientific evidence for a wellinformed decision. Methods: In the “Baden-Württemberg-Study of PG” we compared a large group of 515 male pathological gamblers from inpatient treatment units with 269 matched controls regarding differences in sociodemographic characteristics, gambling-related variables, psychiatric comorbidity, family history of psychiatric conditions and personality traits including impulsivity, sensation seeking and the big five (Mann et al., in press). Personality traits were validated in an 19 | P a g e age and ethnicity-matched subsample of “pure” gamblers without psychiatric comorbidity (exception: nicotine dependence). Data were analysed using two-sample t-tests, Chi2 analyses, Fisher’s exact test and Pearson correlation analysis as appropriate. Results: Notably, 88% of the gamblers had a comorbid diagnosis of substance dependence. We found the highest axis I comorbidity rates for nicotine dependence (80%), followed by alcohol dependence (28%). Only 1% of the gamblers had an impulse control disorder diagnosis. Compared with controls first degree relatives of gamblers were more likely to suffer from alcohol dependence (27.0% vs. 7.4%), PG (8.3% vs. 0.7%) and suicide attempts (2.7% vs. 0.4%). Significant group differences were observed in all five factors of the NEO-FFI. In addition, gamblers were more impulsive but did not differ in their sensation seeking. Conclusions: In addition to recent papers on the neurobiology (Fauth-Bühler et al., in press) and genetics of gambling (Lang et al, in press), our findings support the classification of PG as behavioural addiction in the ICD-11. Learning Objectives: 1) Learn more about the impact of comorbidity on behavioural addictions 2) Gain a better understanding of personality characteristics of pathological gamblers 20 | P a g e S3: Continuity of Care for Adolescent SUD & Co-Occurring Disorders: An Update Yifrah Kaminer, MD Email: [email protected] This symposium will address clinical research and experience in providing Continuity of Care (COC) for youth with substance Use Disorders (SUD) and co-occurring psychiatric disorders. The rational, design, mechanisms of behavior change, implementation, monitoring and outcomes of treatment and aftercare would be reviewed. Finally, proposed adaptive treatment strategies addressing poor response to treatment would be illuminated including potential future clinical research. Kaminer Y, Godley M (2010) From assessment reactivity to aftercare for adolescent substance abuse. Child and Adolescent Psychiatric Clinics of North America. 19(3):577-590. Kaminer Y. (2015) Youth Substance Abuse and Co-occurring Disorders. American Psychiatric Publishing Inc. Psychiatric Association. Learning Objectives: 1. The audience will be able to understand how to implement the COC model for dually diagnosed youth 2. The participants will be able to plan COC for youth within systems of care agencies Continuity of Care (COC) for adolescents with co-occurring psychiatric disorders Author(s): Robert Milin MD Royal Ottawa Mental Health Centre, 1145 Carling Ave, Ottawa, ON. Canada, K1Z 7K4 Email: [email protected] The transitional and formative period of adolescence presents itself as an especially critical and vulnerable time for the onset of substance use disorder (SUD) with its impact on normal development, future SUD, and other mental disorders and thereby for society as a whole. Adolescence is a period of major risk for the onset of SUD. Treatment approaches must be tailored to developmental patterns of substance use and include comprehensive assessment and a continuity of care. High rates of comorbid mental disorders among adolescents with SUD further emphasize the need for psychiatric care. An integrated and systematic approach to treatment for youth with SUD and comorbid mental disorders is paramount to effective intervention. Reference: 21 | P a g e 1) Milin R & Walker S (2015) Adolescent Substance Abuse. In N. el-Guebaly, G. Carrà & M. Galanter (Eds), Textbook of Addiction Treatment: International Perspectives, Volume 4, pp.2219-2247. Milan, Italy: Springer. 2) Courtney D, Milin R. Pharmacotherapy for Adolescents with Substance Use Disorders. Current Treatment Options in Psychiatry, 2(3), 312-325, 2015, DOI: 10.1007/s40501-015-0053-6. Learning Objectives: 1. To describe the common concurrent disorders of adolescent SUD. 2. To appraise and apply effective treatment for SUD and concurrent disorders. Systems of care for adolescent SUD with co-occurring psychiatric disorders Author(s): Marc Fishman MD 3800 Frederick Ave, Baltimore MD 21229 Email [email protected] This presentation will examine challenges and opportunities presented by current delivery systems for youth with SUD and co-occurring psychiatric disorders. Central issues include limitations to current knowledge regarding diagnostic conundrums and treatment outcomes, limitations to dissemination and application of the current knowledge that already exists,, workforce development, training and competence, coordination and integration of care. The American Society of Addiction Medicine’s Adolescent Patient Placement Criteria (ASAM Criteria) will also be used as an illustrative framework, through its delineation of the idealized, aspirational continuum of care for youth services, its approach to matching treatment services to patient needs based on multi-dimensional assessment, and its decision rules for placing patients in best-fit treatment services settings based on clinical appropriateness and practical accessibility. The presentation will conclude with a summary of gaps in the current treatment system, a call to action for addressing priorities regarding some of the most critical challenges facing youth treatment, and most importantly, a roadmap for future progress. Learning Objectives: 1. Participants will identify barriers and facilitators to implementation of effective care delivery systems for youth with SUD and co-occurring disorders 2. Participants will recognize the ASAM Criteria as a standard for assessment and treatment matching for youth with SUD and co-occurring disorders Initiation of Addiction Treatment and Access to Services: Young Adults’ Accounts of their Help-Seeking Experiences Author(s): Vincent Wagner, Karine Bertrand, Jorge Flores-Aranda, Didier Acier, Natacha Brunelle, Michel Landry, and Serge Brochu Laboratoire de Psychologie des Pays de la Loire, Faculté de Psychologie, Université de Nantes, Chemin de la Censive-du-Tertre, BP 81227, 44312 Nantes Cedex 3, France Email: [email protected] 22 | P a g e Substance addiction in young adults is particularly problematic. Yet, much remain at stake in understanding the specifics of this population’s access to services. The objective of this study is to explore young adults’ perspectives of their initiation of substance abuse treatment. Our study sample was composed of 35 individuals aged 18 to 30 with problematic psychoactive substance use who have been identified in criminal courts, hospital emergency departments and Health and Social Services Centers in Quebec (Canada). A thematic analysis was performed on the 62 semi-structured interviews conducted with participants. Three components emerged from the analysis. First, personal elements— expectations, individual motivations, perceptions of use and capacity to control it—influence initiation of substance abuse treatment. Second, family and peers have noticeable influences. Finally, system characteristics and prior care experiences also shape the process. Young substance users’ initiation of substance abuse treatment lies at the intersection of personal, social and institutional trajectories. Consideration should be given to tailor interventions that can reach young adults and encourage them to initiate appropriate care. Learning Objectives: 1. Specific needs and difficulties of young adults during initiation of addiction treatment. 2. Roles of personal, environmental and institutional factors on access to substance abuse treatment. Anabolic-androgenic steroid and polysubstance use among inmates in Norwegian prisons Ingrid Amalia Havnes, Lund IO, Rognli EB, Stavseth MR, Lobmaier P, Skurtveit S, Clausen T, Kunøe N, Bukten A Email: [email protected] Background: Prison inmates constitute a group with overrepresentation of lifetime substance use and mental health problems. Objective: The study aims at exploring use of anabolic androgenic steroids (AAS) and other substances among prisoners in Norway in a lifetime perspective. Methods: This study is part of a national survey on mental health and addiction in Norwegian prisons. Prisoners from 57 of 63 prison units participated and reported previous and present use of AAS, cannabis, synthetic cannabinoids, heroin, met/amphetamines, cocaine, ecstasy, hallucinogens, GHB, inhalants, non-prescribed medications (OMT-medications, other opioids, benzodiazepines, hypnotics, stimulants) and other substances. Results: Of 1499 participating prisoners (males 93.1%), 350 (23.3%) reported AAS use, 623 (41.6%) reported use of other illicit substances and 526 (35%) reported no substance use in a lifetime perspective. Among the AAS users, 18/350 (5.1%) had used 1-4 substances, 79 (22.6%) had used 5-9 substances and 253 (72.3%) reported lifetime use of 10-16 substances. In the substance use group, 268/623 (43%) had used 1-4 substances, 167 (26.8%) had used 59 substances and 188 (30.2%) reported lifetime use of 10-15 substances. Conclusion: Life time AAS use is more common among male inmates than in the general population. Those reporting lifetime AAS use seem to have a more serious history of substance use than substance users who had never used AAS. Screening for previous and present use of substances including AAS among inmates is needed to tailor treatment approaches accordingly. Learning Objectives: 1) identify physiological and psychological side effects of non-medical use of anabolic-androgenic steroids, and 2) describe lifetime prevalence of anabolic-androgenic steroid and other substance use in a prison population. 23 | P a g e S4: Forensic Aspects of Addiction Medicine Laurence M. Westreich, MD Email [email protected] Presentations within symposium and Author(s) Name : Criminal Justice reform for the Addicted Person – Greg Bunt, M.D. Addiction Treatment in the Canadian Penal System – Leo Lanoie, M.D. Occupational Drug Testing – Laurence M. Westreich, M.D. People who suffer from Substance Use Disorders (SUDS) come into contact with the law early and quite often, and this symposium will present some very common practice issues for addiction medicine specialists who work in the forensic sphere. Reform of the criminal justice system for those with SUDS is enormously important, because of the increasing number of highly sophisticated treatment programs within drug courts, jails and prisons, as well as the ongoing societal forces which have – in effect – transferred addicted and dually-diagnosed individuals from the medical system to the criminal justice system. As an example, the Canadian Penal System has a variety of innovative addiction treatment programs, including Opioid Substitution Therapy1. Careful monitoring has revealed that former prisoners are at increased risk of premature death from accidental overdose, and require harm reduction messages. On the civil side, drug and alcohol testing done in the workplace2 is best approached with a broad knowledge of the various laws and regulations and the relevant case law. Given the impact of a positive drug or alcohol test on the testee’s employment opportunities, workplace drug testing programs must be scientifically sound, legally appropriate, and transparent to all involved. This symposium will delve into all of these fascinating interactions between law and addiction. 1. Lanoie, LO: Opioid substitution therapy in Canada’s prisons. The Canadian Journal of Addiction/Le Journal Canadien d’Addiction. Volume 6, No.3. December, 2015 2.Marques PH, Jesus V, Oleas SA, et. Al: The effect of alcohol and drug testing at the workplace on individual’s occupational accident risk. Safety Science, Volume 68, October 2014, Pages 108–120 Learning Objectives: 1. Participants will identify the most pressing issues for reform of the treatment of addicted people within the criminal justice system. 2. Participants will understand the specific addiction treatment modalities available in the Canadian Penal System 3. Participants will learn skills for treating and managing occupational drug/alcohol testing. Criminal Justice Reform for Addictions Author(s): Gregory Bunt, MD 611 Palmer Road 6X, Yonkers NY 10701 USA Email: [email protected] CJS Reform for addictions is of the utmost priority to global public policy. Many issues regarding CJS Reform were addressed presented and discussed at the UN Special Session of the General Assembly 2016. 24 | P a g e CJS issues of importance and some controversy are: Legalization v Decriminalization Harm Reduction Treatment Alternatives Incarceration Access to integrated evidence-based effective treatment for Addictions Co-occurring Psychiatric and Medical Disorders These issues will be outlined with a discussion of various viewpoints and global perspectives. Learning Objectives: 1. Review of CJS Reform for global public policy 2. Review Treatment alternatives to incarceration An overview of addiction care in Canadian prisons Autho(s) Name: Leo Omer Lanoie 1083 River Street E., Prince Albert, SK SGV 7N6 Email l.lanoie@sasktel,net The vast majority of inmates in Canadian prisons will be released and will become contributing members of society. The system is called "conections" because its purpose is to achieve that goal. There are three levels of incarceration in the Canadian penal system, dependent on the length of sentence. Service available vary from local to provincial to federal systems. This presentation attempts to provide an overview of addiction care available at each level. Learning Objectives: 1. To provide an overview of the Canadian Penal System and its levels 2. To provide an overview of the addiction care in each of the three levels of incarceration Anabolic-androgenic steroid and polysubstance use among inmates in Norwegian prisons Author(s) Name : Ingrid Amalia Havnes, MD, PhD, Lund IO, Rognli EB, Stavseth MR, Lobmaier P, Skurtveit S, Clausen T, Kunøe N and Bukten A. Norwegian National Advisory Unit for Substance use disorder Treatment, Oslo University hospital, P.O. 4959 Nydalen, 0424 Oslo, Norway Email [email protected] Background: Prison inmates constitute a group with overrepresentation of lifetime substance use and mental health problems. 25 | P a g e Objective: The study aims at exploring use of anabolic androgenic steroids (AAS) and other substances among prisoners in Norway in a lifetime perspective. Methods: This study is part of a national survey on mental health and addiction in Norwegian prisons. Prisoners from 57 of 63 prison units participated and reported previous and present use of AAS, cannabis, synthetic cannabinoids, heroin, met/amphetamines, cocaine, ecstasy, hallucinogens, GHB, inhalants, non-prescribed medications (OMT-medications, other opioids, benzodiazepines, hypnotics, stimulants) and other substances. Results: Of 1499 participating prisoners (males 93.1%), 350 (23.3%) reported AAS use, 623 (41.6%) reported use of other illicit substances and 526 (35%) reported no substance use in a lifetime perspective. Among the AAS users, 18/350 (5.1%) had used 1-4 substances, 79 (22.6%) had used 5-9 substances and 253 (72.3%) reported lifetime use of 10-16 substances. In the substance use group, 268/623 (43%) had used 1-4 substances, 167 (26.8%) had used 59 substances and 188 (30.2%) reported lifetime use of 10-15 substances. Conclusion: Life time AAS use is more common among male inmates than in the general population. Those reporting lifetime AAS use seem to have a more serious history of substance use than substance users who had never used AAS. Screening for previous and present use of substances including AAS among inmates is needed to tailor treatment approaches accordingly. Learning Objectives: At the end of this presentation, participants will be able to: 1) identify physiological and psychological side effects of non-medical use of anabolic-androgenic steroids, and 2) describe lifetime prevalence of anabolic-androgenic steroid and other substance use in a prison population. Occupational Drug Testing Author(s) Name: Laurence M. Westreich, M.D. 127 West 79th Street# iN, NY NY 10024 Email [email protected] Occupational drug testing (ODT) can be of enormous importance in the clinical, employment related, or forensic spheres, and the technology involved can be the crux of court cases, employment grievances, and custody hearings. So, ODT must be scientifically sound, legally appropriate, and transparent to all involved. This presentation contains a wide range of material on the subject of occupational drug testing, designed to present the outlines of competent practice, as well as stimulate audience questions and discussion. The legal ramifications of ODT affect all involved, in the U.S. most prominently via the Americans with Disabilities Act, which provides limited 26 | P a g e legal protection for those who are dependent on drugs or alcohol'. Therapeutic Use Exemptions (TUEs) for employees, who have legitimate medical reasons for ingesting a substance banned by their employer, will be reviewed. Medical Review Officers (MROs), who are physicians trained and certified in ODT, can develop coherent, focused ODT programs which withstand scrutiny in courtrooms or occupational hearings. These programs include specimen collection, laboratory analysis, MRO review, and recommendations about employer action and subsequent treatment. The underlying philosophical basis for occupational drug and alcohol testing will be depicted, along with data on the prevalence of this testing worldwide. The practical arrangements necessary for successful testing will be discussed, along with data on employee attitudes, effects on drug use 2, and workplace safety. The presentation will conclude with some discussion of the future of ODT programs. References: 1. Westreich LM: Addiction and the Americans with Disabilities Act. J Am Acad Psychiatry Law 30:355-63, 2002, pages 353- 363 2. French MT. Roebuck C, Alexandre PK: To test or not to test: do workplace drug testing programs discourage employee drug use? Social Science Research Volume 33, Issue 1, March 2004, Pages 45-63 Learning Objectives: 1. Understand the basics of a scientifically sound, legally appropriate, and transparent occupational drug testing program. 2. Distinguish between pre-employment testing, reasonable cause testing, random testing, post-accident testing, periodic testing, and rehabilitation testing. 27 | P a g e S5: International Policies: Public health approach as a basis for addiction policy, the Swiss model Author :Riaz Khan Department of Mental Health and Psychiatry HUG 20 bis rue de Lausanne 1201 Geneva Switzerland Email [email protected] Introduction: Current addiction policy in most European countries including Switzerland consists primarily of a range of separate policies on alcohol, tobacco and illegal psychoactive substances. There is little or no coordination between these policy sectors. Aims: The Swiss report on the Challenge of Addiction is a contribution towards an integrated understanding of addiction policy based on the foundation of a public health approach. From a health policy perspective, the approach aims to broaden the scope of addiction policy in Switzerland, the strategic focus and path to deliver healthcare. It recommends ten principles which are intended to contribute to a coherent policy response to the problematic consumption of all psychoactive substances and to behaviours with addictive potential. Conclusion: The presentation will highlight the salient features of the ten guiding principles of the proposed policy approach with the intention that the principles of the policy framework become the subject of an ongoing debate in the domain Learning Objectives: 1. Understanding the rationale based on an integrated public health policy 2 Understanding the role and processes involved in evidence based health policy frameworks People with a history of injecting drugs in Europe: comparative assessment of addiction and HCV treatment Author(s) Name :Reimer, J (1), Somaini, L.(2), Wright, N. (3), Roncero, C. (4), Maremmani, I.(5), Simon, N. (6), Krajci, P. (7), Littlewood, R.(8), D’Agnone, O. (9), Rolland, B. (10), Alho, H.(11). J REIMER, Direktor des ZIS, Zentrum für Interdisziplinäre Suchtforschung der Universität Hamburg, Martinistrasse 52, 20246 Hamburg GERMANY Email: [email protected] People who inject drugs are often marginalized, face inequality and may be underserved for healthcare. They have a high prevalence of chronic hepatitis C infection (HCV). Lower healthcare access and serious potential morbidity/ mortality associated with HCV define “addiction-HCV” as a major public health problem. This work aimed to review population sizes for people with HCV and a history of injecting drugs in European countries. Method: A European faculty of addiction-specialists with direct HCV management experience reviewed evidence of population size, OST treatment access and HCV prevalence, HCV management readiness based on personal real world experience 28 | P a g e Results: Data from major European countries were assessed. In these countries 2-3M people have ever injected drugs, up to 1.5M are currently (within 12 months) involved in injecting drugs and 0.75M people are engaged in opioid substitution treatment programs. 30-60% of people currently involved in opioid injecting are engaged with substitution therapy programs. HCV prevalence ranges 45-85%. Access to HCV treatment for these populations was variable according to expert experience. Addiction care guidelines do not include clear guidance on HCV management in most cases. Conclusion: HCV is prevalent in people with history of injecting; many with a history of drug injecting engage with OST: an important starting point for HCV treatment planning. Access to HCV treatment is limited in many countries in practice; it is essential to develop policy and practice to address HCV treatment in this population. Learning Objectives: 1.To review the evidence describing population sizes, treatment for addiction/ OST in European countries 2 To define the prevalence of HCV in people with a history of injecting drugs Guiding principles on framework and support measures for opioid dependence treatment including the prescription of agonist medicines Author(s) Name : Olivier Simon, Valérie Junod, Robert Haemmig, René Stamm 7, rue saint-martin, CH-1003 Lausanne, Switzerland Email [email protected] In most countries, the prescription of agonist medication for the treatment of opioid dependence (AM/ODT) is subject to restrictions which significantly impede access to care. Linked with the international system of psycho-active substances, these special regimes are based on the traditional understanding of this process as the “replacement of an illegal drug by a legal one”. Actually, through their specific pharmacological effects, these opioid agonist medicines stabilise the emotional state, reduce or eliminate the subjective reinforcing effects responsible for dependence and protect against overdose risks, in a wider, integrated medical and psychosocial treatment. As AM/ODT reduce comorbidities, particularly those related to intravenous heroin use (HIV, HCV), they are also a key component of the public health approach to risk and harm reduction. To meet their obligations relating to healthcare and the prevention of discrimination, the States are therefore asked to review their regulations on the use of AM/ODT. The Council of Europe (Pompidou Group) mandated a group of health and legal experts to identify and detail criteria for the appropriate regulation of AM/ODT in line with ethical standards, international law, scientific knowledge and medical best practice. A Delphi technique was used to test the degree of consensus on some forty proposals. We present a working document entitled “guiding principles” including following keypoints: terminology, medical act, protection of personal data, primacy of the right of access to care, non-discrimination and equivalence of care, affordability, basic training of doctors and pharmacists, supervision of professionals, role of health authorities, international cooperation and monitoring. Learning Objectives: 1. To know the main variants of the legislative and regulatory framework measures for existing opioid agonist treatments. 29 | P a g e 2. To be able to identify, within the country, the applicable standards for exercising addiction medicine. Specifically, to locate the support and framework measures under modernisation, that relate to opioid dependency treatment. Special Session of the UN General Assembly on the World Drug Problem April 19-21 Author(s) Name : Norman Wetterau MD DFASAM 6 Clinton St, Dansville, N. Y. 14437 Email [email protected] WHO address the world’s drug problems. Because of increasing worldwide drug problems a special session of the general assembly was called. A resolution was passed which addresses prevention. treatment as well as illegal drug trade and other issues. The document focused on a public health model. During the three days various sessions were held where nations shared what they were doing about both supply and demand and how they planned to support the goals of the document Unfortunately there was little input from organized medicine outside of the UN agencies. ASAM was not aware of this event until a few month ago and only one delegate was able to go and represent both ASAM and ISAM. As the UN tries to help nations address drug problems using a public health model, we need to be involved. This session will review the treaties, and the new document. The session will review the UN and US government efforts , along with ISSUP in developing training materials and international guidelines for prevention and treatment. At this session these efforts will be introduced and references to the material given In 2019 the UN General Assembly will followup on this session There will be opportunities for input from ISAM and from our members who belong to national affiliates of ISAM. At the end of this session we hope several of our members will agree to become involved. Learning Objectives: 1. To learn what was the outcome of the UN Special Session of the World Drug Problem held in April 2016 2 To consider some ways that ISAM and ISAM members can support the goals of UNGASS and help in preparation for the UNGASS follow-up in 2019 30 | P a g e S6: Capacity Building on Addiction Treatment in India: Models and approaches Atul Ambekar Email [email protected] Title of individual talk 1. Incorporating addiction treatment training in medical curriculum 2. Specialized training programmes for health professionals 3. Online training: An innovative training method Presenter Sudhir K Khandelwal Anju Dhawan Atul Ambekar 4. Beyond classroom training: Mentoring and hand-holding 5. Evaluation of Quality Assurance and performance of OST dashboard index Ravindra Rao Alok Agrawal centres – a The shortage of medical doctors in India is felt most acutely in all the areas of mental health, and specifically in Addiction Treatment. We describe the variety of training models on addiction treatment in India, which exists in varying forms. As a part of graduate medical curriculum, addiction issues are encompassed in the psychiatry training, which is currently limited in scope. MD (Psychiatry) curriculum however, features addiction prominently, with most institutes providing three to six months (out of total 36 month) of residency programme exclusively in addiction settings. Recently, three institutes have initiated the super specialty DM Addiction Psychiatry course with 36 month residency programme. Recognising the shortage of specialists and the need to provide addiction treatment services through general physicians, Short-term, on-the-job training courses have been implemented. Some courses are aimed at providing training in all areas of addiction treatment (a 2-week course), while others are focused specifically on diverse areas Opioid Substitution Treatment (a 5-day course) or alcoholism (a 3-day course). Harnessing the potential of information-technology revolution in India, online training programmes have been developed on OST. Webinars and virtual-classrooms have also been initiated as tools for continuous professional development. Systems have been developed which combine monitoring and evaluation visits with that of technical-guidance and hand-holding. Such onsite mentoring of service providers is valuable for those who receive short-term training and need additional guidance. Through these approaches an attempt is being made to address the human-resource gap in the area of addiction treatment. These small scale models need to be massively scaled-up. Learning Objectives: 1. Understanding the variety of approaches and models which exist in a developing country (India) for providing training on addiction treatment 2. To appreciate the challenges in implementing these strategies and addressing the human-resource gap 31 | P a g e Evaluation of Quality Assurance and performance of OST centres: A dashboard index Author(s) Name : Alok Agrawal, Sudhir K. Khandelwal. Anju Dhawan, Atul Ambekar, Ravindra Rao, National Drug Dependence Treatment Centre, Dept. of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi – 110029, India Email [email protected] The shortage of medical doctors in India is felt most acutely in all the areas of mental health, and specifically in Addiction treatment. We describe the variety of models of training and quality assurance on addiction treatment in India in this symposium. Specifically in the case of Opioid Substitution Therapy (OST), besides training and mentoring, to assess and compare the functioning of centres, a composite index of 10 key indicators has been developed which serves as a dashboard and helps track the performance and quality of services with minimal investment of time and resources. Through these approaches, an attempt is being made to address the human-resource gap in the area of addiction treatment. These small scale models need to be massively scaled-up. Learning Objectives: 1. Understanding the variety of approaches and models which exist in a developing country (India) for capacity building on addiction treatment 2. To appreciate the challenges in implementing these strategies and addressing the human-resource gap Beyond classroom training: Mentoring and hand-holding Author(s) Name : Ravindra Rao, Sudhir K. Khandelwal. Anju Dhawan, Atul Ambekar, Alok Agrawal National Drug Dependence Treatment Centre, Dept. of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi – 110029, India Email [email protected] The shortage of medical doctors in India is felt most acutely in all the areas of mental health, and specifically in Addiction Treatment. We describe the variety of models of training and quality assurance on addiction treatment in India. Besides classroom-type training programmes, Quality Assurance systems have been developed which combine monitoring and evaluation visits with that of technical-guidance and hand-holding. Such onsite mentoring of service providers is valuable for those who receive short-term training and need additional guidance. Through these approaches an attempt is being made to address the human-resource gap in the area of addiction treatment. These small scale models need to be massively scaled-up. Learning Objectives: 1. Understanding the variety of approaches and models which exist in a developing country (India) for capacity building on addiction treatment 2. To appreciate the challenges in implementing these strategies and addressing the human-resource gap 32 | P a g e Incorporating addiction treatment training in medical curriculum Author(s) Name : Sudhir K. Khandelwal. Anju Dhawan, Atul Ambekar, Ravindra Rao, Alok Agrawal National Drug Dependence Treatment Centre, Dept. of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi – 110029, India Email: [email protected] The shortage of medical doctors in India is felt most acutely in all the areas of mental health, and specifically in Addiction Treatment. We describe the variety of models of training and quality assurance on addiction treatment in India. As a part of graduate medical curriculum, addiction issues are encompassed in the psychiatry training, which is currently limited in scope. MD (Psychiatry) curriculum however, features addiction prominently, with most institutes providing three to six months (out of total 36 month) of residency programme exclusively in addiction settings. Recently, three institutes have initiated the super specialty DM Addiction Psychiatry course with 36 month residency programme. Through these approaches an attempt is being made to address the human-resource gap in the area of addiction treatment. These small scale models need to be massively scaled-up. Learning Objectives: 1. Understanding the variety of approaches and models which exist in a developing country (India) for capacity building on addiction treatment 2. To appreciate the challenges in implementing these strategies and addressing the human-resource gap Specialized training programmes for health professionals Author(s) Name : Anju Dhawan, Sudhir K. Khandelwal. Atul Ambekar, Ravindra Rao, Alok Agrawal National Drug Dependence Treatment Centre, Dept. of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi – 110029, India Email [email protected] The shortage of medical doctors in India is felt most acutely in all the areas of mental health, and specifically in Addiction Treatment. We describe the variety of models of training and quality assurance on addiction treatment in India. Recognising the shortage of specialists and the need to provide addiction treatment services through general physicians, Short-term, on-the-job training courses have been implemented. Some courses are aimed at providing training in all areas of addiction treatment (a 2-week course), while others are focused specifically on diverse areas such as alcohol use disorders (a 3-day course). Through these approaches an attempt is being made to address the human-resource gap in the area of addiction treatment. These small scale models need to be massively scaled-up. Learning Objectives: 1. Understanding the variety of approaches and models which exist in a developing country (India) for capacity building on addiction treatment 33 | P a g e 2. To appreciate the challenges in implementing these strategies and addressing the human-resource gap Innovative training methods for Opioid Substitution Therapy Author(s) Name : Atul Ambekar, Sudhir K. Khandelwal. Anju Dhawan, Ravindra Rao, Alok Agrawal National Drug Dependence Treatment Centre, Dept. of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi – 110029, India Email [email protected] The shortage of medical doctors in India is felt most acutely in all the areas of mental health, and specifically in Addiction Treatment. We describe the variety of models of training and quality assurance on addiction treatment in India. A fairly elaborate system of capacity building has been developed on Opioid Substitution Treatment. This includes classroom training (a 5-day induction and a 3-day refresher course). In addition, harnessing the potential of information-technology revolution in India, online training programmes have been developed on OST. Webinars and virtual-classrooms have also been initiated as tools for continuous professional development. Through these approaches an attempt is being made to address the human-resource gap in the area of addiction treatment. These small scale models need to be massively scaled-up. Learning Objectives: 1. Understanding the variety of approaches and models which exist in a developing country (India) for capacity building on addiction treatment 2. To appreciate the challenges in implementing these strategies and addressing the human-resource gap 34 | P a g e S7: Intervention for addiction and associated health risks: how to reach “hidden” populations Karine Bertrand Longueuil QC [email protected] Addiction services providers face many challenges in their efforts to reach “hidden” populations who may need help to reduce their substance-related problems and associated health risks. Multiple minority status may accentuate stigmatization and contribute to the various barriers in access to health care. People who inject drugs (PWID) and men who have sex with men (MSM) who misuse drugs constitute “hidden” populations, these people being reluctant to seek help in formal services, despite significant health needs and suffering. The first two conferences included in this symposium aims to understand specific health needs of two “hidden” populations who misuse drugs, based on qualitative analysis of individual interviews with PWID and MSM. Specifically, taking into account the point of view of cocaine users about their drug injection risk practices and related mental health issues, in relation to their health needs and services utilization, can contribute to improve services better adjusted to their street life experiences. Also, understanding addiction services trajectories of MSM, from their own perspective, highlights issues and challenges for the implementation of comprehensive services for them. The last two presentations will illustrate innovative practices to reach PWID and MSM who misuse drugs, in order to contribute to a more effective health response to their needs. EMPIR project evaluate motivational interviewing to reduce drug injection risk among drug users using irregularly community services. The participatory project Mon Buzz implicates MSM drug users, clinicians and community stakeholders to develop strategies to increase access to addiction services in this “hidden” population. Learning Objectives: 1. To understand specific health needs of two “hidden” populations: People who inject drugs and men who have sex with men who misuse drugs 2. To learn about two innovative intervention for addiction and associated health risks for people who inject drugs and men who have sex with men who misuse drugs Mental health and injection risk behaviors: cocaine users’ perspectives about their health needs. COSMO Study. Karine Bertrand Email [email protected] Background and Objectives. Mental health problems are common among cocaine users and seem to be associated with HIV and hepatitis C high risk injection behaviors. However, little is known about how mental health problems are interrelated with these risk behaviors. This study was undertaken to 1) gain a better understanding of cocaine users’ experience of sharing injection material and how it’s related to their mental health problems; and 2) examine cocaine users’ perspectives about their health needs. Methods. The sample of this qualitative study, based on symbolic interactionism, was drawn from COSMO prospective cohort study. Semi-structured interviews were conducted with 32 participant (22 men) who reported cocaine use during the preceding year. Results. Based upon the participants’ experience analysis, complex interrelations are documented between mental health problems and substance-related risk behaviors. A reciprocal relationship seems to be emerging where mental health problems, mainly anxiety symptoms, appears to trigger or aggravate risk behaviors and in turn risk behaviors cause anxiety. In some cases, this anxiety acts as a trigger that brings the person to increase efforts to avoid risk behaviors. Crisis episode and moments of anxiety following risk taking constitute contexts that facilitate helpseeking. Help-seeking is also facilitated by the availability of a significant relationship with a helper, consolidated over time, 35 | P a g e typically in the context of community outreach services. Still, most of the times, participants use diverse strategies, without formal service, to diminish their health risks behaviors and to enhance their wellbeing. Conclusion. Effective HIV and hepatitis C prevention programs should integrate components to take into account mental health needs. Learning Objectives: 1. To understand how mental health problems and drug injection risk behaviors are interrelated 2. To understand specific health needs of people who inject drugs Experiences of drug abuse among men who have sex with men: issues and challenges for the implementation of comprehensive services Jorge Flores-Aranda Email [email protected] Gay and bisexual men present more substance use problems compared with their heterosexual peers. However, they delay seeking addiction services, and when they do, the services do not always meet their needs. The objective of this presentation is to describe issues and challenges regarding the implementation of addiction services which take into account gay men needs. A qualitative study based on symbolic interactionism was carried out. Semistructured interviews were conducted with 35 gay/bisexual men aged 18 years and over who had substance use problems, were born in Canada and lived in Greater Montreal. A thematic analysis was performed. The majority of participants had already used addiction services, but almost half of them had been referred to such a service. For some, their problematic substance use had not been detected at the right time. The factors triggering a request for help with addiction services were sometimes associated with the gay life-course experience and the substance use trajectories. Indeed, an increase in substance use and introspection leading to a request for help thus occurred when participants were having difficulties accepting their sexual orientation, during sexual experimentation or when they were diagnosed with HIV. According to some participants, sexuality is not sufficiently addressed in addiction services. Offering comprehensive services, including substance use and sexuality represents a challenge for caregivers. Learning Objectives: 1. To understand the perception of gay and bisexual men who have a problematic substance use in regards of their needs in terms of addiction services 2. To discuss about the issues and challenges of offer comprehensive services, including substance use and sexuality, in addiction services. Motivational interviewing to reduce drug injection risks : lessons learned from a mixed -methods study Élise Roy Email [email protected] Objectives: To test the efficacy of a brief intervention based on motivational interviewing (MI) to reduce injection risk behaviours (IRB) among people who inject drugs (PWID) and to explore the mechanisms and effects of the intervention from PWID’s perspective. Methodology : An embedded experimental design was used combining 1) a two-group parallel randomized controlled trial that compared MI with a brief educational intervention (EI) (n= 221) and 2) in-depth interviews with a subsample (n=29) of the RCT participants. 36 | P a g e Results: The probability of reporting an IRB decreased in both the MI and the EI groups over the 6-month study period. At 6-month follow-up, participants who reported any IRB were 50% [odds ratio (OR) = 0.50; confidence interval (CI) = 0.13–0.87] less likely to be in the MI group than in the EI group as well as those who reported sharing containers (OR=0.50; CI=0.09–0.90). Participants’ accounts showed that they liked EI and felt it was helpful. EI not only allowed them to learn safer injection techniques, it also made them take stock of their good and bad habits. Participants who received the MI had fuzzy memories of the intervention and some reported that they felt disturbed and challenged due to the introspection it forced. Conclusions: Both brief MI and EI can contribute to reducing IRB among PWID although MI was more effective in reducing some IRB. However, some differences in terms of efficacy, acceptability and effects should be taken into account when it comes to choosing an approach for intervention. Learning Objectives: 1. To learn about the feasibility of brief interventions aimed at reducing injection risk behaviours among people who inject drugs 2. To learn about the effects of educational and motivational brief interventions aimed at reducing injection risk behaviours among people who inject drugs Gathering users’ perspective, clinicians’ and community stakeholders’ experience to increase access to addiction services in men who have sex with men Mathieu Goyette et Jorge Flores-Aranda Email [email protected] Men who have sex with men (MSM) use less addiction services than other men. This is especially true for MSM who live outside urban centers or who don’t already have a connection with addiction or sexual health services. It is therefore necessary to rethink the strategies used to reach MSM to raise their awareness about risks and harms related to their substance use. In order to reach these men, “MON BUZZ” project was developed. MON BUZZ is a French speaking webbased screening and brief intervention on substance use and misuse designed by potential users, clinicians and researchers to reach MSM. The current presentation aims 1) to describe strategies developed by different stakeholders (potential users, clinicians and researchers) to reach MSM that have been used in MON BUZZ and 2) to put in relation the target population and the strategies used related to MSM reached in the current project. In a community based participatory research perspective, strategies used to reach this population (format, content and communication and diffusion strategies) are described related to the contribution of each groups of stakeholders. Then, preliminary data related to user’s profiles (severity of substance use, geographical area and current and past addiction services used) on the first weeks of MON BUZZ deployment are presented. Results are discussed related to the reaching out achievement of the target population and the Conceptual framework of access to health services (Lévesque et al., 2012). The strategies used are discussed related to their potential transposition in others addiction’s field. Learning Objectives: 1. To understand the plus-value of using different actor’ perspectives to deploy reaching out perspectives with “hidden population”. 2. To learn about the use of web-based intervention to reach “hidden population”. 37 | P a g e S8: Canadian Research Initiative in Substance Misuse: a focus on prescription opioid misuse Chair: Julie Bruneau Presentations and speakers Presentation of Vancouver Coastal Health and Providence Health Care Evidence Based “Guideline for the Clinical Management of Opioid Addiction” - Keith Ahamad MD, Eugenia Socsiias MD, and Evan Wood MD PhD Presentation of the OPTIMA trial protocol: Optimizing patient centered-care, a pragmatic randomized control trial comparing models of care in the management of prescription opioid misuse - Didier Jutras-Aswad MD and the OPTIMA team The OPTIMA trial: a unique opportunity to expand the research agenda on prescription opioid misuse - Ron Lim MD and the OPTIMA team In Canada non-medical use of prescription opioids (PO)has substantially increased over the last decade and currently constitutes the third highest burden of disease attributable to substance u with escalating overdose death rates. Thus there is an urgent need for an evidence-based response to address thi public health crisis that includes the treatment of opioid use disordr (OUD). Although methadone has long been the standard of care for treatment of OUD in Canada, there is growing consensus that the superior safety profile of buprenorphine/naloxone, as well as other comparative advantages, supports its use as a first-line therapy. The proposed workshop aims to present recent Canadian initiatives to further develop evidence-based practice and knowledge around the treatment of OUD. This workshop will include a presentation on the development of an evidence-based guideline for the management of OUD In British Columbia. We will also describe the OPTIMA trial, an open-label randomized trial that will compare the effectiveness of methadone and buprenorphine/naloxone adapted models of care in reducing opioid use among adults with prescription OUD. Potential ancillary studies and other opportunities for research on PO misuse will also be presented. ________________ Canadian Research Initiative in Substance Misuse: a focus on opiate prescription misuse Didier Jutras-Aswad [email protected] Global utilization of prescription opioid (PO) PO-related harms (e.g., hospitalization, overdose) increased substantially in Canada, and constitutes the third highest burden of disease attributable to substance use. There is an urgent need for evidence-based treatment solutions to address the prescription opioid crisis in Canada. Although methadone has long been the standard of care for treatment of opioid use disorder in Canada, there is growing consensus that the superior safety profile of buprenorphine/naloxone, as well as other comparative advantages, supports its use as a first-line therapy. The proposed workshop aims to present recent Canadian initiatives to further develop the evidence-based practice and knowledge around the treatment of PO use disorder. This workshop will include a presentation on the development of an evidence-based guideline for the management of opioid addiction in British Columbia. We will also describe the OPTIMA trial, an open-label randomized trial that will compare the effectiveness of methadone and buprenorphine/naloxone adapted models of care in reducing opioid use among adults dependent on prescription opioids. Potential ancillary studies and other opportunities for research on PO misuse will also be presented. Learning Objectives: 1. Learn about the development of new clinical guidelines for the treatment of opioid use disorder 2. Discover a current research initiative that aims at expanding knowledge on the evidence-based treatment of prescription opioid misuse 38 | P a g e Optimizing Patient Centered-care: A Pragmatic Randomized Control Trial Comparing Models of Care in the Management of Prescription Opioid Misuse: the OPTIMA Trial protocol Author(s) Name : Didier Jutras-Aswad, Ron Lim and the OPTIMA Trial team Centre Hospialier de l'Université de Montréal 900 St-Denis, room R06.444, Montreal, Qc, Canada H2x 0A9 Email: [email protected] There is an urgent need for evidence-based treatment solutions to address the prescription opioid (PO) crisis in Canada. Although methadone has long been the standard of care for treatment of opioid use disorder (OUD), the superior safety profile of buprenorphine⁄naloxone may support its use as a first-line therapy. However, previous trials that compared these two treatment options focused largely on heroin users rather than PO users, and utilized nearidentical double blind designs with rigid dispensing schedules for both treatments. As such, how these medications compare for PO use disorder in Canada, where methadone is initially provided daily via witnessed ingestion and buprenorphine/naloxone provided with more flexible take-home dosing, is not known. This open-label randomized trial will compare the effectiveness of methadone and buprenorphine/naloxone adapted models of care in reducing opioid use among adults dependent on PO. Participants will be eligible if aged 18 years or older, diagnosed with OUD and self-reporting primary abuse of PO medication. A total of 240 patients in 8 sites will be randomised. The study timeline will span 26 weeks, including an 2-week initial screening period and a 24-week follow-up phase. Alongside the urine screens, participants will also respond to interviewer-administered standardized questionnaires. The trial’s primary outcome is opioid use, to be ascertained as the proportion of negative urine screens collected during the last 20 weeks of the trial. There will also be an opportunity to add many outcomes that have the potential to generate knowledge on closely related issues to the OPTIMA trial. Learning Objectives: 1. Learn about the limitations of current knowledge on prescription opioid use disorder treatment 2. Discover a current research initiative that aims at expanding knowledge on the evidence-based treatment of prescription opioid misuse. A Guideline for the Clinical Management of Opioid Addiction Author(s) Name : Dr. Keith Ahamad BC Centre for Excellence in HIV/AIDS, 1081 Burrard Street- Vancouver, BC V6Z 1Y6 Email [email protected] Opioid use disorder (OUD) is one of the most challenging forms of addiction facing the health care system in North America. There is a growing research base describing the benefits, side-effect profiles and safety concerns surrounding the various approaches to the treatment of opioid use disorder. However, across Canada, practice has fallen behind the evidence, in part due to a lack of evidence-based clinical practice guidelines articulating the full range of therapeutic options for the optimal treatment of adults and young adults with opioid use disorder. To address this, a diverse interdisciplinary committee of health care providers and experts in the field developed guidelines for the clinical management of opioid use disorder. These guidelines review the full spectrum of treatment options including different pharmacotherapies, dosing strategies and psychosocial treatment interventions, and utilize a hierarchical grading system to identify first-line treatment approaches for opioid use disorder. Community-based peer and family and patient advocacy groups were integrally involved in the development process. This presentation will review the evidence for withdrawal management strategies, psychosocial interventions, opioid agonist treatments, alternative agents and combination approaches and movement between treatment options. With the greater incorporation of evidence-based medicine principles into the treatment of opioid use disorder through adherence to 39 | P a g e data-driven therapeutic guidelines, there is substantial potential to improve systems of treatment for opioid use disorder and significantly reduce the burden of disease and health and social service costs associated with untreated opioid addiction on a broad scale in BC and Canada. Learning Objectives: 1. Review the systematic development of an evidence-based clinical practice guideline for treatment of opioid use disorder (OUD) including different opioid agonist treatments, withdrawal management strategies, and psychosocial treatment interventions. 2. Discuss the implementation of the guideline in primary care settings throughout British Columbia. Prescription Opioid Crisis and Ancillary Studies for Optima Trials Author(s) Name: Dr. Eugenia Socias, Dr. Ronald Lim, Dr. Keith Ahamad BC Centre for Excellence in HIV/AIDS, 1081 Burrard Street- Vancouver BC V6Z 1Y6 Email: [email protected] Global utilization of prescription opioid (PO) analgesics has dramatically increased in recent years, and accidental deaths, harms and social costs associated with PO misuse and addiction has escalated, particularly in North America. The United States and Canada report the highest PO consumption rates in the world. Although the US reports higher overall levels of consumption, over the past 10 years, PO use in Canada has increased at a much faster rate, leaving Canada with the second highest opioid consumption rate among developed countries, and tripling the rate of pharmaceutical opioid use in the past decade. Despite similar rates of chronic pain across Canada, there is substantial variation in the rates and types of opioids prescribed across provinces. For example, British Columbia (BC) dispenses more than double the amount of opioids compared to Quebec, the lowest opioid dispensing province.1,2 Rates of prescription opioid related death in British Columbia have plateaued in recent years, however, the province is still experiencing annual mortality rates of close to 4 deaths per 100,000 people. Opinion leaders across Canada have declared PO misuse a growing public health crisis. As a result, the prevention and treatment of opioid use disorder (OUD) in Canada has become an urgent public health priority necessitating an evidence-based response. An interdisciplinary team of experts, representing the Canadian Research Initiative in Substance Misuse (CRISM), will present national and provincial level data on PO abuse in Canada, summarizing the current state of the epidemic and future research directions and areas for intervention. References: 1. Fischer B, Jones W, Rehm J. Trends and changes in prescription opioid analgesic dispensing in Canada 20052012: an update with a focus on recent interventions. BMC Health Serv Res 2014;14:90. 2. Smolina K, Gladstone EJ, Morgan SG. Pharmaceutical opioid monitoring and surveillance in British Columbia: Current state and future direction: University of British Columbia; 2015. Learning Objectives: 1. Describe Prescription Opioid (PO) epidemic in Canada, with a specific focus on regional differences in the burden of prescription opioid use disorders, and response to the epidemic. 2. Discuss current and emerging evidence in the area of PO use disorders research and potential areas for intervention. 40 | P a g e S9: Behavioral Addictions; An Update Name of the Coordinating Author : Dr Henrietta Bowden-Jones National problem gambling clinic, Crowther Market, 282 North end road , London SW6 1NH Email [email protected] Presentations within symposium and Author(s) Name : Joel Billieux ( Catholic university of Louvain, Belgium) Hermano Tavares _( Universidade de Sao Paolo, Brasil) Daniel Kardefelt-Winther, Karolinska Institute, Sweden Hannu Alhu ( University of Helsinki , Finland) Symposium Abstract This symposium will embrace not only the currently awaited decision on the classification of pathological gambling in ICD11 but also the ongoing evolution of the body of research on Gaming Disorder . The latest evidence-based studies on internet addiction disorder will be presented with particular reference to the authors’ work in Belgium and Switzerland. An update on recent pathological gambling research in Brasil and Finland will confirm the global approach to pathology that ISAM is renowned for. Learning Objectives: 1. To bring the latest research on behavioural addictions to the symposium delegates 2 To continue in a smaller setting the roundtable discussion on the future classification of pathological gambling and Internet addiction disorder in ICD11. Profiling the Forensic Gambler Dr Matthew King (Forensic Psychiatrist), Andy Bayston (Assistant Clinical Psychologist), Dr Henrietta Bowden-Jones (Consultant Psychiatrist). Background and aims Gambling has been present in society for thousands of years and is known to be associated with crime and antisocial behaviour. The authors of this paper hypothesise that there is a distinct group of gamblers which may predisposed to committing crime and that current therapies and treatment may be inadequate. 41 | P a g e Methods The National Problem Gambling Clinic, London, UK has an extensive database of over 1600 clients assessed for gambling disorder. 1229 clients had a documented history of no offending (n=706) or any form of offending (n=532) and were included in the study. Results No statistical difference was found between age, gender and race between offenders and non offenders. Offenders were statistically more likely to have started gambling at a younger age, have more severe gambling disorder, have a lower level of academic achievement, were more likely to earn less and more than twice as likely to have lost a job. Offenders had higher rates of comorbid mental illness and childhood abuse as well more likely to have a positive family history of mental illness. There was no statistical difference in treatment outcomes. Conclusions This study has shown that offenders who gamble have a higher burden of disease and present with more comorbid difficulties when compared to non offenders. The authors propose that there should be increased screening for gambling disorder in forensic populations and a prospective study on treatment outcomes is needed. Why do you play online ? Self-reported motives, in-game behaviors, and addictive use of Massively Multiplayer Online Role Playing Games (MMORPG) Author(s) Name : Joël Billieux Place Cardinal Mercier 10, 1348 Louvain-la-Neuve, Belgium Email [email protected] Research on online games has highlighted that an individual’s motivations for playing MMORPGs have a crucial role in the onset of online game involvement and in its continuation. A decade ago, Yee (2006) conducted the first empirical studies aimed at identifying the various motivations of online game players. Three broad types of motivations were identified: those related to achievement, to social activity, and to immersion in a virtual world. Each was subdivided into specific subcomponents (e.g. the social factor comprises distinct types of motives such as playing to create new relationships or seeking to solve problems through teamwork). In the current talk, I will emphasize how considering models such as the one developed by Yee is relevant to explore the uniqueness of MMORPG misuse (e.g., in comparison to other types of Internet-related disorders). Results from recent studies having longitudinally explored the relations between gaming motives and actual in-game behaviours will also be presented. References Billieux, J., Deleuze, J., Griffiths, M.D., & Kuss, D.J. (2014). Internet gaming addiction: the case of massively multiplayer online role playing games. In N. El-Guebaly, M. Galanter, G. Carrá (Eds.). The Textbook of Addiction Treatment: International Perspectives. New York: Springer (pp.1515-1525). Yee, N. (2006b). Motivations for play in online games. Cyberpsychology and Behavior, 9, 772–775. Learning Objectives: 42 | P a g e 1. Critical approach of Behavioural Addiction Diagnostic Criteria 2. Critical approach on pathologization of everyday behaviours Problematic online gaming – addiction or coping process? Author(s) Name : Daniel Kardefelt-Winther Piazza SS Annunziata 12, 50122 Florence, Italy Email [email protected] While initial research on excessive online gaming focused on people’s psychological characteristics as the main predictor of problematic outcomes, recent empirical work suggests that a focus on the motivations for online gaming might be more useful and informative (e.g., Kardefelt-Winther, 2014a; 2014b). Specifically, it has been shown that playing games primarily to escape from negative feelings and mood states might lead to excessive use with problematic outcomes; these findings have also been replicated for excessive use of mobile phones. This suggests that excessive use of technology in general might be a way for people to escape negative feelings, which is a proposition that frames excessive use of technology as a coping strategy. Given that the sole application of an addiction framework in the study of excessive use of technology has not been particularly fruitful, I argue in this presentation that a shift in perspectives could be a good way forward. Conceptualizing excessive use of technology as a new form of coping is helpful because it moves beyond diagnostic criteria initially developed to study substance use disorder which have become standard also in the study of excessive use of technology. Furthermore, such a perspective demands more focus on the phenomenology of excessive use of technology to reveal patterns of behaviour that are unique to this condition. This in turn would strengthen the development of assessment criteria for a range of excessive behaviours related to technology use, as well as inform the conceptualization of behavioural addictions more broadly. References: Kardefelt-Winther, D. (2014). Problematizing excessive online gaming and its psychological predictors. Computers in Human Behavior, 31, p. 118-122. Kardefelt-Winther, D. (2014). The moderating role of psychosocial well-being on the relationship between escapism and excessive online gaming. Computers in Human Behavior, 38, p. 68-74. Learning Objectives: 1. Focus on the role of escapism in the study of excessive online gaming 2. Enhance the motivation of the treatment How to engage patients with gambling problems into treatment Author(s) Name : Hannu Alho & Sari Castren POB 30, 00271 Helsinki, Finland Email [email protected] Gambling-related ham affects not only individual level, but also society as a whole. Individuals suffering from gambling dependence use disorders rarely seek help or treatment and this demographic seems to be underdiagnosed and untreated. Some reasons for treatment gap are low recognition of a problem by a patients and professionals; negative image of addiction treatment services; perceived stigmatization, low non-gambling rates after 43 | P a g e treatment and neglecting a patient’s goal preference. Early detection as well as understanding, collaborative, compassionate, accepting and evoking approach (Motivational Interviewing) seem to promote patient’s motivation for change. The other essential components of treatment that can be helpful are use of gambling diary and introduction of relapse prevention into a treatment. In addition, the typical treatment goal of gambling abstinence may not be a primary one for all patients. However, our experience indicates that "controlled " gambling is not successful treatment goal. Use of opioid antagonists combined with psychosocial support can better motivate patients compared to a goal of abstinence. Learning Objectives: 1. Engagement of PGs to the treatment 2. Enhance the motivation of the treatment Neuroimaging of Dopamine Transporters in Disordered Gamblers Author(s) Name : Renata Faro Guerraa, MD, Ilza Rosa Batistab, PhD, Marcelo Queiroz Hoexterc, MD, PhD, Ming Chi Shihb, MD, PhD, Rodrigo Affonseca Bressanb, MD, PhD, Hermano Tavares, MD, PhD R. Dr. Ovídio Pires de Campos, 785 - Cerqueira César, São Paulo - SP, 01060-970 Email : [email protected] Background: Gambling Disorder (GD) shares many features with other addictions, including evidence of low dopaminergic activity in the reward system, a condition known as reward deficiency syndrome (RDS). To date, there have been no reported imaging studies of dopamine transporter (DAT) density in GD. Methods: We evaluated 30 subjects in two groups: GD (disordered gamblers, n = 15); and controls (non-gambling individuals, matched for age, gender, handedness, and smoking status, n = 15). The GD group completed selfreported questionnaires regarding gambling (behavior, severity, and expectancy). All subjects underwent singlephoton emission computed tomography with a technetium-99m-labeled tropane derivative as a radiotracer. Results: Striatal DAT density did not differ between the two groups. Within-subject analysis of the GD group revealed that striatal DAT density correlated significantly with various measures of recent gambling, although not with measures of lifelong gambling and related problems. Multivariate analysis, adjusted for age and smoking status, showed that DAT density in the right striatum correlated negatively with the number of continuous days of gambling abstinence in the last month (β = −0.811, p = 0.002), whereas DAT density in the left striatum correlated negatively with abstinence self-efficacy (β = −0.624, p = 0.013). Conclusions: Taken together with the positive correlations between recent gambling activity and DAT density, the similarity between the two groups, in terms of DAT density, suggests that gambling “normalizes” dopamine activity in the striatum. That would support the RDS theory, providing further evidence of the acute effects of gambling on striatal dopamine activity. Learning Objectives: 1. To get acquainted with the concept of gambling as a behavioral addiction 2. To get acquainted with the research on biomarkers for behavioral addictions 44 | P a g e Social aspects of on-line gambling: A latent class analysis Author(s): Yasser Khazaal1,2 1. Geneva University Hospitals, Geneva, Switzerland 2. Geneva University, Faculty of medicine, Geneva, Switzerland Email: [email protected] Introduction: Online gambling and Poker games are popular on the Internet since several years leading to important shift in how consumers engage in gambling. The present study aimed to characterize Internet gamblers in relation to a number of social variables: indebtedness, loneliness and in-game social behaviors. Methods: On-line gamblers (584) were recruited through advertisements posted in specialized forums and websites. Participants completed questionnaires related to social variables (indebtedness, loneliness, some in-game social behaviors), the Gambling Motives Questionnaire, the Gambling Related Cognitions Scale, the Internet Addiction Test, the Problem Gambling Severity Index, the Short Depression-Happiness Scale and the UPPS-P impulsive Behavior Scale. The social variables were explored in a latent class analysis. Results: Three clusters were fond: a first cluster (6.5%: lonely indebted gamblers), a second one (75.4%: not lonely not indebted gamblers) and a third one (18%: not lonely indebted gamblers). The three groups differ on most of the assessed variables. Learning objectives: Assessment of social aspects of on-line gambling Assessment of the links between social aspects of gambling and problem gambling 45 | P a g e S10: THERAPEUTIC COMMUNITIES AROUND THE GLOBE Dr. Gregory Bunt Email [email protected] Presentations within symposium and Author(s) Name : o o o Addiction Medicine and Integrated Therapeutic Communities - Gregory Bunt, M.D Therapeutic Communities : A Global Perspective- Sushma Taylor, Ph.D Spirituality and Recovery in the Therapeutic Community - Marc Galanter, M.D. Therapeutic Communities (TC’s) for the treatment of addictions and co-occurring health and mental health disorders provide a continuum of care from outpatient to short-term residential to long-term residential treatment that is both cost-effective and clinically effective. Increasingly, the need for this affordable continuum of care model is recognized in communities afflicted with epidemics of addiction. The TC also offers uniquely an alternative to incarceration treatment opportunity for many addicted individuals encountering criminal justice sanctions related to drug abuse. Historically, some TC’s have not embraced the professional influence of Addiction Medicine. However, today most TC’s have integrated evidence-based treatment modalities that include Addiction Medicine. For those addicted individuals who need support in medical and/or mental health treatment, vocational and housing assistance as well as rehabilitation toward recovery, the biopsychosocial-spiritual treatment continuum of an evidence based integrated Therapeutic Community may be the best hope for individuals, families and communities afflicted with severe addictions. Learning Objectives: 1. Participants will be familiar with concepts related to the integrated Therapeutic Community 2. Participants will be familiar with collaboration between Therapeutic Communities and criminal justice systems 3. Participants will be familiar with the complimentary relationships between Therapeutic Communities and Addiction Medicine Social Support as a Modality for Promoting Abstinence: Clinical and Biological Mechanisms Gregory Bunt The capacity of group influence to establish and sustain abstinence in persons addicted to alcohol and other drugs is now well established. Mechanisms underlying the modalities that employ such influence need to be clarified for optimal medical addiction practice, where emphasis is generally focused on pharmacologic and behavioral interventions, rather than social modalities. The objective of this session is to clarify these mechanisms and to illustrate how they have been applied in two different contexts. Two examples will be elaborated on how social support mechanisms have, in practice, been institutionalized to stabilize and sustain abstinence. The talks will 46 | P a g e provide a research background on these mechanisms, and provide attendees with a basis for optimally employing these modalities in clinical practice. The first modality is that of the drug-free therapeutic community, employed worldwide in different national adaptations. An example elaborated is that of Daytop Village, a network of programs with both residential and ambulatory components. In this modality, the community itself is the therapeutic instrument. The second modality is that of Twelve Step programs, Alcoholics Anonymous and Narcotics Anonymous,that wed mutual support among members to a spiritual orientation. Here a strongly espoused ideology acts to support the influence of group membership. An example will be provided of neural correlates of AA ritual in generating decreased responsivity to alcohol triggers. Learning Objectives 1. To understand mechanisms underlying how therapeutic communities and Twelve Step groups achieve their therapeutic effect. 2. To improve skills in employing these modalities in clinical practice. 3. To integrate knowledge of the biology of social support into models of addiction and recovery. “Social Model Recovery Systems: A Novel Approach to Addiction Treatment Program Management” Authors: Donald J. Kurth, MD, MBA, MPA, James O’Connell, CEO 223 E. Rowland Street, Covina, CA 91723 E-mail: [email protected] In the Los Angeles Skid Row area in the early 1980’s, a schizophrenic alcoholic woman was found dead in an alley. The death of this woman attracted public attention and politicians began to address treatment for co-occurring disorders. Prior to this, patients typically bounced between psychiatric care and drug rehabilitation, never succeeding at either. Soon Charles “Bud Hayes, received a grant to established Social Model Recovery Systems and River Community, the first residential treatment center dedicated to treating co-occurring disorders. Over the next thirty years Social Model absorbed twelve more independent programs. The non-profit network now houses eight residential programs and five outpatient programs totaling almost a thousand residents and outpatients. Bound together by our written “Core Beliefs” SMRC has successfully evolved into decentralized semi-autonomous cost centers. In addition, rather than depending entirely on public funding SMRC has evolved public-private funding balance. Public funding provides strength while private funding allows a richness of resources. We are a nimble and flexible private entity yet a stable and solid public entity. As we move into the future, we see “no wrong door.” Opportunities become available where and when we least expect them. We must be ready to embrace the unexpected. Our goal is to encompass all recovery, mental health, and physical health so that our participants will be able achieve their highest possible potential productivity and happiness in life. Learning Objectives: 1. The student will be able to describe a paradigm for public-private addiction treatment 47 | P a g e 2. The student will be able to describe the method by which addiction treatment administration maintains solid funding while still achieving a nimble and flexible treatment environment. SELF DIRECTED RECOVERY IN THE CASE MANAGED THERAPEUTIC COMMUNITY Peter Vamos, Executive Director Portage Program for Drug Dependencies The presentation will trace the evolution of the Portage therapeutic community from a confrontational to a strength based, positive psychology model. Twenty one social competencies have been identified as the goals of treatment with acquisition being realized in six consecutives treatment phases. Each phase builds on the previous one and each phase is accompanied by a phase specific interactive workbook, in which each client monitors daily their progress though treatment. The therapeutic community’s positive and dynamic milieu is complemented by a process of individual case management with the client playing a major role in setting of treatment priorities. Empowerment and increasing selfesteem are the threads that run through the entire treatment process. The resulting treatment alliance is essential ingredient in maintaining motivation for ongoing treatment participation. Impact on client retention, treatment compliances and outcomes will be discussed. The effects on the client’s readiness and commitment to complimentary interventions for co-occurring disorders will also be described. Comparative statistics between the prior and current approaches will be presented. 48 | P a g e S11: Neuroscience Update Impulsivity and compulsivity in chronic opioid dependence and short term abstinence Author(s) Name : Professor Alexander Baldacchino, Dr Serenella Tolomeo, Professor Douglas Steele Medical and Biological Sciences Building, North Haugh, St Andrews University, St Andrews, Fife, Scotland, United Kingdom, KY16 9TF [email protected] Objective: Chronic opioid exposure, as a treatment for a variety of disorders or as drug of misuse, is common worldwide, but behavioural and brain abnormalities remain under investigated. Only a small percentage of patients who receive Methadone Maintenance Treatment (MMT) for previous heroin misuse eventually achieve abstinence and neuropsychological studies on such patients are rare. Method: The Cambridge Neuropsychological Test Automated Battery was used to study a cohort of 122 male individuals: a clinically stable opioid dependent patient group receiving MMT (n=48), an abstinent (less than 6 months abstinent) previously MMT maintained group (ABS) (n=24) and healthy controls (n=50). Cambridge Gambling Task (CGT), Stockings of Cambridge (SOC) and Intra/Extra Dimensional Task (IED) data were acquired to test hypothesised abnormalities in cognitive impulsivity, non-planning impulsivity and compulsivity. Results: Stable MMT individuals deliberated longer and placed higher bets earlier in the CGT and showed impaired strategic planning compared to healthy controls. In contrast, short term abstinent individuals (ABS) showed impairment in choosing the least likely outcome, delay aversion and risk adjustment on the CGT, and exhibited nonplanning impulsivity compared to controls. Abstinent individuals were more impaired than methadone users in compulsivity measures. Conclusion: We suggest that a longitudinal study is required to determine whether long term abstinence improves impulsivity and compulsivity measures. Learning Objectives: 1. 2. Understanding the clinical relevance of impaired cognition in opioid users Understanding the impairments present in short term abstinent group following a history of chronic heroin use and methadone treatment Selective Dopamine D3 Receptor Antagonism Attenuates a Major Drug Addiction Co-Morbidity Factor Stress-Induced PTSD-Like Behavior Author(s) Name: Eliot L. Gardner, PhD BRC Building, Suite 05-707, Neuropsychopharmacology Section, Intramural Research Program National Institute on Drug Abuse, 251 Bayview Boulevard, Baltimore, MD 21224, USA Email: [email protected] Introduction: Addiction is often co-morbid with post-traumatic stress disorder (PTSD), a debilitating anxiety disorder that develops after exposure to psychologically traumatic events. PTSD is posited to be a major causal factor in addiction. PTSD elevates brain catecholamine levels – including in amygdala and hippocampus. Amygdala and hippocampus express high levels of dopamine D3 receptors, and over-activity of amygdala dopaminergic projections 49 | P a g e is posited to partially underlie PTSD. We have shown that selective D3 receptor antagonism inhibits stress-triggered relapse to drug-seeking. Objective: To determine whether D3 antagonism attenuates PTSD-like behavior in laboratory rats. Methodology: We used a modified single prolonged stress (SPS) animal model of PTSD, which has face- and construct-validity to human PTSD. After exposure to SPS, animals were returned to their home cages and left undisturbed for 14 days. On day 14, animals were administered vehicle, or the selective D3 receptor antagonists YQA-14 or SB-277011A, and then exposed to the original SPS-associated auditory tone. Freeze time was quantified. Results: Animals exposed to modified SPS showed greater conditioned fear when re-exposed to the tone-paired stressful environment following the 14-day sensitization period. YQA-14 or SB-277011A significantly decreased freeze time on day 14 (SPS test day). Conclusions: Selective D3 antagonism prior to re-exposure to stress-associated cues attenuates PTSD-like fearconditioned responses, congruent with findings that D3 antagonism attenuates footshock stress-induced operant response suppression. Selective D3 receptor antagonists may have translational utility in the treatment of PTSD in humans, thus reducing co-morbid drug addiction. Learning Objectives: 1. PTSD is a major co-morbidity with, and causal factor in, addiction 2. Selective dopamine D3 receptor antagonism attenuates an animal model of PTSD, thus suggesting translational utility for treating PTSD in humans, thus reducing co-morbid drug addiction Useful Biomarker to Identify Hazardous drinking in Korean Suicide Attempters Author(s) Name : Seongho Min, MD, PhD, Min-Hyuk Kim, MD, Jin Hee Lee, MD, Mi-Ae Yum, RN Department of Psychiatry, Yonsei University Wonju College of Medicine, 20, Ilsanno, Wonju, Kangwon, 26426, Republic of Korea Email : [email protected] Objective: Excessive or problematic alcohol drinking are important factors for suicide. Even though It is difficult to identify that alcohol problems of suicidal attempters in emergency center, due to invalid information and patients’ denial attitude. Aspartate transaminase (AST), alanine transaminase (ALT), gamma-glutamyl transferase (GGT), Mean corpuscular volume (MCV), Carbohydrate-Deficient Transferrin (%CDT) and GGT-%CDT combine parameter are potential biomarkers to identify for excessive alcohol drinkers and alcohol problem drinkers. This study was performed to evaluate the usefulness of GGT-%CDT parameter as a marker of hazardous drinking in Korean suicide attempters. Method: Three hundred suicide attempters (130 males and 170 females) were selected among those who visited the west kangwon emergency center. We surveyed the Korean version of AUDIT Alcohol Consumption Questions (AUDIT-C-K). The correlation of AUDIT-C-K with AST, ALT, GGT, MCV, %CDT and GGT-%CDT was examined. The sensitivity, specificity, positive predictive value, negative predictive value and ROC curve of the biomarkers for hazardous drinking (optimal cut-off point of AUDIT-C-K: 8) were also investigated. 50 | P a g e Results: AUDIT-C-K showed a significant positive correlation with ALT (r=0.123, P<0.05), GGT (r=0.339, P<0.001), MCV (r=0.229, P<0.001), %CDT (r=0.378, P< 0.001) and GGT-%CDT (r=0.563, P< 0.001). The sensitivities of GGT, %CDT and GGT-%CDT to hazardous drinking were 65.4%, 72.4% and 72.9% respectively, and the specificities of 70.1%, 81.2% and 72.9% respectively. The areas under ROC curve (95% confidence interval) of GGT, %CDT and GGT-%CDT were 0.762 (0.709~0.815), 0.810 (0.760~0.861) and 0.818 (0.771~0.865) respectively. Conclusion: GGT-%CDT is considered as the most useful biomarker for identifying hazardous drinking in suicide attempters. Learning Objectives: 1. To learn biomarkers for hazardous drinking 2. To learn the relation with alcohol and suicide 51 | P a g e S12: Opioid education Opioid abuse and dependence among patients with chronic non cancer pain: a training challenge in pain management for Québec family physicians Author(s) Name : Élise Roy1,2, Christiane Thibault2, Pierre-André Dubé2, Denis Hamel2, Maud-Emmanuelle Labesse2, Richard Coté1,2. 1Addiction Research and Study Program, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, QC, Canada; 2Institut national de santé publique du Québec, Montréal, QC, Canada. University of Sherbrooke, campus Longueuil, 150 Place Charles-Le Moyne. bureau 200, Longueuil, Qc, Canada, J4K 0A8 Email : [email protected] Objective: To assess concerns, practices and training needs of family physicians (FP) who prescribe opioids for chronic non cancer pain (CNCP) with respect to risks of abuse and dependence among patients. Methodology: An online survey was carried out from 10/14/2016 to 11/16/2016. Concerns were assessed asking “To what extent do you agree or disagree that the following factors cause you to avoid prescribing or hesitate to prescribe opioids for CNCP?” Among the suggested factors, four were about risks of adverse effects. Practices were assessed asking how often participants applied each of the Collège des médecins du Québec recommendations. Regarding training needs, participants had to rank their three most important topics out of eight suggestions. For analyses, frequency distributions were calculated, weighted according to the age and gender distribution of the Québec FP population. Results: Of 636 respondents (43.8% men; 55.3% ≥ 50 years old), 15.2% and 70.9% felt very or somewhat confident that they could properly prescribe opioids for CNCP. Concerns related to abuse (72.5% strongly agree/somewhat agree), dependence (73.2%) and lack of support should these complications occurred (75.4%) were the main barriers reported. Yet only 19.7% always/often screened their patients for risks of abuse and dependence. Almost half (46.4%) identified training on abuse and dependence risks assessment and management as one of their three top priorities, but only 13.7% ranked it first. Conclusions: Although risks of opioid abuse and dependence are major concerns among FP, screening practices are suboptimal, suggesting that many FP need training in this area. Learning Objectives: 1. To know the concerns, practices and training needs of family physicians regarding risks of opioid abuse and dependence among patients who receive prescription opioids for chronic non cancer pain 2. To be able to discuss ideas to support family physicians in their day-to-day practice in this domain WHY DOCTORS HAVE TROUBLE SAYING “NO” Author :JOEL BORDMAN 3250 EGLINTON AV EAST, SCARBOROUGH, ON, M1J 2H6 Email [email protected] 52 | P a g e A lot has been written and discussed in relation to the risk factors present in a patient to develop opioid dependence when exposed to prescription opioids. Less has been discussed around the risk factors present in the doctor for prescribing opioids in high doses or in inappropriate situations. Dr. Bordman explores internal factors (personality types) and external factors which influence a physician in prescribing opioids for chronic pain. It is hoped that Addiction health care providers will gain insight into this issue. The health care provider will be able to understand which colleagues display certain risk factors as well as taking an introspective look at himself Learning Objectives: 1. To explore what factors influence prescribers in interactions with patients and colleagues 2. To explore the concept of ‘adverse selection’ 3. To redefine ‘helping’ in our practices Wait list management of opioid use disorder: A novel program incorporating interim methadone therapy delivered on a mobile unit. John Fraser Halifax, Nova Scotia [email protected] Abstract Opioid agonist therapy (OAT) is the treatment of choice for opioid use disorder1. Barriers to treatment include wait lists2 and travel restrictions3. Interim methadone reduces harms associated with wait lists4. Mobile methadone units improve OAT admission rates6, and increase treatment retention7. In 2014, Direction 180, a Halifax-based OAT program, had a wait list of 300 people, resulting in admission delays of 6 months or longer. A program was developed providing interim methadone therapy on a mobile unit. Within 6 months, the wait list was eliminated, resulting in treatment access of 3 days or less. The structure of this novel program will be described, and the treatment outcomes presented. References 1. Connery HS. Medication-assisted treatment of opioid use disorder: review of the evidence and future directions. Harv Rev Psychiatry. 2015;23(2):63-75. 2. Kourounis G, Richards BD, Kyprianou E, Symeonidou E, Malliori MM, Samartzis L. Opioid substitution therapy: Lowering the treatment thresholds. Drug Alcohol Depend. 2016;161:1-8. 3. Deck D, Carlson MJ. Access to publicly funded methadone maintenance treatment in two western states. J Behav Health Serv Res. 2004;31(2):164-77. 4. Sigmon SC. Interim treatment: Bridging delays to opioid treatment access. Prev Med. 2015;80:32-6. 5. Hall G, Neighbors CJ, Iheoma J, Dauber S, Adams M, Culleton R, Muench F, Borys S, McDonald R, Morgenstern J. Mobile opioid agonist treatment and public funding expands treatment for disenfranchised opioid-dependent individuals. J Subst Abuse Treat. 2014;46(4):511-5. 53 | P a g e 6. Greenfield L, Brady JV, Besteman KJ, De Smet A. Patient retention in mobile and fixed-site methadone maintenance treatment. Drug Alcohol Depend. 1996;42(2):125-31. Learning objectives 1. To understand some of the barriers to accessing opioid agonist therapy 2. To learn about one approach to reduce wait lists and improve access to OAT through interim methadone therapy on a mobile unit 54 | P a g e S:13 Youth Issues The Association between Mental Illness and Tobacco Use Disorder: evidence from studies in Adolescence. Author(s) Name : Urvashi Prasad, BSc (1), Amit Y Rotem, MD (1,2,3), Trisha Tulloch, MD , FRCPC, FAAP (1,3) and Peter Selby, MBBS, CCFP, FCFP, DipABAM, FASAM (1,2). (1) The Faculty of Medicine, University of Toronto, Toronto , ON (2) Nicotine Dependence Services, The Centre for Addiction and Mental Health, Toronto, ON (3) Youth Addiction and Concurrent Disorder Services, The Centre for Addiction and Mental Health, Toronto, ON CAMH, 80 Workman Way, Toronto, ON, M6J 1H4 Canada. Email: [email protected] Objective: Tobacco Use Disorder (TUD) is highly prevalent among adolescents diagnosed with mental illnesses and addictions. This review aims to explore associations between mental illness and tobacco smoking, including ecigarette use, reported in published studies in adolescence. Method: A systematic review of peer-reviewed clinical publications on adolescent psychopathology and Tobacco Use Disorder was conducted using the following search terms: adolescents (6 MESH-related terms), mental health (32 MESH-related terms), tobacco (5 MESH terms) and e-cigarette. UP and AYR reviewed titles and abstracts. Only articles meeting criteria for clinical controlled trials were fully reviewed. Data were extracted into tables describing the population, intervention, comparison and outcomes. Results: There were 101 clinical studies published from 1980, of these articles, 23 met inclusion criteria. Unipolar Mood Disorders (9 studies, N=14,646) and ADHD (8 studies, N=850) were top-most associated with TUD. Anxiety and Bipolar Affective Disorder were found to be associated with TUD as well. No studies involving e-cigarettes and adolescent psychopathology were found. Conclusion: TUD was common in Control trials in mental illness studies in adolescence. No conclusion can be drawn about the causal mechanisms within the association. Regardless, TUD should be addressed as part of routine psychiatric care for children and adolescents and future studies should control for tobacco use status in reporting results. Learning Objectives: 1. To discuss associations between common mental illness and Tobacco Use Disorder in adolescents. 2. To discuss possible explanations to the association presented, using a bio-psycho-social model. “PAUSE”: A Novel SBIRT Initiative for Alcohol, Marijuana or Nicotine Use Targeting University Students Author(s) Name : Catharine Munn, James MacKillop, Allan Fein, Kathleen Mockler & Jillian Halladay McMaster University, MUSC B101, 1280 Main Street West, Hamilton, ON. L8S 4M4 Email [email protected] Motivational interviewing approaches and SBIRT (Screening, Brief Intervention, Referral to Treatment) have been shown to effectively reduce the negative outcomes of alcohol use among post-secondary students1,2. However, few SBIRT programs have addressed the use of marijuana, alcohol or nicotine in a single program or have integrated SBIRT with a pre-session online survey of both substance use and mental health. These gaps are addressed by a novel program, PAUSE, part of McMaster University’s “Arrive and Thrive” Programs, designed to reduce maladaptive substance use and improve adaptive coping. PAUSE has been developed, manualized, and pilot tested. 55 | P a g e Implementation of the program began in March 2016 and runs until December 2016. This presentation will describe the intervention, provider training, recruitment, and referral pathways. A frozen dataset from March 2016-September 2016 will be reported. Preliminary results will be presented, including sample characteristics and effects on the primary in-session outcome, change on the Readiness Ruler. This assessment measures students’ readiness to change their use of the target substance, (alcohol, marijuana or nicotine) and is measured pre-intervention and immediately post-intervention. The primary external outcomes are frequency of substance use and connecting to other resources at 1-month and 3-months post-intervention. References: Tanner-Smith, E.E. & Lipsey, M.W. (2014). Brief alcohol interventions for adolescents and young adults: A systematic review and meta-analysis. Journal of Substance Abuse Treatment, 51:1-18. Harris, S.K., Louis-Jacques, J. & Knight, J.R. (2014). Screening and brief intervention for alcohol and other abuse. Adolescent Medicine: State of the Art Reviews, 25(1):126-156. Learning Objectives: 1. To examine the effectiveness of a novel, single-session, brief intervention designed to increase readiness to change alcohol, marijuana or nicotine use among university students. 2. To examine the feasibility of conducting a 1:1 brief intervention to reduce the use and harms of alcohol, marijuana and nicotine on a Canadian university campus. Usefulness of cigarette per day (CPD), time to first cigarette (TTFC) and heaviness of smoking index (HSI) in assessing cigarette dependence in India Author(s) Name : Pratap Kumar Jena KIIT School of Public Health, KIIT University, Patia, Bhubaneswar, India-751024 Email [email protected] Background: Lower consumption of cigarette as well as simultaneous use of multiple tobacco products in India remains a threat to validity and reliability of Cigarette smoked per day (CPD) and time to first cigarette (TTFC) and heaviness of smoking index (HSI) in assessing cigarette dependence. Objective: To examine usefulness of CPD, TTFC and HSI in explaining dependence outcome measures. Methods: CPD, TTFC and HSI were compared for their influence on dependence outcome indicators like past quit attempt and future quit intention considering cigarette only use and cigarette plus other product use. Results: In cigarette-only use setting low-cigarette-dependence (CPD≤10sticks) explained 90.4% of quit attempt (p=.537) in the past year and 92.7% of positive quit intention (p=.004). Also low-cigarette-dependence using TTFC≥30minutes, explained 56.4% of quit attempt (p<.001) and 51.3% of positive quit intention (p=.029). High dependence (HSI score≥4) explained 3.5% of no quit attempt (p=.124) and 4.5% of no quit intention (p=.029). CPD and HSI performance in multiple use settings was more or less same. But TTFC ≥ 30 minutes explained only 45.4% of quit attempt and 41.1% of no-attempt (p=0.001), as well as 55.2% of quit intention and 61.3% of no intention (p<.001). Conclusions: Performance of CPD, TTFC and HSI to explain the cigarette dependence outcomes in India is limited, where multiple tobacco product use is common. Consumption of other tobacco products simultaneously, each 56 | P a g e delivering nicotine, affects CPD & TTFC; necessitating to explore other reliable and valid tobacco dependence indicators in India. Learning Objectives: 1. Apprise the audience about tobacco dependence assessment in community settings 2. Apprise the audience about performance of commonly used tobacco/cigarette dependence indicators in India, where simultaneous use of multiple tobacco products is common. 57 | P a g e S14: Aboriginal Communities Hope and Despair – Culturally Sensitive Community Led Opiate Maintenance Programs in Remote First Nations in Northwestern Ontario Author(s) Name : Mike Franklyn MD CCFP, Sharon Cirone MD CCFP 2110 Sunnyside Rd Sudbury Ontario Canada P3G 1H8 Email [email protected] Perhaps nowhere in Canada is the impact of Prescription Drug Abuse (PDA) as devastating as amongst Canada’s First Nations (FN) communities. Physical isolation and lack of road access result in illicit drug costs ten times those of urban centres, adding to the negative social and community impact experienced elsewhere due to PDA. In respond to the PDA/opiate crisis, a number of grassroots, community driven, culturally sensitive treatment programs have been initiated in 16 remote, fly-in communities in Northwestern Ontario. The first program began in 2013 and they have been highly successful, with retention rates in excess of 90%. Working collaboratively, consultant addiction physicians, northern primary care physicians/ nurse practitioners, community mental health workers and community leaders, all working together, have created a network of opiate maintenance programs, using a variety of models, as designed by the community. Over 500 patients have been successfully treated using Buprenorphine/Naloxone and traditional healing practices. Multiple indicators of ‘community wellness’ reflect the extremely positive influence that these programs have had. Communities have gone from desperation to hope, as families remain intact, child poverty and health improve, as patients in these programs, who are parents and grandparents, begin to heal and re-engage in life. Learning Objectives: 1. Design of successful, culturally sensitive, grassroots opiate agonist treatment programs for First Nations Communities 2. Impact of community treatment programs on the health of First Nations Communities 58 | P a g e S15: SALOME project Safety profile of injectable hydromorphone in a medically supervised treatment program for long term severe opioid use disorder in Vancouver Canada: Outcomes from a recent SALOME RCT Author(s) : Suzanne Brissette, Scott MacDonald, Daphne Guh, Kirsten Marchand, Heather Palis, Martin T. Schechter, David C. Marsh, Eugenia Oviedo-Joekes Centre de recherche du Centre hospitalier de l’Université de Montréal, (CRCHUM) Email: [email protected] Objective: To describe the safety profile of hydromorphone and its relationship with treatment retention and dose in the context of medically supervised program. Background: For patients with long-term, severe, opioid use disorder not benefitting from oral opioid-agonist treatment (e.g., methadone, buprenorphine), the recent SALOME (Study to Assess Longer-term Opioid Medication Effectiveness) clinical trial found injectable hydromorphone to be as effective as diacetylmorphine. Methodology: Participants were randomly assigned to injectable hydromorphone (n=100) and diacetylmorphine (n=102), prescribed and delivered double-blind in a supervised clinical setting, up to three times daily. Trained Registered Nurses assessed participants for adverse events (AEs). Results: Over the 180 days study period, hydromorphone-assigned participants received 167 average days of treatment, a total of 41,027 injections, and an average daily dose of 261 mgs (from a max. allowed of 500 mgs). A total of 206 related AEs were reported in 48 participants, the most common of which included histamine reactions and over-sedation. There were no related seizures or mortality. There was no relationship between AEs and total days receiving treatment or dose. Conclusions: Medically supervised injection-assisted therapy with hydromorphone is a safe treatment for severe opioid use disorder when prescribed properly, dosed precisely and administered under supervised conditions. Learning Objectives: 1. To describe the safety profile of injectable hydromorphone treatment for people with severe opioid use disorder. 2. To understand the most common adverse and serious adverse events associated with high doses of hydromorphone. Predictors of treatment assignment guess in a double-blind randomized controlled trial testing the noninferiority of hydromorphone to diacetylmorphine for the treatment of severe opioid use disorder Author(s) : Kirsten Marchand; Eugenia Oviedo-Joekes; Heather Palis; Daphne Guh; Suzanne Brissette; Scott MacDonald, David C. Marsh, Martin T. Schechter 575- 1081 Burrard St., St. Paul's Hospital, Vancouver, BC, V6Z 1Y6, Canada Email: [email protected] Background: SALOME (Study to Assess Longer-term Opioid Medication Effectiveness) tested in a double-blind noninferiority clinical trial if hydromorphone could be as effective as diacetylmorphine for severe opioid use disorder. Although participants did not guess treatment correctly beyond what is expected by chance, perceived treatment 59 | P a g e assignment can affect patients’ response to treatment. This study aims to test if treatment allocation guess is associated with treatment outcomes and identify predictors of guess. Methods: Data were obtained through questionnaires and clinical records. Participants were asked what medication they thought they were receiving (diacetylmorphine, hydromorphone or unsure) and their open-ended reason for the guess. Multinomial logistic regression for modeling nominal outcome data was used to assess the predictors of treatment guess. An inductive thematic analysis was used to code open-ended questions. Findings: Participants referred to their prior experience with opioids and the presence or absence of specific drug effects as reasons for their guesses. There were no differences in illicit opioid use and retention by guess; however those who guessed diacetylmorphine had better physical and mental health scores. Participants with a treatmentrelated observed drowsiness event, and higher perceived drug-related high scores were more likely to guess diacetylmorphine compared to hydromorphone. Guessing hydromorphone was more likely among those who made negative comments as reasons for treatment guesses. Conclusions: Understanding the clues participants use in making treatment allocation guesses and relating them to their expectations could be integrated with accurate information about the treatment, providing an opportunity for patient-physician shared decision-making in opioid maintenance treatment. Learning Objectives: 1. To understand predictors of treatment allocation guess and its relationship with outcomes. 2. To discuss the implications of treatment expectancies for opioid maintenance treatment planning. Non--inferiority of hydromorphone compared to diacetylmorphine for long-term opioid dependence: A Randomized Clinical Trial Author(s) : Eugenia Oviedo-Joekes, Suzanne Brissette, Daphne Guh, Kirsten Marchand, Scott MacDonald, David C. Marsh, Martin T. Schechter. School of Population and mental health, UBC, 2206 E Mall, Vancouver BC V6T 1Z9 Email [email protected] Objective: To test if injectable hydromorphone is non-inferior to injectable diacetylmorphine in reducing illicit heroin use for chronic injection opioid users after six months of intervention. Methods: SALOME (Study to Assess Longer-term Opioid Medication Effectiveness) was a phase III, double blind, non-inferiority trial. The study randomized 202 long-term street opioid injectors in Vancouver (Canada). Participants were randomly assigned to receive injectable diacetylmorphine or hydromorphone for six months under supervision. Both intent-to-treat (ITT) and per protocol (PP) analyses were conducted, reporting the mean difference between diacetylmorphine and hydromorphone (two-tailed 90% confidence interval [90% CI]). Results: Non-inferiority of hydromorphone was confirmed in the PP analysis for street heroin use (-1.44; 90% CI = 3.22, 0.27), although the margin of 4 days was not excluded in the ITT analysis (-2.34, 90% CI=- 4.14, -0.52). Noninferiority was confirmed for any street opioids in ITT (-0.85; 90% CI=-2.97, 1.25) and PP analysis (-0.15, 90% CI=2.09, 1.76), as well as for the urinalyses (ITT: 0.09; 90% CI=-0.02, 0.19; PP: 0.13, 90% CI=0.02, 0.24). The most 60 | P a g e common related serious adverse events were opioid overdoses (n=14) and seizures (n=11), all successfully treated on site without hospitalization. Conclusions and Relevance: This study provides evidence to suggest non-inferiority of injectable hydromorphone relative to diacetylmorphine for long-term opioid dependence. In jurisdictions where diacetylmorphine is currently not available or for patients where it is contraindicated or unsuccessful, hydromorphone could be offered as an alternative. Learning Objectives: 1. To explain the results of the SALOME clinical trial 2. To discuss implications of the results for the addiction treatment system Characteristics and response to treatment among Aboriginal people receiving injectable opioids for the treatment of long-term opioid-dependence Author(s): Heather Palis, Eugenia Oviedo-Joekes, Daphne Guh, Kirsten Marchand, Suzanne Brissette, Scott MacDonald, Scott Harrison, Kurt Lock, David C. Marsh, Martin T. Schechter 575-1081 Burrard Street, Vancouver BC, V6Z 1Y6 Email [email protected] Background and aims: The Study to Assess Longer-term Opioid Medication Effectiveness (SALOME) was a double-blind non-inferiority clinical trial. The trial found injectable hydromorphone (HDM) to be non-inferior to injectable diacetylmorphine (DAM) for the treatment of severe opioid-dependence. The present study aimed to determine whether the conclusions reached for the overall SALOME sample can be extrapolated to Aboriginal participants. Methods: Baseline characteristics were analysed by “Aboriginal ancestry” (i.e. First Nations, Inuit, or Metis) and treatment outcomes (collected at six-months) were analysed among Aboriginal participants, reporting the difference between DAM and HDM arms, adjusted for baseline values where applicable. The outcome of days of crack cocaine use was explored by gender and ethnicity to determine differences between and within subgroups. Results: Approximately one third of SALOME participants self-identified with “Aboriginal ancestry”. Among Aboriginal participants, analysis of differences in treatment efficacy between arms showed no significant differences in all but one outcome: days of crack cocaine use (DAM-HDM: -3.46 (-7.87, -0.10). This variable was further explored by gender and ethnicity, revealing that Aboriginal women used significantly more days of crack cocaine (19.93±12.85) compared to non-Aboriginal women (11.06±13.07), Aboriginal men (11.52±12.90), and non-Aboriginal men (7.69±11.55). Conclusions: Among Aboriginal participants, the present study found no differences compared to the outcomes of the main trial among all SALOME participants. Both hydromorphone and diacetylmorphine are effective treatment options for Aboriginal people with opioid-dependence. Learning Objectives: 1. To explain the outcomes of the clinical trial among Aboriginal participants. 2. To discuss implications of the results for the delivery of opioid assisted treatments among Aboriginal participants. 61 | P a g e S16: Behavioral Addiction WHO-ICD11 – Part I The taxonomy and concept of behaviourla addictions: discussion of controversies and relevance to ICD-11 Coordinating Author : Susumu Higuchi National Hospital Organization Kurihama Medical and Addiction Center, 5-3-1 Nobi Yokosuka, Kanagawa, 2390841, Japan Email : [email protected] .ne.jp Presentations within symposium and Author(s) Name : o Behavioural addictions in the context of ICD-11 development (Vladimir Poznyak, WHO, Switzerland) o Pathological gambling in ICD 11: addiction or impulse control disorder? (Henrietta BowdenJones, National Problem Gambling Clinic, UK) o Behavioral and substance addictions: Neurobiological and clinical considerations (Marc Potenza, Yale University, USA) Despite the magnitude of behavioural addictions (BAs) worldwide and the associated health and social consequences, these types of disorders are poorly defined and their place in the established diagnostic and classification systems disputed. In ICD-10 only pathological gambling is included as a discrete clinical entity, under “habit and impulse disorders”. In DSM-IV, this was classified under “impulse control disorders not elsewhere classified”. In DSM-5 gambling disorder is now classified under “substance-related and addictive disorders” - a groundbreaking change. Located in section 3, it contains a 9-item criteria set for Internet gaming disorder (IGD). Work on ICD-11 is underway. However, in the beta draft version of ICD-11, pathological gambling is still classified under “impulse control disorders”. Moreover, excessive Internet use has not been included as a disorder in the classification. WHO convened meetings of experts in 2014 (Tokyo) and 2015 (Seoul) to discuss classification and public health issues related to what is often called internet addiction or IGD. Consequently, it was proposed to classify “gambling disorder” under “disorders due to substance use and addictive behaviours” and to develop clinical descriptions and diagnostic guidelines for gaming disorder based on a careful review of current evidence. The resulting draft will be extensively reviewed and field tested for clinical utility, validity and reliability. This round table discussion will facilitate discussion among addiction experts. Learning Objectives: 1. To understand the current status of taxonomy and diagnostic guidelines and/or criteria of behavioural addictions in the ICD and DSM systems 2. To review recent evidence concerning the conceptualization of behavioural addictions and discuss their possible inclusion in ICD-11 Behavioral and substance addictions: Neurobiological and clinical considerations Author :Marc N. Potenza, MD, PhD 34 Park Street, New Haven, CT USA 06519 62 | P a g e Email [email protected] In DSM-5, “pathological gambling” was renamed “gambling disorder” and reclassified as a “Substance-related and Addictive Disorder.” This change was based on data from multiple domains (e.g., epidemiological, clinical, genetic, neurobiological) and helped further substantiate the existence of non-substance or behavioral addictions. While gambling disorder, as compared to other proposed behavioral addictions, has arguably received the most study with respect to similarities to and differences from substance addictions, other conditions (e.g., relating to Internet use, gaming, sex and other behaviors) have been proposed and studied. In this presentation, neurobiological and clinical data from a broad range of behavioral addictions will be reported, and when possible, direct examination with drug addictions will be included. Data will include fMRI, gray-matter and white-matter studies of gambling disorder and cocaine-use disorders, and fMRI studies of Internet gaming disorder, compulsive sexual behavior and problematic pornography use will be considered. Clinical characteristics linked to behavioral addictions (relating to Internet use, video-gaming, gambling, pornography use and shopping) will be considered, as will treatments for behavioral as compared with substance addictions. These data suggest neurobiological and clinical overlaps between behavioral and substance addictions. Although gambling disorder is the only behavioral addiction in the main text of DSM-5, data suggest that the range of behavioral addictions is broader and that there exists a need to identify and treat these conditions at earlier points in time. Future research efforts should consider how best to advance policy and prevention efforts relating to behavioral addictions. Learning Objectives: 1. To understand a broad range of behavioral addictions and similarities with and differences from substance addictions. 2. To understand the clinical importance of behavioral addictions and their treatment. Behavioral Addictions in the context of ICD-II development Vladimi Poznyak – no abstract PATHOLOGICAL GAMBLING IN ICD11: ADDICTION OR IMPULSE CONTROL DISORDER? Bowden-Jones Henrietta Director, National Problem Gambling Clinic, UK. Honorary Senior Lecturer, Brain Sciences, Imperial College. 63 | P a g e The relatively recent changes pertinent to Pathological Gambling in DSM 5 led to a reclassification of the illness as Gambling Disorder and a move from impulse control disorder to addiction, sitting alongside alcohol, drugs and nicotine addiction in the chapter ‘Substance related and Addictive Disorders’. Gambling Disorder was , in 2013, the first behavioural addiction to be listed in DSM5 and has led to subsequent speculation on the possible future inclusion of other behavioural addictions in this category. There is a significant polarization of views as to whether ICD 11 should follow its American counterpart or strike out on its own and keep Pathological gambling as an impulse control disorder. This presentation will outline both sides of the debate giving the most relevant clinical and neuroscientific research findings to illustrate the underpinnings of the debate 64 | P a g e S17: Tobacco Tobacco Addiction Treatment in patients with concurrent addictions: an update Peter Selby MBBS, CCfP,FCFP, MHSc, DFASAM, dipABAM CAMH, 175 College Street, Toronto, ON, M5T 1P7 Email [email protected] Tobacco addiction is the leading cause of preventable death in Canada, killing 37,000 Canadians every year. Current smokers are more likely to be less educated, live in poverty and suffer from other addictions and or mental health disorders. Canadaptt guidelines ( www.Canadaptt.net) recommend treating tobacco addiction in every patient with other addictions. Addiction treatment settings are optimal to provide combined evidence based behavioural and medication assisted treatment. However, a lack of specialized knowledge in medication assisted treatment for tobacco addiction pose a challenge to adapting and tailoring treatment for patients with other mental illnesses and or addictions. Additionally, the challenge of variable motivation and firmly held beliefs regarding tobacco use pose a challenge for practitioners and patients. This presentation will assist practitioners adapt the latest evidence to their patients with comorbid addictions and or mental illnesses. This dynamic and interactive session will give attendees practical, relevant knowledge and skills to incorporate evidence-based approaches to tobacco dependence treatment in their practice, with particular emphasis on adapting and tailoring pharmacotherapy for patients with co-morbid conditions. Attendees will leave the session with a better understanding of how to recommend and prescribe pharmacotherapy for tobacco addicted individuals. This session emphasizes learner engagement, interaction and practice though the use of polling technology through cell phones or tablets. Participants will receive links to clinical tools and resources to facilitate sharing with colleagues and community stakeholders. Learning Objectives: 1. List the efficacy of 5 evidence based pharmacotherapies for the treatment of tobacco addiction 2. Adapt the use of pharmacotherapy for patients with concurrent addictive disorders The Neuropsychiatric Safety of Smoking Cessation Medications (An Overview of the EAGLES Study) Milan Khara Vancouver BC In many randomized trials and observational studies, the Health Canada approved smoking cessation medications, varenicline and bupropion, have both been shown to significantly improve . smokers’ chances of long term quitting.(1) Nonetheless, shortly after approval, concerns were raised about the neuropsychiatric safety of these medications. 65 | P a g e Many of these concerns were based on anecdotal reports rather than the adverse effects observed in randomized controlled trials, and received extensive media attention. Consequently, and applying great caution, both bupropion and varenicline had box warnings included in their product monographs. This followed previous wording changes to the Varenicline monograph highlighting potential changes in behaviour, mood and suicidal ideation. These warnings have predictably resulted in public concern about the safety of these cessation medications and there by restricted choice and access to the full armamentarium of tobacco treatment medications. However, the recently published EAGLES study(2) (Lancet April 2016) provides strong evidence that for both stable psychiatric patients who smoke and "non-psychiatric" smokers prescribed the tobacco treatment medications varenicline, bupropion, or transdermal nicotine patches, the incidence of neuropsychiatric adverse effects are essentially the same as those observed in subjects assigned to the placebo condition. Over 8,000 study participants from 140 research centers in 16 countries were randomly assigned to either a varenicline, bupropion, transdermal nicotine patch or placebo group. Approximately half the smokers had stable psychiatric diagnoses, the other half were "non- psychiatric" smokers. In the "non-psychiatric" cohort, 13 (1.3%) of 990 participants reported moderate and severe neuropsychiatric adverse events in the varenicline group, 22 (2.2%) of 989 in the bupropion group, 25 (2.5%) of 1006 in the nicotine patch group, and 24 (2.4%) of 999 in the placebo group. In the psychiatric cohort, moderate and severe neuropsychiatric adverse events were reported in 67 (6.5%) of 1026 participants in the varenicline group, 68 (6.7%) of 1017 in the bupropion group, 53 (5.2%) of 1016 in the nicotine patch group, and 50 (4.9%) of 1015 in the placebo group. Varenicline-treated participants achieved higher abstinence rates than those on placebo (OR 3.61, 95% CI 3.07 to 4.24), nicotine patch (1.68, 1.46 to 1.93), and bupropion (1.75, 1.52 to 2.01). Those on bupropion and nicotine patch achieved higher abstinence rates than those on placebo ( 2.07,1.75 to 2.45 and 2.15,1.82 to 2.54, respectively). Across cohorts, the most frequent adverse events by treatment group were nausea (varenicline, 25%), insomnia (bupropion, 12%), abnormal dreams (nicotine patch, 12%), and headache (placebo, 10%). Efficacy treatment comparison did not differ by cohort. The EAGLES study did not demonstrate a significant increase in neuropsychiatric adverse events attributable to varenicline or bupropion compared to nicotine patch or placebo. As a result of the EAGLES study, the European Medicines Agency removed the Varenicline box warning in May 2016. The FDA is currently considering whether to take similar action. This brief presentation will overview this ground-breaking study. REFERENCES 1Cahill K, et al. Pharmacological interventions for smoking cessation: an overview and network meta-analysis. Cochrane Database Syst Rev 2013; 5: CD009329. 2 Safety and efficacy of varenicline, bupropion, and nicotine patch in smokers with and without psychiatric disorders (EAGLES): a double-blind randomised, placebo-controlled clinical trial. Anthenelli, RM et al. The Lancet, Volume 387, Issue 10037, 2507 – 2520 66 | P a g e S18: Telemedicine and Clinical Management of Hepatitis C Virus Infection in Drug Abusers Organizers: Jag H. Khalsa, MS, PhD, National Institute on Drug Abuse, NIH, and Andrew Talal, MD, State University of New York (SUNY) at Buffalo. Sponsors: National Institute on Drug Abuse, NIH and Chronic Liver Disease Foundation (CLDF) Speakers: Dr. Andrew Talal, Dr. Clewert Sylvester, Dr. Julie Bruneau, and Dr. Jag H. Khalsa. This symposium will explore current issues and innovative models for treatment of hepatitis C virus (HCV) infection among substance users. While substance users remain the population with both the highest incidence and prevalence of HCV infection, many have not received HCV evaluation or treatment due to poor linkage to care. Integration of HCV care into venues, such as opiate agonist treatment (OAT) programs, has been widely advocated but difficult to implement. Telemedicine, two-way videoconferencing between a patient and a physician each geographically separated, is a modality that can virtually integrate specialty care, such as that required for HCV, with substance use treatment. While telemedicine treatment of HCV infection has been successfully implemented in a small number of patients, challenges remain to treatment of this population including restrictions on direct acting antivirals for substance users, treatment of active injection drug users, and the psychiatric issues related to addiction. Each of these topics including the funding mechanisms at NIH will be discussed. References: (i) CDC, 2013, (ii) Deming P et al. Pharmacotherapy, 2016; (iii) Mashru J. et al. J Telemed Telecare 2016; (iv) Rossaro L et al. Dig Dis Sci, 2013. Learning Objectives: 1. Attendees will learn the current status of HCV infection in drug abusers 2. Learn about the latest methodologies including telemedicine used in clinical management of HCV infection in drug abusers 3. Learn about Integrative methods for managing infections in drug abusing populations. Management of Hepatitis C Infection in Substance Abusers Jag H. Khalsa, MS, PhD, Chief, Medical Consequences of Drug Abuse Branch, Division of Therapeutics and Medical Consequences, National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland, USA Email: [email protected] Substance abuse and co-occurring infection of viral hepatitis C (HCV) and related morbidity and mortality remain the most significant health problems in the world today. An estimated 153-300 million people abuse illegal drugs regularly; about 16 million people inject drugs. An estimated 170 million people are living with HCV infection. Injection drug use is a major vector in acquisition and transmission of HCV infection. Up to 60% IDUs may be infected with HCV infection, while up to 90% of HIV-infected IDUs may also be co-infected with HCV infection. Among IDUs worldwide, the incidence and prevalence of HCV infection is 50-90% and 10-30%/year, respectively. HCV infection is a serious blood-borne infection that causes liver cirrhosis, liver cancer and death. If untreated, up to 10% of HCV infected people may die from liver cancer each year. In 2014, about 20,000 people died from HCV-associated complications while 12,900 people died from HIV/AIDS. More recently significant increases in incident HCV infections have occurred among young 18-25 year old injectors who’ve recently transitioned from oral opioid abuse. This has presented an important public health challenge requiring a comprehensive, community-based response. This lecture 67 | P a g e will discuss newly approved therapies and modalities for the management of viral hepatitis C infection in substance abusers. It will also briefly describe funding opportunities at NIDA/NIH. Learning objectives: attendees will learn (i) (ii) (iii) the current status of HCV infection in substance abusers; whether multi-infected substance abusers can be clinically managed; and the various funding opportunities available at NIH. Interferon-free direct acting antiviral hepatitis C therapy for people who inject drugs Jason Grebely BSc PhD UNSW Sydney NSW 2052 Australia Email [email protected] A/Prof. Jason Grebely - The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia Abstract: The availability of simple, tolerable interferon-free direct-acting antiviral (DAA) therapies for HCV infection with cure >95% represents one of the most exciting advances in clinical medicine in recent decades. Adherence and response to interferon-free DAA therapy among people receiving opioid substitution therapy and people with recent injecting drug use are comparable to populations without a history of injecting. Given the potential prevention benefits of treatment, interferon-free DAA therapy has also been shown to be cost-effective among PWID. As HCV therapy is expanded to populations of PWID with greater risk behaviours for re-exposure, it is crucial to acknowledge that HCV reinfection will occur and that appropriate strategies are in place to maximize prevention of reinfection and offer retreatment for reinfection. This presentation will also discuss essential components for broadened access to HCV care for PWID as we strive for the global elimination of HCV infection. Following this presentation, the participant should understand the following learning objectives: 1) IFN-free DAA therapeutic development and evidence among people receiving opioid substitution therapy and recent PWID; 2) The risk of HCV reinfection following successful interferonfree HCV therapy and how this relates to clinical management. Following this presentation, the participant should understand the following learning objectives: 1) IFN-free DAA therapeutic development and evidence among people receiving opioid substitution therapy and recent PWID; 2) The risk of HCV reinfection following successful interferon-free HCV therapy and how this relates to clinical management. Prevention of Hepatitis C among persons who inject drugs: challenges and opportunities. Author: Julie Bruneau 900 rue Saint-Denis, Montreal, QC, H2X 0A9 Email [email protected] Injection drug use is a major public health problem and the leading cause of new infections with hepatitis C virus (HCV) in developed and emerging countries. Early detection of HCV and a combination of preventive interventions are needed to reduce the transmission of HCV among people who inject drugs. The provision of clean injecting equipment through syringe and injection material distribution programs (SIP) and involvement in opiate substitution treatment (OST) constitute the cornerstone of harm reduction strategies (HR) to reduce HCV and HIV transmission 68 | P a g e among people who inject drugs (PWID). Evidence of the effectiveness of HR for HCV prevention is, however, not well established. To achieve significant reductions in incidence, prevalence and health effects associated with HCV, intervention strategies must reduce transmission rates among uninfected people at risk while increasing HCV screening and access to treatment for those more likely to transmit the infection or progress to more advanced stages of liver disease. Following this presentation, the participant should have a better understanding the challenges associated with HCV prevention: 1) by reviewing current harm reduction strategies and their application and impact on persons who inject drugs living in various contexts; 2) by exploring novel integrated prevention strategies in the context of the new antiviral treatments. Learning Objectives: 1. Review incidence, prevalence and health effects associated with HCV 2. Review Intervention strategies The Changing Paradigm for Psychiatry in the Treatment of Hepatitis C in Those with a Co-morbid Substance Use Disorder Clewert Sylvester, MD Brooklyn, NY 11201 (USA) Email : [email protected] The association between Hepatitis C and psychiatric symptoms has always been an exercise in managing risks. This neurotropic virus can produce psychiatric manifestations and its treatment has been frequently complicated by psychiatric side effects. Traditionally Psychiatry had 3 basic functions in the treatment of Hepatitis C in those with a co-morbid substance use disorder (SUD). The main function was a gate keeping function that assessed a patient’s appropriateness for treatment. Answering the questions of whether the patient was emotionally stable enough to undergo treatment and if their addictive disorder was stable enough to attempt HCV treatment. The second function of Psychiatry was to address the psychiatric symptoms that resulted from interferon based treatments, and the third function was to assess the degree of neuropsychiatric involvement of the infection itself. With the advent of Direct Acting Anti-viral agents which did not require the use of Interferon we see that Psychiatry has taken on other important roles in the treatment of patients with SUD and HCV. In addition to assessing the appropriateness of a patient for treatment and determining the extent of neuropsychiatric involvement secondary to the infection, Psychiatry now plays a major role in treatment adherence. This is especially true in patients with SUD. Those that drop out of treatment tend to be those who have one or more of the following issues; unmet psychiatric needs, unstable housing, or relapse of their addiction. Also , Psychiatry is an important player on the treatment team for 2 other reasons ; managing drug - drug interactions with psychotropic meds and the issue of suicide and its relation to serious infections. So the advent of interferon free treatment regimens for Hepatitis C have changed the concerns of the involved psychiatrist, but have not diminished his importance to the safe and effective treatment of HCV, especially in vulnerable groups like those patients with SUD. Learning Objectives : (1) The attendee will learn the 3 main reasons why patients with SUD drop out of HCV Treatment (2) The attendee will understand the basis of Direct acting Anti-viral medication interaction with psychotropic medications 69 | P a g e S19: Education in Developing Countries Randomized control trials (RCTs) results and qualitative data demonstrate meaningful impacts of the NextGenU.org online training model on health workers, their patients and the health system. Author(s): Veronic Clair M.D. M.Sc., PhD 1,2, , Victoria Mutiso Ph.D.2, Abednego Musau M.B.Ch.B.1, Albert K Tele M.Sc.2, Erica Frank M.P.H., M.D.1, David Musyimi Ndetei M.B.Ch.B. Ph.D.2,3, 1 University of British Columbia, Canada; 2 Africa Mental Health Foundation (AMHF), Nairobi, Kenya; 3 University of Nairobi, Nairobi, Kenya Rm 109, 2206 East Mall, Vancouver, BC, V6T 1Z3 Email: [email protected] Objective: eDATA K assessed the impact of online training on urban and rural Kenyan healthcare workers’ (HW) delivery of substance use disorders (SUD) services and their patients’ health outcomes; using the NextGenU.org model of free competency based online courses with peer and mentored activities, in collaboration with the Annenberg Physician Training Program in Addiction Medicine (APTPAM), and Africa Mental Health Foundation (AMHF). Methodology: The methods include two RCTs (one in public and one in private facilities) comparing the impact of the WHO ASSIST screening with feedback by lay health worker (Fb) to receipt of that feedback plus a brief intervention (BI) delivered by a clinician (both group of health workers trained through the online courses with peer and mentored activities for the screening, feedback, and interventions). Results: The courses improved knowledge and decreased stigma among health workers who took them. Patients receiving Fb or BI in both public and private facilities in the RCTs decreased their alcohol use significantly, and to a similar level; with documented meaningful impact on patients health and functioning through the qualitative data. The quality improvement course led sustained implementation and some dissemination of the interventions in two counties. Conclusions: Populations worldwide could benefit from access to health workers trained with these NextGenU, APTPAM, and AMHF free courses. Further studies are needed to assess the impact on other substance use consumption and on cost-effectiveness of the online training model. Learning Objectives: 1. Be aware of the feasibility and impact of blended online learning methods on capacity building of health care workers in mow-middle income countries; 2. Realize the impact on patients’ health outcomes and health systems sustainability of increasing health workers capacity in screening for substance use disorders, delivering brief interventions and using quality improvement methods to disseminate and sustain these interventions. 70 | P a g e Extending capacity in health outcomes in addiction medicine and psychosocial interventions for community health workers Author(s): Wiplove Lamba, Michael O'Rourke, Kyrsten Howat, Bonnie Cheuk St. Michael’s Hospital, 30 Bond Street, Toronto, ON M5B1W8 17th floor Email: [email protected] Background: The addiction field is full of passionate care providers with different philosophies that sometimes have limited education on the other areas. Komaromy etal 2016, developed Project ECHO (extension for community health outcomes), a novel hub and spoke tele-mentoring model for knowledge translation and building capacity that works through didactic talks, case based learning and a community of practice. Methods and Aim: With mentorship from the group at New Mexico, the ECHO model was adapted to community workers. A pilot nine session project was carried out to test feasibility and sustainability. Results: A needs assessment was done identified key topics and nine ECHO sessions were conducted with didactic talks, case based learning and discussions where the audience members would guide the discussion and share their expert opinion. The impact of the sessions will be shared and discussed and audience members will be engaged in a discussion about how to create their own model. References Komaromy etal. "Project ECHO (Extension for Community Healthcare Outcomes): A new model for educating primary care providers about treatment of substance use disorders". Substance Abuse. 2016. Vol 37. No 1. 20-24. Learning Objectives: 1. Describe a knowledge translation model developed in New Mexico and how it was adapted to train community workers in addiction medicine and psychosocial interventions at an inner city hospital. 2. Discuss with local colleagues the steps required to build capacity in addiction medicine and psychosocial interventions within their community. Addiction/ HIV Researchers Mentoring the Next Generation of Clinician Scientists Author(s): Klimas, J., McNeil, R., Ahamad, K., Mead, A., Rieb, L., Cullen, W., Wood, E., Small, W. British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608 – 1081 Burrard Street, Vancouver, British Columbia, Canada, V6Z 1Y6 Email [email protected] Objective: Despite a large evidence-base upon which to base clinical practice, most health systems have not combined the training of healthcare providers in addiction medicine and research. As such, addiction care is often lacking, or not based on evidence or best practices. We undertook a qualitative study to assess the experiences of physicians who completed a clinician-scientist training in addiction medicine within a hospital setting. Methodology: We interviewed physicians from the St. Paul’s Hospital Goldcorp Addiction Medicine Fellowship and learners from the hospital’s academic Addiction Medicine Consult Team in Vancouver, Canada (N=26). They 71 | P a g e included psychiatrists, internal medicine and family medicine physicians, faculty, mentors, medical students and residents. All received both addiction medicine and research training. Drawing on Kirkpatrick’s model of evaluating training programmes, we analysed the interviews thematically using qualitative data analysis software (Nvivo 10). Results: We identified five themes relating to learning experience that were influential: (i) attitude, (ii) knowledge, (iii) skill, (iv) behaviour and (v) patient outcome. The presence of a supportive learning environment, flexibility in time lines, highly structured rotations, and clear guidance regarding development of research products facilitated clinicianscientist training. Competing priorities, to include clinical and family responsibilities, hindered training. Conclusions: Combined training in addiction medicine and research is feasible and acceptable for current doctors and physicians in training. However there are important barriers to overcome and improved understanding of the experience of addiction physicians in the clinician-scientist track is required to improve curricula and research productivity. Learning Objectives: 1. Describe how diversity in addiction medicine education hinders its progress 2. List the three phases of the project 3. List the main themes from the qualitative interviews 72 | P a g e S20: International Neurosciences Auditory P300 event-related potential and dopaminergic polymorphisms of Internet gaming disorder Author(s): Yeon Jin Kim, A Reum Choi, Ji Yoon Lee, Minkyung Park, Jung-Seok Choi Dept of Psychiatry, SMG-SNU Boramae Medical Center, Boramaero 5-gil, Dongjakgu, Seoul, Republic of Korea Email: [email protected] Introduction: P300 event-related potential (ERP) is a promising endophenotype. Moreover, the dopaminergic system has been implicated in P300. Catechol-O-methyltransferase (COMT), dopamine receptors 2 (DRD2) and 3 (DRD3) have been candidates for contributing to addictive disorder. We hypothesized that genetic dopaminergic polymorphism was involved in the difference of auditory P300 between IGD and healthy control (HC). Material and Methods: We examined the effect of COMT, DRD2 and DRD3 polymorphism on auditory p300 amplitude and latency in a sample of 22 IGD patients and 18 HC. Val158Met (rs4680; COMT), H313H (rs6275; DRD2) and Ser9Gly (rs6280; DRD3) polymorphisms were analyzed. Subjects completed an auditory oddball paradigm while EEG was recorded. Results: The genotype x diagnositic interaction was observed for DRD3 at precentral (Cz) in P300 amplitude (F=6.326, p=0.017) and for COMT at centroparietal (CPz) electrode in P300 latency (F=13.107, p=0.001 ). DRD3 T/T(Serine/Serine) homozygotes showed higher Cz P300 amplitude than C (Glycine) allele carriers in IGD (p=.038), but not in HC. For COMT, Met carrier in IGD showed increased latency at CPz compared to those with HC(p= .038). DRD2 polymorphism did not significantly contributed to variance in P300. Conclusion: This finding suggests DRD3 Ser9gly and COMT Val158Met polymorphisms are associated with differential effects on P300 amplitude and latency in IGD, respectively. Dopaminergic genetic factors can influence on dysfunctional informational processing related to working memory and attention in the pathophysiology of IGD. Learning Objectives: 1. To evaluate differential pattern of auditory P300 between Internet gaming disorder and healthy control across genotype. 2. To describe possible role of COMT and DRD3 polymorphism in difference of auditory P300 amplitude according to diagnostic status Altered resting-state cortico-striatal connectivity in adolescents and adults with Internet gaming disorder Author(s): Jung-Seok Choi, Heejung Kim, Yeon Jin Kim, A Ruem Choi, Yu Kyeong Kim Dept of Psychiatry, SMG-SNU Boramae Medical Center, Boramaero 5-gil, Dongjakgu, Seoul, Republic of Korea Email: [email protected] Introduction: To understand neurobiological mechanisms underlying Internet gaming disorder (IGD), we investigated full patterns of functional connectivity in adolescents with IGD and young adults with IGD, and then we further explored cortico-striatal functional connectivity with seed-basis analysis using resting-state fMRI data. 73 | P a g e Methods: A total of 71 subjects were included in this study. 18 adolescents (15.78 ± 1.74 yrs) and 18 adults (23.74 ± 5.08) with IGD and 11 normal adolescents (14.77 ± 1.28) and 24 normal adults (26.12 ± 3.49) underwent restingstate fMRI scans. Results: At full pattern of whole brain, we found that in IGD adults compared to the normal adults, several enhanced functional connections were shown between occipital regions and right middle frontal, left NAcc and amygdala, and between right thalamus and left precentral gyrus and reduced functional connections between occipital regions and pre/postcentral gyrus. We also found that IGD adolescents compared to the normal adolescents represented only reduced functional connections between left putamen and inferior/middle temporal gyrus, and medial frontal. At cortico-striatal functional connectivity, IGD adults showed increased connectivity in frontal and temporal regions and decreased connectivity in bilateral hippocampus with putamen. However, unlike that of IGD adults, IGD adolescents showed reduced connectivity in medial frontal regions, temporal regions and putamen. Conclusions: Our results provide evidences that there are distinctive functional connections in the resting-state with age in IGD groups. Different functional circuits of cortico-striatal between adults and adolescents with IGD suggest considerations of developmental influences on brain functions in the pathophysiology of IGD. Learning Objectives: 1. To understand neurobiological aspects in Internet gaming disorder using resting-state fMRI 2. To understand different brain changes with a point of view of developmental course in Internet gaming disorder Structural Brain Correlates of Impulsive Delayed Reward Discounting in Alcohol and Nicotine Use Disorders Author(s): Michael Amlung, PhD; Luciano Minuzzi, MD PhD; Nicholas Bock, PhD; James MacKillop, PhD Peter Boris Centre for Addictions Research. 100 West 5th Street; Hamilton ON L8N 3K7 Canada Email [email protected] Background and Objective: Impulsive delayed reward discounting (DRD) is a core behavioral process underlying reinforcement pathology in addiction. A growing number of studies in neuroeconomics have begun to characterize the functional and structural brain correlates of DD. Although prior research in healthy sample has reported significant associations between cortical and subcortical brain volumes and DRD, the relationship between DD and cortical thickness remains unclear. We examined the relationship between DRD and cortical thickness in individuals with alcohol and nicotine use disorders. Methods: Structural MRI data were drawn from two prior neuroeconomics studies in heavy drinkers (N = 26) and daily smokers (N = 43). Data were processed using FreeSurfer to generate measures of cortical thickness. We examined associations between cortical thickness and performance on two monetary DRD assessments. Results: Initial data analyses indicated that steeper DRD (i.e., greater impulsivity) was associated with decreased thickness in a number of regions, namely bilateral insula, inferior parietal lobule, and precuneus; right dorsolateral prefrontal cortex; and left anterior cingulate cortex. Steeper DRD was also associated with greater thickness in right medial orbitofrontal cortex. Future analyses will compare drinkers and smokers. Conclusions: These results suggest that individual differences in cortical thickness in regions related to executive 74 | P a g e control, prospective thought, and reward processing are associated with DRD. The pattern of results support the theoretical model that impulsive DRD in addiction samples may be attributed to disruption in the balance between limbic (medial orbitofrontal cortex) and frontal (prefrontal cortex and anterior cingulate) brain regions. Learning Objectives: 1. Understand how individual differences in brain morphology relate to impulsive delayed reward discounting 2. Examine commonalities and differences in the relation between delayed reward discounting and cortical thickness in heavy drinkers and cigarette smokers 75 | P a g e S21: Advances in Pharmacotherapy – part I Long-acting Formulations to Improve Substance Abuse Treatment Adherence Author :Ivan D. Montoya, M.D, M.P.H. NIDA, 6001 Executive Blvd., Bethesda, MD 20892, USA Email [email protected] Low treatment adherence is prevalent across all medical conditions and a major barrier to achieving the benefits of effective therapeutic interventions. This is especially relevant among patients with Substance Use Disorders (SUD) whose clinical condition make them more prone to have poor treatment adherence. Multiple strategies to improve treatment adherence among SUD patients have been evaluated. For example, intensive counseling, contingency management techniques, prescribed pill counts, biomarkers in urine (e.g., riboflavin, quinine and acetazolamide), electronic tools, etc. but they have not been completely successful. Long-acting formulations of medications have greatly helped to improve the treatment adherence y many areas in medicine. They include, long-acting antipsychotics (e.g., paliperidone palmitate) and removable depots of contraceptive agents (e.g., Norplant). Similarly, long-acting formulations are expected to improve medication adherence and help patients with SUDs. A long-acting formulation of naltrexone approved by the FDA has demonstrated better adherence than the oral formulation. Recently, the FDA approved an implantable formulation of buprenorphine that delivers stable blood levels of this medication for six months and showed non-inferiority as compared to the oral formulation. Furthermore, several research groups are developing long-acting formulations of medications to treat SUDs. Although they seem to be well tolerated, and improve pharmacokinetic coverage and treatment outcomes, complexities around their safety, tolerability, and starting/stopping protocols require careful consideration. The purpose of this presentation is to review the risks and benefits of long-acting formulations of medications as tools to improve the adherence to and outcomes of SUD treatments. Learning Objectives: 1. To gain knowledge about the negative effects of poor adherence on substance abuse treatment outcomes. 2. To learn about the development of long-acting formulations of medications to improve the outcomes of substance abuse treatments. Early implementation of the Probuphine REMS program Author(s): Ole W. Snyder, MD, Angie E. Kell, PhD, Ryan D. Dammerman, MD, PhD, Steven E. Chavoustie, MD, FACOG, CCRP47 Hulfish Street | Suite 441 | Princeton, NJ 08542 Email [email protected] The Probuphine Risk Evaluation and Mitigation Strategy (REMS) is unique from other REMS programs in addiction medicine due to its procedural aspect. Its development required years of research, human factors studies, clinical trials, modifications and feedback from FDA. In its final iteration, the REMS program has become a four-hour comprehensive training program delivered by highly experienced “Master Trainers”. Pre-selected participants who attest to procedural experience attend a didactic lecture and observe a porcine-model demonstration of the procedure. Subsequently, participants are required to have intensive, hands-on, step-by-step instruction, followed by evaluation by the “Master Trainers”. Finally, all participants must pass a Knowledge Test and potential Implanters 76 | P a g e and Removers of Probuphine must have passed a procedural competency test under direct observation on the porcine-model. All Health Care Practitioners who prescribe, implant, or remove Probuphine must be certified via this REMS program and tracked in a unique Closed Distribution System. The varied skill sets and backgrounds of those in Addiction Medicine have led to many refinements and adjustments of the training process within the first six months of implementation. This oral symposium will review the evolution of the Probuphine REMS program and the logistics of its first six months of implementation. Learning Objectives: 1. To gain knowledge of the procedural component of the Probuphine REMS Program. 2. To assess the early implementation of the Probuphine REMS Program. Slow Release Oral Morphine (SROM): closing the gap between methadone and diacetylmorphine in OST Author: Robert Haemmig University Psychiatric Services Bern, P.O. Box 52 / Zieglerstr. 7, 8010 Bern / Switzerland Email [email protected] In a prospective, multiple-dose, open label, randomized, non-inferiority, cross-over, multi-center study over two 11week periods and an additional 25-week observation period slow release oral morphine (SROM) was tested against methadone in patients on stable methadone doses of 50mg/d or more. Patients were switched from oral methadone solution to SROM capsules in a ratio 1:6 to 1:8. Both treatments were well tolerated. The methadone induced prolongation of QTc disappeared after a switch to SROM. Patients reported a higher treatment satisfaction, fewer cravings for heroin, and lower mental stress under SROM. Additionally, the metabolism of SROM is independent from liver function. SROM was registered as a substitution medication based on the above mentioned study in May 2013. Since then more than half of the patient in our treatment center wished to switch from methadone to SROM. Clinical experience shows that a too rapid switch to SROM results in an unpleasant histamine reaction. We developed a scheme that avoids this AE. The SROM formulation releases the morphine slowly in the intestines, so the SROM does not cause a rush. All the characteristics and effects taken together, SROM is to position somewhere in between methadone and diacetylmorphine. Learning Objectives: 1. SROM is a safe and more pleasurable alternative in OST to methadone 2. SROM does not prolong QTc 77 | P a g e S22: The taxonomy and concept of behavioural addictions: discussion of controversies and relevance to ICD-11 – Part II Coordinating Author: Susumu Higuchi Email : [email protected] Presentations o Risks associated with the development of diagnostic criteria for behavioral addictions: the case of Internetrelated disorders (Joël Billieux, Catholic University of Louvain, Belgium) o Conceptualizing internet use disorders - how to distinguish healthy engagement from harmful behavior? (Daniel Kardefelt-Winther, Karolinska Institute, Sweden) o Evaluation of the draft diagnostic guidelines for gaming disorder using clinical subjects (Susumu Higuchi, National Hospital Organization Kurihama Medical and Addiction Center, Japan) o Contribution of different diagnostic criteria to the assessment of gaming disorder – What we can learn from the DSM-5 classification of IGD? (Florien Rehbein Criminological Research Institute of Lower Saxony, Germany) Despite the magnitude of behavioural addictions (BAs) worldwide and the associated health and social consequences, these types of disorders are poorly defined and their place in the established diagnostic and classification systems disputed. In ICD-10 only pathological gambling is included as a discrete clinical entity, under “habit and impulse disorders”. In DSM-IV, this was classified under “impulse control disorders not elsewhere classified”. In DSM-5 gambling disorder is now classified under “substance-related and addictive disorders” - a groundbreaking change. Located in section 3, it contains a 9-item criteria set for Internet gaming disorder (IGD). Work on ICD-11 is underway. However, in the beta draft version of ICD-11, pathological gambling is still classified under “impulse control disorders”. Moreover, excessive Internet use has not been included as a disorder in the classification. WHO convened meetings of experts in 2014 (Tokyo) and 2015 (Seoul) to discuss classification and public health issues related to what is often called internet addiction or IGD. Consequently, it was proposed to classify “gambling disorder” under “disorders due to substance use and addictive behaviours” and to develop clinical descriptions and diagnostic guidelines for gaming disorder based on a careful review of current evidence. The resulting draft will be extensively reviewed and field tested for clinical utility, validity and reliability. This round table discussion will facilitate discussion among addiction experts. Learning Objectives: 1. To understand the current status of taxonomy and diagnostic guidelines and/or criteria of behavioural addictions in the ICD and DSM systems 2. To review recent evidence concerning the conceptualization of behavioural addictions and discuss their possible inclusion in ICD-11 Risks associated with the development of diagnostic criteria for behavioral addictions: the case of Internetrelated disorders Author: Joël Billieux Place Cardinal Mercier 10, 1348 Louvain-la-Neuve, Belgium Email [email protected] 78 | P a g e Behavioral addictions research has been particularly flourishing over the last two decades. Consequently, recent publications have suggested that nearly all daily life activities might lead to a genuine addiction. Based on two decades of research on Internet-related disorders, this talk will address how the use of a-theoretical and confirmatory research approaches may result in the identification of an unlimited list of “new” behavioral addictions, and how this approach suffers from both theoretical and methodological shortcomings. The talk will also explain how studies overpathologizing regular daily life activities are likely to prompt a dismissive appraisal of behavioral addiction research. This would be problematic, as the study of excessive forms of behavior seems very valuable in a digital age. Stimuli such as gaming, gambling, erotica, and complex forms of social media are easier to reach than ever and harder to control. References Billieux, J., Schimmenti, A., Khazaal, Y., Maurage, P., & Heeren, A. (2015). Are we overpathologizing everyday life? A tenable blueprint for behavioral addiction research. Journal of Behavioral Addictions, 4, 119-123. Learning Objectives: 1. Critical approach of Behavioural Addiction Diagnostic Criteria 2. Critical approach on pathologization of everyday behaviours Assessment of Internet Gaming Disorder - how to distinguish healthy engagement from harmful behavior? Author(s) Name : Daniel Kardefelt-Winther & Michelle Colder Carras Piazza SS Annunziata 12, 50122 Florence, Italy Email [email protected] The release of DSM-5 saw Internet Gaming Disorder (IGD) included in Appendix III as a potential disorder worthy of future study. Following the inclusion of IGD in DSM-5, a number of researchers have attempted to develop standardized assessment instruments that can capture the proposed criteria and reliably identify the disorder in various populations. However, these assessment instruments tend to recycle substance use disorder criteria and uncritically apply them also in the study of IGD. This is problematic, as there is no evidence that substance use disorder criteria can be used to reliably identify the harms associated with other excessive behaviors. In this presentation, I argue that what is harmful in the context of substance abuse is not necessarily harmful in the context of online gaming. To demonstrate this point empirically, I propose a conceptual distinction between criteria that indicate potentially risky behavior and those that indicate truly harmful outcomes and test this proposal through Latent Class Analysis in a representative sample of 7900 gamers. The results show that a large group of people who endorse many DSM-5 criteria for IGD do not report experiencing harmful outcomes as a consequence of gaming. Furthermore, those who report many harmful outcomes as a consequence of gaming do not always endorse the DSM-5 criteria for IGD. This questions both the sensitivity and specificity of the DSM-5 criteria for IGD and suggests that, at this point, it might be more useful to ask directly about harmful outcomes when assessing IGD. Learning Objectives: 79 | P a g e 1. Identifies problems with IGD criteria for DSM-5 2. Suggests a new approach to assessment of behavioral addictions Evaluation of the draft clinical description and diagnostic guidelines for gaming disorder using clinical subjects Author(s) : Susumu Higuchi, Hideki Nakayama, Satoko Mihara, Kristiana Siste National Hospital Organization Kurihama Medical and Addiction Center, 5-3-1 Nobi, Yokosuka, Kanagawa, 2390841, Japan Email: [email protected] According to a recent review, the prevalence of a condition called Internet use disorder (IUD), varied widely, from 0.8% in Italy to 26.7% in Hong Kong. Despite the magnitude of the problem, globally accepted diagnostic criteria or guidelines for IUD have not yet been established. Recently, the American Psychiatric Association published an updated version of the DSM and included the diagnostic criteria for Internet gaming disorder (IGD) in Section III, as a condition requiring further research. ICD is in widespread use across the world and the development of ICD-11 is currently in progress. However, the beta draft version of ICD-11 does not include IUD or IGD as a disorder. Consequently, WHO convened meetings of experts in the fields of IUD and behavioural addiction in 2014 and 2015, in Tokyo and Seoul, respectively. As a result, a draft clinical description and diagnostic guidelines for gaming disorder (GD), including predominantly online and offline options were developed, based on a careful review of current evidence. We have conducted a study to examine how the draft can be applied, the comparison on applicability between the draft and the IGD diagnostic criteria, and possible associations with other factors, including demographic data, clinical laboratory data, personality characteristics and psychiatric comorbidities using patients with IUD at our center’s specialized outpatient clinic. The results of our preliminary study will be presented in this symposium for discussion on the validity and clinical utility of the draft. Learning Objectives: 1. To understand the draft clinical description and diagnostic guidelines for gaming disorder 2. To discuss the validity and clinical utility of the draft using a clinical study Contribution of different diagnostic criteria to the assessment of gaming disorder – What we can learn from the DSM-5 classification of IGD Author(s): Florian Rehbein Kriminologisches Forschungsinstitut Niedersachsen, Luetzerodestr. 9, D-30161 Hannover Email [email protected] Internet gaming disorder (IGD) was listed in Section 3 of the DSM-5 as a condition for further study. This inclusion was intended to stimulate further research on this condition to determine if it should be classified as a unique metal disorder (Petry, Rehbein, Ko, & O’Brien, 2015). The DSM-5 proposed nine criteria, representing an important first step for standardized classification (Petry et al., 2014). Many of these criteria were adapted from substance use and 80 | P a g e gambling disorder, but further research is needed to ascertain their validity and reliability in the context of gaming. Current research on the DSM-5 criteria for IGD will be presented, which should inform ICD-11. References: Petry, N. M., Rehbein, F., Ko, C.-H., & O'Brien, C. P. (2015). Internet Gaming Disorder in the DSM-5. Current Psychiatry Reports, 17(7), in press. doi: 10.1007/s11920-015-0610-0 Petry, N. M., Rehbein, F., Gentile, D. A., Lemmens, J. S., Rumpf, H.-J., Mößle, T., . . . O'Brien, C. P. (2014). An international consensus for assessing internet gaming disorder using the new DSM-5 approach. Addiction, 109(9), 1399–1406. doi: 10.1111/add.12457 Learning Objectives: 1. To give deeper insight in the intended meaning and diagnostic contribution of the DSM-5 IGD criteria 2. To discuss the DSM-5 IGD in the context of inclusion of gaming disorder in ICD-11 81 | P a g e S23: MARIJUANA, ISAM PHYSICIANS AND PUBLIC POLICY 2016 Dr. Gregory Bunt Email [email protected] Presentations within symposium and Author(s) Name : o o o Marijuana – Decriminalization v. Legalization - Gregory Bunt, M.D Cannabinoids as Medicine- Jag Khalsa, PhD International and Global Consequences of Legalization of Marijuana – Kevin Sabet Marijuana is an illegal drug in most countries around the globe, however efforts to legalize marijuana in a number of countries are gaining momentum. Addiction physicians are consequently are more involved in public policy debates on the subject. This symposium will provide an overview of global developments pertinent to marijuana legalization and decriminalization efforts and the central role of addiction physicians in the respective public policies. The increasing use and abuse of marijuana around the globe raises questions about the impact of this substance on communities, and the role of addiction physicians in influencing public policies. Questions about the safety, toxicity, addictive potential, gateway effects of marijuana are now being fiercely debated, as states in the USA (Colorado and Washington) are legalizing marijuana, and other countries are considering decriminalizing i.e. Uruguay. Furthermore, the "medical" use of marijuana is being permitted by some US states and nations (i.e. Canada) This symposium will provide an overview of the current scientific and clinical controversies and professional opinions pertinent to addiction physicians. It will provide the participants an important historical and international perspective on the subject of marijuana use, abuse and dependency, and the relationship addiction physicians can establish with the public, policymakers and governmental authorities. Learning Objectives: 1. Participants will be familiar with concepts related to the definition of decriminalization and legalization of marijuana 2. Participants will be familiar with global consequences of marijuana legalization Cannabis, pain and addiction: can we learn from the opioid crisis? Dr. Mark Ware Montreal, Quebec Email: [email protected] The proliferation of policies that have eased restriction on access to the use of cannabis for medical and non-medical purposes has caused concern among pain and addiction physicians alike. The absence of large scale controlled trials evaluating the efficacy of cannabinoids in chronic pain management, and concerns about increasing abuse and misuse of cannabis for non-medical purposes, have certain similarities to the rise of opioid use in non-cancer pain management. This session will explore this phenomenon, and point to pharmacovigilance approaches as an option to 82 | P a g e both allow access and identify problem use, and to prevent the scale and severity of complications from the clinical use of this poorly understood drug. Learning objectives: At the end of this session, attendees will: 1. Appreciate the importance of pharmacovigilance approaches to medical cannabis 2. Recognize the complex interaction between opioids and cannabinoids from pharmacology to policy Marijuana Myths, Facts, and the Rise of Big Marijuana Dr. Kevin Sabet [email protected] Harnessing more than two decades of experience in policy, Dr. Sabet, 37, combines humor with science, wit with clarity, and pragmatism with inspiration in this lively presentation. He will talk about the perils of Big Pot -the big tobacco of our time, as Dr Kevin Sabet will argue. Dr. Sabet will go through the latest developments over the battle to legalize marijuana, and will review the latest science about the drug. Dr. Sabet’s presentation is based on his book “Reefer Sanity: Seven Great Myths About Marijuana.” In his presentation he will provide an overview of the current drug policy trends in the United States, and debunk some of the most cited myths about marijuana use, for instance: marijuana is harmless and non-addictive, and legalization will solve the government’s budgetary problems. Dr. Sabet makes the claim that our greatest concern should be the inevitable rise of a second Big Tobacco industry, this time marketing marijuana to our children and youth. He will refer to the already arising problems in Colorado and Washington state as examples. Learning Objectives: 1. Overview of our policy options, describing a smarter, science-based approach to marijuana policy that neither legalizes marijuana nor demonizes its users. 2. Review marijuana policy, the health effects of the drug, and the current political landscape 83 | P a g e S24: Medical Education – part I MEDICAL EDUCATION IN SUBSTANCE MISUSE/ADDICTIONS: International perspectives & study results Coordinating Author: Prof. Dr. Alex Baldacchino [email protected] Presentations within State of the art symposium 1. UPDATE ON THE NEW FULL SPECIALTY IN ADDICTION MEDICINE IN NORWAY (Gabrielle WelleStrand, Norway) 2. PREGRADUATE TEACHING IN ADDICTION MEDICINE IN SWITZERLAND (Barbara Broers, Switzerland) 3. ADDICTION MEDICINE PATHWAYS FOR VALIDATION FOR FAMILY PHYSICIANS AND SPECIALISTS: THE CANADIAN EXPERIENCE. (Nady El-Guebaly) 4. INTEGRATING ADDICTION MEDICINE IN PSYCHIATRY TRAINING (Darius Jokubonis, Lithuania) 5. CAPACITY BUILDING OF GENERAL PHYSICIANS AND LINKAGE TO SERVICE DELIVERY: INDIAN EXPERIENCE (Anju Dhawan) In this dual symposium representatives from all over the world (Norway, Switzerland, Canada, Lithuania, India, Indonesia, Ireland and The Netherlands) will present the current state concerning Addiction Medicine Training (AMT) in their respective countries. In the first symposium the presentations will focus on the development or implementation of AMT for professionals ranging from undergraduate medical students to addiction medicine specialists to non-addiction medical doctors like general practitioners and psychiatrists. Learning Objectives: 1. Participants will learn what goes in the world with regard to Addiction Medicine Training 2. Participants will learn that in the field of AMT interesting educational topics are under investigation and that, based on the results of ongoing research, the methods for AMT can be improved An update: the full medical specialty in Addiction Medicine in Norway Presenter Bjorn-Magnus Simonsen Introduction: In 2012 the Ministry of Health and Care Services decided to establish a full specialty in Addiction Medicine in Norway. The specialty and interim regulations were decided by the Ministry in November 2014. Methods: An evaluation of the present situation concerning the specialty in Addiction Medicine was performed in April 2016. Results: The requirement for the full specialty is five years of internship in accredited institutions and 270 hours of coursework. Three and a half years of internship must be in Addiction Medicine, including one year in a detoxification 84 | P a g e ward, one year in a department for out-patient treatment and half a year in a hospital department for in-patient treatment. One year of training should be in psychiatry. The candidate should be supervised closely in his/her clinical work by a specialist in Addiction Medicine. The evaluation showed that so far 43 specialists have been appointed after interim regulations and an additional 80 specialists will probably be approved within the end of interim regulations in November 2016. 82 doctors have started their training for the full specialty. 19 institutions/hospitals reported that they will apply to become teaching institutions/hospitals before the end of 2016. Discussion: The full specialty in Addiction Medicine in Norway is developing approximately as expected Learning Objectives 1. Learn about the full specialty in Addiction Medicine in Norway 2. Learn about the development of specialists, doctors in training and teaching institutions in Addiction Medicine Pre-graduate Teaching in Addiction Medicine in Switzerland Author: Prof Barbara Broers Unit for Dependencies, Geneva University Hospitals; 6, rue Gabrielle-Perret-Gentil, 1211 Geneva-14, Switzerland Email: [email protected] In 2014 a report on pregraduate training in addiction medicine (mandated by the Swiss Federal Office of Public Health) showed that total number of hours of teaching varied between 14 and 52 hours between the 5 Swiss medical faculties, there was no concept, no coherence and no coordination between the teachings. The report recommended a formal support and coordination for training in addiction medicine in each Medical Faculty, to make sure that substance use and addiction was presented as an essential part of the training of all physicians, and that personal attitudes towards substance use as well as personal substance use in medical students should be addressed. During the preparation of the report, including visits to all faculties and two national meetings, a real interest and enthusiasm to develop a coherent curriculum in addiction medicine had grown. Still, 15 months later no real change had occurred in the faculties and the energy of change had disappeared. The Swiss Society of Addiction Medicine is now developing a core-curriculum including learning objectives and examples of teaching modules for all Swiss universities, with a special emphasis on student’s representations and misconceptions regarding substance use and addiction. This project coincides with a revision of the Swiss catalogue of learning objectives for pregraduate medical students, focusing more on medical competencies. Details of the project will be presented. Learning Objectives: 1. To understand some of the difficulties in introducing a coherent addiction medicine curriculum in medical faculties 2. To learn about possible solutions to make addiction medicine a standard, appreciated and transversal part of medical pregraduate curricula Addiction Medicine in Canada: A Multispecialty Subspecialty Nady el-Guebaly MD, Vice-Chair, Royal College Focus Committee Alberta Health Services Addiction Centre, 1403 0 29 St NW, Calgary AB T2N 2T9 Canada Email [email protected] 85 | P a g e The long road to recognition of Addiction Medicine within the House of Medicine has been further clarified in North America this year. In the United States, the subspecialty of Addiction Medicine will be included under Preventive Medicine alongside Space Medicine, Deep Sea or Hyperbaric Medicine, etc. Other recognized American Board multispecialty subspecialties include Hospice and Palliative Medicine, Sports Medicine and Clinical Informatics. The subspecialty will be open to all 24 member specialty boards of which Family Medicine is one. These developments helped also clarify the Canadian College of Family Physicians and Royal College options. Contrary to some European developments, Addiction Medicine will therefore not become its own independent specialty at this stage, but members of any practice will be able to provide evidence of predetermined common core competencies that may or may not be time related and with an as yet undetermined process of external validation or exam. The next steps in Canada are to confirm the competencies, curricula, accredited training programs and workforce needs as well as the requirements of maintenance of competence without exam. In conclusion we just became a multispecialty subspecialty opened to all College members. The journey continues! Learning Objectives: 1. Update on the Canadian Journey towards subspecialty status 2. Overview of the next steps Integrating Addiction Medicine in psychiatry training Presenter Cor de Jong Addiction becomes more and more integrated in the training of psychiatric residents in Lithuania. Nevertheless there is strong need for more competent doctors to cope with the large number of addicted patients. In 2016 we therefore started with knowledge and skills enhancement with all residents in Kaunas University. Concerning knowledge enhancement the residents had to read recent articles on the definition of addiction, assessment and diagnosis of substance related disorders, epidemiology, burden of the disease, stigmatisation, pathophysiology including genetics and neurobiology, treatment including recovery and psychiatric comorbidity. They presented their critical appraisals during plenary sessions. The quality of the presentations was assessed based on the content and the style of presenting. Furthermore we believe that it essential to work on skills for doctors to work with addicted patients. One of the skills is to learn how to deal with the complex feelings these patients evoke in care givers. Usually it are negative thoughts, feelings or reactions that confirm the stigma that these patients carry with them. So, we started a small group experience with first year residents. In the group we shared their experiences with addiction or problematic use of substances. It could concern patients, someone outside the consulting room, someone close to them or even themselves. The opening question was: ‘What do you think, feel and do in such occasions’? During the symposium we will present the evaluation of the two teaching and learning methods. 86 | P a g e Learning Objectives: 1. Share experiences on knowledge transfer 2. Share experience on improving skills in dealing with negative feelings, thoughts and behavior towards patients with substance related disorders Capacity Building and Linkage with Health Services Author: Anju Dhawan Room 4080, 4th floor,Teaching Block, Department of Psychiatry, AIIMS, Ansari Nagar, New Delhi- 110029 Email : [email protected] Capacity building of medical and paramedical professionals in the field of Substance Use Disorders has been an identified area of priority as part of the Drug De-Addiction Programme of the Ministry of Health and Family Welfare (MOH), Government of India. Efforts in this direction at the National Drug Dependence Treatment Centre (NDDTC) have included development of curricula through a national consensus meeting; development of resource materials for training including a trainer’s manual; conducting trainings; supporting other institutions in the country to conduct trainings and evaluation of the trainings. Based on the evaluations, it was recommended that the strengthening of drug dependence treatment services required modifications and additions in the programme over and above capacity building. These included 1) primarily an outpatient model of treatment at the district level, 2) provision of contractual support staff (doctors, nurses, and counsellors), 3) provision of medicines and 4) sensitization of the key persons in the hospitals as well as local community. It is likely that with adequate monitoring and mentorship, these additions will lead to enhanced treatment seeking and better quality of services in the hospitals where the services have been strengthened. Learning Objectives: 1. Carrying out national capacity building exercise for in-service doctors in substance use disorders 2. What else needs to be done besides capacity building to facilitate service provision 87 | P a g e S25: Treatment with opioid pharmacotherapy in the Middle East: A diversity of approaches. A Panel of Presentations and Discussion Co-Chairs: Richard Rawson, Ph.D., Research Professor, University of Vermont; Professor Emeritus, UCLA. and Traci Rieckmann, Associate Professor, Oregon Health Sciences University. Mailing Address : 1952 Rte 73 Brandon Vermont. 05733 Email [email protected] Presentations: UAE: Clinical considerations for the use of Suboxone within a comprehensive treatment context Presenter: Tarek Abdul Gawad, Medical Director, National Rehabilitation Center, Abu Dhabi, UAE Lebanon: Rapid expansion of buprenorphine use in Beirut. Treatment experiences and considerations about medication diversion. Presenter: Ramzi Haddad, Medical Director, Skoun Addiction Treatment Center, Beirut, Lebanon USA/State of Vermont: A hub and spoke system to organize and facilitate pharmacotherapy for the treatment of opioid use disorders. Presenter: John Brooklyn, MD., Clinical Professor, University of Vermont School of Medicine, Burlington, Vermont. Discussant: Vladimir Pozynak, MD, WHO, Geneva, Switzerland. Learning Objectives: 1. Understand three different models of service organization for the treatment of opioid use disorders. 2. Understand the steps required and challenges involved with the implementation of pharmacotherapy for opioid use disorder Clinical considerations for the use of Suboxone within a comprehensive treatment context Author : Tarek Abdul Gawad, MD, Medical Director National Rehabilitation Abu Dhabi, UAE National Rehabilitation Center, PO Box 55001 Abu Dhabi, UAE Email [email protected] Physicians at the National Rehabilitation Center in Abu Dhabi have been using buprenorphine for the treatment of opioid dependence for over a decade. At the NRC, buprenorphine is used as part of a comprehensive treatment approach within a system of care with a strong rehabilitation emphasis. Patients are monitored closely and are strongly encouraged to attend counseling and other support services. Suboxone maintenance is used selectively with opioid users and the criteria for Suboxone use is described. The presentation will review the extent of buprenorphine use in UAE, the treatment protocol used and the treatment response of patients treated. Measures used to reduce medication diversion will be discussed. Learning Objectives: 1. How the National Rehabilitation Center has developed a treatment approach using Suboxone that promotes recovery from opioid dependence within an intensive treatment context. 88 | P a g e 2. The challenges of using Suboxone with a cultural context in which medication diversion has to be minimized. Rapid expansion of buprenorphine use in Beirut. Treatment experiences and considerations about medication diversion. Author : Ramzi Haddad, MD Skoun AddictionTreatment Center, 97, Monot Street, Nakhleh Bldg., Beirut, Lebanon Email [email protected] Buprenorphine received governmental approval as an opioid treatment medication in 2012. Use of buprenorphine in Beirut has expanded rapidly, with the Skoun Addiction Treatment Center providing a substantial amount of this treatment from outpatient clinics in Central and Southern Beirut. Skoun has championed the expansion of buprenorphine within a framework of harm reduction. Skoun has clinics in central Beirut, as well as in the religiously conservative Southern part of the city. The steps taken to gain acceptance for buprenorphine and other harm reduction strategies will be described. The presentation will describe the nature of the patient population treated, a description of the treatment protocol used and some indications of patient treatment response. The issue of medication diversion will be discussed, along with strategies for addressing this problem. The rapid expansion of buprenorphine and acceptance within the public health community is a model for use of buprenorphine in the Middle East. Learning Objectives: 1. Understand how a community organization played a key role in the governmental approval and implementation of buprenorpine in Beirut 2. Understand how buprenorphine treatment for opioid use disorders is provided within a harm reduction framework and address the issue of medication diversion. The organization of opioid treatment service into a hub and spoke system in Vermont Author : John Brooklyn, MD University of Vermont, Healthcare System, 1 Prospect Street, Burlington, Vermont 05401 Email [email protected] In response to a severe epidemic of prescription opioid and heroin/fentanyl addiction, the State of Vermont has organized its services for the treatment of opioid use disorders (OUD) into regional networks comprised of a hub facility (providing methadone and high intensity Suboxone services) and spokes (primary care settings providing Suboxone and support services). This “hub and spoke” system has resulted in a rapid scaling up of geographically distributed OUD treatment services throughout the state. Elements of the system will be described and strategies for placing patients onto the most appropriate medication and setting will be discussed. Use of learning collaboratives to promote coordination of care will be reviewed. Data will be presented on the impact of these services. Learning Objectives: 1. Understand the rationale and elements of the Vermont hub and spoke system for the treatment of OUDS 2. Understand the steps needed to develop a hub and spoke system. 89 | P a g e S26: Young Investigators Towards improved Addiction Management Services in a low-resource country: staff regard and perceived facilitators for management of Alcohol use Disorders in Malawi Author(s): Beatrice L. Mwagomba1,2,3, Alex Baldacchino2,4, , William Stones2,3, Moffat Nyirenda3,5. 1NCDs and Mental Health Unit, Ministry of Health, Malawi; 2University of St Andrews, Scotland; 3College of Medicine, University of Malawi; Health System, Fife, Scotland; 5London School of Hygiene and Tropical Medicine 4National Medical & Biological Sciences Building, St Andrews, Fife, KY16 9TF Scotland, UK. Email: [email protected] Aim: To assess available health care services and staff perceptions for managing patients with alcohol use disorders (AUDs) in in Malawi, in 2016. Methods: This was a cross-sectional mixed methods study, conducted in out-patient departments (OPDs), noncommunicable disease (NCD) and/or mental health clinics of three specialised psychiatric hospitals, two general tertiary hospitals and four secondary hospitals. A Medical Condition Regard Scale (MCRS) measured individual staff regard for working with patients that present with AUDs among other NCDs such as diabetes mellitus, hypertension, other cardiovascular diseases and mental health disorders. Qualitative data was collected from same MCRS participants through multi-disciplinary focus group discussions. Mean MCRS scores and multi-factor analysis of variance were used to determine factors associated with regard for AUDs relative to other NCDs. Qualitative data transcripts were coded and analysed using NVivo. Results: Analysis is currently in progress. Preliminary results are showing that only the specialised psychiatric hospitals and mental health clinics have guidelines for managing AUDs with various identification tests including: CAGE, SCID and the DSM-IV alcohol module. Regard for working with AUDs was consistently lower than regard for other NCD conditions in general OPDs. Availability of standardised protocols and training were the commonly perceived facilitators for improved management of AUDs. Conclusion: Strengthening the health system for management of AUDs can potentially enhance staff perceptions and competencies, thereby paving way for improved addiction management in Malawi. Learning Objectives: The proposed presentation is expected to help participants to: 1- Learn the health care services available to people affected by harmful use of alcohol and the current implementation challenges in Malawi. 2- Understand that there is potential for improved addiction management services in low resource countries such as Malawi by learning the gaps and recommendations as perceived by implementers. Co-Curricular Drug Abuse Treatment in a University: Implementation and Evaluation Author(s): Bello Abidemi, Onifade Peter, Sotunsa John, Ariyo Moji, Okonkwo Elizabeth, Banjo Olufikayo Babcock University Teaching Hospital, Ilishan, Ogun State, Nigeria Email [email protected] 90 | P a g e Objectives: To evaluate the immediate outcomes of the co-curricular drug abuse treatment program among undergraduates. Methodology: The study was approved by the university’s research ethics committee. The participants were the students who screened positive to urine drug test and hitherto suspended from school to receive treatment but were offered the option of continuing their studies while receiving treatment in the co-curricular treatment program. They had a 12-week outpatient drug abuse treatment based on the Living in Balance core curriculum. The main outcome measures were urine drug test and Addiction Severity Index. The client’s satisfaction and treatment perception were also assessed. Results: The 30 clients comprised of 25 (83%) males. Mean age was 21.3 (sd=2.88). The most common primary drug of abuse was cannabis (66.7%). The rate of retention in the program was 86.7%: The rate of positive urine drug test reduced from 100% pretreatment to 3.8% post treatment. There was 36% - 71% decrease in the domain specific Addiction severity index. There was also significant difference between the pre and post treatment global addiction severity index (z= -0.2845, p=0.004). More than 95% of the clients reported that treatment program was good or excellent and would refer a friend in need of similar help to the program. The mean Treatment Perception score by the clients was 28.95 (sd=6.09, min=17, max=40) out of the maximum obtainable of 40. Conclusions: The co-curricular drug abuse treatment program had immediate positive outcomes. Students with problematic drug use can receive effective treatment alongside their academic program. Learning Objectives: 1. To determine the feasibility of a co-curricular drug abuse treatment program among University undergraduates. 2. To evaluate the impact of a co-curricular drug abuse treatment program among undergraduates in a University system. A Graduated Severity Level Approach to Food Addiction Classification Karren-Lee Raymond (PhD Cand.) School of Social Sciences, University of the Sunshine Coast, Locked Bag 4, Maroochydore DC Queensland. 4558. Australia. Email: [email protected] Objective – To propose and evaluate a graduated severity level approach to food addiction (FA) classification. Research Design and Methods – Four hundred and eight participants with type 2 diabetes (t2d) diagnoses completed a survey including the Yale Food Addiction Scale (YFAS; Gearhardt, Corbin & Brownell, 2009) and demographic questions of t2d status, age, gender, height, and weight. Results – While YFAS symptom count was significantly and meaningfully positively associated with body mass index (BMI kg/m2), four distinct YFAS symptom severity groups were evident: non-food addict (0 to 1 YFAS FA symptoms), mild FA (2 YFAS FA symptoms), moderate FA (3 to 4 YFAS FA symptoms), and severe FA (5 to 7 YFAS FA symptoms). One-way analysis of variance with post hoc tests demonstrated that each severity classification group was significantly different in BMI, with each grouping being associated with increased World Health Organisation obesity classifications. Conclusion – In line with the most recent Diagnostic and Statistics Manual (American Psychiatric Association, 2013), FA can be classified into four severity level groups based on YFAS symptoms count and that this classification has predictive and convergent validity with respect to obesity in people with t2d. This finding has implications for the treatment and prevention of obesity in people with t2d. References: American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author 91 | P a g e Gearhardt, A. N., Corbin, W. R., & Brownell, K.D. (2009). Preliminary validation of the Yale Food Addiction Scale. Appetite, 52, 430-436. doi: 10.1016/j.appet.2008.12.003 Learning Objectives: 1. Review classifications for Food Addiction 2. Review implications for treatment and prevention of obesity in people with Type 2 Diabetes 92 | P a g e S27: Advances in Pharmacotherapy II Pharmacokinetic evaluation of CAM2038 (buprenorphine FluidCrystal® injection depot) q1w (once weekly) and q4w (once monthly) versus intravenous and sublingual buprenorphine in healthy volunteers Author(s): Muna Albayaty, Margareta Linden, Håkan Olsson, Markus Johnsson, Kerstin Strandgården and Fredrik Tiberg Camurus, Ideon Science Park, SE-223 70, Lund Sweden Email [email protected] Introduction: CAM2038q1w and CAM2038q4w are weekly and monthly buprenorphine formulations based on FluidCrystal® technology developed for the treatment of opioid dependence. Objective: To evaluate pharmacokinetics and safety of buprenorphine after subcutaneous administration of CAM2038q1w or q4w versus active controls. Methodology: After randomization, all healthy volunteers received intravenous buprenorphine 0.6mg on Day1 (Groups A–E), once-daily sublingual buprenorphine 8mg (A), 16mg (B) or 24mg (C) on Day8–14, single-dose CAM2038q4w 64mg (A) or 128mg (B) on Day21 or 96mg (D) or 192mg (E) on Day8 or four doses of CAM2038q1w 16mg on Day21, 28, 35 and 42 (C). All subjects received naltrexone (Nalorex ®); 100mg on Day-1 (all groups), 50mg Day1–70 (A, B, C), and Day1–6 and 11–64 (D and E) with 100mg Day7–10 (D and E). Results: 87 subjects were randomized (N=19 each for A, B, and C; N=15 each for D and E). Median buprenorphine tmax after CAM2038q4w was 4–10h (24h for CAM2038q1w); terminal half-life was 19–25days (5days for CAM2038q1w). CAM2038q4w showed dose-proportional buprenorphine release, with similar exposure to repeatdose CAM2038q1w at comparable dose level. CAM2038q1w and q4w showed complete absolute bioavailability versus intravenous buprenorphine, with a 5.7–7.7-fold bioavailability relative to sublingual buprenorphine. CAM2038 formulations were well tolerated. Conclusions: The pharmacokinetics of CAM2038q1w and q4w support weekly and monthly dosing, respectively. Extended buprenorphine release with availability of flexible, individualized doses and durations may provide continuous treatment effect at all stages of buprenorphine maintenance treatment, and also overcome limitations of daily administered buprenorphine formulations. Learning Objectives: 1. This abstract describes a head-to-head comparison of intravenous and sublingual buprenorphine versus the novel buprenorphine formulations CAM2038 q1w (once weekly) and q4w (once monthly) under development for treatment of opioid use disorder 2. The study determined the pharmacokinetics, safety and tolerability of CAM2038 q1w and q4w versus intravenous and sublingual buprenorphine in healthy volunteers under naltrexone blockade A randomized, multiple-dose opioid challenge study to assess blockade of subjective opioid effects by CAM2038 (buprenorphine FluidCrystal® injection depot) q1w (once weekly) in adults with opioid use disorder 93 | P a g e Author(s): Sharon L Walsh, Sandra Comer, Michelle Lofwall, Bradley Vince, Debra Kersh, Marion A Coe, Jermaine D Jones, Fredrik Tiberg, Behshad Sheldon, Sonnie Kim. Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Avenue, Lexington, Kentucky 40508 Email [email protected] Introduction: CAM2038 q1w is a novel once-weekly, ready-to-use, injectable buprenorphine formulation based on FluidCrystal® technology in late-phase development for the treatment of opioid use disorder. Objective: To evaluate the degree of subjective opioid blocking efficacy of CAM2038 q1w in non-treatment-seeking participants with moderate-to-severe opioid use disorder. Methodology: Phase II, three-center, randomized, double-blind, inpatient study. After screening, participants were admitted to clinical research units and stabilized on immediate-release morphine (30 mg po qid). Subsequently, on three consecutive days, test sessions were conducted during which one randomized hydromorphone dose was administered per day (0, 6, or 18 mg intramuscular). Participants meeting a priori specified scoring criteria on positive subjective outcomes in response to hydromorphone were randomized 1:1 to CAM2038 q1w 24 mg or 32 mg onceweekly injections for two weeks (Day 0 and 7). Thereafter, four 3-day hydromorphone challenges were conducted as described above on Days 1–3, 4–6, 8–10, and 11–13. Pharmacodynamic effects, including measures of safety, were assessed throughout the sessions. The primary endpoint was maximum effect (Emax) for the drug liking visual analog scale (VAS), with secondary endpoints of high, good effects, bad effects, sedation, any effects, and desire to use VAS. Plasma samples were collected before each of the 12 sessions to measure buprenorphine concentrations. Results: 47 participants were randomized with 46 completing the study. Mean age is 35 years with 12 (26%) females randomized. Final results from the primary and secondary analyses will be presented. Learning Objectives: 1. Participants will become familiarized with a Phase II study of a novel buprenorphine formulation, CAM2038, as an investigational therapy for treatment of opioid use disorder 2. Participants will understand the concept of opioid blockade, its clinical importance and the degree and duration of blockade efficacy with CAM2038 q1w. Efficacy and safety of CAM2038 (buprenorphine FluidCrystal® injection depot) q1w (once weekly) and q4w (once-monthly) in adult outpatients with opioid use disorder: A randomized, controlled trial. Author(s): Michelle Lofwall, Edward Nunes,, Genie Bailey, Sharon Walsh, Stacey Sigmon, Fredrik Tiberg, Margareta Linden, Behshad Sheldon, Sonnie Kim. 617 West End Avenue, Apartment 1B, New York, NY 10024, USA Email [email protected] Introduction: Buprenorphine (BPN) is an efficacious treatment for opioid use disorder, but suboptimal adherence, exposure and potential for misuse and diversion can undermine its effectiveness. CAM2038 q1w (weekly) and q4w (monthly) subcutaneous injections are novel, ready-to-use, extended-release BPN formulations using FluidCrystal® technology, which may improve effectiveness and reduce need for daily pill taking and diversion risk. Objective: To demonstrate efficacy and safety of CAM2038 q1w and q4w in the treatment of adults with moderatesevere opioid use disorder compared with sublingual BPN/naloxone. 94 | P a g e Methodology: This Phase III, multi-center outpatient study employs a randomized double-blind, active-controlled, double-dummy, parallel-group design. Eligible participants are randomized (1:1) to daily sublingual BPN/naloxone and weekly placebo injections (Group 1) or weekly injections of CAM2038 q1w and daily sublingual placebo (Group 2) for 12 weeks (Stage 1). Participants then transition to monthly visits for 12 weeks (Stage 2); at each visit, Group 1 receives a monthly supply of sublingual BPN/naloxone and a q4w placebo injection, and Group 2 receives a monthly supply of sublingual placebo and a single CAM2038 q4w injection. Individual counseling is provided throughout the study. Urinalysis results, self-report of drug use and other outcome measures are collected at each study visit. The primary outcome is response rate, defined as the proportion of participants with ≥33% of urine toxicology samples collected during Stage 1 and ≥67% during Stage 2 testing negative for illicit opioids (if self-report is positive, the urine test is considered positive). Results: Enrolment is complete (432 participants randomized). Preliminary results will be presented. Learning Objectives: 1. This abstract details a Phase III study of the efficacy and safety of the novel buprenorphine formulations CAM2038 q1w (once weekly) and q4w (once monthly) as investigational therapies for initiation and maintenance treatment of opioid use disorder with buprenorphine 2. The study will evaluate CAM2038 q1w and q4w versus current standard of care (sublingual buprenorphine) in adult subjects with opioid use disorder Modelling the effectiveness of subdermally implanted Buprenorphine, injectable Naltrexone, and sublingual Buprenorphine for clinically stable adults with Opioid dependence Author(s): John A Carter, Ryan Dammerman, Walter Ling, Michael Frost 1315 West 22nd Street #410, Oak Brook IL, 60189 Email: [email protected] OBJECTIVE: To assess subdermally-implanted buprenorphine (SI-BPN) versus injectable-naltrexone (XR-NTX) or sublingual-buprenorphine (SL-BPN) for opioid dependence. METHODS: A Markov model simulated cohorts for 6-12 months (1 month/cycle, clinically-stable patients at baseline). A network meta-analysis of the aforementioned treatments was undertaken to generate probabilities for state transitions governed by treatment effectiveness. Treatment effectiveness was defined as the cumulative proportion of patients without evidence of illicit opioid use. Risks of the following outcomes were modeled with literature estimates specific to Canada in the base case and specific to the United States for comparison: nPatients diverting/misusing, nPatients relapsing, pediatric exposures, detox utilization, suicides/drug-related deaths. Univariate and probabilistic sensitivity analysis assessed the impact of underlying model uncertainty on outcomes. RESULTS: The Markov model illustrated SI-BPN’s effectiveness over XR-NTX (+10%) and XR-NTX over SL-BPN (+5%). Non-oral treatment benefits were driven by reduced rates of diversion/misuse. A greater risk of overdose associated with the XR-NTX versus SI-BPN (+2-6%) drove benefits of the latter. CONCLUSIONS: Investigational SI-BPN may reduce patient- and societal-level burdens of opioid dependence. Although generalization of these findings may be limited by use of indirect comparisons (some using secondary 95 | P a g e outcomes), this model suggests improved morbidity and mortality with SI-BPN treatment relative to XR-NTX and SLBPN. Learning Objectives: 1. To understand how the societal consequences of opioid addiction are largely driven by misuse, accidental use, and diversion of prescribed opioids. 2. To understand the population-level mechanisms by which subdermally implanted buprenorphine, injectable naltrexone, and subdermal buprenorphine may differentially attenuate or exacerbate societal consequences of opioid addiction. C-EDGE CO-STAR: Risk of Reinfection Following Successful Therapy with Elbasvir (EBR) and Grazoprevir (GZR) in Persons who Inject Drugs (PWID) Receiving Opioid Agonist Therapy (OAT) Author(s): Conway B , Dore GJ, Altice F, Litwin AH, Grebely J, Dalgard O, Gane EJ, Shibolet O, Luetkemeyer A, Nahass R, Peng C-Y1, Gendrano IN, Huang H-C, Chen E, Nguyen B-Y, Wahl J, Barr E, Robertson M, Platt HL Vancouver Infectious Diseases Centre 201-1200 Burrard St Vancouver BC V6Z2C7 Email: [email protected] Background: The fixed-dose combination of EBR/GZR 50mg/100mg (NS5A inhibitor/NS3/4A protease inhibitor), is a highly effective, well-tolerated, all-oral, once-daily regimen utilized in diverse populations of HCV GT1/4/6-infected patients, including PWID on OAT. Data on reinfection rates after successful HCV therapy will help inform the development of treatment programs in this population. Methods: The double-blind, placebo-controlled CO-STAR study evaluated the efficacy of EBR/GZR for 12 weeks in treatment-naïve HCV GT1/4/6-infected patients ± cirrhosis ± HIV receiving OAT. Patients were randomized 2:1 to an immediate (ITG) or deferred (DTG) treatment group. Recurrent viremia was evaluated among patients with undetectable HCV RNA at end of treatment (EOT). If this was detected, population sequencing and phylogenetic analysis were performed to distinguish relapse from reinfection. Results: Of 301 randomized patients, 201 were in the ITG (76% male; 15% black; 76% GT1a; 20% cirrhotic; 8% HIV+). Baseline OAT included methadone (81%) and buprenorphine (19%); 62% had detectable drugs on urine drug screen. 197/200 patients had undetectable HCV RNA at EOT. Recurrent viremia was detected in 14 patients, with 7 virologic relapses, and 7 probable reinfections; 5 through follow-up week (FW)12 and 1 at FW24. Three subjects with documented reinfection had subsequent clearance of HCV RNA. Conclusion: Reinfection following successful therapy was seen in some patients as early as FW8. Although subsequent spontaneous clearance occurred in 3/7 cases, further work is needed to identify correlates of reinfection and develop strategies to reduce its occurrence. Learning Objectives: 1. Become familiar with models of care for HCV treatment in patients on opiate agonist therapy 2. Become familiar with the importance of HCV re-infection in this setting 96 | P a g e S28: Food Addictions: New Horizons Coordinating Author: Dr. Gregory Bunt Email [email protected] Presentations within symposium and Author(s) Name : o o o o Introduction, Definition and Overview of Food Addictions - Gregory Bunt, M.D Neurochemical and Neurophysiological Substrates of Food Addictions - Nora Volkow, M.D. Methods of Identification and Treatment of Food Addictions - Mark Gold, M.D. Marc Potenza, MD Behavioral Addictions as spending/gambling, internet, sex and food are increasingly recognized as major public health problems globally and dramatically increase the scope of addiction treatment services that are needed. Food addictions are related to but not directly associated with obesity, cardiovascular disease, cancer and other substance addictions. During this symposium, various perspectives toward a definition of Food Addiction will be advanced. Neurochemical and neurophysiological substrates of food addictions will be illuminated, and finally methods of identification and treatment of food addictions will be described. Learning Objectives: 1. Participants will be familiar with concepts related to the definition of food addictions 2. Participants will be familiar with neurochemical and neurophysiological mechanisms of food addictions Food Addiction: Neurobiological Findings and Clinical and Public Health Implications Marc N. Potenza, M.D., Ph.D. Yale School of Medicine Email: [email protected] Data indicate that some foods may have addictive potential similar to substances of abuse and scales assessing food addiction have been developed. Individuals with binge-eating disorder oftern meet criteria for food addiction and amongst the formal eating disorders, binge-eating disorder may be most similar to substance addictions. In this presentation, neurobiological and clinical data on similarities between binge-eating and addictive disorders will be presented. Findings suggest that approaches helpful in combating drug addictions may be helpful in targeting food addiction and thus may exert a significant public health benefit. Learning objectives 97 | P a g e 1. Identify the distinguishing characteristics of binge-eating disorder and food addiction and how they relate to drug addictions. 2. Understand how shared neurobiological features of binge-eating and substance addictions may relate to treatment outcomes and treatment development. Food, Sugar and Addiction Mark S. Gold, M.D. , DFASAM, DLFAPA Atlanta Georgia, USa Email: [email protected] While best known for his groundbreaking work on the neurobiology of opioid addiction and withdrawal and cocaine neurobiology and addiction, Dr. Mark Gold has pioneered the field of hedonic overeating or pathological attachment to food as an addiction. He first published on food addiction in the early 80s and then subsequently with Princeton Colleagues Bart Hoebel and Nicole Avena and Yale Colleagues Kelly Brownell and Ashley Gearhardt . This work is much less controversial after the conference of national experts was convened at Yale University. This Historic Yale Conference on Food and Addiction served as the basis for Brownell and Gold's Oxford University Press book Still, many silos remain as eating disorders experts and treatment programs often ignore substance abuse and misuse...and vice versa. But, many researchers and clinicians recognize the similarities between food and compulsive overeating and other process addictions such as gambling. Gold and others worked very hard to demonstrate cocaine could be addicting and if so, process could be addicting as well. But what does science show, and how strong is the evidence that food and addiction is an important enough phenomenon that it can help with diagnosis, new medications and approaches and treatment decisions? Dr. Gold will review his 30+ years of work, bring scientific order to the issue of food and addiction, spanning multiple disciplines to create the foundation for what is a rapidly advancing field, and to highlight needed advances in science and public policy. Learning Objectives 1. Review shared mechanisms mean that when drugs are on , food is off 2. Review how Treatment of Obesity may come to resemble treatment of addiction in the office and rehab 98 | P a g e S29: Updates in the Treatment of Trauma, Post-Traumatic Stress Disorder and Addictions Coordinating Author: Kathleen T. Brady, MD, PhD [email protected] Presenters Kathleen T. Brady, MD, PhD Medical University of South Carolina, 125 Doughty Street, Suite 140, Charleston, SC 29403 Email: [email protected] Louise F. Haynes, MSW Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences, 67 President Street Charleston, SC 29425 Email: [email protected] Therese K. Killeen, PhD, APRN, BC Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences, 67 President Street Charleston, SC 29425 Email: [email protected] Traumatic events commonly occur in the lives of individuals with addictions and the sequalae of trauma, including Post-traumatic Stress Disorder (PTSD), can alter the course of addictive disorders leading to difficulties in treatment and poor prognosis. Over the last 20 years, there has been growing recognition of the interaction between trauma and addictions and a number of advances have been made in both pharmacotherapeutic and psychotherapeutic approaches tailored specifically for this group. In this symposium, Dr. Kathleen Brady will provide an overview of the prevalence, presentation and assessment of trauma and PTSD in addictions treatment settings. Dr. Sudie Back will present data from medication treatment trials, including a successful treatment trial using N-acetylcysteine. Dr. Therese Killeen will review data concerning psychotherapeutic treatments, including exposure therapy and mindfulness-based relapse prevention. Finally, Ms. Louise Haynes will discuss the implementation of empirically based practices in front-line treatment settings. Learning Objectives: 1. To learn about state-of-the-art pharmacotherapeutic treatment for co-occurring PTSD and addiction 2. To learn about state-of-the-art psychotherapeutic treatment for PTSD Implementing Empirically-Based Trauma Services: A Challenge for Community Treatment Providers Author(s); Louise F. Haynes, MSW Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences, 67 President Street Charleston, SC 29425 Email: [email protected] Treatment providers face many challenges in implementing empirically-based practices to improve patient outcomes, and integrating effective treatment services for persons who have experienced trauma is no exception. Treatment 99 | P a g e interventions developed in academic settings and proven to be efficacious through randomized controlled trials may require substantial adaptation for use in the real world, due to the contrasting needs of randomized controlled trials (control, fidelity) and clinical practice (adaptability, flexibility). Numerous factors are important predictors of whether a research-based innovation will be adopted, including: intervention characteristics (the type and strength of evidence, and the ease of implementation), contextual factors external to the organization (funding availability and policy priorities), contextual factors internal to the organization (priorities, feasibility, and needs of the patients/clients), characteristics of the individuals involved (opinion leaders), and specific characteristics of the implementation process. An increased awareness of the interconnectedness of trauma, substance use disorders, mental health disorders, quality of life, and overall health has motivated many providers to modify existing substance abuse treatment models to integrate trauma-informed treatment. This presentation will trace the development of traumainformed treatment in the US. Learning Objectives: 1. Describe factors that predict adoption of empirically-based practices 2. Describe the evolution of trauma-informed treatment Update on Psychotherapeutic Approaches for the treatment of comorbid PTSD and SUD Author(s): Therese K. Killeen, PhD, APRN, BC Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences, 67 President Street Charleston, SC 29425 Email: [email protected] The high comorbidity and functional relationship between SUD and PTSD validate the need for integrated therapies that address both disorders concurrently. Over the past several years integrated psychosocial treatment options have become available to address both disorders concurrently in a single treatment episode. Concurrent Treatment for Comorbid PTSD and SUD using Prolonged Exposure (COPE) has been successfully implemented in both combat and civilian populations. Research has demonstrated that addressing PTSD using exposure techniques in the context of SUD recovery does not adversely affect substance use outcomes but rather improvements in PTSD symptom severity can improve SUD outcomes. The safety, retention in treatment and preliminary outcomes of COPE implemented in a group of OEF/OIF veterans with comorbid PTSD and SUD will be presented. Mindfulness meditation, an intervention that addresses emotional dysregulation and avoidance, has shown some efficacy in the treatment of PTSD and SUD, separately. The development of meditation interventions to address both disorders concurrently may be particularly useful for those individuals who have difficulty tolerating exposure techniques. Learning Objectives: 1. Participants will gain a better understanding of the effectiveness of integrated versus sequential psychosocial treatment for comorbid PTSD and SUD 2. Participants will describe evidence based treatment approaches and evolving approaches being developed for the treatment comorbid PTSD and SUD. 100 | P a g e S30: MEDICAL EDUCATION – Part II Coordinating Author: Prof. Dr. Cor De Jong Email [email protected] Presentations within Research results symposium 1. INTERPROFESSIONAL LEARNING: RESIDENTS IN GENERAL PRACTICE MEET ADDICTION MEDICINE SPECIALISTS (Mary Janssen-van Raaij, Cor de Jong) 2. EVALUATION OF THE ADDICTION MEDICINE TRAINING IN INDONESIA: THE ISCAN (Shelly Iskandar, Indonesia) 3. THE EFFECT OF ADDICTION MEDICINE TRAINING ON THE ATTITUDE TOWARDS ADDICTED PATIENTS (Astri Parawita Ayu) 4. ADDICTION MEDICINE TRAINING NEEDS ASSESMENT (AMTNA): COMPARING IRELAND, THE NETHERLANDS, LITHUANIA AND INDONESIA (Jan Klimas, Lucas Pinxten) In this dual symposium representatives from all over the world (Norway, Switzerland, Canada, Lithuania, India, Indonesia, Ireland and The Netherlands) will present the current state concerning Addiction Medicine Training (AMT) in their respective countries. The results will be presented on AMT research/evaluation studies. The following questions will be answered: How can different specialists learn from each other? How does a course on addiction medicine influence the attitudes of medical doctors to their patients with addiction related problems? How do participants of such a course evaluate the course and how can it be improved? Does an addiction related course introduced within the undergraduate medical curriculum influence their perceptions of and stigma towards addicted patients? What are the training needs concerning Addiction Medicine in different countries and how do they differ? The studies are most observational in design, making use of qualitative as well as quantitative data. At the end of the second symposium the role and remit of the ISAM EDUCATION and TRAINING COMMITTEE will be presented. This can be summarized as: to increase and improve the capability and capacity of addiction medicine training and other educational activities. Learning Objectives: 1. Participants will learn what goes in the world with regard to Addiction Medicine Training 2. Participants will learn that in the field of AMT interesting educational topics are under investigation and that, based on the results of ongoing research, the methods for AMT can be improved How doctors can learn from each other: family physician meets addiction physician. Author(s) Name: Janssen van Raay, M.E.²Scherpbier- de Haan, N¹, Pinxten, L², Stappers, H¹, de Jong, C.A.J², 1: Radboud University, Institute for family medicine, 2: Radboud Centre for Social Sciences Hebronstraat 4c, 3061 KC Rotterdam Email [email protected] 101 | P a g e In our healthcare system currently themes are dominating such as multiple morbidities, transmural care, and shared decision making. These themes require professionals well capable of collaborating and communicating with other disciplines¹. These “general competencies” are increasingly important for medical professionals in primary and secondary care. Recently a Dutch platform in medical leadership gave rise to a framework in medical leadership. One of the competencies within this framework is “collaborator”. This competency is defined in Canmeds 2015, as: a physician can work effectively with other health care providers. The medical specialist training offers an opportunity to train multidisciplinary collaboration, by means of interprofessional education². According to the WHO definition this entails professionals from different specialties learning from and with each other. In our educational institute we identified the following problem: Family practitioners need to learn how to deal with patients with problematic substance abuse, and addiction physicians need to learn to share their knowledge. So from the idea of interprofessional teaching we brought together two groups of doctors in the second year of their specialist training for an experiment. The group of family practitioners in training were to raise patient-related questions on addiction matters and the addiction physicians in training were expected to give high standard consultation to their colleagues. After that session, they discussed the quality of their competencies and they filled in a short questionnaire on each other’s achievements. In the presentation the intervention itself will be explained and the first result of 4 groups will be presented. References 1. http://www.royalcollege.ca/portal/page/portal/rc/common/documents/canmeds/framework/the_7_canmeds_r oles_e.pdf. 2. Reeves S, Perrier L, Goldman J, Freeth D, Zwarenstein M. Interprofessional education: effects on professional practice and healthcare outcomes (update). Cochrane Database Syst Rev 2013;3:CD002213. Learning Objectives: 1. Know how the competency of collaborator can be acquired during specialist training 2. Know how to stimulate doctors in training to communicate outside their fields Evaluation of The Addiction Medicine Training In Indonesia: The ISCAN (Indonesian Short Course on Addiction Medicine) Author(s): Shelly Iskandar, Teddy Hidayat, Arifah Nur Istiqomah, Lucky Saputra, Cor AJ De Jong Department of Psychiatry, Faculty of Medicine, Padjajaran University/Hasan Sadikin Hospital, Jl Eijkman no. 38 Bandung 40161, West Java, Indonesia. Email: [email protected] Background: Drug use and HIV cases keep on increasing in Indonesia. Educating health professionals on addiction and HIV topics is a key to target the “national epidemic”. The six month-Indonesian Short-Course in AddictionMedicine (ISCAN) was developed based on the training need assessment and involves addiction professionals from several universities in Indonesia and The Netherlands, mental health hospitals, and National Narcotics Board. The aim of this study is to evaluate the training program for its improvement in the future. 102 | P a g e Methods: The first batch of ISCAN participants were evaluated using pre-test and post-test, homework, video on interviewing their clients, presentation, and final examination. Participants also appraise each module and give feedback on the topics and quality of the lecturers. Results: Twenty-five participants participated in the first batch came from many institutions in many cities in Indonesia. None of the participants were fail to improve. All comparisons of the pre-test and post-test in each module shown significant different (p<0.05). The average of the total pre-test was 65 and the post-test was 80. The skill of participants in evidence based medicine need to be improved. The participants have the highest overall satisfaction to module “monitoring and evaluation” and stated that this module motivated them the most for learning addiction. Conclusion: The course has improved the knowledge and the skill of the participant significantly and overall participants were satisfied with the course. The scale up and the improvement of the course is needed to address the needs of addiction care in Indonesia. Learning Objectives: 1. to evaluate the training program for its improvement in the future The Effect of Addiction Medicine Education on the Attitude towards Patient with Addiction and the Perception of Addiction among Medical Students Author(s): Astri Parawita Ayu, M.D.; Arnt Schellekens, M.D., PhD.; Prof. Cor De Jong, M.D., PhD. Toernooiveld 5, 6525 ED, Nijmegen, the Netherlands Email: [email protected]/[email protected] Background Medical doctors often have negative attitude towards patients with addiction problems, which is related with low knowledge and less experiences, as a result of limited addiction medicine education. The concept that addiction is a chronic relapsing brain disease is not widely known among medical doctors, which is also associated with limited addiction medicine education. Addiction medicine topic in any level of medical education should be improved.1,2 All established addiction medicine education should be continuously monitored and evaluated.2 Objective: Evaluate the effect of addiction medicine education in changing perceptions of addiction and improving the attitude towards patient with addiction among medical students. Method: Participants are fourth-year medical students (n=108) from three blocks: addiction medicine, healthcare entrepreneurship, and palliative care. The Addiction version of Illness Perception Questionnaire and the Medical Condition Regard Scale were used to measure perception and attitude towards addiction, respectively. All participants were asked to fill in questionnaires anonymously, before and after the block. Results: The addiction medicine block participants more attributed hereditary to addiction, they significantly improved their understanding and attitude towards addiction, compared to participants of other blocks (p<.01). References: 1. Ayu AP, Schellekens AFA, Iskandar S, Pinxten L and DeJong CAJ. Effectiveness and organization of addiction medicine training across the globe. Eur Addict Res. 2015;21:223-239. 103 | P a g e 2. El-Guebaly N, Toews J, Lockyer J, Armstrong S and Hodgins D. Medical education in substance-related disorders: Components and outcome. Addiction. 2000;95(6):949-957. Learning Objectives: 1. Improve the understanding of the importance of addiction medicine education. 2. Improve the knowledge in the effect of addiction medicine training in undergraduate medical education. Comparing training needs among addiction professionals across Ireland, the Netherlands, Lithuania and Indonesia using: the Addiction Medicine Training Need Assessment (AMTNA) Author(s): Lucas Pinxten, NISPA, Radboud University The Netherlands and Jan Klimas, British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6; Department of Medicine, University of British Columbia, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6 and School of Medicine, University College Dublin, Coombe Healthcare Centre, Dolphins barn, Dublin 8, Ireland Email: [email protected] BACKGROUND: Addiction science has developed new treatment approaches in response to the growing burden of substance use disorders. Yet, many of them remain underutilised among health professionals primarily due to the lack of adequate training. Very few countries have systematically assessed addiction medicine training needs of health professionals. We compared addiction-training needs of physicians in Ireland, The Netherlands, Lithuania and Indonesia. METHODS: AMTNA questionnaire, designed for the development of competence-based addiction medicine curricula, covering the three main areas of addiction treatment: a) assessment and diagnosis, b) starting treatment and c) maintaining treatment. RESULTS Respondents were addiction medicine-trainees from the Netherlands (n=118), GP-trainees from Ireland (n=136) and psychiatrists from Lithuania (n=69) addiction medicine professionals form Indonesia (n=28). We plan to include additional Dutch post training AMTNA results in June this year and will present besides the socio-economic data, results on differences and similarities in training needs in Addiction Medicine in the 4 countries and additional information about the reliability of the AMTNA. Learning goals: 1. To understand the differences and similarities in training needs in Addiction Medicine in the 4 countries: Ireland, the Netherlands, Lithuania and Indonesia as measured by the AMTNA? 2. To determine the reliability of the AMTNA in this research setting? 104 | P a g e S31: Aspects of Service Delivery Abstinence variations in paid versus free OST services Author(s): Adrian O Abagiu1,2, Raluca Jipa1, Cristina I. Fierbinteanu2, Archontis Koulosousas2, Florin M. Duna1, Affiliation: 1 National Institute for Infectious Diseases Prof. Dr. Matei Bals; 2 Romanian Association Against AIDS. Dr. C. Grozovici street, No. 1, zip code 021105, Bucharest, Romania Email [email protected] OBJECTIVE: We offer now free OST services (for HIV + patients, and pregnant women), full payed services and partial payed services. The partial payed services provides up to 60 mg of methadone daily, without monthly urine testing. In the free and full payed services after a period of 6 weeks patients get take home doses, if they have good urine tests. A positive test except THC leads to loosing privileges. In the holydays the center is closed and all patients receive a 2 weeks prescription. Returning from holiday all are urine screened. As we have only 100 free slots, patients on free treatment lose their slot at the second positive urine test. We wanted to analyze the impact of this services, extending our research from 2010. METHOD: We have analyzed and compared the urine tests results, after the 3 holydays from 2015. At the end of the year we have compared the retention, and quality of life of our 3 groups. RESULTS: Finally we had analyzed 86 free (FP), 90 full paying (fP) and 52 partial paying (pP) patients. As expected the pP had the most MOP/OPI + tests in all periods, but the fP had the most THC + test in each period. After the Christmas holiday we had the most + tests compared to the other two. Compared to 2010, retention was not better in the FP group due to the high mortality through HIV/legal highs effect. The best improvement in the QOL was paradoxically seen in the pP group. Learning Objectives: 1. Offering free opioid substitution treatment improves abstinence 2. In a harm reduction oriented OST, full payment has better results than partial payment The effectiveness of telemedicine-delivered opioid agonist therapy in a supervised clinical setting Author(s): Dr. Joseph K. Eibl, and Dr. David C. Marsh Northern Ontario School of Medicine; 935 Ramsey Lake Rd; Sudbury ON; P3E 6J5 Email [email protected] Objective: Opioid addiction is a major health care issue across North America, and it has been declared a crisis in rural regions of North America. Opioid agonist therapy (OAT) is the standard of care for patients suffering from opioid dependence. Despite the increasing adoption of telemedicine as a delivery method for OAT, its effectiveness has not 105 | P a g e been evaluated against traditional in-person treatment. This study compared treatment outcomes for in-person versus telemedicine-delivered OAT. Methods: We conducted a retrospective cohort study using an administrative database for patients who commenced OAT between 2010 and 2012 across 45 clinic sites in the province of Ontario, Canada. Patients were stratified by primary treatment modality as being: in-person (<25% appointments by telemedicine) or via telemedicine (>75% appointments by telemedicine). The primary outcome was continuous retention in treatment as defined by one year of uninterrupted therapy based on pharmacy dosing records. Results: 5685 first-time OAT patients were identified. Patients being treated via telemedicine were as likely to be retained in therapy as patients being treated in-person (aOR = 0.91; 95% CI 0.80 - 1.02). Telemedicine patients demonstrated a retention rate of 40% (n=3618) at one year whereas in-person patients were retained at a rate of 39% (n=2067). Interpretation: The results of our study demonstrate that telemedicine is an effective method of delivering opioid agonist therapy, and this treatment modality has the potential to be expanded to increase access to care in rural, remote and urban regions. Learning Objectives: 1. Understand how telemedicine delivered opioid agonist therapy can be used to treat patients with opioiddependence 2. Appreciate the limitations of telemedicine delivered care for patients with opioid-dependence. Enhancing the adherence on psychotropic medications in patients with substance use disorders. Author(s): Ahmed N. Hassan & Wiplove Lamba Ahmed Hassan, MD, FRCPC, MPH Centre for Addiction and Mental Health, 100 Stokes Street, Third floor Toronto, ON M6J 1H4, Wip Lamba MD FRCPC Dip ABAM, St Michaels Hospital, 30 Bond St., Toronto, ON, M5B 1 Email [email protected] Background: Psychiatry disorders are common among patients with substance use disorders. Treatment with psychotropic medications is essential for some of these psychiatry disorders. However, unfortunately, non-adherence to these psychotropic medications is a frequent problem. Reviews indicated that more than 50% of patients are considered non-adherent to their prescribed medications (Julius et al., 2009). This is a particular concern in patients with substance use disorders. This non-adherence can lead to several negative outcomes including relapse into substance use, violence, suicide and frequent hospitalization. Methods and aim: This presentation will review several systematic and individual factors that lead to non-adherence to psychotropic medication. It will also review the rates of non-adherence to psychotropic medications in this population. We will use up-to-date peer-reviewed literatures to presents these facts with orientation to several approaches to enhance the adherence on these medications. Results: We will present the demographics, medications, therapeutic and social factors that lead to non-adherence. We will present several factors to enhance the therapeutic alliance to achieve treatment goals. We will also present motivational interviewing techniques to enhance patients’ motivation. Reference: Julius, R. J., Novitsky Jr, M. A., & Dubin, W. R. (2009). Medication adherence: a review of the literature and implications for clinical practice. Journal of Psychiatric Practice®, 15(1), 34-44. 106 | P a g e Learning Objectives: 1. To review the recent rates of non-adherence and the several factors that contribute to this non-adherence. 2. To provide a review of several approach to enhance patients’ motivation including the use of motivational interviewing techniques. Bringing Harm Reduction to the Bedside in an Inner City Acute Care Hospital Author(s): Kathryn Dong MD, MSc, FRCP, DABAM, Karine Meador MD, CCFP, DABAM; Esther Leung BA, BSW, MSW, RSW; Ginetta Salvalaggio MD, MSc, CCFP, FCFP; Elaine Hyshka PhD; Jessica Muller BScRN, MN Room 604-2 CSC, Royal Alexandra Hospital, 10240 Kingsway Avenue, Edmonton AB T5H 3V9 Email [email protected] Despite overwhelming evidence documenting the positive health and social benefits associated with harm reduction practices these practices have limited reach inside acute care settings. Consequently, hospitals are considered highrisk environments for patients with substance use disorders because individuals are often unable to access evidencebased interventions such as sterile injection supplies or naloxone kits. This results in additional morbidity and mortality, as well as placing individuals at risk for premature discharge. Instead of abstinence only policies, a focus on reducing harm during hospitalization is a more ethical approach. The Addiction Recovery and Community Health (ARCH) Team is a specialty consult service based out of an inner city acute care hospital. Since 2014, this team has been integrating a harm reduction approach into routine patient care. Interventions provided by the team include: evidence based treatment recommendations for problematic substance use (including the initiation or maintenance of opioid agonist therapy); treatment of acute pain and withdrawal; provision of sterile injection supplies to patients with ongoing injection drug use during hospitalization; overdose prevention and naloxone training; health promotion interventions (including sexually transmitted infection and blood borne virus screening); and intensive social stabilization (including housing, income and identification). In addition, targeted educational programs have been deployed including rotating inservices, Grand Rounds series, symposia, and the development of local champions. The team is also exploring the feasibility of a managed alcohol program and supervised injection services. This presentation will outline the benefits and challenges associated with incorporating harm reduction strategies into an acute care setting. Learning Objectives 1. Discuss the benefits and challenges of incorporating harm reduction into an acute care setting 2. Develop a plan for the implementation of harm reduction strategies at your local hospital 107 | P a g e S32; Alcohol Can alcohol dependent patients return to reduced drinking levels: what do the data indicate? Author(s): Prof. Karl Mann, MD Central Institute of Mental Health, University of Heidelberg, Germany Email: [email protected] Around 80 to 90% of alcohol dependent individuals who perceive a need for treatment do not get involved mainly because they are not willing or not able to subscribe to the goal of complete abstinence. For this reason harm reduction strategies such as a reduction in alcohol consumption have been tested both in psychotherapy and in pharmacotherapy. Observational studies and controlled trials conclude that abstinence remains the best option. However, reduction of consumption for alcohol dependent patients is possible. Stability of remission seems more likely in subjects reporting less severe forms of the disorder. Evidence based treatment guidelines as well as the guidance papers of US and European authorities have taken note of these developments and accept low-risk drinking limits (FDA) or intermediate harm reduction (EMA) as valuable trial endpoints. Learning Objectives: 1. Review treatment guidelines 2. Review Harm reduction strategies Effect of GABA Extract of Black Sticky Rice with giant embryo on alcohol-related indices after acute alcohol; intake on social drinkers Author(s): Woo-Young Jung, Sung-Gon Kim, Hyeon-Kyeong Kim, Jin-Seong Lee, Sang-Ik Han, Sangmin Choe, and Beung-Gu Son Dept of Psychiatry, pusan National University Yangsan Hospital, Korea Email: [email protected] Background: This study was performed to evaluate the effect and safety of a high-gamma-aminobutyric acidcontaining extract (GABA extract) of black sticky rice with giant embryo (BSRGE) on alcohol-related indices after acute alcohol intake in social drinkers. Methods: Subjects were randomized to the GABA extract (G) group, GABA extract and alcohol drinking (GA) group, or placebo intake and alcohol drinking (PA) group in a double-blind design. All subjects were administered GABA extract (200 mg GABA) or placebo at 9 AM on study days 2 and 3, respectively. Subjects in the GA and PA groups were administered an equivalent dose of alcohol that was diluted in a drinking beverage for a total amount of 240 ml at 11 AM on day 3. Blood alcohol concentration (BAC) and the Biphasic Alcohol Effects Scale were measured just before alcohol drinking, and 6 times after alcohol drinking. Results: The peak and area under the curve (AUC) of the total stimulation scale score after alcohol intake in females were significantly higher in the GAthan in the PA group, whereas no significant difference was found between the 2 groups in males. The peak and AUC of the total score on the sedation scale after alcohol intake in males were significantly lower in the GA than in the PA group, whereas both were significantly higher in the GA than in the PA 108 | P a g e group of females. The AUC for BAC in males was significantly lower in the GA than in the PA group, whereas no significant difference was found in females. No adverse events were reported in any of the groups including the G group. Conclusions: Co-administration of a GABA extract to social drinkers while drinking alcohol is supposed to affect alcohol-related indices in terms of pharmacodynamics and pharmacokinetics and did not induce any adverse events. Learning Objectives: 1. Effect of administration GABA extract on social drinkers 2. Pharmacodynamics and pharmacokinetics of GABA extract Making outcome measurement meaningful: Development and implementation of the Visual ADOM-R© - an outcome measure for the Alcohol & Drug Sector Authors: Dr Susanna Galea, M.D.; MRCPsych; MSc in Addictive Behaviour, Dr Virginia Farnsworth, Dr David Newcomb Dr. Susanna Galea, Clinical Director & Consultant Psychiatrist, Auckland Community Alcohol & Drug Services, Waitemata District Health Board, New Zealand; Honorary Senior Lecturer & Associate Director, Centre for Addiction Research, University of Auckland. [email protected] The measurement of outcomes and health gains is an ever increasing requirement for health providers, in particular addiction treatment. Outcome measures are tools that assess the impact of health services through describing a client’s health status at entry to treatment and also at important/meaningful times throughout a client’s treatment journey. Traditionally outcomes data have been used to inform services and/or authorities that the service being provided is effective in achieving health gains and are value for money. Outcome measurement is becoming more and more consumer focused and is aimed at facilitating clients understanding of their own health status so they can make informed choices on their health and recovery. This presentation discusses how the implementation of routine outcome measures in addiction can provide a reliable measure of the health of populations and outlines the development of the Visual - Alcohol & Drugs Outcome Measure - Revised (Visual ADOM-R©) – an outcome measure designed to facilitate clients’ recovery and person centered planning through the use of a pictorial representation of changes in health status. The Visual ADOM-R© measures outcome pictorially, enhancing client and clinician engagement and making measurement a value process for client, clinician, as well as services. 109 | P a g e S33: ASAM-ISAM Recovery and Addiction: What is It and How Can It Be Measured? Coordinating Author : R. Jeffrey Goldsmith MD Mailing Address : 521 Milton Street, Cincinnati, Ohio, 45202 Email [email protected] Presentations within symposium and Author(s) Name : _Growth and Development in Recovery by R. Jeffrey Goldsmith MD __Addiction and Recovery: A Quality Measurement Dashboard by Yngvild Olsen, MD, MPH ___A Multidimensional Model of Recovery by Ken Roy III, MD Addiction is a chronic, primary brain illness that lasts a lifetime. Like other chronic diseases, science continues to increase our understanding of addiction and how to manage it. Central to this understanding is recovery. Recovery involves discontinuation of substance use, changing lifestyles, identifying relapse triggers, creating a supporting environment, managing co-occurring problems, and emotionally developing from past trauma. Recovery therefore has to include many dimensions. This symposium reviews a multidimensional model that describes Recovery and the scientific support for it, reviews the co-occurring psychosocial deficits that are barriers to the growth and development that is necessary to recovery, and presents a quality measurement dashboard based on the scientific literature that describes quality treatment and how to monitor it. The matrix of standards and measures comes from the Baltimore Heroin Treatment and Prevention Task Force in 2014 that developed a practical measurement of quality and effectiveness of addiction treatment. Learning Objectives: 1. The Learner will develop a multidimensional model of Recovery from Addictive Disease. 2. The Learner will develop a multidimensional model for measuring Recovery from Addictive Disease. Growth and Development in Recovery Author(s): R Jeffrey Goldsmith MD, DLFAPA, DFASAM Name : 521 Milton Street, Cincinnati, Ohio, 45202 Email [email protected] After stabilizing abstinence, people with addictive disorders grow and develop. Emotional and interpersonal maturity depend on childhood experience and trauma. Psychotherapy, working with mentors and relationship partners can help us grow and develop. Regulating moods and healthy relationships are important skills in this development. This talk will detail the phases of Recovery that focus on developing skills for abstinence, relapse prevention, as well as emotional growth and development. Learning Objectives: 1. The Learner can assess mood regulation skills. 110 | P a g e 2 The Learner can assess when to focus on relapse prevention and when to focus on psychological growth. Addiction and Recovery: A Quality Measurement Dashboard Author(s) :Yngvild Olsen MD, MPH 2104 Maryland Avenue, Baltimore, Maryland, 21216 Email [email protected] In October 2014, Baltimore City’s mayor convened the Baltimore Heroin Treatment and Prevention Task Force to address the opioid addiction epidemic facing its communities. The Task Force charged one of its workgroups to identify “solutions for improving the quality and effectiveness of treatment services for individuals with substance use disorders with the goal of improving treatment outcomes.” The workgroup identified the need for a practical, operational way of measuring the quality and effectiveness of addiction treatment. Based on the concept of a dashboard or measurement scale, the group produced a preliminary matrix of standards and measures. Two key frameworks, Prochaska and DiClemente’s TransTheoretical Model of Behavior Change and SAMHSA’s Recovery Oriented Systems of Care (ROSC), informed development of the matrix, in addition to existing standards for addiction treatment and literature reviews. Key items included the use of adaptive care, contingency management approaches, proactive patient engagement through family involvement and other supportive individuals, and repeated and regular measurements of recovery domains including employment, volunteerism, relationships, quality of life, and development of life skills. More work is ongoing to refine the measures for operational application. Learning Objectives: 1. The Learner articulates several dimensions that need to be monitored to create a view of Recovery. 2. The Learner articulates several behavioral skills that are integrated in model of Recovery. A Multidimensional Model of Recovery Author(s): Kenison Roy III MD, DLFAPA, DFASAM Addiction Recovery Resources, 4933 Wabash Street, Metairie, LA, 70001 Email [email protected] The efforts of the professionals who treat addiction have been guided, for the most part, by definitions, such as that in the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM IV, DSM V), that are based on behavior as distinct from biology. A review of the Elements That Define Recovery (Kaskutas, 2014) and a comparison to the ASAM Definition as well as a consensus (Betty Ford) definition may well help expose the need for a different focus on the part of professionals working to treat patients for addiction. A comparison of the Kaskutas Elements, the development of addiction over the life cycle and the ASAM Definition may well suggest a different focus on the part of payers, who have primarily compensated treatment for behavioral definitions consistent with the treatment of Neuroadaptation to drugs or for behaviors of addiction. It is reasonable that a mechanism to help patients move toward achieving Recovery, as defined in the Kaskutas Elements, should instead be compensated. Learning Objectives: 1. Review of the Elements that define recovery 2. Strategies of utilization of newer mechanisms to help patients move towards recovery 111 | P a g e S34: Moving beyond Motivational Interviewing: Using Motivational Communication to facilitate behaviour change to improve outcomes Name of the Coordinating Authors: Kimberly Corace1,2,3 & Melanie Willows1,2 1) The Royal Ottawa Mental Health Centre, Ottawa, Canada 2) Faculty of Medicine, University of Ottawa, Canada 3) Institute of Mental Health Research, Ottawa, Canada 1145 Carling Avenue, Ottawa, ON K1Z 7K4 Emails: [email protected]/[email protected] Presentations within symposium: o What is Motivational Communication and does it improve patient outcomes? o Building an effective relationship between the patient and provider to facilitate change o Applying Motivational Communication skills and concepts to patients with addiction problems o Practicing Motivational Communication skills with challenging patients: Role play exercises Presenters: Kimberly Corace (University of Ottawa), Michael Vallis (Dalhousie University), Kim Lavoie (Université du Québec à Montréal), Tavis Campbell (University of Calgary), Simon Bacon (Concordia University), Catherine Laurin (Hôpital du Sacré-Coeur de Montréal) Motivational communication (MC) is an empirically-validated client centered communication approach, which integrates motivational interviewing (MI) along with other well-established behaviour change theories and guiding principles. MC has become increasingly popular within health care settings, especially when working with patients with addiction problems. MC includes a broad set of evidence‐based, patient‐centered techniques designed to address and promote readiness to change, implement effective behaviour change strategies, and integrate change into the patients’ psychosocial context and lifestyle. The focus of this session will be on building providers’ skills to optimize health outcomes for patients with addiction problems. This symposium will: (1) describe MC and review the evidence that MC is an effective intervention for patients with addiction problems, (2) illustrate the development of a successful change-based relationship between the provider and the patient, (3) discuss the main MC principles and skills, including how it differs from MI and its applications to patients with addiction problems, and (4) demonstrate the use of MC skills with resistant and challenging clients. Small-group breakout sessions will be conducted for role play exercises with constructive feedback. The presenters are members of the Executive Team of the Canadian Network for Health Behavior Change and Promotion (Can-Change). Can-Change is a pan-Canadian network comprised of academic and practice leaders in the area of behavioural medicine. Specifically, the group has expertise in the design and delivery/dissemination of health behavior change interventions (i.e., motivational communication). They have expertise and experience in developing and delivering evidence-based health behaviour change training programs to thousands of physicians and nurses across multiple disease areas, including alcohol and substance use problems. They have pulled together their expertise to form CAN-change to improve the standardization, quality, and availability of health behaviour change training programs and interventions across Canada and internationally. Learning Objectives: 1. Describe Motivational Communication as an effective evidence-based intervention to facilitate change in patients with addiction problems 2. Demonstrate the use of Motivational Communication skills and apply them to challenging patients with addiction problems 112 | P a g e S35: Aboriginal Communities II Suicide and Harm Reduction in Aboriginal Communities, Hudson Bay, Northern Canada Author(s): Arnold J. Hill, MD, M.Sc., FASAM (Presenter), Charleen Banyan, MD. CCFP from Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA and Weeneebayko General Hospital, Moose Factory, Ontario, Canada. Marlborough Medical Center, 320 Bolton Street, Marlborough, MA 01752 Email [email protected] Arnold Hill, M.D., M.Sc., FASAM and Charleen Banayan, M.D., CCFP, from the Suicidal ideation, attempts, and completed suicides involve alcohol in over 80% of cases in this sub-arctic region. Binge and chronic drinking are closely associated with suicidal behaviors in our studied populations. Established treatments such as AA, counseling, and acute detox appear to have little impact in these isolated and small communities. With the suicide rate 34% above the Canadian average, several newer treatment modalities were introduced between 2010-2015: 1) Native Healing Programs 2) Brief Intervention in the ER and SBIRT 3) Help telecommunication and messaging 4) contagion containment 5) courses in effective intervention skills and prevention network development. Our 3 year brief intervention study shows a 30% reduction in binge drinking. Other findings are similar to studies done in various international settings. While reduction in medical morbidities and ER utilization can be associated with decreased alcohol intake, a reduction in suicidal behavior and completed suicides in the studied communities correlates with a reduction in binge drinking. Autopsy data suggests a gradual downward trend in suicidal behaviors and completions in the studied communities. Learning Objectives: 1. To appreciate the scope of self-harm and suicide among aboriginal populations in sub-arctic Canada. 2. Understand the effectiveness of brief intervention in reduced binge drinking and the impact of that reduction on self-harm, completed suicides, and autopsy data. Evaluating the impact of cocaine use in opioid agonist therapy in Northern and rural regions of Ontario Author(s): Alexandra Franklyn, Dr. Joseph Eibl, Dr. David Marsh 935 Ramsey Lake Road, Sudbury, ON, P3E2C6 Email: [email protected] Objective: The proposed study aims to determine the effect of varying levels of cocaine use on patient retention in opioid agonist therapy in Northern and rural regions of Ontario. Methodology: We conducted a retrospective cohort study using anonymized electronic medical records from 48 OAT clinics in Ontario. This dataset consists of roughly 27,000 patients receiving OAT between 2003 and 2013. 113 | P a g e Patients were categorized into one of four cocaine use groups: no use, use at initiation and throughout treatment, use at initiation but not throughout treatment, and no use at initiation but use throughout treatment. Comparing opioid agonist therapy retention rates across these four groups is the primary outcome of interest. The stratified cohorts will be used to determine if patients seeking opioid agonist therapy have a greater probability of positive treatment (defined as one year uninterrupted treatment) based on their cocaine use. A Kaplan-Meier survival analysis will be performed to determine time to discontinuation on each patient who has started opioid agonist therapy in the time frame. If treatment is interrupted for more than 30 consecutive days, the patient will be defined as having left therapy. Statistical analysis will be performed on the proportion of patients who complete uninterrupted opioid agonist therapy for one full year. Descriptive metrics will be used to characterize each patient group. Descriptors will include age, sex, income quintile, prior drug use, among others. Unadjusted and adjusted regression models will be utilized to determine odds ratios between stratified cohorts. Results and conclusions will be discussed. Learning Objectives: 1. To understand how varying levels of cocaine use impacts opioid agonist therapy retention 2. To understand how cocaine use differentially impacts treatment retention based on geographic location 114 | P a g e S36: Substances and Psychiatric Disorders/Psychosis Distinguishing the Psychotic Features of Cannabis and Amphetamine-type Stimulants Author(s): Fares Alharbi, Nady el-Guebaly Mental Health Dept.; King Abdulaziz Medical City, P.O. Box 22490 Riyadh 11426, Saudi Arabia Email [email protected] Background: The recent escalation of cannabis and amphetamine-type stimulant(ATS) use throughout the world and its association with psychotic symptoms in users has fuelled special concerns Objective: This review will present an update on cannabis and ATS’s associated psychotic features Method: A systematic literature search was conducted from 1980 to date in the following databases: MEDLINE, PsycINFO and PubMed. Articles were included if they were highlighting substances induced psychoses, with particular emphasis on stimulants/amphetamine/methamphetamine and cannabis/marijuana induced psychoses, schizophrenia-spectrum disorder or schizophrenia. Results: There are many differences between these two substances regarding source, neurobiological processes, urine screening test, average latency periods before developing psychosis, clinical features as compared to schizophrenia, risk of using drugs and developing psychosis and drugs use & development of schizophrenia. With the recent proposals to regulate cannabis use, a further investigation of the association of this use with psychosis is required. Conclusions: Our search elicited many studies of one substance and its association with psychosis but few comparative studies across substances. Yet in our opinion, these comparisons could shed further insight on the development of psychotic features Learning Objectives: 1. 2. Identify the main features of cannabis and amphetamine psychoses Identify the main clinical relevant differences Cannabis induced psychotic disorder and cannabidiol’s purported antipsychotic properties: The state of the evidence. Author(s): Robert Tanguay, Nady el-Guebaly 6th Fl. North Tower, Foothills Medical Centre, 1403 19 Street, NW, Calgary, AB, T2N 2T9 Email: [email protected] Introduction: This presentation will review the effect of cannabidiol (CBD) in regards to psychosis, schizophrenia, and it’s plausibility as a treatment for psychosis. 115 | P a g e Methods: We reviewed the literature that proposes the mechanisms of cannabis induced psychotic disorders and hence increases the risk of early onset schizophrenia. A PubMed search was completed from 2000 to present for English language articles. Results: There have been recent studies showing psychosis is secondary to the THC in marijuana, more striking is that 69 studies were found showing CBD may be protective and actually have antipsychotic properties equal in efficacy to atypical antipsychotics such as amisulpride, including 8 clinical trials. One of the most worrisome risks is the contribution to the onset of schizophrenia in children and adolescents using marijuana. This leads to a significantly poorer prognosis than adult onset. The percentage of THC is much higher today than in the past and certain formulations have been able to even further concentrate THC such as ‘shatter’, ‘wax, ‘honey oil’, etcetera. Complicating this is that CBD is almost nonexistent in street marijuana. Due to Mendelian genetics, as THC concentration is increased CBD concentration is inversely reduced. This eliminates the protective factors of CBD while increasing the risk of psychosis. THC and CBD seem to have opposite physiologic effects on endogenous anandamide levels and cannabinol receptor binding, the mechanism likely leading to CBD’s antipsychotic effect. Conclusions: Early evidence shows that CBD may be a novel and viable treatment of psychosis. This may have an effect on the regulation of CBD and THC percentages in regards to the prevention of early onset schizophrenia. Learning Objectives: A review of the possible mechanisms of THC and psychosis. 1. CBD’s mechanism as a possible anxiolytic and antipsychotic. 2. Effect of CBD and THC in combination. Efficacy of Psychostimulant Interventions for Amphetamine and Methamphetamine Use Disorders: A Systematic Review & Meta-Analysis Author(s):Meha Bhatt, Laura Zielinski, Lola Baker-Beal, Neera Bhatnagar, Zainab Samaan 7677 Priory Cres. Mississauga, ON L4T3H6 Email: [email protected] Background: Psychosocial interventions are used to manage amphetamine and methamphetamine use disorders (AMD) but it remains difficult to retain patients in treatment (1). Psychostimulant maintenance interventions have been investigated, in combination with psychosocial interventions, to improve treatment outcomes. Objectives: Summarize evidence for the efficacy and safety of psychostimulant drugs for management of AMD. Methodology: We searched MEDLINE, EMBASE, PsycINFO, Cochrane Central, and CINAHL for RCTs examining the efficacy of psychostimulant drugs for AMD, in comparison to placebo. No restrictions were placed on age and studies within sub-populations were included. Screening and data abstraction were conducted in duplicate. Metaanalyses were performed, when possible, and risk of bias was assessed for individual studies and overall quality of evidence. Results: Seventeen trials were included in the review (6 studies of bupropion, 6 of methylphenidate, 3 of modafinil and 2 of dexamphetamine). Psychostimulant treatment showed no significant difference compared to placebo for amphetamine and methamphetamine use measured as mean negative urine screens (mean difference -0.16, 95% CI -1.96 to 1.64), or treatment retention (odds ratio 1.11, 95% CI 0.73 to 1.68). Incidence of serious adverse events did not differ between treatment and placebo groups. 116 | P a g e Conclusions: The findings do not support the use of psychostimulants for managing AMD. The quality of evidence for all outcomes was very low. It remains challenging to conduct trials in this area due to difficulties in ensuring medication adherence and trial completion. References Shearer J. Psychosocial approaches to psychostimulant dependence: a systematic review. Journal of substance abuse treatment. 2007;32(1):41-52. Learning Objectives: 1. Clinical applicability of findings from updated systematic review of psychostimulant use for the management of amphetamine and methamphetamine use disorders 2. Systematic evaluation of literature using GRADE approach and challenges with conducting randomized controlled trials in this area Examining the Association Between Psychiatric Disorders and Cocaine Binge: Results From the COSMO Study Author(s): Louis-Christophe Juteau, Élise Roy, Djamal Berbiche, Nelson Arruda, Julie Bruneau, and Didier JutrasAswad CHUM c/o Dr Louis-Christophe Juteau, 264 Boulevard René-Lévesque, 10e étage, Montréal, Qc, H2X 1P1 Email [email protected] Background: Cocaine binge and mental health problems have been identified as significant risk factors for blood borne infections. Little is known about the relationship between mental health and cocaine binging. The aim of this study is to examine the association between psychiatric disorders and cocaine binging. Methods: Participants were part of a prospective cohort study of individuals who either smoke or inject cocaine. The main outcome, last month cocaine binge, was defined as the use of large quantities of cocaine, repetitively, until the individual was unable to access more of the drug or was physically unable to keep using. Psychiatric disorders were assessed using the CIDI (past 12-month mood and anxiety disorders) and the DIS questionnaire (antisocial personality disorder (ASPD)). Logistic regression models were carried out, one for each disorder, adjusting for age, gender, homelessness, income and severity of cocaine dependence. Results: Of the 492 participants, (86.6% male, 53.7% ≥40 years old),24.4% reported at least one cocaine binge episode during the prior month. 48.0% of the sample met the criteria for ASPD, 45.5% for anxiety disorders and 28.2% for mood disorders. Participants with ASPD were more likely to binge (Adjusted Odds Ratio: 1.69, 95%CI: 1.08-2.67). Anxiety disorders were significantly associated with cocaine binging only in univariate analysis and mood disorders were not. Conclusion: ASPD increased the odds of reporting cocaine binging in our study population. These results highlight the need to better understand specific dimensions of ASPD that are involved in the increased risk of unsafe drug use behaviors. Learning Objectives: 1. Learn about the association between binge drug use and mental health 2. Understand how mental health disorders are related to cocaine binge behavior in the COSMO study 117 | P a g e S37: Men who have sex with other men: addressing substance misuse and sexual health Mathieu Goyette & Jorge Flores-Aranda Email : [email protected]; [email protected] Presentations within symposium and Author(s) Name: o Substance use and sexual risk behaviors profiles among men who have sex with men tested for HIV at SPOT, a community-based rapid testing intervention in Montreal, Bertrand, K., Otis, J., Haig, T., Veillette-Bourbeau, L., Ortiz Núñez, R., Wainberg, M. and the SPOT Study Group (Montréal) o Mon Buzz: An online brief intervention on substance use and sexual health with men who have sex with men: development and implementation process, Goyette, M., Flores-Aranda, J., Ortiz Núñez, R., & Bertrand, K. (Montréal) o Addressing sexuality with gay/bisexual/queer men using crystal meth, Francoeur, V. (Toronto) o Understanding syndemics and addiction in gay male populations, Purdie, A. (Vancouver) Symposium Abstract Frequently, men who have sex with men (MSM) use psychoactive substances during their sexual activities and their substance use is associated with risky sexual behaviors. Few services in the field of addiction or sexual health offer comprehensive interventions tailored to their needs and to their sexual orientation. Moreover, MSM who use psychoactive substances are a difficult to reach population. This situation calls for a better understanding of the access to addiction services and of the nature of services offered to this population. This symposium aims: 1) to make a state of the art on the links between substance use and sexuality among MSM; and, 2) to describe some innovative comprehensive interventions implemented in three Canadian cities (Montreal, Toronto, Vancouver) surrounding substance use and sexuality among MSM. This symposium brings together knowledge users and researchers conducting four separate interventional projects with MSM who use psychoactive substances. The projects involve development, implementation and impact evaluative methodologies. All these projects are based on participatory approaches and are at different stages of development. Substance use and sexuality among MSM will be discussed from different perspectives: project development issues, social acceptance of drug use and sexual minorities, applicability of innovative projects in various context, and issues for research. Learning Objectives: 1) To know the specific interventional issues of psychoactive substance misuse among MSM. 2) To describe innovative initiatives developed to work with MSM who use psychoactive substances and the winning conditions for development and implementation associated with such initiatives. “MON BUZZ”: An online brief intervention on substance use and sexual health with men who have sex with men: development and implementation process 118 | P a g e Author(s): Mathieu Goyette et Jorge Flores-Aranda Université de Sherbrooke – Campus Longueuil, 150 place Charles-Le Moyne, bureau 200, Longueuil (Qc), J4K 0A8 Email [email protected] Men who have sex with men (MSM) have specific characteristics in terms of substance use (SU) and their addiction service’ needs. Sexual health, more specifically the interaction between their SU and their sexual behaviors, sexual disorders, identity and wellbeing, is one central need of MSM substance users. Putting together expertise from addiction and sexual health fields in an integrated service represents an important challenge for this population. This presentation aims to share the development and implementation process of “MON BUZZ”, a web-based intervention targeting MSM substance users. MON BUZZ has been developed by different stakeholders from addiction and sexual health fields working with MSM. The project, which is based in an adapted version of the Screening, Brief Intervention, and Referral to Treatment (SBIRT) model, aims: 1) to raise the awareness of MSM regarding the risks and harms of their SU and the link between their SU and their sexuality and 2) to offer, if necessary, brief and comprehensive interventions and to refer them to local MSM or addiction adapted services. Specific assessment and feedback components have been developed about the link of sexuality-SU. The web-based interventions are tailored to their needs related to their substance use and their sexuality and the respective stage of change in which they currently are. The interventions are divided into two paths based: a completely computer-based intervention and a web-based brief intervention completed in real-time chat interactions with a trained counsellor. Main implementation challenged related to web-based intervention and integration of two fields is discussed. Learning Objectives: 1. To learn about an assessment and feedback tools on the influence of substance use on sexual health. 2. To understand the issues related to implementation of a web-based comprehensive intervention with MSM. Substance use and sexual risk behavior profiles among men who have sex with men (MSM) tested for HIV at SPOT, a community-based rapid testing intervention site in Montreal Author(s): Bertrand, K., Otis, J. Haig, T. Veillette-Bourbeau, L., Ortiz, R, Wainberg, MA., and the SPOT Study Group Mailing Address: Université de Sherbrooke – Campus Longueuil, 150 place Charles-Le Moyne, bureau 200, Longueuil (Qc), J4K 0A8 Email [email protected] HIV prevention strategies used by MSM have become more complex. Participants at SPOT, randomized to standard counseling or motivational interviewing groups, were asked about their substance use and sexual risk behaviors. Aims of this study were to describe the substance use profile among 915 SPOT participants and to examine the associations between substance use and sexual relations before protected or condomless anal intercourse with men of unknown HIV status or HIV-positive men with detectable viral load. Descriptive analyses were completed to describe substance use before sexual intercourse. Univariate regressions were performed with the subsample of those who had anal intercourse during the preceding 3 months (n=828). 22.8% reported substance use before sexual intercourse half of the time or more during the preceding 3 months. Proportions of alcohol and other drugs use varied depending on the substance: Alcohol (17.8%), marijuana (6.1%), poppers (2.1%), cocaine (1.9%), GHB (0.8%), ecstasy/MDMA (0.4%), methamphetamine (0.3%). The probability of reporting condomless anal intercourse increased among those who reported poppers (adjusted odds ratio [ORa]: 3.364, p=0.15) and marijuana (ORa: 1.823, p=0.032) before anal intercourse, at least half the time during the preceding 3 months, after controlling for 119 | P a g e confounding factors. Taking into account interrelations between substance use and sexual risk behaviors is necessary for effective HIV prevention strategies. Exploration of participants’ experience about psychoactive effects and context of substance use before and during sexual intercourse, especially among regular users of poppers and marijuana, could improve tailored interventions for MSM individual needs. Learning Objectives: 1. To understand interrelations between substance use and sexual risk behaviors among men who have sex with men (MSM) 2. To discuss implications of the results to improve HIV prevention strategies Addressing sexuality among gay, bi, and queer men using Crystal Meth Vincent Francoeur 4th Floor, 543 Yonge St, Toronto, ON M4Y 1Y5 Email [email protected] In order to address Mental Health and substance use amongst gay man, ACT has developed 4 new group-based counselling programs. These 8 weeks programs are offered to any gay, bi or queer cis and trans men and incorporate treatment modalities such as Cognitive Behavioral Therapy (CBT) and Motivational Interviewing (MI). One of the 4 new programs focuses on sexuality amongst cis and trans gay, bi, queer men using Crystal Meth. Use of crystal methamphetamine amongst men who have sex with men has been linked to unprotected sex, sex with multiple partners, sex with partners of unknown status, and a number of other risky sexual behaviors that may facilitate transmission of sexually transmitted and blood borne infections. Crystal meth is highly linked to sexuality, as it increases the feeling of personal attractiveness and sexual confidence, and creates a quick and strong addiction, notably making sober sex challenging to enjoy. In addition, gay, bi and queer men using crystal meth are faced with very high levels of stigma, even when participating in other substance use and harm reduction groups. ACT runs a 6week harm reduction group on substance use called Spunk!, and we identified the need for a group that addresses both sexuality and crystal meth use among gay-bi-queer men. This new trauma informed program offers a safe space for participants to explore their relationship with substance use, body image, stigmatization and crystal meth use. Learning Objectives: 1. To learn about the implementation of a six week harm reduction program targeting MSM who use crystal meth 2. To share experiences and challenges regarding the program implementation A syndemic based understanding of addictions in gay male contexts Aaron Purdie #310 - 1033 Davie Street Vancouver, B.C. V6E 1M7 Email [email protected] 120 | P a g e The intersections between sexual health and other determinants of health add complexity to existing frameworks of addiction treatment for gay men. Health professionals do their best to address the unique needs of gay male populations, and the emergence of higher-quality queer-focused substance use studies contribute to overall higher potential for good care. Syndemics theory shows a clear connection between experiences of marginalization, and other social and psychological health problems; considerations that might go un-noticed without recognition, and location as an essential part of treatment. Based on the observations above, and to support community health care professionals, HIM has developed a course designed to prime practitioners with a syndemics based understanding of gay men's mental health. In addition to this, an online resource and campaign has been developed to celebrate and promote and celebrate individual mental health self-work and resiliency. A framework of the course and resource will be presented along with some of the successes and challenges encountered. Survey and evaluation data will be presented with examples and suggestions for future interventions. Learning Objectives: 1. To understand the intersections between determinants of health, sexual health and addiction among gay men 2. To share the experiences regarding the implementation of a course designed to practitioners with a syndemic based understanding of gay men’s mental health 121 | P a g e S38: Opioid prescribing education Improving opioid prescribing with an educational and self-monitoring strategy in primary care Pamela Leece UHN-Toronto Rehabilitation Institute, 550 University Avenue, 2-019-1, Toronto, Ontario, M5G 2A2 Email [email protected] Presentations within symposium and Author(s) Name : n/a – see abstract below Symposium Coordinators: Pamela Leece, Dalla Lana School of Public Health, University of Toronto Caitlyn Timmings, Li Ka Shing Knowledge Institute of St. Michael’s Hospital Daniel Buchman, University Health Network Aaron Orkin, Dalla Lana School of Public Health, University of Toronto Meldon Kahan, Women’s College Hospital Andrea Furlan, University Health Network For the Safer Prescribing of Opioids (SPO) Team: Investigators: Dr. Daniel Z. Buchman – Bioethicist, UHN Dr. Andrea Furlan – Physician Scientist, UHN Dr. Michael Hamilton – Consultant and Medication Safety Specialist, ISMP Canada Dr. Meldon Kahan – Medical Director, Substance Use Service, WCH Dr. Pamela Leece – Family Physician and Resident, Public Health and Preventive Medicine, U of Toronto Dr. Nav Persaud – Family Physician, St. Michael's Hospital, Toronto Dr. Beth Sproule – Clinician Scientist and Advanced Practice Pharmacist, CAMH - Project management: Yalnee Shantharam - Project administration: Gina Marinakos - KT Consultant Team: Dr. Sharon Straus, Dr. Julia Moore, Caitlyn Timmings Drug-related harms in North America have reached unprecedented levels, and this rise has largely been driven by increasing use of prescription opioids. Despite a number of clinical practice guidelines developed to improve opioid prescribing, there remains a wide range of variability in opioid prescribing and co-prescription of other sedating medication. To improve the adoption of opioid guidelines, we used implementation science and behaviour change theory to design an intervention for primary care. Using practical educational and self-monitoring tools, prescribers receive feedback on their opioid knowledge and current prescribing behaviours, which they can use to develop safer medication practices. This intervention has implications for national application of opioid quality improvement tools in primary care settings and health system quality improvement indicators. Practitioners in addiction medicine have a unique perspective of population harms related to prescription opioids. We will seek the perspectives of experts in addiction medicine, as a key stakeholder group, in efforts to improve primary care opioid prescribing and inform the spread and scale up of intervention activities. This session will take two parts: (1) a plenary session with information about prescribing factors contributing to opioid-related harms, facilitators and barriers to guideline adherence, and evidence-informed, theory-driven interventions to influence prescribing behaviour; and (2) a focus group discussion on perceived barriers and facilitators to using our intervention to improve opioid prescribing practices in primary care. We will seek ethics approval for the study and informed consent of all participants. The insights from participants will be used to enhance the pilot intervention. 122 | P a g e Learning Objectives: 1. Outline the development of an educational and self-monitoring intervention designed to assess and enhance adherence to Canadian opioid guidelines in primary care. 2. Identify relevant facilitators and barriers to implementing an educational and self-monitoring intervention in primary care. 123 | P a g e S39: Homelessness, Recovery and Prevention A hepatitis C treatment program for homeless patients Author(s): Pierre Lauzon MD, Marie-Guétie Vieux inf. Centre hospitalier de l’université de Montréal (CHUM), Service de médecine des Toxicomanies (SMT), 1058 St-Denis, Montréal Qc Canada H2X 3J4 Email: [email protected] Being homeless increases the risk that a substance user will become infected with hepatitis C. Moreover, people who experience residential and social instability are less likely to access health care and to comply with medical recommendations if they do seek care. Given these unique characteristics of homeless people, investigation and treatment of hepatitis C in this population requires an approach tailored to their needs. We established a hepatitis C treatment program for homeless patients in collaboration with the Old Brewery Mission (OBM) shelter in downtown Montreal. OBM houses clients in a 14 bed “medical” unit and each person has a bed in a cubicle with a locker and access to a shared living room and kitchen. As part of the multifaceted program, a counsellor from the Mission offers psychosocial services. Also, a nurse from the service de médecine des toxicomanies (SMT) is present 30 hours per week and art classes and other activities are offered. Finally, when patients complete the intervention and transition to stable housing, a 500$ bursary is given to them. Comprehensive health care including psychiatric services are offered at the SMT outpatient clinic, which established a hepatitis C clinic in 2010 targeted at patients with substance use disorders. The first patient entered the treatment program in May 2014. Since then, 93 homeless patients have been evaluated and 54 were admitted into the program for different periods of time. Descriptive data on the participants and their treatment episode will be presented and discussed. Learning objectives 1- Hepatitis C treatment in homeless patients with comorbidity 2- Organisation of care for homeless patients Addiction-treatment and recovery programming from patients perspectives: Exploratory focus groups of homeless patients with addiction and mental health disorders Author(s): Ashok Krishnamurthy, MD CM CCFP dip ABAM, John Young, MD; Joyce Mak, MA; Edwin Chu, MB BCh BAO AAPRICOT Program, 412 Queen Street East, Toronto, ON, M5A 1T3 Email: [email protected] Addiction and mental health disorders are highly prevalent in homeless populations (1). There is limited research into examining patient-perceived needs in addiction treatment and recovery programming, although consideration is being given to reflecting patient-needs in program design in marginalized populations (2). 124 | P a g e The objective of this study was to conduct a needs-assessment, with homeless persons who had an active addiction disorder or who were in recovery to learn about their recovery goals, barriers to accessing treatment or recovery supports, and the type of supports they were seeking to assist in their overall stability. Twenty-six participants were recruited into four separate focus groups held at four different community organizations serving homeless persons in downtown Toronto. Preliminary analysis of focus group transcripts indicated that participants’ needs centered on desiring timely access to treatment resources; seeking support in creating individualized recovery plans; community support around housing, finances, finding a job and the acquisition of lifeskills. Patients also suggested a holistic approach using “here-and-now”, practical, and solution-focused strategies. Further analysis is required to determine the nature of addiction treatment programming that can be offered to homeless persons to best meet their needs in recovery. References: 1) Supportive Housing: An Evidence-Based Intervention for Reducing Relapse among low income adults in addiction recovery. Collard, Lewinson and Watkins. Journal of Evidence-Based Social Work, Oct 2014, 11(5) 468-479. 2) Maslow and Mental health recovery: A comparative study of Homeless Programs for adults with serious mental illness Benjamin Hawood, et al. Journal of Administration and Policy in Mental Health Research, Mar 2015, 42(2), 220-228. Learning Objectives: 1. Patient-elicited needs may be valuable in creating effective addiction-treatment and recovery programming. 2. How to use an interdisciplinary team approach to serve patients with addictions in homeless settings. Is substance use associated with lack of hygiene and prevention? Exploration of multi-risk behaviors in the French population. Author(s): Joffrey Marchi1, Jean-Baptiste Richard2, Aurélie Mayet1,3. Centre d’épidémiologie et de santé publique des armées, Marseille, France. Institut national pour la prévention et l’éducation pour la santé, Saint Denis, France. UMR 912: INSERM–IRD–Université Aix-Marseille, Marseille, France. Centre d’épidémiologie et de santé publique des armées. GSBdD Marseille Aubagne - 111 avenue de la Corse - BP 40026, 13568 Marseille cedex 02 France. Email : [email protected] Objective Psychoactive substance use may be related to other hazardous behaviors. Aim was to identify one or several profiles for multi-risk behaviors in the French population. Methodology Data from a 2010 population-based survey were used (2,893 subjects aged 15-54). Multiple component analysis was performed to explore some behaviors: substance use (tobacco, alcohol, cannabis, inhalants, hallucinogens, stimulants and depressants), hazardous sexual exposure, poor vaccine acceptance and lack of hygiene towards respiratory infections. Ascendant hierarchical classification was then performed to identify clusters of subjects according to their behaviors. 125 | P a g e Results Four clusters were identified: 1) 102 subjects reporting good hygiene towards viruses (85.3% reporting washing hands and 100.0% being careful when coughing) and very low rates for substance use; 2) 2,517 subjects reporting average hygiene and low rates of substance use; 3) 226 subjects reporting average hygiene, sexual exposure (67.7%), dependence for tobacco (38.0%) and alcohol (32.3%) and cannabis use (16.8%); and 4) 48 subjects reporting sexual exposure (37.5%) and important use prevalences for all substances (64.6% for tobacco dependence, 33.3% for alcohol dependence, 83.3% for cannabis use, and between 29.2% and 75.0% for other illicit drugs use). Clusters 1 and 2 reported more being vaccinated up-to-date (around 85% versus 75% in clusters 3 and 4 – p=0.005). Conclusions Substance users, both occasional (cluster 3) and heavy polysubstance users (cluster 4), report less health-related behaviors, which could reflect common personality traits underlying hazardous behaviors as a whole. Prevention programs towards drugs should move beyond the addiction field and integrate a multi-risk approach. Learning Objectives: 1. Describe associations between substance use and some health-related behaviors. 2. Replace substance use in the perspective of a global propensity to hazardous behaviors. The Addiction Recovery and Community Health (ARCH) Team: Patient, hospital and community stakeholder perspectives Author(s): Elaine Hyshka, BA, MA, PhD; Jalene Anderson MA; Kathryn Dong MD, MSc, FRCP(C), DABAM; Shehzad Kassam; Ginetta Salvalaggio MD, MSc, CCFP. 606-1 Community Services Centre, Royal Alexandra Hospital, 10240 Kingsway Ave, Edmonton, AB, Canada T5H 3VR Email [email protected] Objective. The Addiction Recovery and Community Health (ARCH) team is a multidisciplinary consult service initiated in July 2014 at a large inner city acute care hospital in Edmonton, Canada. ARCH helps manage alcohol and drug withdrawal, and stabilizes and treats addictions. Social stabilization (income support, ID, housing), health promotion, community linkage, and harm reduction activities are also central to the team’s model of care. ARCH is a novel intervention integrated into an existing complex system; a successful implementation process is critical for positive patient outcomes. Methodology. Accordingly, we conducted a qualitative process evaluation to (1) examine the perspectives of patients and hospital and community stakeholders, (2) develop insight into program implementation and functioning, and (3) track contextual factors that may facilitate or impede ARCH’s ability to achieve positive patient outcomes. Semi-structured interviews were conducted with 20 patients, 18 internal and 10 external stakeholders. Patient interviews focused on perceived impacts on health, and views on quality and experience of ARCH care. Hospital and community stakeholder interviews examined barriers and facilitators to ARCH effectiveness, and fit with broader service-provision environments. Results. Patients and internal and external stakeholders view ARCH as a valuable intervention for a variety of reasons. However, participants of all three groups provided significant insight for further improving ARCH and strengthening integration and collaboration within and outside the hospital. 126 | P a g e Conclusions. Results of this evaluation provide useful information for both refining ARCH, and developing and implementing community-engaged multidisciplinary care interventions for patients experiencing substance use disorders and social inequities. Learning Objectives: 1. Understand how enhanced multidisciplinary care interventions may be implemented in acute care hospitals. 2. Learn how patients, internal and external stakeholders view enhanced multidisciplinary care for inner city populations. 127 | P a g e S40: Concurrent Personality Disorders Substance Dependence and Concurrent Personality Disorders: Phenomenology, Influence on Treatment Outcomes and Evidence-Based Treatments Author(s): Ronald Fraser, MD, FRCPC and Katheryn Gill, PhD Email: [email protected] Presentations within symposium: o ”Phenomenology and Epidemiology of Co-occurring Personality Disorders and Addictive Disorders” Ronald Fraser MD, FRCPC; Addictions Unit, McGill University Health Centre (MUHC) and Department of Psychiatry, McGill University, Dalhousie University o ”Influence of Personality Disorders on Detoxification Outcomes: A Mixed Methods Study.” - Kathryn J. Gill PhD, Ronald Fraser MD, FRCPC; Jorge Palacios-Boix MD, FRCPC; Dara Charney MD FRCPC; Juan-Carlos Negrete MD, FRCPC; Laura Heath MSc & Kevin Hamdullahpur MSc.; Addictions Unit, McGill University Health Centre (MUHC) and Department of Psychiatry, McGill University o ”Evidence Based Treatments for Concurrent Personality Disorders and Substance Dependence” Kathryn J. Gill PhD, Ronald Fraser MD, FRCPC; Addictions Unit, McGill University Health Centre (MUHC) and Department of Psychiatry, McGill University Patients with personality disorders (PDs) and concurrent substance dependence pose particular challenges to care such as poor motivation and social support, disorganization, higher rates of suicide and early dropout from treatment. In addition, patients with personality disorders appear to experience particular difficulty in tolerating both the physical and emotional effects of drug/alcohol withdrawal. This symposium will explore assessment, prevalence, and differential diagnosis for concurrent disorders. Evidence-based interventions for effective treatment of concurrent disorders will be reviewed, as well as basic strategies for approaching individuals with Cluster B personality disorders and addictions issues. Finally, the symposium will include the results of recent research on the effects of PDs on treatment retention and detoxification outcomes. Learning Objectives: 1. At the end of the session, participants will be able to conceptualize the relationship between addictions and personality disorders. 2. At the end of the session, participants will be able to utilize evidence based approaches for the screening and assessment of patients with personality disorders. 128 | P a g e S41: Epidemiology, Drugs & Youth Non-Medical Prescription Opioid Use Among High-School Adolescents in Atlantic Canada Author(s): Miroslava Kolajova, Mark Asbridge, Donald Langille, Selene Etches 5530 Merkel Place, Halifax NS B3K 2H8 Email: [email protected] Non-Medical Prescription Opioid (NMPO) use is one of the most prevalent forms of substance use among Canadian adolescents. Despite the evidence of NMPO use as a major public health concern, we have major gaps in our understanding of the correlates that shape NMPO use patterns. Our study addresses the gaps by: 1- describing the sociodemographic, substance use, and psychosocial characteristics of Atlantic Canada high-school student NMPO users, and examining whether frequency of use is differentially shaped by these measures; 2- examining the substance use patterns by which NMPOs are used, and whether these patterns are associated with psychosocial outcomes, particularly mental health (depression, suicidality, and anxiety) and protective (school connectedness and parental monitoring) factors. We analyzed data derived from the 2012 cycle of the Student Drug Use Survey in the Atlantic Provinces using descriptive statistics and regression models. Our results indicate that frequent and infrequent NMPO users carry the same mental health burden, are similarly affected by protective factors, and are similarly likely to engage in other substance use. NMPO use is robustly associated with medical opioid use, with one-third of medical users engaging in misuse. Subgroups of NMPO users (based on patterns of additional substance use) share a similar burden of mental health problems; however, a strong negative association between greater parental monitoring and any additional substance use is evident. The results of this project provide impetus for strengthening promotive factors at the family and school level, and for developing comprehensive provincial regulations. Learning Objectives: 1. Increase attendees’ awareness / knowledge of the prevalence and key correlates of NMPO use among high-school adolescents 2. Increase attendees’ understanding of associations between protective factors and substance use patterns among high-school NMPO users Prevalence and Awareness of Novel Psychoactive Substances in a Northern Irish student population Marty Gillan 19 Griffith Park, Culmore Road, Derry, N. Ireland, BT48 8PE Email [email protected] Novel Psychoactive Substances (NPSs, also known as ‘Legal Highs’) have garnered considerable attention in recent years. However, there has been relatively little literature investigating their use. This study sought to examine the 129 | P a g e prevalence of NPS use within a Northern Irish student population, as well as associations with perceived ease of access, use of Alcohol & Illegal drugs and levels of depression, anxiety and stress. Methods: Participants (N=200; 53.5% Female) completed a self-report questionnaire distributed by opportunistic sampling in the 4 campuses of the Ulster University. Results: A total of 12% of the sample reported last year use of NPSs. Participants who had consumed NPSs were significantly more likely to report peer use (χ2= 10.09, p<.05, Ф=.23)., higher alcohol consumption (χ2= 14.00, exact p<.05, Ф=.27). and higher illegal drug use (χ2= 43.91, p<.05, Ф=.87). Surprising, NPS users were significantly more likely to believe the substances were difficult to obtain than non-users (χ2= 6.72, exact p<.05, Ф=.53). They also reported significantly higher levels of depression (t=3.61, p<.05, d=.79), anxiety (t=5.33, p<.05, d=1.11) and stress (t=3.45, p<.05, d=.79), as measured by the DASS-21. The rates of NPS use were significantly higher in the Derry City area, followed by Belfast and then other areas of Northern Ireland (χ2= 8.02, p<.05, Ф=.20). Conclusion: The results call into question the effectiveness of legislation designed to criminalise NPSs. They also suggest a need for targeting prevention programmes to at risk groups, as well as incorporating psychological therapies for depression, anxiety and stress into NPS-related addiction treatment programmes. Learning Objectives: 1. To appreciate the extent of Novel Psychoactive Substance use in students 2. To predict the likelihood of NPS use in an at risk population Substance use disorder; Impact of childhood abuse in a sample of Egyptian patients Author(s) Name : S.Elghonemy, A. A.Elsameea, A.N. Omar, E.Abdelazeem Mailing Address : 23 St ElShorta Giser ElSuez- Cairo- Egypt PC 11321 Email: [email protected] Background: The effects of child abuse have profound physiological, spiritual, emotional and social consequences that are carried with the victim for the rest of their lives. Child abuse continues to be overlooked and minimized in our culture because there is still a pervading dysfunctional and destructive belief that it is acceptable to use physical violence, verbal aggression and exploitation in the process of child rearing. Objectives: To investigate the impact of childhood abuse on developing substance dependence in abuse victims. Subjects and Methods: 120 substance use disorder patients were recruited from inpatients admitted in four private and public addiction hospitals. They were subjected to the following tools: 1- SCID (I) and SCID (II), 2- ASI, 3Childhood trauma questionnaire (CTQ) and Familial Socioeconomic status scale. Results: Alcohol and drug use ASI profiles were significantly higher in patients with high CTQ (p 0.001, 0.046 respectively) in addition those patients from public hospitals scored higher in family disruption and child abuse. Moreover, patients scored higher on CTQ had significantly higher association with SCID (II) (p 0.005) 130 | P a g e Conclusion: Most abused child grown up to suffer from substance use disorder. Scars of child abuse are exhibited in many maladaptive and self-defeating behaviors in adulthood. Wise approach is needed to minimize the drastic impact on abuse victims. Learning Objectives: 1. Identify the impact of childhood abuse on developing substance use in adulthood 2. Recognize the associated clinical correlates with childhood abuse and substance use in later life 131 | P a g e S42: Concurrent Disorders – International Aspects Concurrent Substance Use Disorders and PTSD in an Inpatient Addiction Treatment Program in Canada Author(s): James MacKillop, Wendi Woo, Christopher Ryan, Sarah Sousa, Isabella Romano, Courtney Ropp, Roy Cameron, Harry Vedelago Peter Boris Centre for Addictions Research, St. Joseph’s Healthcare Hamilton, West 5th Campus, 100 West 5th Street, Hamilton Ontario L8P 3R2 Email: [email protected] Objective: To characterize concurrent substance use disorders and post-traumatic stress disorder (PTSD) among individuals being admitted to an inpatient addiction treatment program toward improving treatment quality. Methodology: Patients were 142 (66% male) treatment-seeking individuals who completed an assessment battery at admission to the Addiction Medicine Service at Homewood Health Centre in Guelph, Ontario. The battery comprised the following: World Health Organization (WHO) Alcohol, Smoking, and Substance Involvement Screening Test; WHO ICD-10 Alcohol Use Disorder Symptom Checklist (adapted to include all symptoms in DSM-5); Drug Use Disorder Identification Test; PTSD Checklist for DSM-5 (PCL-5); Life Events Checklist for DSM-5 (LEC-5). Results: Overall, 76% and 37% of patients had severe alcohol and drug use disorders, respectively. More than half used only one substance regularly (excluding tobacco), while 45% reported regular use of two or more substances. Close to half (43%) met the PCL-5 screening criterion threshold for PTSD. Although exposure to any of the traumatic events on the LEC-5 significantly increased the odds of the PTSD threshold (ps <.05-.0001), effect sizes varied substantially between individual events. Significant associations were present between level of use of alcohol, marijuana, sedatives or prescription sleep aids in relation to specific PTSD symptom clusters. Conclusions: The results reveal high rates of concurrent substance use disorders and PTSD in this treatment setting and suggest quality improvement strategies should focus on addressing this comorbidity. These data provide valuable directions for treatment planning and program development to promote positive patient outcomes. Learning Objectives: 1. To better understand concurrent substance use disorders and post-traumatic stress disorder (PTSD) among a treatment seeking inpatient population. 2. To guide treatment planning and program development with the aim of promoting positive outcomes among an inpatient population in an addiction treatment program 132 | P a g e S43: Opioid Issues and Outcomes Understanding opioid use disorder: Highlighting the heterogeneity in patterns of use and methadone maintenance therapy outcomes Author(s) Name : Caroline Brunelle, Department of Psychology, University of New Brunswick, Saint John, Kelsey Morrison, Department of Psychology, University of Saskatchewan, Saskatoon Email [email protected] Objective: The prevalence of prescription opioid use (POU) has been increasing steadily in North America, along with a concerning number of opioid-related mortalities (Fischer et al., 2015). This presentation will integrate findings from two separate studies, with different goals. Study 1 aims to determine whether distinct homogenous subgroups of opioid misusers exist in order to gain a better understanding of the treatment needs of these individuals. Study 2 focuses on identifying predictors of continued illicit opioid use in Methadone Maintenance Treatment (MMT) clients. Methodology: Two separate samples (n= 60 & n=52) of MMT clients were recruited. In study one, clinical records were examined to code for physical and mental health indicators at entry into treatment, six months, and one year post onset of MMT. In study 2, MMT clients completed a number of questionnaires assessing substance use and personality. Results: In study 1, two clusters of MMT clients emerged using a latent class cluster analysis. The first, composed of one third of the sample respond poorly to treatment, display higher levels of psychiatric comorbidity and substance use severity while the second cluster are younger, have less severe substance use history, report greater frequency of pain conditions and respond better to MMT. In study 2, a regression analysis indicated that impulsivity is the only personality trait predictive of continued illicit opioid use while receiving MMT. Conclusions: Taken together, these findings highlight individual differences in opioid misusers and the importance of matching opioid misusers to their specific treatment needs. Learning Objectives: 1. Gain a better understanding of the distinct profiles and needs of opioid users for optimal clinical management 2 . Identify which factors are associated with continued illicit opioid use in MMT users A Project to Determine the Spectrum of Substance Use Severity, Patterns of Substance Use, and Readiness to Change in an Acute Care Hospital Author(s): Keith Hansen, Minh Nguyen, Wiplove Lamba, Adam Quastel, Raj Gupta, Tim Guimond 30 Bond St. , Room 17-020 Cardinal Carter Wing South, Toronto, Ontario, M5B-1W8 Email [email protected] Objective: To identify differences in demographics, alcohol and drug severity, readiness to change, and types of substance used between inpatients and outpatients presenting for addictions care. Further, to determine which factors predict a higher motivation to change. The aim was to understand the differing populations to guide service improvements. 133 | P a g e Methods: A secondary chart review from July 2014 to August 2015 was conducted, using the Addictions Team contacts database from St. Michael’s Hospital, Toronto, Ontario, Canada. The team consists of a nurse practitioner, case worker and physicians from internal medicine, family medicine, emergency medicine, and psychiatry with specialized training in the field of addictions to all areas of the hospital and includes an outpatient rapid access clinic. Patients’ demographic information, co-morbid conditions, referral source, types of substances used, substance use severity, and readiness to change were collected. The Addictions Severity Index (alcohol and drug subscales) were used to measure substance use severity and Readiness Ruler for patient’s readiness to change. Results: Contacts with 171 inpatients and 75 outpatients were compared. No global differences on addictions severity were found. The subgroup of individuals who present only with alcohol use disorder from inpatients had greater alcohol severity than outpatients (p=0.014). Hospitalized patients on the whole had lower levels of motivation to change (p=0.0001). Conclusions: Inpatients consultation provides a unique opportunity to engage with individuals with high addiction severity and a broader range of motivation. Older patients may be better engaged as inpatients and may require home care addictions services. Learning Objectives: 1. To introduce and discuss services offered by the Addictions Team at St. Michael’s Hospital 2 To discuss patterns of substance use, substance use severity, gender and age difference in substance use patterns, and motivation to change amongst a sample of inpatients and out patients followed by the Addictions Team. Development and Early Findings from the Homewood Post-Discharge Outcome Monitoring System in the Addiction Medicine Service Sarah Sousa, MSc.1, Jean Costello, PhD1, Chris Ryan, MSc.1, Courtney Ropp, MSc.1, Brian Rush, PhD2, Wendi Woo, MA,3 Harry Vedelago, MD, FCFP, ABAM3 1 Homewood Research Institute 2 Centre for Addiction and Mental Health 3 Homewood Health Centre 150 Delhi Street, Guelph ON N1E 6K9 Email: [email protected] Objective: To build an effective and sustainable recovery outcome monitoring system (OMS) that: 1. incorporates the experiences and needs of various stakeholders (e.g., patients, clinicians, organization leaders); and 2. includes functional-level outcomes to provide a more complete picture of recovery beyond the measurement of substance use alone. Methodology: The Post-Discharge Outcomes (PDO) monitoring system developed by the Homewood Research Institute (HRI) collects, analyzes and disseminates information on recovery-oriented outcomes throughout treatment and up to one year post-discharge from patients attending the in-patient Addictions Medicine Service at the Homewood Health Centre (HHC) in Guelph, Ontario. Results: Early findings suggest the PDO system serves as a useful tool for reporting on treatment effectiveness and impact. Aggregate patient-level data from April 2015-2016 provides initial insights into progression during treatment suggesting significant improvements (p<0.005) in areas such as mental health status, confidence and hopefulness, life satisfaction and quality of life. Selected recovery-related outcome data from 1-month post-discharge will also be presented. 134 | P a g e Conclusions: Recovery from addictions is a complex process; however to better understand the process OMSs should include repeated measurement of outcomes across a variety of life domains, extending beyond the point of discharge. An effective and sustainable OMS will provide value in advancing knowledge of addictions recovery both within HHC and to the broader research community. Learning Objectives: 1. To generate dialogue about defining, capturing and sharing the recovery journeys of people after treatment 2. To provide knowledge and lessons learned to inform future directions in the field of outcome monitoring for the addictions medicine sector 135 | P a g e S44: Cannabis Regulating Cannabis: What do Physicians Need to Know About Legalization? Rebecca Jesseman and Amy J. Porath-Waller Canadian Centre on Substance Use, 500–75 rue Albert Street, Ottawa, ON K1P 5E7 Email : [email protected] Canada is poised to be the second country in the world to develop a legal regulatory approach to the recreational use of cannabis. Canadian policymakers face the challenge of developing an innovative but evidence-informed approach that minimizes known risks to public and individual health and safety. This session will outline the regulatory options available and their potential impacts, drawing on analysis of lessons learned through the regulation of substances such as alcohol and tobacco as well as on the early experiences of Colorado, Washington state, Alaska, Oregon, and Uruguay. The session will begin with an overview of the health risks of cannabis use, including the risks to youth associated with the developing brain as well as impacts related to cognitive and mental health, the respiratory system and dependence. This component will also highlight new and emerging evidence and associated policy implications regarding cannabis-impaired driving. The session will provide an overview of the different regulatory models in place internationally, focusing on evidence of the health and social impacts to date, and how these can be applied to the Canadian context. It will conclude with a summary of implications for practitioners, including considerations such as training, contributing to data collection and monitoring, and advancing evidence. Learning Objectives: 1. To provide participants with an understanding of the different models being used to regulate cannabis in other jurisdictions, the evidence available with regard to their impact and the public health considerations that should guide a made in Canada approach. 2. To provide participants with an understanding of the potential implications of regulatory change for addiction medicine practitioners Synthetic Marijuana & Refractory Epileptogenicity Author(s) Name : Neil Patel, MD, Jason Jerry, MD, Xavier Jimenez, MD Mailing Address : 9500 Euclid Avenue, P57, Cleveland, OH 44195 Email [email protected] Introduction: Synthetic cannabinoids (SCs), also known as “spice” or “K2”, are recently-recognized as etiologic agents of seizures. i,ii We report a case of SC abuse resulting in refractory epileptogenicity. Case: A 19 year old male with history of polysubstance abuse was admitted with persistent generalized tonic-clonic (GTC) seizure activity. He had recurrent seizures with unremarkable neuroimaging studies. ICU course was complicated by sepsis, respiratory failure requiring intubation, non-ischemic cardiomyopathy, acute kidney injury requiring temporary dialysis, and Clostridium difficile infection. Psychiatry was consulted for agitation, hallucinations, and paranoia. 136 | P a g e Exam was revealing for an intermittent, waxing/waning hypoactive delirium with slowed speech, thoughts, and movements. History revealed significant (daily, recurrent, binge pattern) SC use prior to admission. Most pertinently, he had been using spice for the past 12 months and had experienced two seizure episodes earlier in the year immediately after spice binges (amounts unknown). At time of discharge, the patient was administered five antiepileptic agents, yet was readmitted for breakthrough seizures at time of this writing. Conclusions Cannabidiol targets Cannabinoid (CB) receptors. Marijuana is known as an anticonvulsant agent with partial agonism at CB1 receptor (CNS) as compared to CB2 receptor (immune cells), thought to be related to decreasing glutamate (excitatory) transmission at the CB1 receptor. It is hypothesized SCs may impact a novel cannabinoid-sensitive receptor or may create a more potent decrease in GABA (inhibitory) transmission at CB1 receptor, explaining its epileptogenicity.iii This case illustrates the importance for providers to consider spice/SC abuse in the differential diagnosis of epilepsy. Havenon A, Chin B, Thomas K, Afra, P, 2011, The Secret ‘‘Spice’’: An Undetectable Toxic Cause of Seizure, The Neurohospitalist. 1(4) 182-186 Khullar V, Jain A, Sattari M, 2014, Emergence of New Classes of Recreational Drugs—SyntheticCannabinoids and Cathinones, J Gen Intern Med, 29(8):1200–1204 Louh K, Freeman W, 2014, A 'spicy' encephalopathy: synthetic cannabinoids as cause of encephalopathy and seizure, Critical Care, 18:553 Learning Objectives: 1. To present a severe complication of an increasingly prominent drug of abuse 2. To understand the proposed mechanisms of various cannabidiol receptors and their impact on epileptogenicity A CROSS-SECTIONAL STUDY OF CANNABIS USE AMONG OPIOID DEPENDENT PATIENTS MAINTAINED ON BUPRENORPHINE IN A COMMUNITY-BASED DRUG TREATMENT CLINIC Author(s) Name : Igam Bagra, Dr Ravindra Rao, Dr Anju Dhawan, Dr Alok Agrawal National Drug Dependence Treatment Centre, Dept. of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi – 110029, India Email : [email protected] Objective: To assess the rates and pattern of cannabis use among opioid dependent subjects maintained on buprenorphine. Methodology: Cross-sectional design. A convenient sample of hundred opioid dependent subjects maintained on buprenorphine in a community clinic was recruited. The subjects were interviewed using a semi-structured performa, Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) and World Health Organisation Quality of Life-BREF instruments. Results: Mean age of the subjects was 43.9 years (SD: 11.1); all were males. About 35% used cannabis in last three months (Average ASSIST scores – 20.7), with ganja being the most commonly used cannabis through inhalation. 137 | P a g e Cannabis users smoked an average number of 2.3 cannabis cigarettes per day and spending INR 27/day on cannabis. About 48.6% used cannabis daily. Other substances used by cannabis users in past three months were: 60% alcohol (average ASSIST scores 7.8), 20% illicit opioids; none used sedatives or stimulants. Their average buprenorphine dose was 7.7 mg /day (SD: 2.5), with 95.5% compliance rates, and 23% reported opioid withdrawals in the past three months. About 2% were HIV positive, while 12% and 10% had lifetime history of physical and psychiatric illnesses respectively. With cannabis use, 34% reported physical problems, 20% reported psychological problems, 17% financial, 20% occupational, 25.7% familial and 8.5% social problems. About 85.7% were gainfully employed in the past three months, working for 78.8% of days. The mean WHOQOL (BREF) scores were 83.03 (SD 17.3). Conclusions: Substantial proportion of opioid dependent subjects maintained on buprenorphine use cannabis, and report problems with its use. Learning Objectives: 1. The prevalence and pattern of cannabis use among opioid dependent patients on buprenorphine can be understood 2. The rates of other substance use, quality of life, and extent of problems in various spheres among cannabis using buprenorphine maintained patients. The Association between Cannabis Use and Methadone Maintenance Treatment (MMT) Outcomes: A Systematic Review Author(s) : Laura Zielinski, Meha Bhatt, Ming Zhu, Rebecca B. Eisen, Stefan Perera, Neera Bhatnagar, James MacKillop, Meir Steiner, Stephanie McDermid Vaz, Lehana Thabane, Zainab Samaan 162 Haddon Ave North, Hamilton ON, Canada L8S 4A6 Email [email protected] Laura Zielinski1, Meha Bhatt2, Ming Zhu3, Rebecca B. Eisen1, Stefan Perera2,4, Neera Bhatnagar5, James MacKillop6,7, Meir Steiner6,8,9, Stephanie McDermid Vaz6,10, Lehana Thabane4,11, Zainab Samaan4,6,7,12 1MiNDS Neuroscience Graduate Program, McMaster University 2Health Research Methodology Graduate Program, McMaster University 3St.George’s University of London, 4Department of Clinical Epidemiology and Biostatistics, McMaster University 5Health Science Library, McMaster University 6Department of Psychiatry and Behavioural Neurosciences, McMaster University 7Peter Boris Centre for Addictions Research, St. Joseph’s Healthcare Hamilton 8Women’s Health Concerns Clinic, St. Joseph’s Healthcare Hamilton 9Department of Obstetrics and Gynecology, McMaster University 10Cleghorn Early Intervention Clinic, St. Joseph’s Healthcare Hamilton 11Biostatistics Unit, Research Institute at St Joes, St. Joseph’s Healthcare Hamilton 12Population Genomics Program, Chanchlani Research Centre, McMaster University Introduction: The number of patients requiring methadone maintenance treatment (MMT) for opioid use disorder has increased dramatically in the last 20 years [1]. Cannabis is generally perceived as harmless [2], and its use is often not monitored during MMT. Current literature regarding the effects of cannabis use on MMT is conflicting, and the presence and nature of an association has not been clearly established. Objective: Conduct a systematic review of the literature to determine whether an association exists between cannabis use and MMT outcomes (illicit opioid use, treatment retention, criminal activity, polydrug use, and comorbid psychiatric outcomes). Methods: The search was conducted on the following electronic databases using a predefined search strategy: MEDLINE, EMBASE, PsycINFO, and CINAHL. Two authors independently screened articles and extracted data. An assessment of quality and risk of bias was conducted on all included articles. 138 | P a g e Results: 35 articles were included in the review, with a total of 13,205 participants. Meta-analysis was not possible due to significantly heterogeneity and moderate to high risk of bias. Conclusion: The literature is largely conflicted, which may be partially explained by significant methodological differences between studies such as definition and timing of drug use measures, variable measurements, and follow-up times. References: [1] Fischer B, Rehm J, Patra J, Firestone Cruz M. Changes in illicit opioid use across Canada. Can. Med. Assoc. J. 2006;175:1385. [2] Volkow ND, Baler RD, Compton WM, Weiss SRB. Adverse health effects of marijuana use. N. Engl. J. Med. 2014;370:2219– 27. Learning Objectives: 1. Conduct a systematic evaluation of the literature to elucidate the association between cannabis use and methadone maintenance treatment outcomes 2. Identify gaps in the literature requiring further research and suggest solutions to overcome methodological limitations identified in past research. . 139 | P a g e
