Challenges and New Horizons in Substance Use and Addictions: Overview of the 2019 Conference of the Association of Multidisciplinary Education and Research in Substance use and Addiction (AMERSA)

With approximately two-thirds of overdose deaths involving opioids, ¹ complex questions and considerations challenge clinicians, educators, researchers and policy makers around areas such as treating chronic pain, acute management of opioid use disorders, and increasing access to care for difficult to reach populations. In their systematic review, King and colleagues posit that preventing opioid-related mortality will likely require interventions that address the complex, multifaceted, and geographically varied web of determinants (i.e., provider-related, patient-related, environmental and systemic) and interventions that are tailored to specific locations and populations. ² In the midst of the opioid crisis, it is important to not lose sight of those for whom other substances exact a heavy burden. For example, alcohol is the third leading preventable cause of death in the United States ³ and contributes to more than 200 health conditions. ⁴ Ongoing research and evidence-based education and practice are needed to reduce the prevalence of substance use and substance use disorders and the associated consequences. Also important is the need to address stigma, which continues to be a barrier to accessing life-saving treatment and resources as well as development of equitable, humane and compassionate policies for those living with substance use disorders.^{5, 6}

In keeping with the mission of the Association of Multidisciplinary Education and Research in Substance use and Addiction (AMERSA) held its 43^rd annual conference, this year focusing on the “Challenges and Horizons in Substance Use and Addictions.” ⁷ AMERSA’S mission is to improve health and well-being through interdisciplinary leadership in substance use education, research, clinical care and policy. A key goal of the annual conference is to improve education and clinical practice in the identification and management of substance-related problems by promoting leadership, mentorship and collaboration among multiple healthcare professions.

A traditional New England fall in the heart of Boston provided the backdrop for the conference, hosted at the Hyatt Regency Hotel in Boston on November 7–9, 2019. With more than 500 attendees from the nursing, social work, behavioral health, psychiatry, medicine, pharmacy, research and policy among others, the conference provided a platform to address challenges and new horizons in substance and addiction prevention, treatment and research, as well as opportunities for collegial discussion and networking.

During the pre-conference on Wednesday, many arriving for the conference participated in local site visits to agencies doing innovative work to address addiction. One site, Boston Healthcare for the Homeless Program (BHCHP), aims to provide access to the highest quality care for all individuals and families who are homeless in the greater Boston area.⁸ The site visit included an overview of BHCHP clinical services, street-based mobile van, and Supportive Place for Observation and Treatment (SPOT), a medically observed facility for people who use drugs. Following this, a site visit to Boston Medical Center’s nationally-recognized Office-Based Addiction Treatment (OBAT) program allowed participants to tour the clinical services and meet with experienced nursing staff who treat hundreds of patients with addiction.⁹

For conference attendees interested in pediatric addiction treatment and support, a visit to the William J. Ostiguy Recovery High School showcased how high school academics can be integrated with a curriculum for students to develop supportive life skills for recovery.¹⁰ This site visit included information about the day-to-day operations of the recovery high school and allowed visitors to hear about student and staff experiences at Ostiguy. In addition, Maryanne Frangules, the executive director of the neighboring Massachusetts Organization for Addiction Recovery (MOAR), an agency committed to organizing “recovering individuals, families, and friends into a collective voice to educate the public about the value of recovery from alcohol and other addictions”, shared how their work helps to increase access to prevention, treatment and recovery support. MOAR’s mission also includes developing strategies to address stigma and discrimination for those in recovery through education, advocacy and policy reform.¹¹

The conference officially opened on Thursday with Ayana Jordan, MD, PhD from Yale University Department of Psychiatry delivering an inspiring and vitally important plenary titled Systems of Oppression: The Ecology of Health Disparities. Dr. Jordan’s dynamic presentation style engaged the audience in a discussion about the impact of systemic forces of oppression, in particular those rooted in racism, as well as key contextual factors that lead to disparities in addiction risk and treatment. Dr. Jordan challenged the audience to understand and address “othering” and social determinants of health in clinical and research settings, and in the addiction workforce more generally.

Elizabeth Miller, MD, PhD, FSAHM of the University of Pittsburg School of Medicine and Lynn Sanford, MSW of the Trauma Center at Justice Resource Institute (JRI) offered a plenary focused on novel, evidence-based healing and resiliency-centered approaches to trauma treatment.¹² An interdisciplinary panel of experts including Mary P. Cosimano, MSW and Matthew W. Johnson, PhD of Johns Hopkins University School of Medicine and Christopher Stauffer, MD of University of California San Francisco presented a plenary session on the use of psychedelics in addiction treatment.^{13, 14}

The “Spicy Debate”, an AMERSA tradition, was delivered by Anna Lembke, MD of Stanford University and Stefan Kertesz MD of University of Alabama at Birmingham School of Medicine, on the topic of Tapering Opioids: Compassionate Care or Punitive Policy? Drs. Lembke and Kertesz debated two propositions: (1) dose reduction among patients taking high dose opioids for chronic pain promotes patient well-being and safety, and (2) policies that strongly incentivize or mandate opioid dose reduction or discontinuation promote the safety and well-being of patients and the public health. Drs. Lembke and Kertesz debated the clinical and public health implications of current research as well as the factors, including stigma, that inform, feed and fuel public policy and practice related to chronic pain management.

Longstanding experts in addiction medicine received awards for their contributions to the field. Betty Ford Award winner and plenary speaker, Gail D’Onofrio, MD, MS, Professor and Chair of Yale University’s Department of Emergency medicine presented her innovative work in Emergency Departments: A 24/7/365 Option for Combatting the Opioid Crisis.¹⁵ Daniel P. Alford, MD, MPH Professor of Medicine and Associate Dean of Boston University School of Medicine’s Office of Continuing Medical Education Program received AMERSA’s prestigious John P. McGovern award and presented an inspiring talk on Opioids and Me: The Long and Winding Road.¹⁶

Beyond the provocative plenaries, the conference was rich with opportunities to review and discuss current trends in educational, clinical, research and policy work by both established and early-career professionals working in the field. At Thursday evening’s scientific poster session, Massachusetts Attorney General Maura Healey, JD addressed the audience by highlighting the state’s innovative initiatives to address many of the public health and social justice concerns related to substance use, including her office’s initiative Project Here, a middle school substance use preventive intervention.¹⁷ She shared her respect and gratitude for the work done by AMERSA attendees. The poster session also provided ample opportunity to review novel work in the field and network with fellow AMERSA attendees. Innovative scientific work and programming was also presented during two afternoons of oral abstracts offering a broad spectrum of topics in substance use and addiction from a variety of disciplinary perspectives. Conference attendees chose among seven workshops to engage in in-depth interprofessional discussion in the practice and policy areas listed below:

• Understanding the Needs of Youth in Recovery from Opioid Use Disorders: What’s Worked and What’s Still Needed - Nicholas Chadi, MD, MPH; Avik Chatterjee, MD, MPH; Leslie Green, MSW, LICSW; Evan Malkiewich, MSW, LCSW Adolescent Substance Use and Addiction Program, Boston Children’s Hospital; Boston Healthcare for the Homeless Program/Brigham and Women’s Hospital; CATALYST Clinic, Boston Medical Center

• Safer Shooting: A Harm Reduction Curriculum for Patient Centered Advocacy in the Treatment of People Who Inject Drugs (PWID) - Davis Bradford, MD; Raagini Jawa, MD, MPH; Joseph Wright, MD - Boston Health Care for the Homeless Program; Boston University School of Medicine; Boston Medical Center

• Writing for Popular Media About Substance Use - Nathaniel P. Morris, MD - Stanford University School of Medicine

• Advances in Identifying and Engaging Cannabis Users in Medical Settings Win Turner, PhD, LADC; Jody Kamon, PhD - Stony Brook University; Center for Behavioral Health Integration

• When Buprenorphine Gets Complicated: Acute Pain, Precipitated Withdrawal, Pregnancy, Overdose, and More - Andrew Herring, MD; Aimee Moulin, MD; Arianna Sampson, PA-C - Highland Hospital; University of California San Francisco; University of California Davis; US Acute Care Solutions, Marshall Medical Center

• You Believe What? Dealing with Discomfort and Diversity in Religion and Spirituality in Clinical Care - Brian Earl, MDiv, BCC; Ellen Edens, MD, MPH, MA; James Cooke, STM, BCC, ACPECE; Anne Klee, PhD, CPRP - VA Connecticut Healthcare System; Yale School of Medicine

• Getting Everyone the Care they Need: Supporting Justice-Involved Patients with Substance Use Disorder - Amanda Johnson, MD, MBA; Rebecca Linn-Walton, PhD, LCSW - Office of Ambulatory Care, New York City Health + Hospitals; Office of Behavioral Health, New York City Health + Hospitals

Special interest group meetings (nursing, social work and behavioral health, physicians, pediatric and adolescent, geriatric adults, medication for substance use disorders and the multidisciplinary interest group in acute care addiction services) and mentor-mentee opportunities provided additional learning platforms, and rounded out the successful conference.