Disclosure Information Dr. Kevin Kunz has had no relevant financial - - PowerPoint PPT Presentation
Disclosure Information Dr. Kevin Kunz has had no relevant financial relationships with commercial interests within the ten years. Dr. Kunz is the EVP of the American Board of Addiction Medicine and The Addiction Medicine Foundation:
Kevin Kunz, M.D., M.P.H., DFASAM OMED 2018 October 7, 2018
for more ADM subspecialists
in osteopathic practice, credentialing and education
NORADRENALINE
.
buprenorphine
X X X X
Dopamine D2 Receptors are Lowered in Addiction
Cocaine Alcohol Heroin Meth
control addicted
need for more ADM subspecialists
in osteopathic practice, credentialing and education
Tobacco 480,000 deaths Rx & Illicit Opioids 44,000 deaths Alcohol 88,000 deaths Illicit Drugs
21,000 deaths
* CDC, 2016
2.6 Million Total Annual U.S.
Opioids 1% 2.6 Million Total Annual U.S.
All Other Causes
Opioids 1% Alcohol 3.5% 2.6 Million Total Annual U.S.
All Other Causes
Opioids 1% Alcohol 3.5% Nicotine 19% 2.6 Million Total Annual U.S.
All Other Causes
Opioids 1% Alcohol 3.5% Nicotine 19%
Other Drugs ~1%
2.6 Million Total Annual U.S.
All Other Causes
23% 19%
33% 27% 30% 28% 30% 23% 33% 28%
26%
29% 26% 25%
28%
26% 27% 29% 20% 25% 29% 25%
23%
24% 28% 22% 29% 20% 27% 25% 23% 28% 26% 27% 29% 23% 22% 12% 28% 28% 27% 25% 24%
Percentage of All Annual Deaths
24% 28% 29% 28%
28%
25% 25% 30%
214 - 302 185 - 213 0 - 184 KEY 26 - 35 25 - 27 0 - 24 KEY
Nicotine + Alcohol + Opioids, 2015 The United States of Drugs?
– ~600,000 deaths – 25 % of the population infected, 20% death rate – Young adults and minority groups major victims: children and the elderly with less morbidity, mortality
Designed by L. Rossen, B. Bastian & Y. Chong. SOURCE: CDC/NCHS, National Vital Statistics System
2016 around 64,000 OD deaths: 22% increase from 2015
Peak gun deaths, 1993 Peak HIV deaths, 1995 Peak car crash deaths ‘72
40,000 60,000 20,000
Graphs from NY Times Article based on CDC MMWR Report 2017
Fentanyl-Rela lated Deaths Su Surp rpassed Heroin in or r Rx x Opio ioid ids in in 2016
National rate of opioid-related inpatient stays increased 64.1% and ED visits 99.4% between 2005-2014
Weiss et al., AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project 2017
Hospitalizations for Opioid Overdoses with/without Alcohol
Source: Nationwide Inpatient Sample (NIS), unpublished
*More than have heart conditions (27.0 million),
More than have diabetes (25.8 million) More than have cancer (19.4 million)
*
conditions requiring acute and chronic care
consequences
HEALTH CARE COSTS PRODUCTIVITY LOSS CRIME, ACCIDENTS
Medical
SOCIAL DISCORD VIOLENCE LOST OPPORTUNITIES
Alcohol and drug problems are factors in 70% of child abuse and neglect cases.
80% of inmates have been incarcerated for alcohol or drug offenses, were intoxicated at the time of their offense, committed the
addiction, or had a history SUD
* One in every 100 American adults is incarcerated * *
Sources: Prevalence – NSDUH (2014), NCI (2014), CDC (2012); Cost – CDC (2015), National Drug Intelligence Center - National Drug Threat Assessment (2011), 2014 Surgeon General’s Report, NHLBI (2012), Hutchinson
Interventions
need long term care
Hypertension Diabetes Depression Addiction
77% 73% 71% 11%
25% 9% 17% 9% 16% 19%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Knudsen et al., J Addict Med 2011.
Treatment programs offering FDA approved SUD medications
There was a statistically significant inverse relationship between heroin overdose deaths and patients treated with buprenorphine (P = .002).
Schwartz et al AJPH 2013
– ABPM ADM Certified: 1,230 – ABAM Certified: 2,700 (200 DOs) – AOA ADM certified: 100?
for more ADM subspecialists
ABMS board certified physicians
physicians certified in January, 2018
1,000 expected to sit for the exam
certification requires an ACGME accredited ADM fellowship
CERTIFICATION
Addiction Medicine Certification Exams The following list includes scheduled Addiction Medicine OCC examinations. Select an item to view additional information and log in to apply, submit documentation or make a
committee to find out when future exams will be offered.
Kunz, 2018
AOA Conjoint Subspecialty of:
Conjoint Committee Members
– Joseph Brown, DO: IM – Ingrid Brown, DO: FM – Roy Meland, DO: N&P
ABMS Subspecialty of :
Allergy and Immunology Anesthesiology Colon and Rectal Surgery Dermatology Emergency Medicine Family Medicine internal Medicine Medical Genetics and Genomics Neurological Surgery Neurology Nuclear Medicine Obstetrics and Gynecology Ophthalmology Orthopaedic Surgery Otolaryngology Pathology Pediatrics Physical Medicine and Rehabilitation Plastic Surgery Preventive Medicine Psychiatry Radiology Surgery Thoracic Surgery Urology
98th ANNUAL AOA HOUSE OF DELEGATES MEETING, July 25, 2018
SUBMITTED BY: American Osteopathic Academy of Addiction Medicine WHEREAS, the American Osteopathic Association (AOA) approved the Addiction Medicine conjoint CAQ in 1995; and WHEREAS, on April 12, 2016, the AOA passed a resolution that will provide DOs who are ABAM diplomats with a process to attain an AOA subspecialty certification in Addiction Medicine; and WHEREAS, there are many DOs who will not benefit from the 2016 AOA resolution and still seek subspecialty certification in Addiction Medicine…… WHEREAS………
RESOLVED, that Osteopathic physicians who have completed an American Osteopathic Association (AOA) approved fellowships in Addiction Medicine be allowed to take the primary CAQ examination in Addiction Medicine; and, be it further RESOLVED, that clinical practice pathway previously approved by the AOA in Addiction Medicine be reopened for six (6) years for all DOs who wish to become certified in the subspecialty of Addiction Medicine.
– Cost expected to be greater than $100,000
– July 22, 2019 in Chicago
faculty across all fields
subspecialists expand acceptance of prevention and treatment in the sponsoring institution, and in the community
disease, not just the complications
52
Fellows are trained as: Expert clinicians who provide
quality care for patients and consultation for other physicians;
Faculty who train medical and
professionals and practicing health care providers who translate science to practice;
Researchers who seek to
improve knowledge and practice; and
Change agents who educate
the public, inform public policy and integrate evidence-based practices within health systems.
Medical School
4 Years
Exam
Residency
3-4 Years
Exam
Fellowship
1-2 Years
Exam
Maintenance
Certification
Annual
Exams
Fellowship Training Drives Knowledge and Practice Across Medicine, Health Care and Community
Fellowship training programs form the core of Addiction Medicine Centers of Excellence – training ADM physicians and driving change across medicine and health care practice, building the science, increasing public understanding of unhealthy substance use and the disease of addiction, and informing public policy.
Programs
Justice Programs
Institutions/Organizations
Pharmacology, Dentistry, Public Health, Psychology, Social Work
Addiction Medicine Fellowship Training Programs
Foundation accredited 55 fellowships between 2010-17
ADM fellowship : Largo Medical Center Fellowship Program in ADM, Nova Southeastern University
projected national goal of 125 by 2025
55
– 12 months (if PT must be completed in 24 months)
– ACGME accredited – Has a residency program in at least one of the following:
– Fellowship must have a “parent” ACGME-accredited residency in
– Certified in Addiction Medicine (or other acceptable qualifications) – 0.2 FTE
– At least 1 faculty member (besides Program Director) certified in ADM – At least 1 faculty member certified in Psychiatry – At least 1 faculty member from Anesthesia, Emergency Medicine, Family Med, Internal Med, Neurology, Ob-Gyn, Peds, Preventive Med, or Surgery
– Inclusion of multiple disciplines encouraged – counseling
– Patient panel in outpatient setting
– Weekly conference, journal club, etc – Self-directed learning
– Research – Quality improvement project
19.6% 6.5% 8.7% 10.9% 21.7% 4.3% 37.0% 15.2% 13.0% 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0%
Medical School Federal Government (NIH, VA, DoD, etc.) State Government Local Government Foundation Business/Industry Hospital/Health System Clinical Services Private Donor
Percent of programs endorsing
– immediately available with ACGME accreditation
2018: 210 graduates, 81 current fellows
– Addiction medicine physician: 43% – Medical director (addiction med): 24% – Medical school faculty: 17% – Physician (not primarily addiction): 12% – Advanced trainee: 3%
www.addictionmedicinefoundation.org
adanzo@addictionmedicinefoundation.org
for more ADM subspecialists
in osteopathic practice, credentialing and education