PCSS Podcast

Mental health counselor and educational specialist Mr. Raymond Isackila, Ed.S., LPCC, LICDC speaks on the powerful communication technique of motivational interviewing. Mr. Isackila is an educational specialist and Manager of Addiction Recovery Services in the Department of Psychiatry at University Hospitals of Cleveland At University Hospitals. He is regarded as one of the leading authorities on substance use and counseling of chemically dependent patients. He has worked with numerous organizations including the National Football League. 

Medication-assisted treatment is widely accepted treatment for patients with opioid use disorders. Still, patients have many reasons, spoken and unspoken, to be reluctant to start this potentially life-saving treatment. On this episode, Ashley Braun-Gabelman, PhD, discusses the importance of addressing this resistance and why it's important to explore this barrier to treatment head on. Dr. Braun Gabelman is a clinical psychologist in Addiction Recovery Services at University Hospitals Cleveland Medical Center and an Assistant Professor in the Department of Psychiatry at Case Western Reserve University School of Medicine. She specializes in the treatment of substance use and co-occurring disorders including major depression, anxiety disorders, and PTSD.

Today we discuss non-opioid pharmacological management of chronic pain with Dr. Kevin Sevarino. Dr. Sevarino received his Doctorate of Medicine in 1982 from McGill University and his Ph.D. in Molecular Biology in 1983 from the University of Connecticut. He is an Assistant Clinical Professor of Psychiatry at Yale University and the University of Connecticut Schools of Medicine. Dr. Sevarino is an active clinician, serving as Medical Director attending for the VA Connecticut Healthcare System Newington Mental Health Firm. He is director of the Addictions and He is Medical Director of SAMHSA's Providers' Their Treatment Course for the American Academy of Addiction Psychiatry for eight years, and is Vice President for that organization. He is Medical Director of SAMHSA's Providers' Clinical Support System for Opioid Therapies. His main interests are in treating those with chronic pain and opioid use disorders and in developing new ways to educate primary care providers in safe and responsible opioid prescribing.

Today we will be talking about the use of naltrexone for the treatment of opioid use disorder therapy. Naltrexone is an opioid blocker, or antagonist, that has limited prevalence of use compared with buprenorphine, a partial agonist, and methadone, a long-acting agonist. Joining us for this conversation is Dr. Adam Bisaga, an academic psychiatrist, educator and clinician.  He is a Professor of Psychiatry at the Columbia University Medical Center, and a Research Scientist at the New York State Psychiatric Institute. He was a recipient of a Career Development Award and a Principal Investigator on grants funded by the National Institute of Drug Abuse. His research interests include development of human laboratory and clinical trial models for testing medications to treat substance use disorders, including trials to improve effectiveness of antagonist-based treatment of opioid use disorder. Dr. Bisaga publishes and lectures in the area of addiction research and he is a member of the editorial board of the journal Addiction.

Dr. Lynn Webster is one of the world's leading pain experts. He is board certified in anesthesiology, pain medicine and addiction medicine. Among his numerous accomplishments, Dr. Webster is the founder of Lifetree Pain Clinic in Utah, has served as a Past President of the American Academy of Pain Medicine and has published more than 150 scientific peer-reviewed journal articles over the course of his career. He is the author of the books The Painful Truth and Avoiding Opioid Abuse While Managing Pain. Dr. Webster will discuss his impression of the current climate of pain medicine and opioid prescription and discuss strategies and important considerations in prescribing short-acting and long-acting opioids.

As a member of the committee that developed the CDC opioid guidelines and a primary care physician who treats chronic pain patients, Dr. Roger Chou is a uniquely situated authority in the conversation on opioid management. In episode one Dr. Chou talked about the guidelines themselves and, in this episode, he rejoins the podcast to discuss his personal experiences in applying the CDC guidelines in challenging patient cases and gives his impressions on sample cases physicians often encounter. Dr. Chou serves as an Associate Professor of Medicine/General Internal Medicine and Geriatrics and Medical Informatics and Clinical Epidemiology at Oregon Health & Science University. He is also Scientific Director of the Oregon Evidence-based Practice Center, funded by the Agency for Healthcare Research and Quality (AHRQ), and an Investigator for the Scientific Resource. 

Opioid use disorder is commonly known to be dangerous. The media has effectively spread the message of the danger and fatal consequences of overdose from misused prescription opioids and illicit drugs such as heroin. What many people, including medical professionals, do not commonly know is that opioid use disorder is the psychiatric condition with the highest mortality. Each year opioid use disorder kills roughly 1% of the people with this condition. Expressed another way, the risk of death from this condition at ten years is 10%. And when you factor in the estimates that more than two million Americans have opioid use disorder, then it makes sense that this condition has attained the status of public health crisis. Every day, more than one-hundred people die from opioid overdose. The vast majority of overdose deaths are from prescription opioids rather than "street drugs" such as heroin. Dr. Adam Bisaga will discuss opioid use disorder with us today. Learn about the clinical criteria for determining opioid use and how it is treated. Dr. Bisaga is an academic psychiatrist, educator and clinician.  He is a Professor of Psychiatry at the Columbia University Medical Center, and a Research Scientist at the New York State Psychiatric Institute. He was a recipient of a Career Development Award and a Principal Investigator on grants funded by the National Institute of Drug Abuse. His research interests include development of human laboratory and clinical trial models for testing medications to treat substance use disorders, including trials to improve effectiveness of antagonist-based treatment of opioid use disorder. Dr. Bisaga publishes and lectures in the area of addiction research and he is a member of the editorial board of the journal Addiction.

Buprenorphine is the most frequently used medication to treat opioid use disorder in this country. It is also under-utilized due to the dearth of physicians trained and familiar with how to start it. On this episode Dr. Edwin Salsitz will discuss how to initiate buprenorphine in the office setting, called induction. Dr. Salsitz is an attending physician in the Beth Israel Medical Center, Division of Chemical Dependency in New York City since 1983, and is an Assistant Professor of Medicine at the Mount Sinai School of Medicine. Dr. Salsitz is a course director for the American Society of Addiction Medicine sponsored buprenorphine trainings and is a mentor in the Providers Clinical Support System for Medication Assisted Treatment mentoring program. 

Medication-assisted treatment is an important approach for some people with substance use disorders. It is also frequently misunderstood--isn't treating someone with methadone for a heroin problem simply "trading one addiction for another?" Our guest, Dr. Frances Levin, will discuss this and other misconceptions regarding medication-assisted treatment.  Dr. Levin is the Kennedy-Leavy Professor of Psychiatry at Columbia University and the Chief of the Division on Substance Abuse at New York State Psychiatric Institute at Columbia University. For the past 17 years she has been the Director of the Addiction Psychiatry Fellowship Program at New York Presbyterian Hospital and for the past 12 years, she has been the principle investigator of a T32 National Institute on Drug Abuse funded Substance Abuse Research Fellowship. Her research interests include pharmacologic and psychotherapeutic treatment interventions for cocaine and marijuana abuse, and treatment approaches for substance abusers with attention-deficit hyperactivity disorder and other psychiatric illnesses.  She is also Medical Director of the Providers' Clinical Support System- Medication Assisted Treatments (PCSS-MAT), a national training and mentoring initiative focused on addressing prescription opioid misuse.

Welcome to episode 1 of the American Academy of Addiction Psychiatry podcast hosted by Lysander Jim, MD and Mauro Zappaterra, MD-PhD. Our first guest is Dr. Roger Chou. As a member of the committee that developed the CDC opioid guidelines released this April, Dr. Chou has a unique perspective on the development, rationale and scientific evidence for the recommendations. Dr. Chou serves as an Associate Professor of Medicine/General Internal Medicine and Geriatrics and Medical Informatics and Clinical Epidemiology at Oregon Health & Science University. He is also Scientific Director of the Oregon Evidence-based Practice Center, funded by the Agency for Healthcare Research and Quality (AHRQ), and an Investigator for the Scientific Resource.