Building an inpatient addiction medicine consult service in Sudbury, Canada: preliminary data and lessons learned in the era of COVID-19.

OBJECTIVE: The goal of this study was to (1) Describe the patient population of a newly implemented addiction medicine consult service (AMCS); (2) Evaluate referrals to community-based addiction support services and acute health service use, over time; (3) Provide lessons learned. METHODS: A retrospective observational analysis was conducted at Health Sciences North in Sudbury, Ontario, Canada, with a newly implemented AMCS from November 2018 and July 2021. Data were collected using the hospital's electronic medical records. The outcomes measured included the number of emergency department visits, inpatient admissions, and re-visits over time. An interrupted time-series analysis was performed to measure the effect of AMCS implementation on acute health service use at Health Sciences North. RESULTS: A total of 833 unique patients were assessed through the AMCS. A total of 1,294 referrals were made to community-based addiction support services, with the highest proportion of referrals between August and October 2020. The post-intervention trend for ED visits, ED re-visits, ED length of stay, inpatient visits, re-visits, and inpatient length of stay did not significantly differ from the pre-intervention period. CONCLUSION: Implementation of an AMCS provides a focused service for patients using with substance use disorders. The service resulted in a high referral rate to community-based addiction support services and limited changes in health service usage.

Virtually there and back again: An overview of the 2021 and 2022 Scientific Annual Conferences of the International Society of Addiction Medicine.

The International Society of Addiction Medicine (ISAM) has held annual conferences for over 20 years. Conference-related information, including main themes and selected abstracts, have been published regularly. This communication describes the events of the 2021 and 2022 conferences, the second virtual and first in-person/hybrid conference. These conferences were widely attended by addiction medicine professionals from around the world, and multiple topics, both pandemic-related and not, were covered. After a three-year period with two virtual meetings, the 2022 event in Valetta, Malta, provided an opportunity to reunite and discuss current information in person. Albeit with different formats, both meetings provided opportunities for sharing of recent, clinically relevant findings to assist in addressing addictions globally.

Commentary: Moving Toward Clear, Evidence-based, and Effective State Policies for Addiction Medicine.

State policies play a critical role in determining health care delivery, health equity, and health outcomes, but vary widely in scope, target, restrictiveness, and goals. Understanding how such policies impact health care is critical to development of evidence-based policies, but difficult in the absence of organized and standardized approaches to analysis. Development of themes and frameworks for analysis, and identification of policies supported by evidence, are important steps in moving toward more rational and aligned policies. Buprenorphine treatment for opioid use disorder provides a good example and methodological foundation. At the same time, state policies are promulgated within a larger policy, treatment, and socio-economic environment, and these influences must be considered as well.

Final-year medical student Psychiatry and Addiction Medicine synchronous summative tele-assessments during a COVID-19 Delta-variant stay-at-home lockdown.

OBJECTIVE: We describe the planning, process and evaluation of final-year Psychiatry and Addiction Medicine summative assessments in a four-year graduate medical degree program, during a COVID-19 Delta-variant public health stay-at-home lockdown. CONCLUSIONS: We conducted separate written and clinical synchronous (real-time simultaneous) tele-assessments. We used online assessment technology with students, examiners and simulated patients, all in different physical locations. Medical students' examination performance showed a good range. This was comparable to other discipline stations, and performance in previous years. There was no differential performance of students through the day of the assessments.

Preparing for the future of medical education: A case series of traditional and virtual clinical rotations in addiction medicine spanning the COVID pandemic.

Background: Substance use accounts for more than 400,000 deaths annually in the United States and overdose rates surged during the COVID pandemic. While the pandemic created increased pressure for better prepared providers, it simultaneously placed restrictions on medical training programs. The purpose of this educational case series is to assess the feasibility of a virtual addiction medicine training program and conduct a qualitative evaluation of medical student attitudes toward caring for people with substance use disorders, both before and after their addiction medicine training experience. Methods: We conducted a qualitative analysis related to course content focused on strengths and limitations of in-person and virtual training modalities. Individual quotes were evaluated and content themes were developed after a thorough review of all codes and detailed examination of interviewee quotes. Results: The primary themes that emerged were (1) Addiction medicine content is important to improve care of patients with substance disorders and is not fully addressed in undergraduate medical education (2) In-person and virtual training contain unique strengths and weaknesses and (3) Students perceived that both experiences provided positive and needed training in addiction medicine that shifted perspective and enhanced confidence to practice. Conclusions: Remote training via virtual lectures and patient visits may enhance training opportunities for students with limited exposure to addiction medicine patients and faculty with addiction medicine expertise. There is a need to further refine virtual care for patients with SUDs and virtual training to meet the needs of patients and learners across the country.

[What's new in addiction medicine in 2021 ?] / Addictions.

Addiction medicine is influenced by societal changes and the environment has an impact on addictive behaviors and how they are experienced. The COVID-19 pandemic has had an impact on addictive behaviors, some of which could be favorable, and others highlight vulnerabilities to be considered by clinicians. Recent legislative changes open possibilities to limit the negative impact of electronic lotteries. In a context favorable to a better acceptance of people of LGBTQIA+ diversity, research and training in addiction medicine also have a role to play. In view of advances in understanding the harmful effects of alcohol, it is necessary to adapt the perception of the risk, in order not to provoke the incomprehension in the population.

La médecine des addictions est liée aux enjeux sociétaux actuels, et l'environnement joue un rôle important sur les comportements addictifs et comment ils sont vécus. La pandémie de Covid-19 a eu un impact sur les comportements addictifs, dont certains pourraient être positifs et d'autres mettent en lumière des vulnérabilités à prendre en compte en clinique. Les récents changements législatifs ouvrent des possibilités pour limiter l'impact négatif des loteries électroniques. Dans le contexte favorable à une meilleure acceptation des personnes issues de la diversité LGBTQIA+ (lesbienne, gay, bisexuel·le, transgenre, queer, intersexe et asexuel·le ou aromantique), la recherche et la formation en médecine des addictions ont aussi un rôle à jouer. Au vu des avancées dans la connaissance des effets nocifs de l'alcool, il est nécessaire d'adapter la perception du risque, afin de ne pas susciter l'incompréhension de la population.

Addiction medicine in the time of COVID-19: An overview of the 2020 Joint Scientific Annual Conference of the International Society of Addiction Medicine and Canadian Society of Addiction Medicine.

For years, Substance Abuse has annually published a communication regarding the annual conference of the International Society of Addiction Medicine (ISAM). These pieces have highlighted the important events of the conference and the work of the organization, as reflected in part by selected abstracts from the conference. This editorial communicates the events of the 2020 conference, the third to be held in conjunction with the Canadian Society of Addiction Medicine (CSAM) and the first virtual conference. The conference was attended by over 800 participants and covered a wide range of topics, including addiction medicine during the COVID-19 pandemic. Despite the challenges of not being able to meet physically in Victoria, British Columbia as had been planned, the virtual event provided an opportunity to share current information in order to help advance prevention, treatment, policy and public helath efforts relating to addressing addictions and helping those impacted by these often devastating conditions.

Conduct and evaluation of final-year medical student summative assessments in Psychiatry and Addiction Medicine during COVID-19: an Australian University Medical School experience.

OBJECTIVE: To describe and share with the medical education community, the conduct and evaluation of summative graduate medical student assessments in Psychiatry and Addiction Medicine during COVID-19 at an Australian university. METHODS: Summative assessments were redesigned as follows: written assessments were administered via an online platform (WATTLE), while the Objective Structured Clinical Examinations (OSCE) were conducted via a secure video-conferencing software (Zoom). RESULTS: Our preliminary analysis of the summative assessments indicated that both examiners and students adapted to the format, with overall performance of the students showing no variation due to timing of the assessment (earlier versus later in the day) and performances similar to face-to-face assessments in previous years. Examiners also expressed positive feedback on the assessment process. CONCLUSIONS: Our graduate fourth-year medical student summative assessments were effectively conducted using online and video-conferencing software in accordance with existing COVID-19 pandemic public health measures for physical distancing and hygiene.

Addressing a rapidly changing service landscape during the COVID-19 pandemic: Creation of the Oregon substance use disorder resource collaborative.

Following the rising crisis of COVID-19 and the Oregon governor's stay-at-home orders, members of the Oregon Health and Science University (OHSU) inpatient addiction consult service recognized that local addiction treatment and recovery organizations were operating at limited capacity. As a result, discharge planning, patient access to local community-based treatment, and safety-net programming were affected. Given structural and intersectional risk vulnerabilities of people with substance use disorders (SUDs), the OHSU members felt that COVID-19 would disproportionately impact chronically marginalized members of our community. These inequities inspired the formation of the Oregon substance use disorder resources collaborative (ORSUD) led by four medical students. ORSUD's mission is to support the efforts of local safety-net organizations that and front-line providers who serve chronically marginalized community members in the midst of the global pandemic. We operationalized our mission through: 1) collecting and disseminating operational and capacity changes in local addiction and harm reduction services to the broader treatment community, and 2) identifying and addressing immediate resource needs for local safety-net programs. Our program uses a real-time public-facing document to collate local programmatic updates and general community resources. COVID-19 disproportionately burdens people with SUDs; thus, ORSUD exists to support programs serving people with SUDs and will continue to evolve to meet their needs and the needs of those who serve them.

Flattening the curve of COVID-19 for medical education in psychiatry and addiction medicine.

OBJECTIVE: To describe the context, challenges and responses to COVID-19 public health measures for medical education in psychiatry, with an emphasis on sharing strategies for ongoing COVID-19 challenges. CONCLUSION: The rapidity of COVID-19 public health measures instituted in Australia required swift action for medical education to address lockdowns of student clinical placements. The responses included a transition to interim online learning followed by a return to truncated clinical placements renegotiated to conform to public health measures. Adjustment of formative and summative assessment has been necessary. However, further contingencies may emerge depending upon the overall progress of the COVID-19 pandemic.