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Addiction Medicine in the Time of COVID.

By Dr. Timothy Wiegand, MD, DABAM, FACMT, FAACT

Huther Doyle Medical Director & Director of Toxicology at the University of Rochester.

As Rochester and the rest of the country grapples with the COVID-19 pandemic, I thought it might be interesting to learn a bit about some of my experiences and change in plans related to COVID-19 that go beyond direct (and indirect) patient care whether in the ED/hospital or through clinic and phone support. At the University, nearly all of the rotators I work with have been pulled back to only participate in remote learning opportunities. Medical and Pharmacy students are now using Zoom to attend lectures or participate in case discussions and complete asynchronous educational content. Much of the support for the toxicology and toxicology/addiction consult service included resident and student rotators who have been pulled back to help with their specific departments during COVID-19 or are participating remotely only to reduce possibility of transmission as we exercise appropriate social distancing. Lots of transition, of course, and presentation content on the fly and many of us had to take a few on the fly lessons on the use of various technology platforms for teaching and remote contact; for a variety of uses not just education. In the past week, I’ve used Zoom®, WebEx®, Doxy.me®, Teams®, Slack® and a few others (thank goodness there are apps that can securely store passwords as it seems all of the criteria, length, special character use, time before change, is just different enough between the platforms that every single one needs something with enough unique differences it is almost impossible to memorize them all).

Normally, the spring season also begins busy period of travel and series of conference events for me starting in February with the annual New York Society of Addiction Medicine (NYSAM) conference held in Manhattan in early February. This was the last ‘normal’ conference I was involved in, as it occurred pre-COVID-19 transmission in the US. This year, there were over 300 attendees and great participation. A few weeks after the NYSAM conference, the Annual Scientific Meeting of the American College of Medical Toxicology (ACMT) was set to occur and for the first time in Manhattan, New York. However, just days before the pre-symposium was scheduled, we received the first travel restrictions from Universities. It became clear COVID-19 was going to impact the US much more than anticipated. A small contingent of ACMT Board members, including myself, met in New York City, to facilitate an in-person and live-streamed event, although most attendees stayed home. The first day of the conference was dedicated to an Opioid Symposium which, during the lunch break, as we learned of potential greater risk of transmission of COVID-19 and that there was cancellations of sporting events and Broadway, we decide to cancel all residual live activities and arranged to quickly travel home. Information was coming very fast and much was inconsistent at this point. I had been hesitant to travel initially but was involved as one of the organizers and sit on the Board for ACMT and felt it important to be present to participate (at least at this point in early March). ACMT did an outstanding job turning the live event into a virtual event so that presentations and interaction between colleagues could still occur –over WebEx.

Before I had left for the ACMT meeting we had already begun making changes to the Huther Doyle group size, reducing on site visits for vulnerable patients and started arranging telehealth capacity. That Thursday night, I also participated in an emergency meeting for the ASAM Board of Directors to determine the fate of the ASAM conference (which as I type this I just finished presenting on fentanyl with my colleagues –two of which are front line EM/Med Tox/Addiction Physicians in New Jersey and Philadelphia respectively, Dr. Lewis Nelson and Dr. Jeanmarie Perrone. Dr JoAn Laes from Hennepin County Medical Center, Minneapolis, MN, my alma mater for residency training, was the 4th member of our panel of presenters). The ASAM Board quickly came to the conclusion that an in-person event was not safe and has done a remarkable job developing two days of content so attendees could view virtually as lectures were live-streamed. This was prior to the more specific guidance on social distancing guidance and meeting size restriction that were subsequently announced and implemented to certain degrees across the U.S. In addition to doing a great job live-streaming the virtual conference, the ASAM website has excellent resources related to the impact of COVID-19 and the treatment of Substance Use Disorder and addiction. ACMT has made all of their E-learning library available for use as medical schools, residencies, fellowships and other settings all turn to remote learning and has been involved in guidance related to medication use (e.g. hydroxychloroquine and azithromycin) putting out several excellent presentations related to the evidence for use and also toxicity with inappropriate use (there have been some deaths related to individuals trying to self-treat COVID-19 using chloroquine –an antimalarial medication).


The final conference I usually attend is typically held the 2nd or 3rd week of May and rotates at venues throughout Europe. It is the European Association for Poison Centers and Clinical Toxicologists (EAPCCT) annual Congress and they, unfortunately, had to completely cancel the event and there will not be a live-streamed event as challenges connecting participants from around the world make this logistically not feasible. It would have been held in Tallinn, Estonia May 19-22, 2020. I’ve never been to Tallinn, but it looks like a beautiful city on the shores of the Baltic Sea. It’s not far from Stockholm, Sweden on one side, and Saint Petersburg, Russia on the other, and it’s just about 80 km south of Helsinki, Finland. An Interesting cultural, political and historical setting I was looking forward to visiting. I was scheduled to present some research from our Toxicology group at the University of Rochester. This research was related to the use of a particular antidote called physostigmine, which we used to treat/reverse overdoses from the medication cyclobenzaprine (also known as Flexeril®). The professional groups I belong to (ASAM, ACMT, NYSAM, EAPCCT) are much smaller than many of the other medical societies, such as those for Internal Medicine and even Emergency Medicine (e.g. ACP, ACEP), and it’s harder to weather abrupt cancellations of conferences and the lost revenue from these events. Most importantly, right now, are the members, many friends and colleagues, that are either on the front lines with COVID-19 in the ED, hospital or in the clinic –in particular in New York and other large cities. Others are directly involved in helping support patients with substance use disorders mostly via telehealth and phone support at this point. I was particularly struck by an early email from a colleague in Italy describing the dire situation that health care providers were in as they made up nearly 10% of all fatalities. They were exhausted, running out of personal protective equipment and still doing their best to take care of patients.


The below sites have some great info about COVID-19 – primarily for medical professionals but also for public (FAQS)


https://www.asam.org/

-the American Society of Addiction Medicine (ASAM)

https://nysam-asam.org/

-the New York Society of Addiction Medicine (NYSAM)

https://www.acmt.net/

-the American College of Medical Toxicology (ACMT)



Dr. Wiegand is the Medical Director at Huther Doyle and the Director of Toxicology at the University of Rochester. He serves on numerous boards, including as an at-large member for the American Society of Addiction Medicine (ASAM) Board of Directors and, as of this February, began a two-year term when he was elected to President of the New York Society of Addiction Medicine (NYSAM) - the state chapter (Region I) for ASAM. Dr. Wiegand was also awarded a medal of recognition related to his work and contributions to the American Society of Addiction Medicine (ASAM).

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