Addiction Consult Service (ACS) – Residents should report to the ACS Workroom at Weiler Hospital (1825 Eastchester Road, Office 224 Room 3 – see map) for work rounds starting at 8:30am on Day 1 of the rotation. The Addiction Consult Service provides consultative services for inpatient evaluation and management of alcohol, opioid, and other substance use disorders, and is staffed by the Addiction Medicine Fellows and Faculty. In-person Addiction & Psychiatry Consult Service Joint Rounds occur on Tuesdays from 9-9:30am. Please contact Dr. Kristine Torres-Lockhart (email@example.com) if any questions.
Addiction Medicine “Bridge Clinic” – Residents should report to the “Bridge Clinic” at Comprehensive Family Care Center (1625 Eastchester Road, Adult Medicine Library) by 1:30pm on both Tuesdays during the rotation. The Addiction Medicine “Bridge” Clinic at CFCC is a multidisciplinary clinic session on Tuesday afternoons that provides primary care-based addiction care for persons with opioid and/or alcohol use disorders, including those new to or unstable in buprenorphine and naltrexone treatment. Please contact Dr. Tiffany Lu (firstname.lastname@example.org) if any questions.
Opioid Treatment Program (OTP) – Residents will be assigned to attend a Montefiore OTP on one of the two Friday mornings during the rotation. A typical rotation day starts with meeting the faculty preceptor at 8:30am, either at the Wellness Center at Port Morris (804 East 138th Street) or Wellness Center at Melrose (260 East 161st Street). Reporting details can be confirmed by contacting Dr. Melissa Stein (email@example.com) on Day 1 of the rotation. OTPs are licensed under federal regulations to provide methadone treatment, and can also provide buprenorphine treatment. In addition, OTPs provide substance use counseling, primary medical care, mental health care, and other supportive services for persons with opioid use disorder.
Addiction Medicine Rounds – Residents should attend Addiction Medicine Rounds via Zoom on the second Friday of the rotation from 12:30pm-1:30pm. Each resident is expected to prepare a case presentation for 20-25 mins; case presentations should include a clinical question, review of evidence, and take-home points for clinical management. Resident case discussions may be cancelled when there are special talks given by invited speakers. Check out the Addiction Medicine Rounds calendar for updated dates and topics, as well as Zoom log-in information. Please contact Sadyn Angeles (firstname.lastname@example.org) if any questions.
Self-study Time – Please see below for orientation videos, buprenorphine waiver training, and readings to be completed throughout the rotation.
E. Self-Study Curriculum
Residents on the Addiction Medicine Rotation are expected to work through the self-study components throughout the two-week rotation. In addition, 2 half-days will be allocated for residents to complete the self-study components without clinical responsibilities during the rotation.
1. Addiction Medicine Orientation Videos: Residents should review orientation videos recorded by Montefiore’s Addiction Medicine Faculty. Please start viewing videos on Day 1 of the rotation. You can access the orientation videos through the rotation resource folder (tinyurl.com/AddictionMedicineRotation).
· Video 1: Addiction Consult Service Orientation
· Video 2: Addiction Care 101
· Video 3: Alcohol Use Disorder 101
· Video 4: Opioid Use Disorder 101
· Video 5: Acute Pain and Opioid Use Disorder
· Video 6: Discharge Planning for Addiction Care
2. Buprenorphine waiver training: 8 hours of buprenorphine waiver training must be completed by all Internal Medicine Residents as a graduation requirement. Buprenorphine is an effective treatment for opioid use disorder that can be prescribed in diverse medical settings. Federal regulation changes now allow physicians to apply for a limited waiver to prescribe buprenorphine for up to 30 patients without completing the waiver training. However, most physicians report a lack of knowledge and training as a key barrier to buprenorphine prescribing, while other physicians will need to treat more than 30 patients. The 8-hour buprenorphine waiver training is therefore required as a part of the Addiction Medicine Rotation to better prepare our graduates to tackle the public health crisis of opioid overdose deaths and opioid use disorders.
Options to complete the buprenorphine waiver training are as follows:
· Complete the free online 8-hour waiver training through PCSS during the Addiction Medicine Rotation (PCSS 8 Hour Online Waiver Training)
· Attend a free ‘half-and-half’ waiver training (4-hours in-person, 4-hours online) taught by the Addiction Medicine faculty at Montefiore in the fall of the academic year. (Residents in Primary Care Social Internal Medicine Program are registered for these trainings during their intern year.)
· Residents who previously completed the ‘half-and-half’ waiver trainings at Montefiore can retrieve their certificates by following instructions posted on the rotation resource folder.
Submitting Certificates of Completion for the buprenorphine waiver training:
· Submit the Certificate of Completion to buprenorphine program coordinator, Sadyn Angeles, (email@example.com) by the last day of the Addiction Medicine Rotation.
· Completion status will be tracked by Addiction Medicine Rotation Directors and shared with Residency Program Leadership.
3. Addiction Medicine Readings: Residents should review key articles that review foundational principles in addiction care for internal medicine physicians. You can access the required readings through the rotation resource folder (tinyurl.com/AddictionMedicineRotation).
General Approach to Addiction Medicine (Covered in Video 2)
Alcohol Use Disorder (Covered in Video 3)
Opioid Use Disorder (Covered in Video 4)
Torres-Lockhart K, Lu T, Weimer M, and Cunningham CO. Clinical management of opioid withdrawal. Addiction. 2022 Feb 3; 1-11. https://doi.org/10.1111/add.15818
Wakeman SE. Opioid use disorder diagnosis and management. NEJM Evid 2022; 1(4). Published March 22, 2022. doi: 10.1056/EVIDra2200038
Cohen SM, Weimer MB, Levander XA, Peckham AM, Tetrault JM, Morford KL. Low Dose Initiation of Buprenorphine: A Narrative Review and Practical Approach. J Addict Med. 2021 Dec 23. doi: 10.1097/ADM.0000000000000945.
Pain Management and Opioid Dependence (Covered in Video 5)
4. Montefiore Clinical Protocols: Be familiar with the clinical protocols implemented at Montefiore hospital campuses for addiction care and naloxone distribution. Access through the rotation resource folder or on the Montefiore Intranet (Policies à Medical Guidelines - Archived à Substance Use):
Management of Opioid Use Disorder and Opioid Withdrawal in Hospitalized Patients
Management of Alcohol Use Disorder and Alcohol Withdrawal in Hospitalized Patients
Perioperative Buprenorphine Management for Elective Surgery
Naloxone Take-Home Kits at Weiler and Moses Campuses
5. Optional Podcasts & Readings: Optional readings related to alcohol or opioid use disorder treatment are available through the rotation resource folder.
Optional: Curbsiders Podcast, Episode #212 – Sober Talk: Managing Inpatient Alcohol Withdrawal with Dr Joji Suzuki. https://thecurbsiders.com/podcast/212 (start at 8m10s)
Optional: Curbsiders Podcast, Episode #194 – Treatment of Alcohol Use Disorder with Dr. Marlene Martin. https://thecurbsiders.com/podcast/194-alcohol (start at 9m45s)
Optional: Curbsiders Podcast, Episode #187 – Buprenorphine Master Class: Managing Opioid Use Disorder for the Generalist with Dr Michael Fingerhood. https://thecurbsiders.com/podcast/187-buprenorphine (start at 16m45s).