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Workshop: The New Multidisciplinary Medical Advocacy Team for Traumatized, Medical Complex Addicted Patients: Addiction Psychiatry, Medicine and Ada Lawyers
Abstract

Hospitalizations due to severe injection-related infections (e.g., endocarditis) are increasing with the opioid crisis. Trauma related to these illnesses and other life events is often unrecognized and impacts patients’ ability to self-advocate. Stigma also impacts treatment options presented to patients. For example, patients with substance use disorder (SUD) and infections requiring prolonged IV antibiotics are often required to remain hospitalized for the entire antibiotic course without offering treatment alternatives. These patients often have significant life traumas, post-traumatic stress disorder (PTSD), and life-threatening infections plus prolonged hospitalizations contribute to further trauma. The University of Kentucky has an ongoing clinical trial evaluating home IV antibiotics in patients with severe infections and OUD on buprenorphine, while also assessing for trauma and PTSD. During the study, additional barriers emerged such as residential treatment facilities and carceral settings not providing patients access to OUD medications (MOUD), leading to severe withdrawal, increased risk of death and other complications. This practice violates the Americans with Disabilities Act (ADA) and other laws, something that physicians and patients generally do not realize. Addiction psychiatrists can spark change and educate other physicians about the ADA as an effective advocacy tool, advocate for patient-centered treatment of injection-related infections and increase screening and treatment of SUD/other psychiatric comorbidity in this vulnerable patient population. We will review the basics of the ADA relevant to physician advocacy and successful collaborations between physicians with addiction expertise, ADA lawyers and advocacy groups to help improve health outcomes for people with SUDS and comorbid psychiatric disorders.

Learning Objectives
  • Participants will be able to explain how anti-discrimination laws protect people with SUDs and name two advocacy strategies and resources
  • Describe types of trauma common among hospitalized patients with infections and SUD during a prolonged hospitalization
  • Identify situations/risk factors where discrimination is likely occurring among addiction psychiatry patients
Keywords / Topics
  • Barriers
  • Trauma
  • Hospitalized Patients
Presenters
Larissa Mooney, MD, Chairperson

 

Larissa Mooney, M.D., is a Professor of Clinical Psychiatry and Director of the Addiction Psychiatry Division in the Department of Psychiatry and Biobehavioral Sciences at UCLA. She directs the UCLA Addiction Psychiatry Clinic and the UCLA-Veterans Affairs (VA) Addiction Psychiatry Fellowship Program, where she teaches psychiatrists being trained in the clinical management of substance use disorders (SUDs) and mental health disorders. Dr. Mooney previously served as the Section Chief for Substance Use Disorders at the Greater Los Angeles VA. She is the President of the American Academy of Addiction Psychiatry (AAAP), a Distinguished Fellow of the American Psychiatric Association (APA), and a fellow of the American Society of Addiction Medicine (ASAM). Dr. Mooney has conducted clinical research at UCLA Integrated Substance Abuse Programs (ISAP) on pharmacological and behavioral treatment interventions for SUDs and co-occurring substance use and mental health disorders. She is one of two Principal Investigators for the Greater Southern California Node of the National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN). She has NIDA funding to study functional outcomes associated with cannabis use reduction and treatment interventions for opioid use disorder and stimulant use disorder.

Laura Fanucchi, MD, MPH, Co-Chair

 

Dr. Laura Fanucchi is Associate Professor of Medicine in the Division of Infectious Diseases and the Center on Drug and Alcohol Research at the University of Kentucky. She received her MD and MPH from Emory University, and completed an Internal Medicine residency and Chief Residency at New York-Presbyterian Hospital / Weill Cornell. She is board-certified in Internal Medicine and Addiction Medicine and is Director of the UK Addiction Consult and Education Service. She also provides treatment for opioid use disorder in the UK Bluegrass Care Clinic and in the UK First Bridge Clinic. Dr. Fanucchi's research focus is in integrating evidence-based treatment of opioid use disorder in medically complex patient populations. She has presented regionally and nationally on the management of hospitalized patients with opioid use disorder, and provides training to physicians and other members of the healthcare team. 

Anna-Maria South, MD, Presenter



Dr. South is board certified in internal medicine and addiction medicine. She works as an academic hospitalist and as a consultant on the addiction consult and education service. She is a passionate advocate for patients, and her work on advocacy for patients with substance use disorder has been published in peer-reviewed journals such as JAMA. She has presented at national conferences for the Society of Hospital Medicine, the Society of General Internal Medicine, and The Association for Multidisciplinary Education and Research in Substance use and Addiction, and has been an invited guest speaker for grand rounds and division rounds at multiple institutions. At the University of Kentucky, she serves as the health equity and advocacy thread leader for the College of Medicine, where she focuses on educating the next generation of physicians on equitable health care. Her clinical interests include evidence-based management of patients with opioid use disorder in the inpatient setting, equitable health care for incarcerated patients and decreasing stigma in care for patients with substance use disorders. 

Rebekah Joab, Presenter

 

As a Senior Staff Attorney at the Legal Action Center (LAC), Rebekah Joab advocates for individuals who have experienced discrimination because of their substance use, arrest or conviction records, and HIV or AIDS status. Rebekah works on LAC's impact litigation and direct legal services across these areas, with a particular focus on LAC’s legal and litigation strategies to increase access to medication for opioid use disorder and enforce anti-discrimination rights for people who use drugs. During her time at LAC, Rebekah has litigated Finnigan v. Mendrick et. al., which challenged a jail’s ban on medication for opioid use disorder, and written amicus briefs in several cases challenging discrimination against people with substance use disorders, including Dominque Harris v. State of Ohio, Vernon Yontz II v. State of Ohio, and Clint Mueck v. LaGrange Acquisitions, L.P. In her role at LAC, Rebekah also educates and trains organizations and individuals about anti-discrimination and other laws protecting LAC's constituencies. Rebekah earned her BA in psychology from the University of Maryland, College Park, and her JD from the Georgetown University Law Center. 

Laurence Westreich, MD, Presenter

 

Dr. Westreich is a board-certified addiction psychiatrist who specializes in the forensic evaluation of addicted persons. After graduating from Northwestern University with a degree in English Literature, he received his medical degree from the University of Minnesota School Of Medicine. Following an internship in Internal Medicine at the Hennepin County Medical Center in Minneapolis, Minnesota, Dr. Westreich completed a residency in General Psychiatry at New York’s Beth Israel Medical Center, and a fellowship in Addiction Psychiatry at the New York University School of Medicine/Bellevue Hospital. He is board certified by the American Board of Psychiatry and Neurology in general psychiatry, addiction psychiatry, and forensic psychiatry. Dr. Westreich is Associate Professor of Clinical Psychiatry in the Division of Alcoholism and Drug Abuse, Department of Psychiatry, New York University School of Medicine and serves as Consultant on Behavioral Health and Addiction to the Commissioner of Major League Baseball. He is licensed as a Medical Review Officer (M.R.O.), and is the author of Helping the Addict You Love (Simon and Schuster), and A Parents Guide to Teen Addiction (Skyhorse Publishing.) 
Summary
Availability:
On-Demand
Cost:
FREE
Credit Offered:
1 CME Credit
1 Other Professionals Credit
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