Friday, November 4, 2011

Canadian Society of Addiction Medicine, Vancouver, 2011

The Canadian Society of Addiction Medicine annual conference opened today at the Hyatt Regency in downtown Vancouver. Today I was especially lucky to catch Dr. Nady el Guebaly first thing in the morning. He's been head of psychiatry in Alberta and head of Canadian Society of Addiction Medicine and the International Society of Addiciton Medicine. His scientific research is impeccable while his clinical insights are truly revealing. Having presented an concise the whole overview of the field he spoke briefly on Gallanter's research on spirituality and addiction treatment, saying "I tell my patient's they're lucky if they have belief."
I was sorry I'd missed Dr. Paul Sobey's presentation. We met some decade or so back studying for our American Society of Addiction Medicine exams.  I was so impressed by his experience, humor and deep concern for  addicted clients.  There's several streams of presentations so it's not possible to hear all the great speakers.
I was very thankful to have atttended Dr. David Marsh's presentation on the History of Methadone Treatment as it was so relevant to my work as a methadone doctor.  I'd just passed Dr. Gary Horvath from Doc Side Clinic in the hall.  Gary mentored me in Methadone Treatment when he wasn't off doing Iron man competitions.
Dr. Marsh's was instrumental in the establishment of Insite, the safe injection site in Vancouver. His presentation of the public health benefits obviously impressed the Supreme Court.  He continues to do research in his position with the University of Northern Ontario. He commented briefly on the Naomi research on heroin as an alternative for methadone in the small subcategory of patients who appeared to have need for this treatment after decades of failed treatments with all the orthodox approaches. Buprenorphine was being used in physician offices in the US and because these were so different from the regulated US methadone clinics it was questionable how much relevance the outcomes had to the very different opioid dependent populations being serviced by Canadian methadone clinics.
Dr. Krauss, Addiction Psychiatry chair at UBC and head of the Burnaby Mental Health and Addiction program presented the need for a truly integrated bio psycho social approach for the polysubstance addicted person with concurrent psychiatric disorders.  Coming from Europe he was truly disappointed by the neglect that these severely disabled patients experienced.  He spoke to the need to meet patients where they were, providing a range of services, as with any chronic mental illness.  Given his experience with the approach to care of patients in Germany , Switzerland, Norway and the UK, it was most interesting to hear how they'd achieved success with a much simpler and more pragmatic approach to some of the problems which had stymied doctors here. His compassionate learned approach to the problems of downtown eastside Vancouver provided a sense of hope to those present.
Attending were doctors and other health care workers, counselors, administrators, family physicians, youth service workers, forensic specialists, those working in  the jails and courts, representatives from various treatment centres and recovery homes,  psychiatrists and those already certified in addiction medicine by the Canadian Society of Addiction Medicine.
The conference continues all weekend and the atmosphere is so invigorating.  As Dr. Kraus said, to audience laughter, those attracted to work in the field of addiction aren't looking to become rich or be the next medical department head.  He said you don't have to go to Haiti or Africa to help the truly disabled you can serve patients with addictions in urban Canada.  Hearing him I was reminded of how Dr. Jack Hildes used just that statement to woo me to work with the University of Manitoba Northern Medical Unit. The 5 years I was associated with that program remain in many ways the time I felt best about being a physician and psychiatrist.
Dr. Marsh shared that a colleague had said that he'd thought himself the most stigmatised of physicians when he'd begun to work with HIV in the early years till recently he'd come to work in addiciton medicine and felt he was even more stigmatised and marginalized.
That said, the conference has provided so many great clinically useful ideas and not at all shied away from the tough questions that are day to day reality in this tragically human  field of chronic medicine.  I'm thoroughly enjoying this conference and delighted to see so many present.
When I first moon lighted as acting head of the Winnipeg Detox in 1985 I had no idea I'd one day be at a scientific conference with the bright and best and so many young health care professionals obviously keen and ready to tackle a problem too long ignored.IMG 0029IMG 0030

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