Canadian Society of Addiction Medicine Annual Conference, Vancouver, 2018

The Canadian Society of Addiction Medicine Annual Conference 2018 at the Fairmont Hotel in Vancouver was a great success. Over 650 attendees.  A wide range of topics from Tobacco Addiction, Alcohol Addiction, timely discussion of marijuana, the opiate fentanyl crisis and the overdose epidemic.  All were discussed by the leading authorities in Canada. Aboriginal communities and peoples, women and addiction,  the role of peer support workers and the advancing importance of nurse practitioners and others in the field all were addressed.
Dr. Paul Sobey, President of CSAM and Dr. Jennifer Brasch, Ontario CSAM Board  were the conference organizers and did a spectacular job of inclusivity and relevance.  One presentation gave an astonishing history of the organization listing all the past presidents many of whom I’d had the privlege of knowing.  So much had been accomplished by the pioneers and those who followed behind.
It was an especially moving moment when Dr. Nady el Guebaly was presented the lifetime achievement award, his contributions to  CSAM early years being legendary as was his part in founding ISAM, the International Society of Addiction Medicine.  I had first met Dr. el Guebaly as a psychiatry resident in the 80’s  when he was a Professor of Psychiatry at the University of Manitoba before he moved on to be the Head of Psychiatry at University of Alberta. I was moonlighting at the time covering nights and call at the Winnipeg Detox. What most impressed me early years was his dedication to scientific research. His work in Gambling Addiction  is unsurpassed.  He is also author of International Addiction Medicine ; A Certification Exam and New Textbook as well as serving as editor for the Journal of Addiction. It was a joy to see him receiving this award and also learning that he’d received the Order of Canada for his work in Addictions.
Having joined  CSAM in 2002, some 16 years ago, the best part of the conference is seeing old faces still looking new and meeting some of the weary new faces. With experienced clinicians the most important aspect of conferences simply doesn’t go on educationally from the perspective of the content and show and tell in the lecture theatres. It’s in the personal discussions in the hallways and the private consultations.  Dr. Raju Hajela is one of the most learned and respected addiction medicine clinicians so it was truly a boon to discuss a difficult clinical situation  that was also personally troubling, with him,  and gaining his insight and  wisdom.
I was delighted to be uplifted by Annie McCullough who was there representing Together We Can Treatment Centre. I see so many of the clients of that program at DocSide Medical where I work with Dr. Gary Hovarth and have been thoroughly impressed with the TWC success stories. The very best inpatient treatment centres, including Homewood, Last Door, Orchard, Cedars, Edgewood, Together We Can, and more were represented in meet and greet area. I especially enjoyed talking to the folk from Narcotics Anonymous.  After all the great science in the lecture halls  I especially loved a spiritually uplifting chat with Geoffrey a young Saskatchewan academic researcher who spoke heartfully of the loss of life in addiction.
I was then  blessed to meet Dr. Elliot Gardner. I have listened in awe to several of his presentations on the field of addiction medicine starting from my first attendance at CSAM. His insights and experience are profound. Yet there I was shaking his hand and chatting amiably with a personal great. The same with Dr. Marsh.
Personally my favourite presentation was by Launette Rieb in the all around incredible workshop Treating Pain in People with Addiction and Mental Health Challenges.  The room was packed and the hallways full for the presentations by Launetter Rieb, Annabel Mead and Robert Tanguay, all three the real bright lights in this growing field. Addiction Medicine, Psychiatry, Internal Medicine,  Family Medicine and Public Health are all overlapping. Representatives from all these specialities were well selected with superb presentations.  My other favourite presentation was the session on Communicable diseases and Substance Use Disorders with Chris Cavacuiti, Astou Thiam and Laura Bell. When it comes to scientific sleuthing I was thoroughly impressed with Laura Bell and her team at Western Ontario in addressing HIV in the using paraphernalia.  An amazing story worthy of NCIS.
The tours of the Injection sites, the down town EAST SIDE hotels, Dr. Peter Centre, were all the rave. Having been to all these, living and working here in Vancouver, I rather enjoyed using the spare time to have a marvellous chat with Rand, Reg and Monte.  Later I cross the street and did some neglected shopping at the Pacific Centre Apple Store.
Next year’s conference is in Halifax and I really do hope to go.

Reno Nevada after IDAA

I loved Cheryl’s Sunday Morning Spirituality talk. Hope and redemption.  Then it was farewells, hugs all round.  Maybe another whole year before seeing people that uplift and sustain me.  We talked of attending other meetings, so many had, a similar one in Melbourne next year, the annual one of the British Doctors, New England doctors and Western conference.  I must make room for this in my schedule if only to keep perspective. Judy smiled knowingly at me when we talked of detaching from the politics of the profession.  So much has been about recognizing our fears.  Aging and the proximity to dying has touched me in ways I’d not noticed before.
My missionary doctor friend organized a workshop on trauma. I didn’t know where to begin.  An ER doctor was unable to get the image of one gunshot wound in LA out of his head. He’d seen so many stabbings and gunshots but this one touched him. I keep seeing thelittle girl who overdosed with her boyfriend last year, taking a year off from college.  He lived. She died. The face on the disease

I’m sitting here in the Reno Outdoor Cafe Campo. It’s on the Riverwalk and gives are really special face to the city.  The main street is casinos while here is this witness to elegance and fine living. The promenade.  Truckee River. A lovely stream with rapids and boulders, yet here and there some depth.  No doubt a happy place for some species of fish.  Hanging potted plants are all  along the way.  A Latin busker sang a sweet song while a young man jogged past the well dressed young lady pushing her baby buggy.

The sun is hot here.  The city has let artists paint the outside of buildings. Across the way a pretty wall of clouds and sky. More eye candy. A many faceted whale is sculpted  in a deep dive a long way from home in Nevada.  
The city is known for it’s restaurants and cuisine. Staying at the Peppermill Resort I loved all the meals they prepared. The smorgasboard brunch with John was a treat with Mexican and Chinese offerings beside the roast beef and all day breakfast items..  Obviously gamblers like to eat too.

The gambling machines in the airport when I arrived were a surprise but then later I told a friend that I expect every home in Reno has it’s own gambling machine shrine. The city is to gambling what Napa is to wine.  

My work with addiction skews my view. Mostly 80 to 90% of people can enjoy pleasurable activities without stealing from their grandmothers or selling their bodies for cash in the pursuit of pleasure to fuel some activity.  Dr. Nady el Guebaly, founder of the International Society of Addiction Medicine spent his life time studying gambling seeking to prevent those small few who simply couldn’t stop. It’s a deep field for research with advances occurring all the time in the study of genetics, Neuro chemistry, social and psychological factors. 

It’s nice sitting here reflecting on all the other activities that occur in a major city regardless of the primary industry. Here tourism is increasingly important but once the town was a centre for ranching and hub of migrations and transportation. The bridge a ways down had a sign recording the history of the development of Reno in the Gold Rush days as a resting point and transit point on the way to the California mines.

I”m just thankful to have been here.  The IDAA conference has taken me to so many American cities I might otherwise not have known. I love these settings of IDAA and the resorts.  Lake Tahoe is close and many chose to take a dinner cruise on Friday evening.  I tried to arrange a horseback ride with Heavenly Hooves but they were booked a week a head.  Sierra Adventures also was booked full, the popularity of the outdoor adventure that apparent.  

I’d only stopped in the past passing through Reno driving from Western Canada down to California.  I was travelling with a wife and Mustang car then but would love to come through here on my Harley. There’s that Wild West flavour here and Hollywood made it’s share of western movies in Nevada at one time.

The airport is calling now.  It’s been a great conference and I’m thankful to Reno for being here to host such events so well.  Till next I come, hopefully with more time and a motorbike or kayak.  

CSAM - Canadian Society of Addiction Medicine - 25th Conference - Ottawa - October 2014

Evolving Perspectives on Addictions (Perspectives Evolutives en Dependences)” was a great success with participants from accoss Canada and the United States.  President Ronald Lim and Conference Chair Paul Sobey,
combined with many others to make this educational experience at the Marriott Hotel clinically extremely beneficial as well as addressing evolving controversies.   Having a Methadone Clinic to attend at Dr. Gary Horvath’s DTES Vancouver Doc-Side Medical Clinic on Wednesday I didn’t make the first day though heard it was extremely well received. All the research and scientific advances in the study of electronic cigarettes and marijuana smoking were addressed.  Thanks to Paul I was emailed   Dr. Mark Wares latest paper.
Dr. Alan Budney , President, Division SO American Psychological Association presented on new regulations related to Marijuana.  Dr. Peter Selby updated the group on Motivational Interviewing.
All of the slides and references for conference are available on the CSAM site.(www.csam-smca.org/Office 403-813-8217)
Dr. Jeffry Turnbull, medical director of the Inner City Health Project, Ottawa presented on evolving psychosocial approaches to Addiction treatment while Dr. Tara Tucker addressed the critical issue of Compassion Fatigue.
Dr. Kim Corace, Director, and Dr. Melanie Willows, Program Development and Research in Substance Use and Concurrent Disorders Program, Royal Ottawa Mental Health Centre, spoke on Bridging Research and clinical Practice:Key Strategies to creating innovative addiction treatment services.  Their presentation addressed the need and importance of the Hub and Spoke Partnership Model, the networking involved and how to get key players involved in the coordination of effort.  It was clear that a whole lot of work and effort had gone into the obvious successes of this remarkable program.
Mel Kahan,
Medical Director, Substance Use Service, Women’s College Hospital, spoke on the Rapid Delivery of Addiction Medicine Service to patients in Detox Centres and Hospitals: the H-SOAP project.  Dr. Kahan is truly one of my favourite ‘rock stars’ of Canada’s Addiction Medicine. His program identified that addicts with their particular series of crisis needed to be deal with  a hospital based service that was responsive to emergencies, psychiatric and internal medicine wards providing the critical cost saving and clinically relevant service at the time they’re needed not weeks or months later.  With his vision and experience he has developed a working model in his community that is practical, profitable and very timely indeed.





Dr. Corey Waller, Medical Director of Spectrum Health Medical Group Centre for Integrative Medicine presented on the major news topic of Prescription Medication Abuse. He was a very exciting speaker with humour, anecdotes and challenging considerations for advocacy at the highest levels.  





Dr. Marie-Eve Morin was a true delight presenting in French on the topic of the Doctor as Drug Pusher.  The conference had provided electronic sound devices for the real time translation of her superb talk.  My french is rudimentary so I really did appreciate this assistance and knew my American friend was loving this ‘international’ aspect of the Canadian conference.  Dr. Marie-Eve Morin’s reviewed the problems of prescription drug abuse, the history and recognition of these in Quebec and the advances in addressing the issues her and her associates had made.   It was a thorough and riveting presentation. C'est bien! Magnifique!
Dr. Beth Sproule,
Clinician Scientist, Centre for Addiction and Mental Health, presented on A Case for Pharmacists and Prescription Monitoring Programs , Decreasing the Harms from Prescription Drugs.





Dr. Melanie Strike’s presentation was very well received, a very revealing presentation of clinically relevant research and insights that really did touch the core and complexity  of concern in the front lines of therapeutics.






Dr. Nady el Guebaly, the humble leading light of  International Addiction medicine has just published the definitive textbook of addiction medicine through Sprinter.com (ordersny@springer.com) “Textbook of Addiction Treatment:International Perspectives” Nady el Guebaly, Giuseppe Carra and Marc Galanter.
Dr. Nady el Guebaly introduced Dr. Ivan Montoya, National Institute of Drug Abuse (NIDA, Director, Practice Research Network, American Psychiatric Association. Dr. Motoya did a comprehensive review of the evidence based research on pharmaceutical treatments to date and introduced new treatments ongoing and/or under review.  This was a very exciting look at the possible future of pharmacotherapy with it’s attendant hope for those still suffering.











Monica Bawar, PhD Student,  Neuroscience program, and Brittany Dennis, PhD Student, Clinical Epidemiology and Biostatistics, McMaster University, presented an elegant study on Factors Affecting Treatment Outcome for Patients Undergoing Methadone Treatment for Opioid Addiction: A Focus on Sex Hormones and Chronic Pain. I was delighted personally to learn from this research that testosterone levels are related to dose of opiods and that there didn’t seem to be any evidence that one opioid acted differently than others. My methadone patients occasionally complain of reduced libidido when they start treatment which struck me as strange because most of the heroin addicts in general complain of lack of libido secondary to any opiate use.  Heroin has never been considered a sexual performance enhancing drug so it was helpful to hear the detailed work of these researchers who also addressed how factors of chronic pain might well contribute to relapse in methadone patients.








Dr. Andrew Smith, Staff Physician, Pain and Addiction Medicine, CAMH presented on Partial Agonists and Half Truths: The Use of Suboxone in the Treatment of Chronic Pain. Dr. Smith’s presentation was a most interesting case presentation with remarkable insights and developments that spoke well to the true complexity that clinical practice presents.  It was really helpful clinically to see how an otherwise difficult and tragic case of a highly successful individual with chronic pain could be best  addressed. The use of Buprenorphine was critical in the resolution of the case which had a previously hard working man utterly prostate with disability but with appropriate care back at work and doing the recreational activities that they so enjoyed. It really did speak to the miracles that we all have seen in this difficult but rewarding work.


“What’s New in Hep C” talk by Dr. Curtis Cooper, Director, Ottawa Hospital Viral Hepatitis Program, was a fascinating  simply for telling us about the facts and success of the new and highly effective treatments for Hep C that are now available. The difficulty that remains is getting the funding for these truly historic advances. 








On this positive note with a celebration of all the new research and advances in the exciting cutting edge field of addiction medicine, the conference closed. Next year’s conference will be in Calgary Nov. 5-7 at the Coast Plaza Hotel (admin@csam-smca.org)
Personally I was delighted to buy Dr. Merville Vincent’s book, Diagnosing and Treating Addictions, An Integrated Approach to Substance Use Disorders and Concurrent Disorders.  Ms McCullough, now in Toronto with Edgewood,  formerly of Vancouver was in the welcoming room when I arrived. It was great to see her again.  Dr. Vincent, psychiatrist with Edgewood is one of the best clinicians in the field but also a very clear thinker in what can often be a fuzzy area. His lectures have always been well worth the effort to attend.
I was equally delighted to actually see Dr. Nady el Guebaly’s Textbook of Addiction Treatment:International Perspectives.  Copies were present for perusal but we couldn’t buy them on sight but had to order from the publisher.  Seeing them was worth the wait as all of us in Addiction Medicine have been looking forward to this comprehensive text. This book had been the talk of the Kuala Lumpur Addiction Medicine conference I'd attended last fall. Now I’m waiting for my copy to arrive and many hours of enjoyable reading this winter.
 For the flight home I was thankful to obtain the latest Canadian Journal of Addiction, the Special Edition: Medical Marihuana: Furthering an Objective Debate. Given all the nonsense in the media and the lies perpetrated by those with  major conflict of interest I’m looking forward to reviewing the truth and science of the matter.   The journal has  articles  by Dr. Nady el Guebaly, Harold Kalant, Mark Ware, Meldon Kahan, Shery Spithoff and Anna Reid.  What a great read this will be.
Thank you CSAM organizers and presenters. What a great conference! A bientot!