Final Day of Addictions Nurses Conference

A much shorter day of speakers today. I am writing this on the bus returning us from Biltmore Estate where we have spent the afternoon. (The bus has wifi so hopefully I'll get this posted before returning to the hotel).

The final two sessions were presented by the same speaker.

08:40am
The Opioid Problem
Stephen Wyatt, DO, Medical Director Behavioural Health Services, Carolinas HealthCare System

Much of this session was similar to previous sessions about the seriousness and the wide spread nature of the use and abuse of opioids. While much blame has been put on physicians for over prescribing, and while much of this is also an issue, the blame needs to be shared.  The other area of blame or fault is placed at the feet of those individuals who are drug addicted. This speaker, a physician of many years, who has worked long term in various areas of medicine and osteopathy, provided us with two main issues related to The Opioid Problem. One statistic is that 55% of overdoses have resulted from family and friends sharing medication that should have been discarded.  The other issue is the nature of pain and the vicious circle of uncontrolled pain:  pain - avoidance - decreased mobility - altered functional status - diminished self efficacy - social limitations - pain. This is enhanced if opioids are over used because pain has not been accurately and effectively assessed, provided with appropriate treatments or if patient's do not understand the nature of this drug.

10:40am
Integration of Addiction Medicine in Primary Care
Stephen Wyatt, DO, Medical Director Behavioural Health Services, Carolinas HealthCare System

After a short break, Dr. Wyatt spoke about a critical change in the primary and medical care community for addictions care. That being, alcoholism and drug addiction being treated as any other chronic disease is treated. It i in fact a chronic brain disease. This would include accurate assessment, recommended treatment of a multimodal nature by the physician that include followup review and discussion of the patient's progress. Much to my pleasure he used an analogy that many of in addictions nursing have used for years:  If a patient with diabetes doesn't follow the regimen prescribed, he or she is not punished and care withheld. There is followup to determine how to help this patient.

There was one other session and I believe it was between these two. Now understand, my brain is kind of on overload, so the exact time I'm not certain. However we had an opportunity to sit with different board members to discuss different areas of the organization. I sat at the table with Stephen Strobbe, our president elect, to discuss position papers. He outlined what they are and his ideas for the upcoming year.

Then it was off to the Biltmore Estate. An amazing piece of architecture and forward thinking of George W. Vanderbilt in Asheville, North Carolina. Furniture, immense wall tapestries, a winter garden indoors,  a heated swimming pool and gymnasium. A vast library. A billiard room and bachelors quarters. An entire floor for guests. Huge kitchens and walk in refrigeration. Separate and beautifully appointed bedrooms and quarters for Mrs Vanderbilt and for any female guests (Even separate change rooms in the pool area.) This all in the early 1900's.

"There is no real ending. There's just the place where you stop the story."

~ Frank Herber

Day Three of the Addictions Nurses Conference

Another full day with a twist!

0805- 0935
This morning's keynote address provided me with some answers to a question I've been asking for several years:
Craving:  Etiology, Epidemiology, Management. The presenter was Omar Manejwala, MD, DFAPA of Manejwala Consulting.  Craving is a phenomenon of addiction to drugs or alcohol that has long puzzled me. Having researched this topic, and not finding a definitive written work on craving, this speaker has written his own book Craving  Why We Can't Seem to Get Enough. Most importantly to my mind, cravings are temporary and not as frequent as many of us would believe.

0945
Then the twist:  I was given the opportunity to share my beliefs and opinions about the geriatric population and addiction in an interview. The interview was conducted out by the pool in cushioned shaded comfort. A Board member doing a project for educational purposes, is interviewing several of us about this topic. I should have more information in a few months about this recorded interview.

I had a few minutes to be able to catch the last ten minutes of
Biopsychosocial-spiritual Management for Persons with Coexisting Pain and Substance Use Disorders presented by Deborah Matteliano, PhD, FNP, ANCC Certified in Pain Management; University of Buffalo
(She and I had had supper together last night - a new friend and colleague)

Before lunch the next presentation was:
11:10 - 12:10
SBIRT Plus Recovery Management (SBIRT + RM) Enhanced Model for Substance Use Disorder Interventions within Primary Care Settings
Katherine Fornilli, MPH, RN, CARN, University of Maryland School of Nursing

Don't you just love the acronyms! Assessments of our clients for referral to treatment centers and followup care are sparse and require a slightly different focus. This speaker has designed such an assessment process to provide improved followup. A new development, this will soon be tested in the speaker's area.

Luncheon from 12:30p to 1:30pm was another 'working' lunch and the Annual Business Meeting of the International Nurses Society on Addictions. As with all business meetings, committee reports, financial statements and goals were discussed. The largest conference in our history many new members were welcomed - more from Canada! And while a small organization, we are slowly expanding globally in the U.K., Europe, Australia and New Zealand.

1:35pm - 2:35pm was another Keynote Address:
Developmental Model of Recovery
Tammy Bell, LCSW, MSW, MAD
I thoroughly enjoyed this speaker. She opened by telling us what her position is on substance abuse treatment - abstinence based, having worked with Father Joseph Martin who did Chalk Talks for the U.S. military many years ago. Her other influence was Terence Gorski who has written and spoken about The Post Acute Withdrawal Syndrome.  Both of these people are part of my own initiation into Addictions care.

2:40pm - 3:40 pm
NADA Ear Acupuncture Protocol: Opportunities and Challenges for Integrating In Addiction Treatment
Michelle Olshan-Perimutter, PMHCNS-BC, FNP-BC; Carolinas Healthcare System
The NADA protocol is practiced at Victoria Detox, my day job, Monday to Friday. This speaker would love to see nurses able to freely practice this low cost and effective modality, however there is variable responses to this practice. This was also another brush with my past as she mentioned Dr. Libby Stuyt, another of my early influences and a mentor in my journey into the field of  addictions nursing.

4:10pm-5:10pm
Harm Reduction: Differing Points of View
Bonnie Franckowiak, DNP, FNP-BC, CARN-AP
From abstinence based treatment now to harm reduction I have come full circle. This speaker, who shared that her experience was initially abstinence based, defined harm reduction and spoke of the need for this care for many clients. Our small group enjoyed good discussion about the pros and cons of these diametrically opposed theories. The nub is that alcoholism and addiction, defined as achronic relapsing diseases, should be treated like any other chronic disease, the most common example being diabetes. Rather than a punitive rigid approach, harm reduction provides a more humane approach to the individuals in our care.

To change the tone of another long and satisfying day, I took a short walk in the warm dry afternoon. In the park across the street, a lovely young couple were being photographed. She in a creamy soft sari, he in a maroon tunic. Geese floated calmly on the still pond.  Mowers were trimming and a worker with a leaf blower was cleaning sidewalks and corners. Traffic moved steadily and busily in front of my hotel.

After a lovely evening meal of gnocchi, apples, squash and garlic mushrooms I returned to my room. Although not able to visit my brother Larry in person, we talked for almost an hour on the phone.  Skype is a blessing!

"What we find changes who we become."

~ Peter Morville

Day Two of Addictions Nursing Conference

Well, I tried. I had planned to post on Facebook the title of the next session I was attending. Then I had lunch. The afternoon was steady with just enough time for getting from room to room, picking up a coffee and visiting the 'necessary room'. Each speaker was as interesting as the last. (And most have a whole lot of letters trailing behind their names!)

The morning was full. The session at 0940 outlined the importance of nutrition and phytonutrients in recovery. In speaking to the presenter following, I expressed my great thanks as I have believed for a very long time in the need for a rebalanced nutrition in this condition. Nutrition in hospitals in general has not been treated as an important part of any form of recovery. Presenter Stephanie Ross, MHD, HT, CNC of Drexel University was an excellent, clear and passionate speaker.

So here's what I did following:

1105: 

Neural Recovery Model: The Science of Sustainable Addiction Recovery
Judith Miller, Ph.D., CACIII, Presented by Daphne Waldo, RN, MSN, CNL

Not one of my favourite presentations - interesting information however the presenter was quite quiet, despite the microphone.  Although I am certain she is an expert on her topic, she didn't present in an interesting manner.

12:10pm:  

Luncheon and Keynote Address:  Luncheon and Keynote Address:  Mindfulness and Yoga in Recovery: Evidenced-based Neuroscience.
Lisa Marzilli, PharmD, CDOE, Rhode Island Primary Care Physician Corporation

An energetic presenter, Ms Marzilli, had to contend with a room full of hungry conference goers, however that did not seem to deter her in the least. She outlined not only the benefits of yoga and meditation, but some research including research from happiness studies.

1:30pm-2:00pm:  Opioid Overdose Prevention and Rescue Project
Sharon Morello, RN, BSN; The Providence Center

The opiate scourge is at least as bad on the east coast as the west coast.  Sharon Morello and her team have established programs for the use of naloxone kits in the community, including in one treatment center.  Upon discharge, each client is provided with a naloxone kit to prevent unnecessary deaths in opiate overdoses. This is, not unsurprisingly, rather controversial, however meeting their goals.

2:00pm-2:30pm: 

The Walley Wallop: The use of naloxone to prevent overdose.
Brianne Fitzgerald, PNP-C, PMHNP-BC

This was an extension of the previous presentation - a tag teaming of the same issue. The sample naloxone 'kits' were either a nasal spray or an injectable. Of the two injectable samples, one operates much like a epipen used for anyphylatic shock, with the added feature of talking to you, giving directions of what to do! Freaked me out when I opened it and didn't expect a voice from the little thing!

2:35pm-3:50pm

Lazarus Project: Community Based prevention, Intervention and treatment to reduce Overdose
Fred Wells Brason II; Project Lazarus

Further to the previous naloxone presentations, Fred Wells took naloxone programs into the community, recognizing that prescription opiates are throughout communities creating potential for opiate overdoses from misuse of prescriptions outside of any substance abuse or addiction - sharing prescriptions, children/adolescents trying medications from cabinets within reach, take higher than prescribed dosages.

Phew! One more before supper:

4:15pm to 5:15pm:

Compassion, Stress and Fatigue:  Why Caring for Others has A Personal Toll on the Care Provider
Donna McCarten-White, RN, PhD, CNS, CARN

A lovely presentation. We work hard and see many traumatic and sad things. Donna stressed that we need to follow airplane guidelines:  take care of ourselves first!

Supper time. Time to wash my face and change!

"You cannot serve from an empty vessel."

 ~ Eleanor Brownn

First Day of Addictions Nursing Conference, Charlotte, North Carolina

Today was a full day of pre-conference starting at 0800.  We had a couple of breaks in the morning, an hour for lunch and then an short break in the afternoon. This workshop I attended was a review for the Certified Addictions Nurse's exam. I must admit, my experience has taught me much. I felt a bit overwhelmed by the credentials, letters and titles of my colleagues in the rooms. Each of us working in different areas and at different levels of Addictions Nursing. Addiction is the same in Victoria as in the United States. The drugs are the same, the drug classes are the same - only the names and the ways they are being used are different. That includes the pharmaceuticals that are used to treat withdrawal, and early sobriety from drugs. Addiction and alcoholism is the same, but only health care laws and structures are constantly evolving and changing. I did hear much more about laws and protocols in the United States. However, there are ethical similarities between our countries.

Do I have a problem with using drugs to treat an addiction? I definitely do, and at same time see their benefit and necessity in some situations. However, it can be too easy to forget about other ways to help those that suffer from this dreadful and potentially tragic condition. In the next few days, we will be learning about other ways to manage addiction care.

After the conference, after putting my feet up for a little while, I took a walk with a new acquaintance. She and I went to Target and then for supper at Chipolte's for a huge burrito and a taco bowl. A lovely walk on a clear calm evening. Walking back into the hotel, music and a full restaurant/lounge were melded and full of energy. I took myself up here to the 15th floor to have a quiet evening with the television and my i-pad.

"Each day is filled with promise, potential and possibility."

~ Tony Curl

A Day of Airports and Flying

There are many changes in this world. One of them that I encountered today was at an airport. I have been to Seattle Airport many times, but the last was five years ago. The first change was going through security. Using my passport at a little ATM shaped kiosk, I scanned the necessary page through. The kiosk took my picture and I moved forward to the real human security officer. Pleasant and smiling, he whisked me through. Another change - I took a wrong turn, got on a shuttle train that wasn't necessary and had to go up and down several escalators. I guess that's not really a change for me to take a wrong turn. After asking several helpful pleasant people where I needed to go, I finally moved on to a ticketing counter. Finding the right ticketing counter, I was issued a new boarding pass with the correct Gate on it by smiling and cheerful American Airlines agent. Then off through security again, because of my misdirection, to join a circuitous lineup that snaked around corners and down long corridors - again nothing new in a large, busy international airport. Once through I went on another long walk to find my gate. Plunking myself down, I sat and almost snoozed while I cooled off from my long walk.

My next change is this Ipad which I have had for a few days now, but this long layover in Seatac Airport has offered an opportunity to learn the Pages program on my new device. I don't have the same folders as I do on my lap top, but I am creating folders in the Cloud! Not sure I've done it right but any blog posts will at least be saved on the Blog site.

Right now, as I type this I am on the last hour of a six hour flight to my destination. I am thirsty, tired and cramped. The time change from east to west is three hours. The hum of the engines is weighing heavily. And yet the most amazing changes in this day of flying was just above the clouds, looking down over rivers or lakes and seeing the reflections of clouds in still water.

Landing in Charlotte, North Carolina, after the almost six hour flight from Seattle, was a relief. A short taxi ride to the hotel and now here I am in bed in the hotel.  It's 11:32 pm here. Good night.

"When you think about flying, it's really nuts really. There you 

are at about 40,000 feet screaming along at 700 miles an hour and 

you're sitting there drinking Diet Pepsi and eating peanuts. It's just nuts!"

  ~ David Letterman

Canada's Election Changes Things

A short evening, dragging myself away from the CBC election results
A change is certainly under way!
All the votes aren’t in yet but
the guy they said was ‘too young’ seems to be doing pretty well.
An interesting turn of events.
But…..an early morning begs that I close this window and head to bed.

“The wheel of change moves on, and those who 

were down go up and those who were up go down. “

~  Jawaharlal Nehru

Technological Changes

A try on my iPad

to copy and paste

to change my style on my blog

to write my bits and bobs of muse

"Never stop dreaming, never stop believing, never give up, 

never stop trying, and never stop learning."

~ Roy Bennett

Finally got this post's format the way I want it!

Author's note: Edited January 12, 2024