Dealing With Drugs Conference Program

Friday, March 23, 2018 | 8:30 am – 4:30 pm
Scaife Hall – 11th Floor Conference Center
University of Pittsburgh

Conference Schedule

8:00 – 8:30 am

Registration and Continental Breakfast

Scaife Hall – 11th Floor Conference Center – Foyer

8:30 – 8:35 am Welcome

Lisa S. Parker, PhD*
Professor of Human Genetics
Director, Center for Bioethics & Health Law
University of Pittsburgh
Room 1105 A/B/C

8:35 – 9:50 am

Ira R. Messer Lecture

 

Combatting the High Price of Drugs: What does patient empowerment have to do with it?

Peter A. Ubel, MD
Madge and Dennis T. McLawhorn
University Professor
Duke University

Room 1105 A/B/C

Abstract: Free market enthusiasts think that empowering patients to act as healthcare consumers will lower the cost, and raise the quality, of healthcare. But how does such “empowerment” play out at the bedside, and what are the ethical implications of asking patients to tackle healthcare costs?

9:50 – 10:00 am

Break

Foyer

10:00 – 11:00 am

Plenary Lecture

The Role of Healthcare Financing in Causing (and Curbing) Opioid Abuse

Valarie Blake, JD, MA**
Associate Professor of Law
West Virginia University

Room 1105 A/B/C

Abstract: The 2016 Comprehensive Addiction and Recovery Act failed to address an important feature of the American sociocultural context of the opioid epidemic: health insurers. Insurers play critical gateway roles in enabling both addiction and its treatment, and they bear many of the economic costs of the epidemic. The public and policy makers should be interested in how insurers undertake to address opioid addiction and should employ regulatory measures to maximize social and health benefits while avoiding unintended, but foreseeable negative consequences.

11:00 am – 12:10 pm Keynote Lecture

Pain Management and Subjectivity in a Climate of Distrust: The case of opioid contracts

Daniel Z. Buchman, MSW, PhD
Bioethicist, University Health Network
Assistant Professor, Dalla Lana School of Public Health
University of Toronto

Room 1105 A/B/C

Abstract: North America is in the grips of an epidemic of opioid-related morbidity and mortality. Opioids are frequently prescribed for chronic pain, and both pain and opioid use are highly stigmatized. One clinical strategy to reduce the various harms associated with prescribed opioids is the use of opioid contracts. Opioid contracts are widely implemented and outline the conditions patients must agree to in order to receive controlled opioids. In this presentation, I review the empirical research on opioid contracts and describe the moral arguments in favor of and against their use. I argue that opioid contracts reflect tensions surrounding the role of subjective knowledge in pain management, uncertainties about addiction, and the trustworthiness of people in pain. I argue that the use of opioid contracts may not only intensify stigma but also facilitate what Miranda Fricker calls epistemic injustice. I discuss a potential role for epistemic humility, as a form of epistemic justice, which may help promote more responsive and collaborative care plans and help all parties place trust wisely in pain management encounters.

12:10 – 1:00 pm

Lunch on your own

PUH Cafeteria is adjacent to the Conference Center

1:00 – 2:00 pm

Concurrent break-out sessions #1 – 3

 

Session #1

Policy Challenges in Expanding Access to Opioid Addiction Treatment

Julie M. Donohue, PhD**
Professor and Vice Chair for Research
Department of Health Policy and Management, Co-Director of the Center for Pharmaceutical Policy and Prescribing (CP3)
University of Pittsburgh

Room on 11th floor TBD

Abstract: The US opioid epidemic has focused attention on the inadequate supply of high-quality addiction treatment providers. Policy levers aimed at expanding access can sometimes exacerbate underlying quality problems. This session will review the current landscape of addiction treatment financing and delivery systems. The discussion will focus on ethical and clinical challenges facing policy makers and regulators seeking to expand treatment access

Session #2

Medication Adherence in the Era of Expensive Oral Cancer Therapy

Walid Gellad, MD, MPH
Associate Professor of Medicine and Health Policy
Director, Center for Pharmaceutical Policy and Prescribing (CP3)
University of Pittsburgh

Room on 11th floor TBD

Abstract: As therapy for cancer increasingly transitions from hospital- or clinic-administered chemotherapy to oral therapy administered at home, the problem of medication non-adherence becomes more challenging. This challenge is accentuated as the costs of these therapies have increased. Ethical and policy issues around medication adherence to expensive oral therapies will be discussed.

Session #3

Smoke Signals: Navigating medical marijuana, compassionate care, and evidence based practice in a conflicted landscape

Jack Rozel, MD, MSL**
Associate Professor of Psychiatry and Adjunct Professor of Law
University of Pittsburgh
Medical Director, resolve Crisis Services, Western Psychiatric Institute & Clinic, UPMC

Jessie Merlin, MD, PhD, MBA
Visiting Associate Professor of Medicine
University of Pittsburgh
Attending Physician, Division of General Internal Medicine and the Section of Palliative Care and Medical Ethics, UPMC

Room on 11th floor TBD

Abstract: Medical marijuana is imminently available in Pennsylvania as it already is in most states.  At the same time, the US Attorney General is authorizing US Attorneys to pursue criminal investigations and charges against medical marijuana programs. Against this backdrop, while waiting for the evidence to catch up to practice, front line providers are faced with the challenges of providing compassionate care for severely ill patients who may benefit from medical marijuana.  Potential adverse effects of medical marijuana in psychiatric patients and developing adolescents remain an open question.  This session will explore some of these conflicts and the legal and ethical challenges that providers and health care systems are currently navigating.

2:00 – 2:10 pm

Break

Foyer

2:10 – 3:10 pm

Concurrent break-out sessions #4 – 6

 

Session #4

How to Save a Life: The ethical and practical considerations of access and interventions addressing the opioid epidemic

John A. Libonati
Mercer County Coroner

Alyson D. Stover, MOT, JD, OTR/L, BCP Assistant Professor
University of Pittsburgh

Room on 11th floor TBD

Abstract: As we identify new and emergent ways to work with individuals with opioid use disorder, many novel issues arise related to the administration of and access to these interventions.  This panel will address the issues surrounding the use of naloxone by the public and emergency medical professionals, as well as non-pharmacological follow-up care options.  Additionally, it will discuss the implications of policy for the delivery of these treatments and the disparity of distribution based on geographical location.

Session #5

Disclosure as a Policy for Managing Conflicts of Interest: Pitfalls and potential

George Loewenstein, PhD
Herbert A. Simon University Professor of Economics and Psychology
Carnegie Mellon University 

Room on 11th floor TBD

 

 

Abstract: This talk will discuss diverse research showing that disclosing conflicts of interest can have perverse effects, decreasing trust in advice but increasing pressure to comply with it.  However, disclosure can also have beneficial effects when providers can eschew conflicts and, with the option of disclosure, reveal that they have “nothing to disclose.”

Session #6

Ethical and Policy Challenges for Pharmacogenomics, Lessons for Precision Medicine

James M. Stevenson, PharmD, MS, BCPP
Assistant Professor of Pharmacy & Therapeutics
University of Pittsburgh School of Pharmacy

Lisa S. Parker, PhD*
Professor of Human Genetics
Director, Center for Bioethics & Health Law
University of Pittsburgh

Room on 11th floor TBD

Abstract: While pharmacogenomics is often considered to present far fewer ethical concerns than other aspects of genomic medicine, pharmacogenomics offers an opportunity to consider at an early stage the ethical and policy questions that will be faced by patients, providers, pharmaceutical researchers, and healthcare systems as precision medicine is more fully implemented. These questions will be explored with particular attention to who stands to benefit and who may be less well-served as populations are stratified with regard to genotypes associated with differential drug response

3:10 – 3:20 pm

Break

Foyer

3:20 – 4:20 pm

Concurrent break-out sessions #7 – 9

 

Session #7

New Issues for New Moms: Challenges in managing perinatal substance use in the midst of the opioid crisis

Jody B. Glance, MD
Assistant Professor of Psychiatry
University of Pittsburgh
Medical Director, Addiction Medicine Services, Western Psychiatric Institute and Clinic of UPMC

Priya R. Gopalan, MD
Assistant Professor of Psychiatry
University of Pittsburgh
Medical Director, Psychiatry Consultation-Liaison Service, UPMC
Chief of Psychiatry, Magee Women's Hospital

Julie Kmiec, DO
Assistant Professor of Psychiatry
University of Pittsburgh
Medical Director, Ambulatory Detoxification and Narcotic Addiction Treatment Programs of Western Psychiatric Institute and Clinic of UPMC

Neeta Shenai, MD
Assistant Professor of Psychiatry
University of Pittsburgh Western Psychiatric Institute and Clinic of UPMC

Room on 11th floor TBD

Abstract: The number of infants born physiologically dependent on heroin and other opioids has increased five-fold in the past 15 years. While just one of many manifestations of the opioid emergency impacting the US, perinatal addiction creates a unique set of clinical, legal, and ethical challenges for health care professionals and social services. This session will feature a panel of addiction and perinatal psychiatry experts exploring some of these issues in an interactive discussion exploring the science and ethics of this challenge.

Session #8

Futility, Fairness, or Frustration:  Considering multiple heart valve replacements for patients with substance use disorders

Valerie Satkoske, PhD**
Director of Ethics, Wheeling Hospital
Associate Director, Center for Health Ethics and Law
West Virginia University

David E. Kappel, MD, FACS
Deputy Medical Director
West Virginia State Trauma System

Room on 11th floor TBD

Abstract: As IV drug use escalates in the US, so does the number of patients with opioid use disorders who develop infected heart valves.  Many of these patients continue to use opioids after an initial valve replacement, which has spawned conversation among healthcare professionals about the fairness of spending healthcare resources for “non-compliant” patients who may be less likely to benefit from the intervention. This presentation will consider the justice concerns that have been raised regarding the fairness of providing multiple heart valve replacements for patients who have not successfully abstained from drug use. The presenters will argue that many of such concerns appear to stem from the stigma attached to having a substance use disorder rather than legitimate justice claims and/or claims of futility. 

Session #9

How can you even think of justifying $300,000 a year for a cystic fibrosis drug?

David M. Orenstein, MD, MA*
Antonio J. and Janet Palumbo Professor of Cystic Fibrosis
Chair, Ethics Committee
Children's Hospital of Pittsburgh of UPMC

 

Room on 11th floor TBD

 

 

Abstract: The past 5 years have shown amazing scientific and therapeutic breakthroughs in understanding and treating cystic fibrosis (CF), with drugs now available that correct the underlying cellular and molecular bases of the disease, resulting in improved lung function, decreased hospitalizations, and improved quality of life for patients. The price tag of $300,000 per year, and the outsized compensation for the drug company’s executives, have raised questions about the ethics of drug production and marketing. Using CF drugs as a case study, we will discuss other possible models for companies and societies to provide access for patients in need of lifelong therapies.

4:20 pm

Adjournment

 

Conference Planning Committee

Ronald L “Ron” Carico Jr, PharmD, MPH,
Pharmacy Fellow in Medication Safety and Outcomes
Center for Health Equity Research and Promotion/VA Center for Medication Safety
*   Lisa S. Parker, PhD, Professor of Human Genetics and Director of the Center for Bioethics & Health Law
** Jack Rozel, MD, MSL, Professor of Psychiatry and Medical Director, re:solve Crisis Network
*   Mark Wicclair, PhD, PhD, Adjunct Professor of Medicine, University of Pittsburgh

*   Center for Bioethics & Health Law faculty member
** Center for Bioethics & Health Law affiliated faculty member

Conflict of Interest Disclosure
No members of the planning committee, speakers, presenters, authors, content reviewers and/or anyone else in a position to control the content of this education activity have relevant financial relationships with any entity producing, marketing, re-selling, or distributing health care goods or services, used on, or consumed by, patients to disclose.

The information presented at this CME program represents the views and opinions of the individual presenters, and does not constitute the opinion or endorsement of, or promotion by, the UPMC Center for Continuing Education in the Health Sciences, UPMC / University of Pittsburgh Medical Center or Affiliates and University of Pittsburgh School of Medicine.  Reasonable efforts have been taken intending for educational subject matter to be presented in a balanced, unbiased fashion and in compliance with regulatory requirements. However, each program attendee must always use his/her own personal and professional judgment when considering further application of this information, particularly as it may relate to patient diagnostic or treatment decisions including, without limitation, FDA-approved uses and any off-label uses.