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ICOO 2019 Keynotes
Sunday, June 9, 2019
8:15am - 9:15am

Pain Management in the Era of the Opioid Crisis: 
A New Approach for Providing Opioid Antinociception While Avoiding Abuse
Alan R. Gintzler, PhD
Professor of biochemistry neurobiology of pain and addiction research
Department of obstetrics and gynecology
SUNY Downstate Medical Center
Brooklyn, New York 
    Alan R. Gintzler, PhD is a professor of biochemistry neurobiology of pain and addiction research in the department of obstetrics and gynecology at SUNY Downstate Medical Center.
Dr. Gintzler has been a SUNY Downstate faculty member since 1980.  He runs a multidisciplinary research laboratory that investigates molecular mechanisms underlying sexual dimorphism in nociception and opioid antinociception and has been continuously funded by National Institutes of Health (NIH) for more than 30 years.  Notably, in 2002, Dr. Gintzler, on behalf of SUNY Downstate, successfully spearheaded and directed the implementation of a Women's Health Research Training Grant, the first such grant in New York State. 

  Dr. Gintzler's approach to research emanates from the firm belief that the inductive approach of clinician researchers, which is steeped in evidence-based medicine, and the deductive, hypothesis-driven approach to research, which is predominantly utilized by preclinical researchers, are complementary, not antithetical or exclusionary.  His current research integrates the use of cell lines maintained in culture, ex vivo integrated neuronal preparations, and whole animals. These approaches are synergistic and provide cross-validation of conclusions.

  Dr. Gintzler has authored more than 100 publications and is a reviewer for more than 15 journals.  He has served on numerous NIH Study Sections and editorial boards.  Currently Dr. Gintzler is an associate editor for the Journal of Pharmacology and Experimental Therapeutics.  
On May 10, 2017, the SUNY Board of Trustees appointed Dr. Gintzler to the Distinguished Faculty Rank.  The Distinguished Professorship is conferred upon individuals who have achieved national or international prominence and a distinguished reputation within a chosen field.

  Dr. Gintzler is a recipient of the prestigious Irma T. Hirschl Career Scientist award and a Fogarty Fellowship, and served as an Aaron Diamond Postdoctoral mentor.  In 2002, Dr. Gintzler received the SUNY Chancellor's Award for Excellence in Research.  He served as interim chair of the department of biochemistry from 2006 until the department was dissolved in 2009.  He was subsequently invited to join the department of obstetrics and gynecology as its research director.

  Dr. Gintzler, with his mentor Sydney Spector, was the first to demonstrate the naturally occurring presence of morphine in neuronal tissue.  As an assistant professor at Columbia University College of Physicians and Surgeons, Dr. Gintzler demonstrated that physiological hesitation is associated with a spinal opioid antinociception and subsequently elucidated the endocrine and opioid components underlying that antinociception.  This line of research has expanded to include the molecular interface between ovarian sex steroids and pain/analgesic pain mechanisms, primarily focusing on the molecular underpinnings of the male/female dichotomy in the prevalence of chronic pain syndromes, analgesic responsiveness to narcotics and addiction mechanisms.  

  Most recently, Dr. Gintzler and his collaborators discovered that the mu and kappa types of opioid receptor heterodimerize in spinal cord in a female-specific fashion, which is regulated by rapid signaling by membrane estrogen receptors.
Dr. Gintzler is a graduate of Hunter College, cum laude.  He received his doctorate from New York University School of Medicine and postdoctoral research training at the Roche Institute of Molecular Biology.  
Monday, June 10, 2019
8:00am - 9:00am

Comorbid Use of Opioids and Benzodiazepines
in Chronic Pain Patients

Gregory A. Acampora, MD
Massachusetts General Hospital
Boston, MA

  Gregory A. Acampora, MD is a Psychiatrist at Massachusetts General Hospital (MGH) and Harvard Medical School (HMS), who specializes in the treatment of patients with addictions, pain and serious co-occurring morbidities.  He trained in Anesthesiology at the University of Virginia and went on to Yale for an advanced cardiovascular fellowship where he conducted research and developed early clinical applications for trans-esophageal echocardiography (TEE). Later, he took interest in substance abuse medicine then broadened his attention to brain study and repair.  After training in Psychiatry and Addiction Psychiatry, he joined as faculty at MGH and HMS, where he educates trainees and medical students, provides clinical care to patients with complex disorders, and consults to other physicians on addiction and pain pathology, treatment, and recovery to expand both knowledge and quality of patient care across medicine domains.

  Dr. Acampora'd major focus is to expand the understanding and clinical treatment of addictions and pain related disorders. His major longitudinal expertise is implementing remission maintenance, with a strong emphasis on psychoeducation; this was first developed for addictions, but the concept is applicable universally to other adversities, including Pain and PTSD.  He promotes his collaborative care models and teaching to facilitate effective interdisciplinary patient health management. He has developed a Clinical Adversity Guided Education (CAGE) psychoeducation simulation package that allows patients to grasp and apply key concepts for reconceptualization of reward and response meant to lessen reward and anti-reward behaviors that limit achievement of durable remission/recovery.  His most recent area of clinical expertise deals with addictions and pain with significant contributions in developing and promulgating the guidelines for the perioperative continuous administration of buprenorphine (BUP).  This most recent innovative approach will likely have significant implication in long-term treatment of chronic pain for patients both for those with SUDS on buprenorphine medication-assisted treatment (MAT). 

  Dr. Acampora's teaching extends to coworkers across disciplines about the evaluation and care of patients with addictions and/or pain as well as co-occurring medical and psychiatric illnesses encompassing: addictions progression; durable recovery; pain process, PTSD; complex pharmacology interactions and neuro/cardiac physiology.  Other areas of interest include:
Addiction Salience, Central Autonomic Network (CAN), Cortico-Striato(Cerebello)-Thalamo-Cortical Circuits, context sensitive pharmacology and TSF (12-Step Facilitation) mechanisms.

  Dr. Acampora 
is a Diplomat of the American Board of Neurology and Psychiatry and Addiction Psychiatry as well as a Diplomat of the American Board of Anesthesiology. He is a faculty Psychiatrist at Massachusetts General Hospital and full time faculty at Harvard Medical School.

Tuesday, June 11, 2019
8:00am - 9:00am

Methadone and Buprenorphine Maintenance: Effective Treatments for Opiate Addiction

Mary Jeanne Kreek, MD
Senior Attending Physician
Patrick E. and Beatrice M. Haggerty Professor
Laboratory of the Biology of Addictive Diseases

An estimated 25 to 33 percent of people who take a short-acting opiate drug — usually heroin — develop an addiction to it. 
This suggests that some people are naturally more vulnerable to addiction than others and that genetics may play a role along with direct drug-induced effects and environmental and psychological factors. Dr. Kreek investigates how genetic factors, as well as neurobiological alterations, factor into addictive diseases such as opiate addiction, nicotine addiction, cocaine dependency and alcoholism.

  Dr. Kreek investigates the biological basis of addictive diseases as well as existing and novel treatments for these conditions. Her lab also researches the medical complications of drug abuse, such as hepatitis C and AIDS. This clinical and lab-based experimental approach led her lab to discover in 1983 to 1984 that the second most common risk group for HIV-1/AIDS is parenteral drug users. 

  Dr. Kreek’s research focuses on the endogenous opioid system, which modulates stress and pain, and the roles that specific opioid peptides and their receptors play in normal and abnormal circumstances. Heroin and morphine, which mimic endogenous peptides, as well as cocaine and alcohol activate these opiate receptors, directly or indirectly. Dr. Kreek and her colleagues examine receptor and peptide function in animals that are given or are allowed to self-administer a drug of abuse in chronic or acute doses to study how this exposure impacts the brain’s neurochemistry, neurobiology and circuitry and how to identify potential treatments. The lab also studies epigenetic, physiologic and behavioral effects of drug administration on the endogenous opioid system and related signaling networks. The scientists use microdialysis in rats and mice to conduct dynamic studies of neurotransmitter release and peptide processing in the brain.

  The lab studies the roles of the mu and kappa opioid receptor systems and vasopressin/V1b receptor systems in alcohol “binge” and dependent-like drinking models using rats and region-specific gene deficient mice. Additionally, as illicit use of oxycodone in adolescence has become a pressing public health problem, the lab is investigating the behavior and neurobiological changes that occur in adolescent versus adult mice during and after self-administration of oxycodone. In collaboration with Rockefeller’s F. Nina Papavasiliou, the group is developing a vaccine to prevent progression from oxycodone use to addiction using a novel platform for small-molecule vaccines. The lab also focuses on the development and study of novel potential medications that may be of value in the treatment of addictive diseases and co-occurring mental health diseases using a translational approach; k opioid ligands are of particular interest. 

  Components underlying the neurobiology of addictive diseases are the focus of clinical studies, including how neuropeptides affect cocaine and heroin addicts, former opiate addicts maintained on methadone and patients dependent on alcohol, nicotine or both. Polymorphisms of genes that may play a role in addiction or genes that may alter responses to medications (pharmacogenetics) and affect normal physiology (physiogenetics) are identified. The lab identified and characterized a functional single-nucleotide polymorphism in the µ opioid receptor, which increases vulnerability to develop opioid and alcohol addictions and significantly alters stress responsivity in healthy subjects. Their more recent work identified functional polymorphisms of the dynorphin gene. Examinations of different ethnic populations have also revealed that other specific polymorphisms may have a greater association with addictive disorders.

  Dr. Kreek is well known for her pioneering work in the development of methadone maintenance therapy for heroin addiction in the 1960s, a therapy that has become common practice throughout the world. She also was one of the first to document that drugs of abuse significantly alter expression of specific genes in specific brain tissues and alter normal perceptions of reward and dysphoria.

  Dr. Kreek received her B.A. from Wellesley College in 1958 and her M.D. from Columbia University College of Physicians and Surgeons in 1962. She (and also the late Marie Nyswander) joined Rockefeller in the laboratory of Vincent Dole in 1964. 

  Dr. Kreek received the Wellesley Alumnae Achievement Award in 2012, a Laurea ad Honorem in Farmacia from the University of Bologna in 2010, an honorary doctorate from Tel Aviv University in 2007, the Gold Medal for distinguished achievements in academic medicine from the Columbia University College of Physicians and Surgeons Alumni Association in 2004, an honorary doctorate from the University of Uppsala in 2000 and the Nathan B. Eddy Memorial Award for Lifetime Excellence in Drug Abuse Research and the R. Brinkley Smithers Distinguished Scientist Award in 1999. She received a Specific Recognition Award for Research in the Science of Addiction from the Executive Office of the President in 1998, and in 1996 she was given the Betty Ford Award. 

  Dr. Kreek is a faculty member in the David Rockefeller Graduate Program and the Tri-Institutional M.D.-Ph.D. Program.

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