Concurrent Disorders Fellowship 

  Overview  

The Concurrent Disorders Fellowship is a 1-year program for UBC PGY-5 psychiatry residents. Fellows will learn to identify, screen, assess, diagnose, manage, and treat substance use disorders, co-occurring mental health disorders, and pain conditions in diverse patient populations at inpatient, emergency, and outpatient settings. The fellowship will prepare fellows to write the examination with the International Society of Addiction Medicine (ISAM).

Program Director: Dr. Pouya Azar 

Clinical

The primary training will take place with the Integrated Psychiatry, Pain, and Addiction consult service (IPPAS), located at Vancouver General Hospital (VGH). Fellows will gain hands-on experience in the following, but not limited to: addiction pharmacotherapies, (e.g., opioid agonist therapy and medications for alcohol use disorder), as well as withdrawal management, and integrated treatment of concurrent mental health disorders, (e.g., mood, anxiety, psychotic, personality, and posttraumatic stress disorders). Fellows will also gain valuable experience in acute, chronic, and perioperative pain management, in the context of substance use disorders. Patient caseloads will offer a well-rounded variety of experiences, tailored to the needs of each fellow. Fellows will work in interdisciplinary teams with nurses, social workers, and pharmacists, etc. to provide patients with comprehensive wrap-around care. At all rotations, fellows will be under the supervision of an addiction psychiatrist. Fellows will be on a mixed IPPAS/General Psychiatry call at VGH.

Core Rotations: Total of 10 months

4 Months	Integrated Psychiatry, Pain, and Addiction Consult Service (IPPAS)  The IPPAS team is a consult service that provides interdisciplinary management of pain, substance use, and mental health disorders across all clinical services at VGH, G.F. Strong Rehabilitation Centre, and UBC Hospital.
3 Months	Concurrent Disorders Inpatient Unit 8 – Joseph & Rosalie Segal & Family Health Centre, VGH  Unit 8 at the Joseph & Rosalie Segal & Family Health Centre offers concurrent disorders inpatient care for clients who require long-term, intensive treatment to return to their community.
2 Months	The Hope to Health (H2H) Clinic  The H2H outpatient clinic, located in the Downtown Eastside (DTES), provides integrated and accessible healthcare to clients in the inner city with complex healthcare needs. In addition to substance use and mental health conditions, clients may have complex healthcare needs, such as HIV and HCV.
1 Month	Residential Treatment Programs  Residential treatment programs consist of 24-hour care at live-in facilities for youth and adults with substance use and behavioural addictions. The length of stay can range from weeks to six months and beyond. Fellows will be under the supervision of an addiction psychiatrist.

Longitudinal Rotations: Throughout the Year

Half a day a week: For 6 months	Transitional Pain Clinic (TPC), Vancouver General Hospital  The TPC is an interdisciplinary, short-term outpatient clinic that provides pain management services, with the aim of optimizing pain control before and after surgery.
Half a day a week: For the other 6 months	Opioid Agonist Therapy (OAT) Clinics  These outpatient clinics provide OAT and psychosocial treatment to patients with opioid use disorder. Fellows will be under the supervision of an addiction psychiatrist.  Royal Oak Clinic: 2 months  The Hope to Health (H2H) Clinic: 2 months  Foundry Vancouver-Granville: 2 months

Elective Rotations  Fellows can choose to spend longer time at a core rotation or choose the following elective rotations for their remaining time in the program.

1 Month	Substance Use Response and Facilitation (SURF) Service, BC Children’s Hospital  SURF is a specialized consult service providing interdisciplinary care for youth with substance use disorders. It provides a safe, trauma-informed space where youth with lived and living experience can share their experiences, and links youth with community-based treatment resources.
1 Month	Red Fish Healing Centre for Mental Health and Addiction  Red Fish is a 105-bed facility in Coquitlam that treats people across BC who live with the most severe, complex substance use and mental health issues. The facility provides evidence-based trauma-informed care, dignity, therapeutic spaces and programs, and virtual health care.
1 Month	Correctional Health Services  At any one time, around 2,700 clients are incarcerated in one of BC’s ten correctional centres. People in custody are much more likely to live with a mental illness or substance use disorder than the general population, with up to 60% of people in custody having either a mental illness, an addiction, or both. Furthermore, around 40% of the client population is on opioid agonist therapy. Health care teams, which include physicians, nurses, mental health and substance use specialists, and pharmacists, work with BC Corrections staff as partners in client care.
1 Month	G.F. Strong Rehabilitation Centre  GF Strong is BC’s largest rehabilitation centre. It provides inpatient, outpatient, outreach and clinical support services to patients in three unique programs: acquired brain injury, spinal Cord Injury, and neuromusculoskeletal.
1 Month	Potentially an international rotations
1 Month	Assertive Community Treatment (ACT)  ACT uses an interdisciplinary team approach to deliver wrap around services that provides a combination of treatment, rehabilitation and support, using team-based care as a community alternative to psychiatric hospitalization. These teams provide intensive, specific, and continuous services to meet the needs of individuals living with serious, persistent mental health and/or substance use challenges, and who have not benefited from traditional outpatient programs.
1 Month	Clinical rotation that is non-addiction or non-pain focused  e.g., neuropsychiatry, mood disorders, sleep disorders
1 Month	Research Rotation

Education

Fellows will take the Provincial Opioid Addiction Treatment Support Program (POATSP) course, and attend didactic lectures/case discussions to learn the latest evidence on such topics as: opioid agonist therapy, alcohol use disorder, concurrent disorders, principles of acute and chronic pain management, perioperative pain management, corrections, pain management in opioid tolerant patients, and youth concurrent disorders. Fellows will learn from presentations led by people with lived/living experience, multicultural and Indigenous backgrounds, and family members. These lectures will take place throughout the year. In addition, fellows will engage in a journal club to critically, evaluate the latest evidence on substance use disorders, mental health disorders, and pain. Fellows will have opportunities to participate at multidisciplinary educational events with the UBC Department of Medicine; Department of Emergency Medicine; Department of Anesthesiology, Pharmacology, Therapeutics; and the Department of Surgery. 

Research

Fellows will carry out a research project in basic science, (UBC Chemistry and Pharmaceutical Sciences), or clinical research, (VGH, UBC, and Hope to Health). Fellows will have the chance to participate, evaluate and critically assess in a wide range of interdisciplinary clinical and translational research opportunities. Some examples of current research projects include: a randomized controlled trial, comparing the effectiveness and safety of buprenorphine induction approaches, a clinical trial examining the feasibility and safety of utilizing intravenous fentanyl to manage withdrawal and facilitate rapid initiation of opioid agonist treatment, and the development and evaluation of a point-of-care electrochemical medical device to assess opioid tolerance.