Archive: 2021

Spring 2021

By Ken Saffier, MD, FASAM, President, Medical Education and Research Foundation (MERF) for the Treatment of Addiction

What is MERF?

MERF was established in 1981 “to increase and improve the education of physicians about alcoholism and other drug dependencies” – specifically about the evidence, the science, and how to apply it to patients with substance use disorders (SUD’s). We particularly stress the clinical continuum of diagnosis, treatment and recovery for patients and their family members. As CSAM and the addiction medicine discipline have grown, we include other health professionals to receive our scholarships and we have evolved to destigmatize use disorders with our language and approach to education.

Progress despite the COVID Pandemic

In spite of social distancing and many changing schedules due to COVID-19, we funded a total of 85 MERF Scholars, the most ever. Forty seven were funded by the CA Department of Health Care Services (“MATES” – Medication Assisted Treatment Expansion Scholars) and 38 were our ”Traditional” Scholars composed of residents, fellows and faculty from graduate medical education programs. We increased our diversity of Scholars – 12 of our MATES were from the CA Department of Corrections and Rehabilitation and there were representatives from CA tribal communities. Most clinicians were employed in clinics from underserved communities. Due to the remote conferencing, we had Zoom orientation sessions for facilitators 2 weeks before and an orientation for all Scholars 1 week before to provide background and context for the conference activities. The “silver lining” for this new normal of COVID social distancing was that we were able to use remote conferencing economically, dramatically reducing the cost of our program per Scholar and admit more learners than ever before.

How does a MERF Mentored Learning Experience enhance Scholars education?

MERF activities are designed to immerse Scholars in an augmented learning environment emphasizing interactive educational with addiction medicine (ADM) experts and facilitators for maximizing meeting individual and program goals.

We started off our activities with a well-received “Motivational Interviewing for Busy Clinicians” pre-conference workshop via Zoom by Ken Saffier, MD and Karena Frances, LCSW, with 95 registrants and 17 small group MI facilitators. Then, during the CSAM conference, our Scholars participated in case discussions and sessions to empower future clinical and curricular change in their home programs and clinics. On the last day, all Scholars met in small groups, discussed and then shared their refined future educational and clinical goals.

We embellished the first series of CSAM plenary sessions by inviting Eric Hargis, DO, and Sharone Abramowitz, MD, speakers on the first day to guide a case study, “The world inside and outside the walls – :A journey of survival to recovery” involving incarcerated patients with SUDs, In their overall evaluations, a surprising number of comments thought their #1 take home point from the whole conference was learning about incarcerated patients’ needs and treatment strategies.

For the second year, we also offered optional ADM coaches who are CSAM members with special or general ADM interests. Some Scholars met with their coaches outside of our scheduled activities for informal discussions and exploration of mutual interests. This contributes to networking, continued clinical education and active, self-directed learning.

As in past years, we continued our quarterly journal clubs with presentation of an article written by the discussant. Our first session was attended by 56 Scholars, another record, to hear Jose Maldonado, MD, our superb SOA plenary speaker, “Novel Algorithms for the Prophylaxis and Management of Alcohol Withdrawal Syndromes – Beyond Benzodiazepines.” And more recently, in March, with 47 attending, we hosted Tauheed Zaman, MD, who presented on another important ADM topic, a review of micro-dosing buprenorphine protocols.

Another first is our new www.MERFposters.org website where all peer-reviewed posters can be placed before and after our annual conferences. We will expand this in the coming year with designated times for authors to present their pre-recorded description of their research, or programs, or cases as a means of promoting scholarly activities for MERF and CSAM.

Looking into our future

We are accepting applications for our MERF mentored learning experience at the upcoming CSAM Review Course. Because we are repeating a virtual conference, we hope to accept Scholars from residency and fellowship programs as well as practicing clinicians. However, without DHCS funding this year, we are reaching out to all CSAM members, prior MERF Scholars and other possible grants to promote our work.

What you can do

Please consider making a donation to MERF by going on our website, www.merfweb.org which also can be accessed from the CSAM website. Your $200 donation will fund 1 MERF Scholar. Please give generously.
We thank you in advance for making a tax-deductible donation today. Hope to “see” you at the review course!

Spring 2021

By Cathy McDonald, MD

Consider using ICOVIDQUIT.com to encourage those with TUD to quit

ASAM president-elect Brian Hurley, MD has renewed the commitment to “standardizing the delivery of individual addiction care, particularly including smoking cessation, and…adequate health insurance coverage for individuals with substance use disorders, particularly tobacco use disorders.” He was speaking at a press conference that reported a 27% drop in calls to state tobacco quit lines during COVID-19. The conference announced a new resource to help individuals with behavioral health conditions to quit smoking, which was developed under the leadership of the UCSF based Smoking Cessation Leadership Center. The site, Icovidquit.com features four diverse individuals with lived experience of behavioral health conditions who quit smoking. The site offers downloadable posters/videos for your office or for posting on social media.

Inform others that a YES VOTE is a vote for a flavored tobacco/menthol BAN on upcoming Tobacco Industry Sparked referendum

Prepare to inform others about the need for ACTION on SB796 (Hill), the menthol and flavored tobacco ban which CSAM supported and Governor Newsom signed. Because the ban on flavored products is being held up by a tobacco industry sponsored referendum, it will be important to inform patients, colleagues, friends and others that THEY MUST VOTE YES on the referendum in order to enact the ban that has been delayed, resulting in the loss of thousands of lives and recruitment of thousands of teens to smoking and vaping. This referendum will likely appear on the ballot in November 2021 with the recall election for Governor Newsom although the exact date has yet to be announced. A menthol ban will begin to address the years of targeting African Americans to buy menthol. You can begin to educate folks by posting something like this on your website or social media:

“Menthol cigarettes are killing Black people, and the @NYTimes just wrote all about it. Californians have the chance to finally end Big Tobacco’s dangerous scheme of hooking our kids on nicotine with candy flavors by voting YES to #ProtectCAKids
https://www.nytimes.com/2021/03/22/health/methol-smoking-ban.html”

The referendum does not affect the ability of local communities to ban the sale of flavored tobacco products and menthol which over 100 communities in California have done either partially or completely. See list here: https://www.tobaccofreekids.org/assets/factsheets/0398.pdf

Let colleagues know Addressing Tobacco Use in Substance Use Disorder (SUD) Treatment Facilities likely to pass the legislature soon and be required

Last but not least CSAM is co-sponsor of AB541 (Berman) which passed by consent in the CA Assembly Health Committee. Despite a smoking rate of 11% in CA, SUD programs in California ranked 41st of 50 states in asking about tobacco use and 32nd in providing tobacco treatment counseling according to an MMWR report. AB541, if passed, requires substance use disorder facilities to assess clients for tobacco use, inform patients how continued tobacco use can affect their recovery, and offer treatment or referral for treatment of tobacco use disorders. Assemblyman Berman’s bill also requires incorporating data on tobacco use amongst SUD clients into the existing SUD database system which will help the state track the magnitude of this issue currently estimated at an incidence of 70% of patients in SUD treatment are tobacco dependent.

To support tobacco related advocacy for CSAM contact Cathy McDonald, Dr.CathyMcDonald@gmail.com or Chwen-Yuen Angie Chen, MD, csameditor@yahoo.com.

Spring 2021

By: Randolph Holmes, MD and Robert Harris, CSAM Public Policy Advisor

The Legislature in Sacramento is slowly moving out of COVID-19 restrictions and getting on with the work of government. There have been limitations placed on the number of bills a Member from one house can carry over to the other side so some of CSAM’s bills have been moved to the 2022 calendar. Here are some important bills CSAM is sponsoring for 2021:

1. CSAM is supporting an appropriation of $40 million to continue a pilot program started in 2019 to grant hospitals $100K for the purpose of hiring behavioral health counselors and peer navigators in ED’s. These people help patients with addiction and behavioral health needs start treatment in the ED and continue it after leaving the hospital. This is included in the budget proposal from the Senate and the Assembly.
2. SB 57 (Wiener) this is the bill that will allow pilots for Overdose Prevention Sites (formerly known as Safe Injection Sites) to be started in San Francisco City and County, the City of Oakland, and the County of Los Angeles. It has passed out of the Senate and we anticipate it passing the Assembly. We will need a campaign to encourage Newsom to sign.
3. SB 110 (Wiener) this is a bill that would allow Contingency Management to be used at a treatment modality in publicly funded treatment programs. It is an evidence-based treatment for stimulant use disorders, but federal regulations prohibit its use with federal funds (Medi-Cal). It is currently out of the Senate and in the Assembly. We will need help from our friends in Washington (ASAM and others) to change federal rules.
4. AB 541 (Berman) originally required SUD treatment centers collect data on client smoking in addition to assessing and offering treatment for tobacco use disorder. It has passed unanimously in the Assembly and is now in the Senate. Unfortunately, the data collection requirement was removed in the appropriations committee. However, the bill still requires programs to do the assessment and offer treatment. Programs must demonstrate compliance with those provisions during their relicensing reviews.
5. Newsom has proposed $3.5 billion for youth behavioral health, this would include substance use treatment as well.