Governor Newsom has invested over $1 billion to tackle the crisis Through CalRx, California will seek to manufacture its own Naloxone Master Plan provides comprehensive approach to save more lives
SAN DIEGO COUNTY – Today, following a visit to the San Ysidro Port of Entry, Governor Gavin Newsom released his administration’s Master Plan for Tackling the Fentanyl and Opioid Crisis. Recognizing the opioid and fentanyl crisis as a multifaceted public health and public safety issue, Governor Newsom’s Master Plan provides a comprehensive approach to save lives. The Master Plan builds on the Governor’s $1 billion investment to tackle this crisis — including an expansion of California National Guard-supported operations that last year led to a 594% increase in seized fentanyl. The Master Plan outlines aggressive steps to support overdose prevention efforts, hold the opioid pharmaceutical industry accountable, crack down on drug trafficking, and raise awareness about the dangers of opioids, including fentanyl.
WHAT GOVERNOR NEWSOM SAID: “Over 150 people die every day in our nation from overdoses and poisonings related to synthetic opioids like fentanyl. Enough. With this Master Plan, California is doubling down to combat this crisis and save lives. Our comprehensive approach will expand enforcement efforts to crack down on transnational criminal organizations trafficking this poison into our communities — while prioritizing harm reduction strategies to reduce overdoses and compassionately help those struggling with substance use and addiction.” View the Master Plan
After almost twenty years of intense medication specific government regulation buprenorphine is now just like other schedule III medications. The era of limited numbers of treatment slots that started at 30 patients per provider who had completed 8 hours of specific training, requirements to maintain lists of patients who received prescriptions and even in person visits by DEA agents to a large…
SB 57 (Wiener) – Overdose Prevention Program Passed by the California Senate
CSAM Sponsored Legislation Heads to the Governor for Signature
SACRAMENTO – The California Society of Addiction Medicine (CSAM) is pleased to announce that SB 57 (Wiener) was passed by the California Senate on August 1, and now heads to Governor Gavin Newsom for his consideration. The Governor has until the end of September to sign or veto the bills passed by the state Legislature at the end of this 2021/2022 legislative session.
SB 57, sponsored by CSAM and authored by Senator Scott Wiener (D-San Francisco), is life-saving legislation that would allow the City and County of San Francisco, the City and County of Los Angeles, and the City of Oakland the discretion to authorize overdose prevention programs where adults may use controlled substances under the supervision of staff trained to prevent and treat overdose, prevent HIV and hepatitis infection, and facilitate entry into drug treatment and other services.
“The California Society of Addiction Medicine, which represents physicians who care for substance use disorders, is pleased that the California Senate has passed SB 57. Our organization is a co-sponsor of SB 57, and we believe this bill will save lives here in California,” said Randolph Holmes, MD, FAAFP, DFASAM, Chair of Public Policy for CSAM. “We urge Governor Newsom to sign this bill into law as quickly as possible so we can move forward with these necessary services for our community.”
Overdose prevention programs (OPPs) — also known as supervised consumption services (SCS) — such as those that could be established under this bill, provide a sanctioned, safe space for people to consume pre-obtained drugs in controlled settings under the supervision of trained staff. These staff have access to sterile consumption equipment and tools to check participants’ drug supply for the presence of fentanyl. Participants can also receive health care, counseling, and referrals to health and social services, including drug treatment.
“If Governor Newsom signs this bill into law, he will not only save uncounted lives from unnecessary death but will also create a pathway into treatment for thousands of Californians for whom there is currently little hope of recovery,” said David Kan, MD, DFASAM, Past President of CSAM.
The mission of CSAM is to advance the ethical and compassionate treatment of addiction through physician-led education of health professionals, patients, and the public. The Society promotes practice, research, prevention, and implementation of evidence-based treatment and sound drug policy. We advocate for our patients, their families, and other support systems at all stages of care.
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!
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:
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.
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:
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.
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.
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.
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.
Newsom has proposed $3.5 billion for youth behavioral health, this would include substance use treatment as well.
FDA Commits to Evidence-Based Actions Aimed at Saving Lives and Preventing Future Generations of Smokers
FDA Commits to Evidence-Based Actions Aimed at Saving Lives and Preventing Future Generations of Smokers
Efforts to ban menthol cigarettes, ban flavored cigars build on previous flavor ban and mark significant steps to reduce addiction and youth experimentation, improve quitting, and address health disparities
Today, the U.S. Food and Drug Administration announced it is committing to advancing two tobacco product standards to significantly reduce disease and death from using combusted tobacco products, the leading cause of preventable death in the U.S. The FDA is working toward issuing proposed…