DEA Issues Interim Final Rule Clarifying MAT Dispensing

The Drug Enforcement Administration (DEA) issued an Interim Final Rule to clarify sections of the 2018 SUPPORT for Patients and Communities Act. The provisions in the Rule seek to further expand providers’ abilities to prescribe medication assisted treatment (MAT) to individuals suffering from opioid use disorders.

Key items addressed in the Rule include:

  1. Providers can prescribe MAT for up to 100 patients immediately, if the provider holds credentialing in addiction medicine or provides MAT using covered medications in a qualified practice setting. This updates prior rules which mandated a waivered provider could only treat up to 30 patients in their first year of the waiver before applying to treat up to 100 patients.
  2. Nurse practitioners and physician assistants had previously been granted the ability to be waivered to prescribe MAT on a temporary basis. The Interim Final Rule made this provision permanent.
  3. The definition of a “qualifying provider” eligible to prescribe MAT was expanded to include clinical nurse specialists, certified registered nurse anesthetists, and certified nurse midwives. These providers are eligible to prescribe MAT on a temporary basis, through October 1, 2023. Waivered providers are eligible to treat up to 30 patients.
  4. A physician is eligible to receive a waiver to prescribe MAT if the physician recently graduated from a medical school that included at least 8 hours of training on treating and managing opioid-dependent patients.This shifts new waivers from post-residency continuing medical education to medical school or residency training.
  5. Pharmacies can permanently provide medications for maintenance or detoxification treatment to providers’ registered locations for use in treatment. Pharmacies previously were only allowed to deliver medications to the ultimate user or research subject.

Please send feedback on the Interim Final Rule to Chris Regal (cregal@ahip.org) by December 3. We will circulate draft comments prior to the December 10 Opioid Addiction Prevention and Treatment Work Group meeting. 

We look forward to your feedback. Please be in touch with questions. Thank you.

Article provided by AHIP.

Press Release: Gov. Newsom, Lt. Gov. Kounalakis To California: Beware Big Tobacco’s Lies and Deception to Overturn Landmark Law to Protect Kids

Click Here to read the Press Release.

COVID-19 Resource Page

California Society of Addiction Medicine (CSAM) has been sending out information related to COVID-19 as it’s become available. We’re putting all of that information in one place.

Covid Information Here

We will continue to update that page with the information we send out to members as it comes available to us.

Also: ASAM has a valuable COVID-19 Resource Page as well: https://www.asam.org/Quality-Science/covid-19-coronavirus (Updated September 18, 2020!)

CSAM Newsletter Winter 2019 Issue

Winter 2019 CSAM Newsletter

  • An Interview with CSAM’s New President Dr. Anthony Albanese – Pgs. 1-2; 7
  • Low Barrier Buprenorphine for Opioid Use Disorder: A Feasible Strategy to Save Lives and Livelihoods – Pgs. 3; 11
  • CSAM Addiction Medicine Review Course and Board Exam Preparation Track 2019 – Pgs. 4-5
  • Timmen Cermak, MD Receives Vernelle Fox Award – Pg. 6
  • CSAM’s Membership Now Tops 700! – Pg. 6
  • CSAM Community Service Award Goes to David Lisonbee, CEO of Twin Town Treatment Centers – Pg. 7
  • MERF Provides 54 Scholarships to 2019 Addiction Medicine Review Course in Anaheim – Pgs. 8-9
  • Highlights of the CSAM Leadership Development Retreat at Asilomar – Pgs. 10-11
  • CSAM Board of Directors Election Results Announced – Pg. 12
  • CSAM Executive Director to Retire in 2020 – Pg. 13
  • Newly Released: Guidelines for Physicians Working in California Opioid Treatment Programs – Pg. 13
  • Welcome New CSAM Members! – Pg. 14
  • CSAM Opposes Changes to Confidentiality of Substance Use Disorder Patient Records (42 CFR Part 2) – Pg. 15
  • CSAM’s Addiction Medicine Review Course is Now Available Online! – Pg. 15
  • State of the Art in Addiction Medicine Conference | August 26-29, 2020 – Pg. 16

Governor signs two addiction treatment reform measures, vetoes two others

This past week Governor Gavin Newsom signed AB-919 (Petrie-Norris) which promises to crack down on financial conflicts-of-interest among rehab operators by limiting how they offer housing and transportation as inducements to treatment. It will require that laboratories that test blood or urine for drugs, or outpatient treatment programs that offer housing to clients, have separate housing contracts specifically stating that payment for housing is the patient’s responsibility and rent should not be indirectly billed to health insurance. The practice has become common in the industry. It also empowers the CA Department of Health Care Services (DHCS) to provide enforcement with seven new positions, costing $1.2 million the first year and $1.1 million after that.

The Governor also signed AB-290 (Wood) which attempts to prevent third party payer tactics designed to steer patients into more expensive insurance plans for dialysis and substance use disorder treatment. Basically, it reduces the financial incentive to lure people to California by promising “free” insurance coverage.

SB-445 (Portantino) was vetoed by Governor Newsom with this message:  “To the Members of the California State Senate: I am returning Senate Bill 445 without my signature. SB 445 would require the Department of Health Care Services (DHCS) to establish youth substance use disorder treatment quality standards including certification requirements for programs and professionals, and convene a workgroup to advise the Department on quality standards. Although I support the author’s intent to strengthen substance use disorder treatment services for youth, implementation of this bill requires significant General Fund spending that should be considered through the annual budget process. I encourage the author and stakeholders to engage with DHCS’s recently-formed Behavioral Health Stakeholder Advisory Committee to address concerns regarding youth substance use disorder treatment services. Sincerely, Gavin Newsom”

AB-920 (Petrie-Norris) was also vetoed: “To the Members of the California State Assembly: I am returning Assembly Bill 920 without my signature. This bill would eliminate an existing voluntary outpatient certification program. Beginning January 1, 2021, it would attempt to require an outpatient substance use disorder (SUD) recovery or treatment services facility which is not licensed under existing law, to obtain licensure from the Department of Health Care Services (DHCS) to provide SUD services. The bill attempts to do this by replacing references to program certification in existing Health and Safety Code references to program licensure. I am supportive of the Legislature’s intent to license all SUD recovery and treatment services. However, developing a new licensing schema is a significant undertaking, and would require a significant departure from the bill as enrolled. This bill would need to be revised to provide adequate statutory authority for DHCS to effectively monitor and ensure compliance with outpatient licensure requirements. In addition, establishing the associated administrative oversight is not without significant cost. After reviewing this bill, it is clear that a substantial amount of work is still needed to develop a program that my administration can implement. As such, I recommend the Legislature and sponsors of this bill work closely with DHCS on a more robust proposal for my consideration. Costs for implementation of such a bill would need to be considered in the budget process. Sincerely, Gavin Newsom”

CSAM is Advancing the Treatment of Addiction

The California Society of Addiction Medicine (CSAM) is the largest state chapter of the American Society of Addiction Medicine (ASAM) comprised of physicians and other healthcare professionals who are dedicated to improving the treatment of substance use disorders. With a growing membership of over 700 members, CSAM offers impactful education, effective advocacy, and leadership in influential state and national roles.

Retirement Announcement

Dear CSAM Members:

I recently announced to the CSAM Board of Directors that I will retire from my position as CSAM’s Executive Director effective January 16, 2020.

I have had the honor of serving in this role since January 1, 2000 upon the retirement of CSAM’s first Executive Director Gail Jara. The decision to leave this position was not an easy one. It has been an honor to work with such a wonderfully supportive team comprised of board leaders, members, and staff, and I will always hold warm memories in my heart for the experiences we have shared.

Between now and January, I will be working to ensure that the activities currently underway are transitioned to the new Executive Director to be selected by the CSAM Board of Directors. Thank you for supporting me over the past 20 years, and thank you for supporting CSAM.

With deepest appreciation and respect,

Kerry Parker, CAE

More

Newly Released: Guidelines for Physicians Working in California Opioid Treatment Programs

The California Society of Addiction Medicine (CSAM) just released an update to its “Guidelines for Physicians Working in California Opioid Treatment Programs (OTPs)” developed to provide an overview and discussion of the matters of clinical care that fall under the responsibility of the Opioid Treatment Program (OTP) Medical Director and Program Physicians. The Guidelines were prepared and distributed first in 1998 and updated first in 2004, and again in 2008. The 2019 update was made possible through a SAMHSA Opioid State Targeted Response Grant through the California Department of Health Care Services (DHCS)

The updated Guidelines are a valuable resource for physicians working in California’s OTPs. “This update represents what has changed in opioid pharmacotherapy and the uniquely challenging medical environment in which the OTP physician is responding to a diverse array of medical, psychiatric, and social problems, said Walter Ling, MD, one of three co-editors who worked with a team of 36 contributors to complete the Guidelines update. “In recent years, OTP physicians are seeing a growing number of patients who are addicted to prescription opioids rather than, or in addition to, heroin. Many of these patients have chronic pain issues as well as Substance Use Disorder (SUD),” said Ling.

The Guidelines are intended to assist OTP physicians in understanding their role and responsibilities in treatment, including those areas governed by state or federal regulation. These describe the role of the physician in an OTP and the clinical judgment involved in the development of an appropriate treatment plan for the delivery of patient care. These describe responsibilities that should be carried out by the physician or the physician’s designee. These do not prescribe a standard of care, or specific treatment choices. Judgment regarding specific clinical situations must be made on the basis of the clinical information available and on the treatment options available.

The Guidelines provide guidance on general approaches to treating patients. “The physician working in the OTP is often the first medical provider with whom these patients establish a long-term therapeutic relationship so the OTP physician can be an important, even lifesaving, resource for patients enrolled in treatment, identifying the multiple medical problems that characterize chemical dependence and providing treatment or referrals to address these problems, said co-editor Deborah Stephenson, MD, MPH. When utilized by OTP physicians, the Guidelines serve to improve community safety and public health.

A copy of the updated Guidelines can be downloaded for free at [PDF download].  Qualified OTP clinicians may request a free print copy of the Guidelines by sending a request to CSAM at: csam@csam-asam.org or calling: 415-764-4855.

Governor gets 4 bills that would crack down on addiction treatment scams, raise standards

Governor gets 4 bills that would crack down on addiction treatment scams, raise standards Link to article about these bills that appeared on 9/18/2019 in the Orange County Register CSAM’s co-sponsored bill, AB-920 (Petrie-Norris), is on the Governor’s desk to sign. This bill would require outpatient centers, which are now unsupervised by the state, to be licensed, regulated, and to adopt treatment criteria set by ASAM as the minimum standard of care. Also on the Governor’s desk:

AB-919 (Petrie-Norris) – would crack down on financial conflicts-of-interest among rehab operators

SB-589 (Bates) – would prohibit rehabs and sober homes from making false or misleading advertising statements

AB-290 (Wood) – would remove the financial incentive for treatment providers to lure people to California by promising “free” insurance coverage

Make your voice heard. By contacting the Governor using the link below, you can send your own comments about any of these bills:

https://govapps.gov.ca.gov/gov40mail/ (Use the pull down menu to click on the bill number to create a subject line for your message)

CSAM Newsletter Spring 2019 issue

CSAM News Spring 2019

  • President’s Message – Follow the Evidence
  • The Death Certificate Project | CSAM President’s Testimony at the Medical Board of CA
  • CSAM Leadership Development Retreat
  • CSAM Addiction Medicine Review Course and Board Exam Preparation Track 2019
  • Funding Provides Scholarships for Mentored Learning Experiences at CSAM Addiction Medicine Review Course
  • Call for CSAM Board of Directors Nominations
  • CA Bridge Program Offers Training and Assistance
  • The CA Department of Public Health’s All Facilities Letter (AFL)