Included in this issue: Letter from the CSAM President, Karen Miotto, Message from the CSAM Conference Committee Chair, MERF Update, How I Ended Up in Addiction Medicine by CSAM President Elect Sharone Abramowitz MD FASAM, CSAM Government Affairs Committee Update, Case Discussions are Back! by CSAM Secretary Dana Harris MD, CSAM Interview with CA Bridge Program Co-Founder Andrew Herring with Ingeborg Schafhalter MD, ABPM Practice Pathway Sunsetting by Chwen-Yuen Angie Chen MD FACP FASAM, PRESS RELEASE: Victory for Public Health: U.S. Supreme Court Refuses to Hear Tobacco Industry’s Challenge to Los Angeles County Law Ending Flavored Tobacco Sales, Tobacco Cessation in Substance Use Treatment: Research & Policy Efforts to Reduce Tobacco-Related Health Inequality by Chwen-Yuen Angie Chen MD FACP FASAM, and A 50 Year CSAM Celebration!
We are pleased to announce that we are hard at work developing our small group case discussions, a time-honored CSAM tradition. Our attendees consistently tell us that this is one of the many things that set CSAM conferences apart, as these discussions enhance both learning and community building.
We have been asked over the years why the case discussions don’t include outcomes and I had the opportunity to discuss this with Dr. Steve Eickelberg, who is one of our cherished long-term CSAM members and who has written so many of the cases that you have been challenged by over the years. Here’s a bit of our conversation:
DH: So, you’ve written dozens of cases over the years, and I know that you and I have often discussed the value of NOT providing more clear outcomes (“the answers”), something that seems to be a challenge for many of our attendees. I wonder if you could speak to that.
SE: Sure. Well, what is the goal of these case discussions? From my perspective the goal is really to experience the value of collaboration and to learn to trust the brain trust of this incredible community. The “answers” come out of the discussion.
DH: Of course. But we know that so many of our attendees are studying for the certification exam in review course years, and as conference planners we often wonder if the ambiguity of these case outcomes is as satisfying to our test takers.
SE: Isn’t that the process of practicing medicine? You have a clinical situation that comes up and there is no single answer. There is a process that involves using our colleagues to try to find the best clinical approach. So, in a sense the case discussions present much more of a real world process – that of learning from your colleagues the information you don’t have and how to apply it to a situation. This is about applying adult learning principles and process based learning. And well, if these cases promote some discomfort about not knowing certain concepts, isn’t that wonderful motivation to continue to seek information and approach peers?
DH: You’ve been such an integral part of carrying on this rich CSAM tradition. I wonder if you could say a bit about what case discussions have meant for you.
SE: When I came to my first CSAM conference as a physician, very new to addiction medicine, I was asked to be a table facilitator for the case discussions and I absolutely fell in love with the process! It was so reassuring to know that as a new addiction doc I could facilitate this group and not know the answers! I realized that the information coming from my colleagues was far better than anything I could have prepared, and the process of drawing my colleagues out in these discussions was just so gratifying.
DH: Well, I for one, want to thank you for the incredible work you have done crafting these truly challenging cases and helping to make CSAM conferences ones that our members continue to return to.
We hope that you share our enthusiasm for case discussions and will join us at the 2023 Review Course, where we will challenge you with all new cases.
Governor Newsom Releases Master Plan for Tackling the Fentanyl and Opioid Crisis
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
On December 29, 2022, with the signing of the Consolidated Appropriations Act of 2023 (the Act), Congress eliminated the “DATA-Waiver Program.”
All DEA registrants should be aware of the following:
A DATA-Waiver registration is no longer required to treat patients with buprenorphine for opioid use disorder.
Going forward, all prescriptions for buprenorphine only require a standard DEA registration number. The previously used DATA-Waiver registration numbers are no longer…
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…
The CSAM News was recently published! Featured articles include Conference Photos, Like Minded Docs, President’s Message, CSAM 50th Anniversary Bash & More!
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.
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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.
Board Exam Preparation Track: The Faculty of experienced educators will cover 16 key topic areas, with sample exam questions and rationale provided for answers. Test-taking and study tips will be covered. Attendees will have access to review these recorded sessions through November. Access to the High Yield Question Bank is included.
Addiction Medicine Review Course: The 2021 all-virtual CSAM conference continues the biannual tradition of reviewing the essentials of addiction treatment while incorporating current evidence-based practices in this everchanging field. The planning committee has selected engaging, dynamic speakers.
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.
Zoom with us at the review course in August 31, September 3 – 6, 2021.
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!
