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: 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: (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)

New MAT Webinars on CSAM Education Center!

Please visit the CSAM Education center to watch the new MAT webinars: Real Cases of Buprenorphine-Naloxone Treatment: What to do and how to do it? featuring CSAM members, Soraya Azari, MD, Kenneth Saffier, MD, FASAM and Scott Steiger, MD, FACP, FASAM.

Transdermal Buprenorphine for Induction of Patients with Co-Morbid Pain featuring CSAM members, Soraya Azari, MD and Tauheed Zaman, MD. These webinars are FREE for CSAM members.

These are two 2019 webinars on Medication Assisted Treatment (MAT) in primary care settings created by the California Society of Addiction Medicine (CSAM) with the support of a grant from the California Department of Healthcare Services (DHCS). 

We hope you enjoy the webinar!
CSAM Education Team

Recommendations for Safe Opioid Prescribing

CSAM Recommendations for Safe Opioid Prescribing

Version 1.0 (03/01/19)

Important Notes:

  • These recommendations were initially developed by Kaiser Permanente and then modified and endorsed by Safe Med LA and on December 12, 2018 by the California Society of Addiction Medicine’s (CSAM) Committee on Opioids. They are based on recommendations and guidelines from the Centers for Disease Control and Prevention (CDC), CSAM, and other subject matter experts. 
  • As with any clinical recommendations, provider judgment should govern considerations involved in high quality and evidence-based patient care. 
  • Importantly, these recommendations should not be interpreted to require involuntary and/or rapid tapers, which can be more harmful than they are beneficial by putting patients at risk for poor outcomes such as medical and/or psychiatric decompensation, relapse or illicit drug use, overdose, and self-harm. Tapering decisions must be made based on the individual circumstances of each case, with careful consideration of the risks and benefits. 
  • Prescribers need to be aware of additional local, state, and federal laws and regulations involving opioid prescribing that may supersede these recommendations. 
  • For any prescribing outside of these recommendations, it is highly advised that the reason(s) be documented in the patient’s medical record. 
  • These recommendations do NOT pertain to palliative care, end-of-life (hospice), or active cancer treatment.

CSAM Newsletter Winter 2018 issue

CSAM News Winter 2018

  • President’s Message – CSAM’s Voice for Treatment is Being Heard
  • California Leads U.S. with Highest Number of Addiction Medicine Fellowships
  • Interested in Supporting Harm Reduction Efforts?
  • A Call to Advocacy Editorial – End Discrimination Against Healthcare Providers with Substance Use Disorders
  • MERF Hosts Record-Breaking Number of Scholars and Mentors at CSAM’s Annual Conference
  • Swath of Bills Signed Into Law by Governor Brown
  • CSAM Seeks a Seat in the House of Medicine
  • CSAM Awards Recognize Outstanding Achievement and Service

CSAM Newsletter Spring 2018 issue

CSAM News Spring 2018

  • President’s Message – What’s Ahead for CSAM in 2018?
  • Applying Your Addiction Medicine Know-How
  • CSAM Implements Grant to Expand Medication-Assisted Treatment in California
  • Membership Update – Vote to Include Associate Members Passes
  • CSAM Welcomes a New Education Director