CSAM Newsletter

By: Jean Marsters, MD, Committee on Membership & Communications Co-Chair,

The Membership Committee decided to look at the race and ethnic identification of our membership at the end of 2022. We evaluated a Dec 22, 2022, data pull of the race/ethnic identification as entered in ASAM’s membership database by members when they first joined. The option of identifying as multi-racial was not offered as a choice at that time, so at least some of those people may be in the “other” category. We wanted to see if active members in the organization mirrored the race/ethnic composition of all members. As a proxy for active members, we used all members listed on the CSAM website’s committee list that same day. Members on committees were only counted once (people on 2 committees were only counted once). Committees not listed on the website were not included such as Nominations Committee.  Activities not appearing on the website such as work groups, task forces and the History Project were not included. Below is the result:

We compared our member numbers with the California Health Care Foundation’s CA Health Care Almanac: A Quick Reference Guide March 20211¹ which has various breakouts of the racial/ethnic identification of active patient care physicians, California Med School graduates and total population in California in 2019 and 2020 (below):

Some of the numbers that break out:

23% of CSAM members “preferred not to answer” or gave no answer to their racial/cultural affiliation. This was a bit less than the 26% of ASAM physicians who answered the same in 2021.

Comparing all CSAM members with those listed on committees:
       White: 44% vs 52%, Asian 12% vs 11%, Hisp/Latino 8% vs 7%, AA 6% vs 2%,
       Other 6% vs 3%, AmInd/Alask Nat 1% vs 0%, Nat Hawaii/Other Pac Isl ~ 0.5% vs 0%,
       Prefer not to Answer 4% vs 7%

6% of Californians and members are African American, but 2% of committee members listed are.

39% of Californians are Latinx, 8% of members are and 7% of committee members listed are

32% of CA physicians active in-patient care are AA/PI, 12% of members are Asian and 11% of committee members listed are.

33% of CA physicians active in-patient care are White, 44% of members are White and 52% of committee members listed are.

Towards these ends and on behalf of the Membership Committee, I presented this data to the CSAM Board yearly kick-off meeting February 11, 2023, along with the recommendation that the Board reviews this and other data on culture/ ethnicity and develop a longitudinal action plan on diversity.

Since that time, there have been various developments:

The Inclusiveness and Social Justice Advisory Group has been created by our current President, Sharone Abramowitz, MD. This group has links to the Membership Committee through shared members.

Last Winter, MERF and the CSAM Membership Committee teamed up to submit a proof-of-concept paper to the California Health Care Foundation seeking funding to develop training for clinicians from race/ethnic groups underrepresented in medicine. Our request was not funded.

Last Spring, MERF and the CSAM Membership Committee teamed up to submit an application for a MAT Access Points grant to the Sierra Foundation (CA DPH SOR-3 funds) designed to promote addiction prevention and treatment for opioids and stimulants to communities of color in California. We offered to develop an 11-month training spanning 2023-24 for 16 California clinicians who either a) identified as an underrepresented medical minority or b) who work in the Tribal Health or Urban Native Indian Health Care systems in California. Our request was not funded.

From my seat on the ASAM Membership Counsel, I have been advocating for improvements in our ability to measure diversity among our membership. Since CSAM and ASAM require joint membership and membership/demographics are in ASAM’s platforms, by improving our ability to measure, we can improve tracking the diversity and identify gaps which need to be addressed. The next horizon for this is to look at sexual orientation, gender identity and expression (SOGI) numbers among membership which ASAM/CSAM has never tracked.

By: Randolph P Holmes MD, FAAFP, DFASAM, Government Affairs Committee Chair

The legislative session has now concluded here in California and Governor Newsom has either signed or vetoed all bills presented before him. CSAM’s Government Affairs Committee worked diligently to vet and review all the bills relevant to Substance Use Disorders/Addictions care. Two bills CSAM supported were signed into law:

• SB 326 & AB 351, both authorize a bond initiative to fund improvement of the mental health and SUD treatment system
• SB 872 authorizes mobile pharmacies to dispense medication for SUD’s

There were several fentanyl bills that were signed (and many that were not). One bill we supported and was signed was:

• AB 33 will create a fentanyl task force that has a representative of CSAM serving; another bill will create an overdose reporting system.

There were five (5) naloxone bills but only one was signed:

• SB 234 which requires Stadiums, concert venues and Amusement Parks to provide naloxone was signed. 
• SB 461 was amended to require Community colleges and CSUs to provide fentanyl test strips.

There were a number of bills that CSAM opposed that were vetoed:

•  SB 58 was one of these bills which would have legalized hallucinogens.

CSAM also supported a number of bills that were vetoed:

• AB 1288 and AB 1060, bills to drop Prior Authorization requirement by private insurers for medication to treat SUD’s and emergency mental health/SUD care but these were vetoed;
• CSAM supported AB 1207 which would have prohibited cannabis products from being produce in ways to attract children, but it was vetoed

CSAM was neutral of SB 43, which redefines the meaning of gravely disabled, and this bill was signed into law.

Lastly, CSAM continues to be involved in our efforts to re-start a Physician Wellness Program for physicians who experience issues with SUD’s or mental health problems. We are preparing comments on the state’s new proposed rules and regulations.

CSAM’s GA Committee welcomes any CSAM members who are interested in California policy issues to attend our monthly Zoom meeting as a guest. Getting involved with advocacy is a great way to advance treatment opportunities in our communities. We do not yet have our list of bills for the 2024 legislative session, but we expect more movement on fentanyl, naloxone, licensing of outpatient treatment programs, and building capacity for mental health/SUD treatment.

By: Farah Zaidi, MD, 2024 State of the Art Conference Committee Chair

On behalf of the California Society of Addiction Medicine (CSAM), I am excited to share some of the early planning highlights of the 2024 CSAM State of the Arts (SOA) Conference in August 2024, taking place in the beautiful city of San Francisco at the spectacular venue Hyatt Regency San Francisco.

I would like to begin by honoring and acknowledging the original people of this vibrant city: We are on the ancestral homeland of Ramaytush Ohlone peoples who are the original inhabitants of the San Francisco Peninsula. We wish to pay our respect to the Ancestors, Elders and Relatives of the Ramaytush Community as the first people of this land. We recognize that we benefit from living and working on their traditional homeland.

San Francisco Bay Area is the hub of innovation, technology, education, research, science, arts, cultural diversity and so much more. The Bay Area is also home to many prestigious Universities, as well as top notch Residency and Fellowship training programs of almost all specialties.

The theme of the 2024 SOA Conference is “Social and Commercial Determinants of Health (SDoH & CDoH)”. While there is increased awareness of SDoH, the understanding about the CDoH appears to be in its infancy and is evolving. The 2023 Lancet series on CDoH, defines CDoH as “the systems, practices, and pathways through which commercial actors drive health and equity.” Tobacco, alcohol, processed/ultra-processed foods and drinks, gaming and gambling are some of the well-known examples of CDoH with significant harmful impacts on public health.

Our expert faculty will highlight the trends, advances, and innovations in the treatment of addictions, as well as the intersectionality of social and commercial determinants with addictions, focusing on the impact of vulnerable and already marginalized communities at disproportionally high rates.

In addition to covering the State of the Art in treatment and research of the most prevalent of substance use disorders, we plan to explore the relationships of climate change and substance use disorders, the role of Artificial Intelligence (AI) in addictions treatment, the link between spirituality in trauma care and recovery, and specific treatment considerations in special populations including the Maternal-Fetal dyad, LGBTQ, Children & Adolescent and Geriatrics.

Our popular Board Exam Preparation Track will be offered again to those who are preparing for the American Board of Preventive Medicine, Addiction Medicine Subspecialty Board Exam in 2024. Our other Wednesday Pre-conference workshops will focus on psychedelics, the state of the art in opioid use disorder treatment, addressing our child and adolescent populations, while MERF (Medical Education Research Foundation) will offer its popular MI (Motivational Interviewing) workshop on Wednesday as well.

And last but not the least, MERF scholars and conference attendees will have an opportunity to share their research and other projects through multiple Poster Sessions over the course of conference.

In short, whether you are a late, mid or early career physician, a physician in training, a medical student, an associate member (i.e., advanced practice provider, therapist, medical assistant), a returning or a novice CSAM conference attendee, the CSAM 2024 SOA Conference promises to offer you a perfect blend of learning, networking, relaxing and sightseeing in San Francisco, one of the top tourist destinations of the United States.

Happy Holidays,

-Farah Zaidi, MD

FOR IMMEDIATE RELEASE: February 27, 2023
Statement of Matthew L. Myers, President, Campaign for Tobacco-Free Kids

WASHINGTON, D.C. – The U.S. Supreme Court announced today that it will not hear R.J. Reynolds’ appeal of a lower court ruling upholding Los Angeles County’s law prohibiting the sale of flavored tobacco products. This decision is a tremendous victory for kids and public health. It allows Los Angeles County’s law to remain in effect, while also preserving the authority of states and localities across the country to enact similar lifesaving measures. R.J. Reynolds and other tobacco companies have desperately fought these laws so they can continue to target kids, Black Americans and other communities with flavored products, including flavored e-cigarettes, menthol cigarettes and flavored cigars.

This decision is a rejection of Reynolds’ argument that the Los Angeles County law and similar state and local laws are preempted by the federal Tobacco Control Act. In fact, the Tobacco Control Act includes explicit language preserving the authority of states and localities to regulate the sale of tobacco products within their borders. For this reason, no court has struck down a state or local restriction on the sale of flavored tobacco products as preempted by the Tobacco Control Act. These courts include the First, Second and Ninth Circuit Courts of Appeal. There is simply no legal basis to deprive Los Angeles County, or any other locality or state, of the ability to protect their citizens against the flavored tobacco products that lure kids into a lifetime of nicotine addiction.

Today’s announcement follows the Supreme Court’s decision in December to deny Reynolds’ request for an emergency injunction to block California’s statewide law ending the sale of most flavored tobacco products.

Reynolds’ battle against these laws shows once again that the tobacco companies haven’t changed and are lying when they claim to care about anything other than their bottom line. R.J. Reynolds and other companies will stop at nothing in order to continue targeting children and vulnerable communities with flavored tobacco products. Policy makers at every level must stand up to the tobacco industry’s bullying and take action to protect kids and save lives.

By: Dana Harris, MD, FASAM, CSAM Secretary

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.

By: Joy Hao, MD, PhD, Conference Committee Chair

For the past three years, we have struggled collectively with an epidemic on top of a pandemic: drug overdose deaths skyrocketed during the first year of the COVID-19 pandemic, predominantly due to synthetic opioids such as fentanyl. In the wake of this fentanyl epidemic, there has been a major shift in public policy in the treatment of opioid use disorder at the same time that the federal Public Health Emergency for COVID-19 comes to an end this year.

For the first time in history, any physician registered with the DEA will be able to prescribe buprenorphine, one of the most effective treatments for opioid use disorder. In December 2022, the United States Congress signed the Consolidated Appropriations Act, thereby eliminating the DATA X-Waiver requirement and ending nearly 20 years of intensive governmental regulation of buprenorphine.

This monumental shift in policy reflects the advocacy efforts of many agencies and organizations over the past decades, including CSAM and ASAM. The mission of CSAM is to promote evidence-based treatment and improve access to high quality addiction treatment for all. As more providers are now able to prescribe buprenorphine, it is even more imperative to promote educational efforts in addiction from medical school through Continuing Medical Education, especially since the DEA now requires all registrants to fulfill mandatory 8-hour substance use disorder training.

CSAM celebrates its 50th anniversary this year. In honor of this momentous occasion, this year’s conference will feature a new approach by combining the traditional review course with panels highlighting cutting edge practices in addiction medicine. We will offer plenary sessions on all major substance use disorders focusing on epidemiology, diagnosis, and treatment, geared towards ABPM Board exam preparation. Furthermore, we will feature multidisciplinary panels for the first time at a CSAM conference, addressing topics as diverse as: treatment of ADHD in substance use disorders, adolescent addiction medicine, frontiers in harm reduction, ketamine and other novel treatments, and alcohol withdrawal management other than benzodiazepines (See schedule here: LINK).

We are excited to present two phenomenal keynote speakers this year: Dr. Dan Ciccarone will speak on the future of fentanyl: supply, use patterns, and public health response. Dr. Anna Lembke will speak on dopamine “fasting” as an early intervention for compulsive overconsumption in the digital age.

The conference will also feature four workshops: Treating Pain and Addiction, Fitness for Duty Evaluation, Bridging the Silos – Arm in Arm for Better Patient Care, and Motivational Interviewing for Busy Clinicians. Lastly, the poster session will return as well.

As we find our footing in a post-pandemic world, I invite you to join us in San Diego this year from August 30th to September 2nd for the opportunity to review, rejuvenate, and reconnect. I hope to see you also at the special CSAM 50th anniversary celebration on Friday evening, September 1st. We look forward to serving you for the next 50 years.

-Joy Hao, MD, PhD

By: Maureen Strohm, MD, FAAFP, DFASAM, MERF Representative

What a banner year this has been and will be going into the 50^th CSAM Annual Conference!  This summer we celebrate CSAM’s 50^th Anniversary.  MERF, the Medical Education and Research Foundation for the Treatment of Addictions, is CSAM’s younger sibling and will mark its 42^th Anniversary at that time.  Over the years, more than 600 residents, medical and psychology faculty, nurse practitioners and physician assistants, as well as new fellows have come through the MERF Scholars programs learning addiction medicine in a unique paradigm – our signature program brings teams of residents and faculty from institutions throughout California and beyond and provides Mentored Learning Experiences with faculty mentors throughout the course and the year that follows. Many of our CSAM and ASAM leaders are MERF graduates!

As our restrictions during the pandemic eased for 2022, we celebrated the chance to come together again with 52 MERF Scholars – residents, fellows, and faculty – participating in person, in small groups to learn strategies of motivational interviewing in the pre-conference workshop, “Motivational Interviewing for Busy Clinicians and Educators”, along with acquiring a myriad of teaching tools to use within the clinic setting once participants returned to their respective institutions.

The small groups continue their work together throughout the conference for case discussions and continued development of their planned projects upon return to their programs. Our quarterly Journal Clubs often continues the camaraderie as the group explores current articles, led by the author(s) of the article under review.

What has changed, and needs your help, is the availability of funding for this long-standing “signature” of MERF. Over the years, the scholarships have been sustained through private donations (including from our own founders and current members) as well as various short-term grants to cover participation expenses. MERF support has evolved from its early stipends mainly covering registration, to our initial MERF Scholars program, then to MERF Champions who came back for follow up training, and then our MATES program supported by state funding to reach out to our colleagues in the FQHCs integrating this important work into their practices.

Since 2022, we have been working to secure new funding and made the decision to support the majority of Scholars last year through our own reserves. At present, outside funding remains uncertain and so we are looking to new strategies to secure a sustainable funding stream that can support MERF scholars for years to come especially at a time when addiction medicine interest is growing and our residents and fellows choosing to specialize in addictions care are expanding.

The opioid epidemic is not going away, and in fact is worsening as it evolves to include stimulant-related deaths, fentanyl and its analogues and now xylazine, maintaining its grip on our patients, friends, families, and communities.

So let’s “pay it forward” – and donate to MERF today!  While $1500 will fund one Scholar this year, we welcome all donations – even larger ones!  If your organization has a charitable foundation, let us know whom to contact with our “ask.”  Better yet, help us get a foot in that door!

Dr. Garrett O’Connor brought his indomitable force in refocusing MERF in 2000 to meet his passionately stated mission: to prevent the harm being done to patients by physicians who lack the knowledge, skill, and training to recognize and treat addiction.  While we have updated that to include all clinicians, we honor his vision.  Stop the harm!  Help us spread the word, the knowledge and experience to all our colleagues!

*Our Mission is to prevent the harm being done to patients by the medical community by bridging the gap in knowledge, skill, and commitment to recognize and treat people with substance use disorders.

By: Jean Marsters, MD, Membership Committee Chair

The membership Committee decided to look at race and ethnicity of our membership in 2022. The results of a Dec 22, 2022 data pull were assembled. It contained race/ethnic identification of all of our members that week. Multi-racial was not offered as a choice at that time, it is in 2023. We wanted to look at all members, and also get a sense if active members in the organization mirror the race/ethnic composition of all members. As a simple proxy for active members, we used all members listed on the CSAM website’s committee list that day. Members on committees were only counted once (people on 2 committees were only counted once). Committees not on the website were not included (such as Nominations Committee). Activities not appearing on the website such as work groups, task forces and the History Project were not included.

We compared our numbers with the California Health Care Foundation’s CA Health Care Almanac: A Quick Reference Guide March 2021¹ which has the racial/ethnic identification of physicians in California in 2019 and 2020 and for the state’s population.

Some of the numbers that break out:

23% of CSAM members “preferred not to answer” or gave no answer to their racial/cultural affiliation. This was a bit less than the 26% of ASAM physicians who answered the same in 2021.

Comparing all CSAM members with those listed on committees:

• White: 44% vs 52%, Asian 12% vs 11%, Hisp/Latino 8% vs 7%, AA 6% vs 2%
• Other 6% vs 3%, AmInd/Alask Nat 1% vs 0%, Nat Hawaii/Other Pac Isl ~ 0.5% vs 0%
• Prefer not to Answer 4% vs 7%

6% of Californians and members are African American, but 2% of committee members listed are.

39% of Californians are Latinx, 8% of members are and 7% of committee members listed are.

32% of CA physicians active in-patient care are AA/PI, 12% of members are Asian and 11% of committee members listed are.

33% of CA physicians active in-patient care are White, 44% of members are White and 52% of committee members listed are.

The authors of the 2022 article in J General Internal Medicine by Garcia et al: Lack of Racial and Ethnic Diversity Among Addiction Medicine Physicians on demographics of Addiction Medicine Physicians call for the development of informed efforts to diversify the addiction workforce. In order to do this, they aptly identify the need to generate accurate numbers so that gaps can be identified and changes through time can be measured.

On behalf of the Membership Committee, I presented this data to the Board on February 11th with the recommendation that the Board reviews this and other data on culture/ethnicity and develop a longitudinal action plan on diversity.

1. https://www.chcf.org/wp-content/uploads/2021/03/PhysiciansAlmanac2021QRG.pdf