By: Randolph P Holmes MD, FAAFP, DFASAM, Government Affairs Committee Chair
with Chwen-Yuen Angie Chen, MD, FACP, FASAM, Communications Committee Chair
CSAM’s Public Policy Committee has a new name, the Government Affairs (GA) Committee. We are early in the legislative session and have been reviewing several bills related to substance use disorders care. There are several bills concerning fentanyl, some of which are more about the old “war on drugs” thinking and do not align with CSAM’s mission. We have several bills that seek to license drug and alcohol counselors and it is likely CSAM will support. Most bills are still in committee so it will be another month or two before the GA Committee will have the final products. CSAM was represented in Sacramento on April 19 for Legislative Day. We will be hearing from our legislators and meeting with staff to elicit support on bills we want to see passed.
When the Section Chief of Special Programs and Utilization Management Branch from the Department of Health Care Services, Steven T. Kmucha, MD JD MMM reached out to CSAM’s President Dr. Karen Miotto with an inquiry for advice and guidance about “best policies” and clinical evidence pertaining to the update of Medi-Cal policies related to Voluntary Inpatient Detoxification (VID), CSAM News Editor and Chair of Communications, Dr. C.Y. Angie Chen connected CSAM Member Dr. Cheryl Ho, Director of Hope Clinic and Co-Founder Valley Homeless Healthcare Program of Santa Clara Valley Health and Hospital System with GA (HPPC) committee for support in crafting a letter, signed by 14 physician-leader colleagues of Dr. Ho who practice addiction medicine within Santa Clara County, outlining the paucity of Medi-Cal funded services for medically supervised withdrawal management in the face of our fentanyl crisis, where ASAM Placement Criteria 3.2 level programs are providing services that would more appropriately fall between 3.2 and 3.7, however, the funding for this level of treatment remains at a level 3.2. We are awaiting a response, and welcome others who are interested in VID reform to reach out to CSAM.
Among the many things that CSAM does as part of our advocacy efforts is submit amicus briefs in support of SUD related legal cases before various courts. CSAM recently signed on to two cases. In the first case (Carpenter), a pregnant woman gave birth and the baby died in San Diego. She is being charged with murder because her urine tested positive for drugs; the submitted brief states why it is wrong to weaponize drug use in pregnancy and the reasoning behind opposing a punitive response to perinatal drug use. In the second case, a man was denied visitation privileges with his child because he tested positive for drugs. Our key arguments include a) substance use, even in high amounts or with high frequency, is not equivalent to a substance use disorder b) The DSM-5-TR distinguishes between substance use and SUDs which should not necessarily be equated c) The frequency, duration, and amount of substance use alone have never been diagnostic criteria in the DSM, because those metrics do not correlate with a lack of control d) A positive drug test alone is not an indicator of a substance use disorder and e) substance use disorders are clinical conditions that should only be diagnosed by trained professionals and not the courts. This latter amicus was filed with CSAM as a lead, with our input on crafting it, and is currently before the State Supreme Court.
CSAM continues to work hard to have our voices heard as the subject matter experts on substance use disorder issues.