News

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

By: Chwen-Yuen Angie Chen, MD, FACP, FASAM, Communications Committee Chair

On February 15, 2023 Dr. Caravella McCuistian, PhD presented her findings on the implementation of AB 541 Tobacco Treatment legislation, at the *UCSF Drug Use Research Group meeting (see below for more information on DURG). In attendance were CSAM members Cathy MacDonald, MD (Program Consultant Lifelong Tobacco Treatment Training Program Oakland, CA) and Chwen-Yuen Angie Chen, MD who were instrumental in initiating AB541: https://bit.ly/43cpS0l

Here is a synopsis of Dr. McCuistian‘s presentation:

“California has prioritized smoking cessation among people who use substances through the Tobacco-Free for Recovery Initiative, which includes an intervention aimed at supporting substance use disorder treatment programs in implementing tobacco-free grounds. Dr. McCuistian led an examination of changes in client smoking prevalence, tobacco use behaviors, and receipt of cessation services among the first seven programs participating in the initiative. Program clients completed cross-sectional surveys at the start of the intervention (baseline: n = 249), at an interim timepoint post-baseline (interim: n = 275), and at the end of the intervention 15 months later (post-intervention: n = 219). Over the course of the initiative, 5 of the 7 programs implemented tobacco free grounds. Results indicated that client smoking prevalence decreased from 54.2% to 26.6% from pre to post intervention. Current smokers and those who quit while in treatment also reported an increase in NRT/pharmacotherapy (11.9% vs. 25.2%) from pre to post intervention. These data suggest that an intervention to promote tobacco-free grounds implemented in residential SUD treatment programs was associated with a significant reduction in client smoking and an increase in NRT/pharmacotherapy. These findings directly supported the enactment of California AB 541, which now requires all California substance use treatment programs to assess and treat smoking among patients in these programs. The Tobacco Free for Recovery Initiative serves as a model for how substance use treatment programs may adhere to requirements of AB 541 while addressing smoking prevalence within their programs.”

Here are two resources for additional information:

McCuistian, C., Kapiteni, K., Le, T., Safier, J., Delucchi, K., & Guydish, J. (2022). Reducing tobacco use in substance use treatment: An intervention to promote tobacco-free grounds. Journal of substance abuse treatment, 135, 108640, 1-8.

https://doi.org/10.1016/j.jsat.2021.108640

Campbell, B. K., Le, T., McCuistian, C., Hosakote, S., Kapiteni, K., & Guydish, J. (2022). Implementing tobacco-free policy in residential substance use disorders treatment: Practice changes among staff. Drug and Alcohol Dependence Reports, 2, 100033. https://doi.org/10.1016/j.dadr.2022.100033, 1-8.

*The UCSF Drug Use Research Group (DURG) is a city-wide seminar attended by faculty, postdoctoral fellows, graduate students, and other investigators with a focus on and for persons who use drugs. Started in 2005 after a friendly debate between an epidemiologist and anthropologist on the merits of quantitative versus qualitative research methods, the DURG monthly seminars provide a community platform for new and established investigators to present their work, formulate research questions, and prepare for grant applications, conferences, and publications in a supportive environment. The seminar has been successful in cultivating new collaborations and mentorship and in sustaining interdisciplinary and interprofessional dialogue between those engaged in basic sciences, epidemiology, clinical research, and qualitative methods.