WORD TO THE WISE
Newsletter: February 2018 - Volume 18, No. 2
In this issue:
  • President's corner: Report from the Opioid Summit
  • Members on the Move: Mike Nerenberg, MD; Julie Newburg, MD
  • Announcements: Directory updates and photos
  • Update from the Pueblo City-County Health Department: CDC CME
  • Upcoming events: PCMS Board meeting and All-Member CME Program, and CMS Annual Meeting
  • Hot topics in medicine: Economic impact, report on aging
  • News from CMS: Earn CME and COPIC points in person or online at Feb. 3 leadership forum (this Saturday), and news from CMS BOD rep Brad Roberts, MD
  • News from AMA: Medical podcast series
PRESIDENT'S CORNER  
Dr. Tom Greidanus reports on the Colorado Hospital Association Opioid Summit

On Jan. 25, 350 health care professionals from around the state attended the first Colorado Opioid Safety Summit. Members Dr. Steve Nafziger and I were in attendance, plus others from our medical community .

The program kicked off with an incredibly personal discussion from Dana Knowles, a recovering opioid addict and retired Channel 9 News Anchor.

Another very personal discussion followed by Admiral James A. Winnefeld Jr., United States Navy (Retired), former vice chairman of the joints chief of staff. He discussed the loss of his son Jonathan last fall to an overdose. Jonathan was a freshman at DU and, to all appearances, was doing well in recovery until his overdose. Admiral Winnefeld discussed his nonprofit SAFE (Stop the Addiction Fatality Epidemic) . He described six lines of operation to combat the opioid epidemic:
  1. Public awareness - scope of problem, it is not a moral failure but a disease
  2. Full-spectrum prevention.
  3. Prescription medicine - raise awareness of non-addictive pain management methods, support tighter opioid prescription protocols, and support research into non-addictive pain management drugs.
  4. Law enforcement and medical response - encourage and support law enforcement efforts to remove illegal drug availability and help prevent overdoses in real time, safe use zones, needle exchange programs, increased use and availability of naloxone, and increased suboxone use.
  5. Treatment and recovery - increased availability.
  6. Family outreach and support.
 
These two powerful presentations were followed by a panel highlighting the key aspects of the Colorado Chapter of the American College of Emergency Physicians 2017 Opioid Prescribing & Treatment Guidelines .

Don Stader, MD, highlighted the ALTO (alternatives to opioids) protocol; for example, using iliofascial block for hip fractures; Haldol for psychological pain; lidocaine, gabapentin and Lyrica for neuropathic pain; or anti-inflammatory medications for inflammatory pain.

Jason Hoppe, MD, discussed the dangers of opioids, citing a statistic that if you start a patient on a short course of opioids, the patient’s risk of long-term use increases by 40 percent. Statewide PDMP reports will come out next month that will allow prescribers to compare themselves to peers.

Jonathan Blum, MD, discussed expanding access to medication-assisted treatment (MAT) and its importance. As he explained, it saves lives. Patients on Suboxone have an annual death rate of 4.5 percent versus 9.5 percent if using heroin. There are 25 fewer deaths per 1,000 people if they stay on treatment. Denver Health is providing MAT in their five largest primary care clinics.

Lisa Raville, executive director of the Harm Reduction Action Center discussed the scope of the problem and some statistics. Black tar heroin, a very pure and dangerous type of heroin featured in the book “Dreamland: The True Tale of America's Opiate Epidemic,” is present in Colorado; its purity varies from 2 to 37 percent. But Colorado is making strides in harm reduction: There are now 152 law enforcement agencies carrying Naloxone. Several needle exchange programs allow heroin users (who average between three and five injections per day) provide clean needles to reduce infectious disease. A bill being considered by the state legislature, Senate Bill 40, would allow for “safe use areas.” She reminded providers in the room to please give a prescription of Naloxone for users; it can save a life. She also challenged the audience to be nonjudgmental and compassionate. “We need to stop the stigma of addiction,” she said.

Robert Werthwein, director of the Colorado Department of Human Services (CDHS) Office of Behavioral Health, discussed the challenges in addressing the dual stigma of substance abuse and MAT, while Charles Smith, PhD, regional administrator of the Substance Abuse and Mental Health Services Administration, discussed combating the opioid epidemic. He highlighted federal strategies, resources and partnerships.
 
Following this came the release of the results from the Colorado Opioid Safety Pilot . This six-month pilot asked 10 hospital emergency departments (EDs) and freestanding emergency departments (FSEDs) to reduce their administration of opioids. The goal was to reduce opioid administration by 15 percent and to increase the use of alternatives to opioids (ALTOs).

The results of the pilot exceeded expectations with an impressive 36 percent decrease in opioid administration. Check out Colorado Opioid Safety Pilot results report to better understand the significant accomplishment that these 10 pilot sites achieved. 
MEMBERS ON THE MOVE
This section of the PCMS newsletter highlights members who are making a difference in our community or medical field. We encourage all members to send us a note about your professional or personal achievements, philanthropy, or those of a colleague that you think should be featured. Email cheryl.law@pueblocms.org .
Mike Nerenberg, MD
Mike Nerenberg, MD, a retired emergency medicine physician in Pueblo, has been instrumental in the opening of a new clean syringe access program in the city. Nerenberg is the president of the Southern Colorado Harm Reduction Association (SCHRA) board of directors. Volunteers and staff of the 501c3 organization have been seeing clients since May, and the harm reduction resource center, located at 1249 E. Routt Ave., is open from 2 to 4 p.m. every Saturday. On a typical Saturday, they will see between 70 and 90 clients.

Nerenberg got involved as he saw an increase in the rise of prescription drug abuse, then a rise in heroin overdoses as prescriptions became harder to obtain. Through his work on the Board of Health he became aware of rising cases of neonatal abstinence syndrome. “Somebody needed to step up and I had the time, interest and energy,” Nerenberg said.

In addition to being a needle exchange program and an entry point to treatment and other services, SCHRA distributes Narcan to clients, provides acudetox (ear acupuncture), has peer recovery coaches and is a Young People in Recovery chapter site. Needle exchange programs have been shown to help reduce needle-transmitted diseases and abscesses. The majority of the center’s clients are heroin or methamphetamine users. Their primary message is “one needle, one time, then return to the center for disposal.”

“We have built a lot in a short period of time and there is significant potential to really develop into a national model in tackling the opioid crisis,” Nerenberg said. “Our most immediate need is funding.” Tax-deductible donations are welcome and can be mailed to the Routt Ave. address. Read more here.
Julie Newburg, MD
Dr. Julie Newburg will be joining the Southern Colorado Clinic effective March 1, 2018. The new address for Dr. Newburg is:

3937 Ivywood Lane
Pueblo, CO 81005
719-544-3752

Southern Colorado Clinic is a multi-specialty clinic that was established in 1972 and has continued to serve the medical needs in the Pueblo community. Dr. Newburg will continue to provide both medical and surgical management of disorders of the ears, nose and throat.  
PCMS ANNOUNCEMENTS
2018 pictorial membership directory - Submit your updates ASAP!

Plans to complete our 2018 Pictorial Membership Directory -- the most comprehensive directory in Pueblo -- by Monday, April 30 are underway. 

Updates: Please click here to review the 2017 Directory and our existing online website at pueblocms.org and contact our office ASAP with any updates. 

We thank you for appreciating the importance of this project and assisting PCMS in making the new website and directory the most successful ever.
NEWS FROM THE PUEBLO CITY-COUNTY HEALTH DEPT.
CDC provides free education on recommendations and alternatives to opioids
The Centers for Disease Control and Prevention (CDC) has released a four-part FREE continuing education training series that aims to help clinicians apply the CDC’s recommendations for prescribing opioids. These trainings will help providers gain a better understanding of the recommendations, risks and benefits of prescription opioids, non-opioid treatment options, patient communication, and risk mitigation. The trainings can be found at www.cdc.gov/drugoverdose/training/online-training.html. 

The CDC also has a seven-part FREE continuing education webinar to help providers choose the most effective pain treatment options and improve the safety of opioid prescribing for chronic pain. The webinars can be found at www.cdc.gov/drugoverdose/training/webinars.html.

For more information, contact Tessa Lewis, Project Specialist with the Pueblo City-County Health Department, at lewist@pueblocounty.us .
UPCOMING EVENTS
Add your event to our calendar by emailing cheryl.law@pueblocms.org .
MARK YOUR CALENDARS!
PCMS Board Meeting and All-Member CME Program & Dinner (combined) - March 14

The date of the PCMS Board Meeting for March has been changed to include an all-member dinner and CME program (with possible COPIC points) and will be held on Wednesday, March 14, 2018, 5:30 to 6pm (Board meeting) and 6pm to 8:30 p.m (social hour, dinner and CME program). Our goal is to bring together as a many of our members to discuss, in this age of opioid abuse, rational limits and usage of opioids as well as alternatives. More details to come. 
PCMS board meetings are open to members who wish to observe their leaders in action. Meetings will be productive and are valuable to the organization!
SAVE THE DATE: 2018 CMS Annual Meeting

Save the date for the 2018 Colorado Medical Society Annual Meeting. It will be held Sept. 14-16, 2018 at the Vail Marriott. Attendees will enjoy camaraderie, interactive workshops and lectures on the hottest topics in medicine, and great special events. Watch for more information coming this summer: www.cms.org/events/annual-meeting.
HOT TOPICS IN MEDICINE
U.S. physicians’ economic impact: 12.6 million jobs and $2.3 trillion
Physicians support 12.6 million jobs in the United States - 17.1 jobs each - and contribute $2.3 trillion to the economy, according to a new report from the American Medical Association (AMA). Physicians contribute $1 trillion in wages and benefits paid to workers, or an average $1.4 million each. Their contribution in state and local tax revenue that support their communities is $92.9 billion (an average of $126,129 for each physician).

The report - prepared by IQVIA, formerly known as IMS Health and Quintiles - breaks down into four sectors the economic benefit of the 736,873 MDs and DOs in the United States (hospital or office-based) who care for patients. In addition to jobs and economic activity, the benefits reach to wages and benefits and state and local tax revenues. (The report did not calculate federal tax contributions.) Read more here.
“Conversations on Aging” statewide report issued
Nearly one out of every five Coloradans will be 65 years or older by 2030, and 
Colorado's seniors and service providers want to be sure they are being heard as the state prepares for this significant demographic shift. That's the conclusion of a report, "Conversations on Aging: Coloradans Identify Gaps, Needs and Hopes for an Aging Population," issued in January by the state's Strategic Action Planning Group on Aging (SAPGA). 

The group, charged with helping the state strategize and plan for the 2030 shift, held a series of five regional meetings last fall across the state to listen to residents tell their stories about aging in Colorado, including one in Pueblo in November. Two major themes emerged from the regional meetings. First, citizens have a perception that the needs of seniors are not a top priority for elected officials from the state to local level. Second, they believe a proactive outreach campaign needs to be launched to bring better awareness of available services and to create awareness of the challenges and opportunities this large influx of aging Coloradoans will bring. Older adults made it clear they want to be part of the solution to help every senior and their families better prepare for getting older. They also want communities to be responsible for sharing critical information about needs and innovative programs to state government and for policymakers to take appropriate action.

A copy of the report may be downloaded online: http://bit.ly/SAPGACOA. The press release about the report is online: http://bit.ly/SAPGAPressCOA.
Primary care physicians: Take advantage of a new leadership training opportunity in Colorado
Ready to make a difference in Colorado health care? Not sure where to start, or if you have the abilities?

Primary Care Movers and Changers (PCMAC) is a new leadership program offered by the Regional Institute for Health and Environmental Leadership (RIHEL). Spend four transformative weekends with fellow primary care providers, learning how to lead and advocate for change in Colorado. This leadership program is advocacy focused, and offers participants a wealth of resources including collaborative training, personal leadership assessments, a peer coach, media training, hands-on advocacy practice and much more.

The program is open to a wide range of primary care providers, including physicians, nurses, physician assistants, behavioral health specialists and dental providers. Participants must practice in underserved, metropolitan communities, or themselves come from an underserved community or background.

The training is provided free of change, and includes stipends to help providers with travel and related expenses. Ready to advocate for the changes you believe in? Click here for more information and to apply.
NEWS FROM THE COLORADO MEDICAL SOCIETY
It's not too late; attend public policy leadership forum in person in Denver or via webinar tomorrow and earn CME and COPIC Points

Earn CME and COPIC points, and gain invaluable leadership and advocacy training at the Public Policy Leadership Forum in Denver this Saturday, Feb. 3. Brought to you by COPIC, CMS CPMG Section and CMS Medical Student Component, the event will be held 8 a.m. - 4:45 p.m. at CMS/COPIC headquarters, 7351 E. Lowry Boulevard, Denver, CO 80230. There is no cost for CMS members or medical students to attend.

How to connect to the webinar:
  • Online from your PC, Mac, Linux, iOS or Android: https://zoom.us/j/741761215
  • Or by telephone: +1 669 900 6833 or +1 646 558 8656; Meeting ID: 741 761 215

Register today to attend in person! Go to www.cms.org/register. Find more information about the event here.
Future Forward CMS: My experience on the CMS Board of Directors so far and what we can do to increase PCMS's presence on the state level

By Brad Roberts, MD

I joined the Colorado Medical Society Board of Directors representing Pueblo County (CMS District 13 of 14 total districts) in the fall. I have already attended two meetings so far in my tenure, one of which included a weekend strategic focus retreat and a complete evaluation of the mission, vision, values and goals of CMS. The CMS board culture invites active participation from board members and I jumped in with both feet.

I am excited to represent Pueblo at the state level. To best represent your views, I need your help. Central Line is a tremendous member engagement tool, giving all members the opportunity to bring your perspective and issues directly to the board of directors, which helps me and my fellow board members make better decisions. 

My top priority serving on the CMS board is to know and represent your views, and through Central Line you can share them directly with me before I cast a vote on a proposed policy and then after the board takes action, to tell me if the board “got it right.” If enough members disagree with the board’s decision, it goes back on the agenda for the next meeting. This is an amazing tool for you to have direct contact and leverage with a large group of physicians across the state to make a difference. One physician may have a hard time making a meaningful difference but 7,500 from across the state can – and we need to hear your voice.

To use Central Line you can just click on the link in the email that is sent to you on a specific topic and vote and/or comment. I then get the votes and present them at the board of directors meeting so that CMS can approach legislators, media, payers and other stakeholders to make a meaningful difference.

If you are not getting the Central Line emails and want to please let us know so that you get them. Email Cheryl Law at   cheryl.law@pueblocms.org to make sure you are getting them. You can also log on to the site ( www.cms.org/central-line) directly to access it as well.

Thank you so much for the hard work you do. Working together we can truly make a positive difference for medicine in Colorado.
NEWS FROM THE AMERICAN MEDICAL ASSOCIATION
 AMA launches new podcast series to tackle the most salient issues in medicine

The American Medical Association has launched a new podcast series for physicians, residents and medical students. "AMA Doc Talk" is a lively, informative, conversation between physicians, ethicists, patients and academics, focused on relevant topics in medicine and packaged for quick consumption. 
 
Season One, a six-episode run, focuses on the difficult discussions with patients that many physicians face as part of daily practice. The new podcast series features physicians' eye-opening encounters with patients and their real-world solutions and insights. Listeners will hear from peers who have struggled to comfort the sick or dying and agonized over word choice, and they can leave the podcast better equipped to handle even the most challenging conversation.

For more information, visit  www.ama-assn.org/ama-doc-talk-podcast-series .
MISSION:   Facilitate meaningful collaboration of medical professionals in Pueblo County.  
VISION:   Create a medical society that serves as a venue for collaboration for the betterment of healthcare in Pueblo County. The Society’s efforts will improve the practice of medicine and life of medical professionals.
Board Officers: President: Thomas Greidanus, MD; President-Elect: Open position; Secretary: Ross Patrick, MD; Treasurer: Lev Asherov, MD; Past-President: Alfredo Vargas, MD; CMS Representative: Brad Roberts, MD |  Directors: Teresa Braden, DO; Donald Luebke, MD; Julie Newburg, MD; Robert Tonsing, MD; Atul Vahil, MD |  Executive Director: Cheryl Law, MA, MNM
This newsletter is intended for the members and interested persons of the Pueblo County Medical Society. If you have received this and wish to opt-out call 719-281-6073 or use the “unsubscribe” link below.