Letter from CSAM’s President, Karen Miotto, MD

As we continue turning the page on the COVID-19 pandemic, we see the progression of pressing issues for our field and our patients. One is the tragic escalation in overdose deaths. There are an increasing number of deaths due to fentanyl and stimulants in combination with fentanyl -- more than 106,000 persons in the U.S. in 2021 -- but deaths associated with prescription opioids have decreased during this time period. At the same time, however, the overall rates of DEA prosecution against doctors have increased.¹

CSAM is advocating for approaches that will not result in doctors who are treating patients in good faith being inadvertently caught up in this growing trend. CSAM has submitted a request to the Medical Board of California (MBC) and the Department of Justice asking for the data and transparency related to these increased accusations. CSAM is asking for increased transparency regarding how these agencies use of the information in CURES, California’s prescription drug monitoring program. Click HERE to read CSAM’s letter.

Some of the MBC’s proposed changes for this year relate to how these accusations will be handled. For example, one is to change the evidentiary standard from “clear and convincing evidence” to “preponderance of evidence,” which would lower the threshold for convicting physicians and is a less rigorous evidentiary standard to meet. CSAM will work with the California Medical Association (CMA) in monitoring the development of all these proposed changes and keep members informed. Click HERE to read CMA’s list of MBC’s proposed changes.

Addressing the escalation in overdose deaths requires prevention efforts and treatment. On the prevention side, CSAM members have advocated for, and succeeded in getting, a proliferation of naloxone vending machines, from rural counties to college campuses and jails. 

Regarding getting an increase in treatment availability, CSAM is watching the proposed action of the California State Board of Pharmacy to permit a broader role for pharmacists in making buprenorphine available. Since 2016, trained pharmacists have been authorized to provide overdose education and furnish naloxone without a prescription, and now California pharmacists will be able to prescribe buprenorphine if they have certain training. CSAM is in meetings to discuss the training and implementation. Click HERE to see the changes outlined in the agenda of the January meeting of the Licensing Committee of the State Board of Pharmacy.

The elimination of the X-Waiver is increasing CSAM’s outreach: both CSAM and MERF are exploring ways to partner with organizations that want to bring the necessary information and training to their clinicians interested in starting to prescribe buprenorphine. Related is the increased use and acceptance of telehealth that has allowed us to reach a greater number of people in need of treatment. CSAM’s Government Affairs Committee members are working on promoting the use and retention of video treatment for opioid use disorder.

Last year’s annual conference brought together clinicians from across California and other states to discuss a wide variety of salient addiction medicine issues, while also keeping in mind the importance of psychosocial and spiritual interventions. I look forward to seeing you in August in San Diego at CSAM’s 50^th Anniversary Celebration and our 2023 conference, where we can delve into these key topics with more detail.

Stay safe and be well,

Karen Miotto, MD, DFASAM

President, CSAM

References

1. Kim, D. D., & Sibai, N. (2020). The current state of opioid prescribing and Drug Enforcement Agency (DEA) action against physicians: an analysis of DEA database 2004-2017. Pain Physician, 23(3), 297.

MERF Update

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...

How I Ended Up in Addiction Medicine

By: Sharone Abramowitz MD, FASAM

CSAM President Elect

As your President-elect, I want to share in the CSAM and MERF traditions, by recounting my journey into addiction medicine. Rather than a straightforward path, my journey was a coalescing of diverse trails. As a daughter of a Jewish Holocaust refugee, who grew up blue collar, and as a gay woman, I felt a natural affinity with those patients, who society marginalizes. And like so many of us, my family suffered the wounds of addiction: my grandfather had an untreated AUD that injured my mother and her family.

After beginning internal medicine training, I switched into psychiatry at UCSF as the HIV/AIDs epidemic was peaking. I was especially drawn to the heart-centered work of San Francisco General AIDS ward as a young consultation-liaison psychiatrist. That led me to become a consultant to a gay men’s outpatient recovery program and supported me to work with folks in recovery in my new psychotherapy practice. They became my favorite group to work with because I found their healing journeys so inspirational.

I left UCSF when I was offered an unusual job. A primary care internal medicine residency at Highland Hospital (a county hospital in Oakland) wanted to fund me to develop a humanist medicine program. For the next twenty-five years, I directed a behavioral health and addiction medicine training program that taught residents who daily treated folks facing the intersection between adverse childhood events, the traumas of structural racism and poverty, and chronic health conditions, including, of course, substance use problems. As I set-up addiction medicine rotations for our residents at local Kaisers, went with them to AA meetings, and trained them in Motivational Interviewing, I got to know a wonderful group of colleagues, who also happened to be CSAM leaders. I had so much more to learn, so a few of us began a CSAM sponsored East Bay addiction medicine consultation group. That group gave me friends and mentors that encouraged me to become ABAM certified which eventually led me on my path into CSAM leadership.

Addiction medicine has become my professional home, and it is a home for me because of its commitment to those whom society shuns, who often became ill because of unhealed trauma, and whose healing journeys require us to use holistic care approaches. I love my CSAM colleagues, I appreciate that we are interdisciplinary and passionate advocates. I appreciate that addiction medicine requires us as clinicians to use the whole of us—head, heart, and soul—and those spiritual, biopsychosocial, and policy advocacy approaches, in turn, can make all of healthcare more humane. 

Tobacco Cessation in Substance Use Treatment:

Research & Policy Efforts to Reduce

Tobacco-Related Health Inequity 

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

A 50 Year CSAM Celebration!

Please join us for a one-of-a-kind event

Friday, September 1, 2023, to celebrate CSAM’s 50^th Anniversary! 

Did you know CSAM initiated ASAM’s AMA Membership? Do you know where the first conference was held and how many people were there? Come find out more about CSAM’s history, celebrate the successes, challenges, and how CSAM has emerged as a leader in the field of addiction medicine.  We will be sharing with conference attendees our incredible journey as an organization – highlighting the events, individuals, milestones, and struggles we’ve shared through the decades to showcase the love and commitment that is uniquely ours.  

This is a GOLDEN opportunity to network with past presidents and leaders that shaped the organization and get a glimpse into the future as CSAM continues to evolve. We encourage you to come dressed in your favorite decade attire. Meander through five decades of CSAM history. Heavy hors d’ oeuvres, beverages, music and dancing are included with purchase of ticket.  

This Anniversary Celebration will not disappoint, so don't miss out! Get your tickets with your conference registration today!