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The Vaping Epidemic SEPTEMBER 2019 THE LATEST NEWS FROM THE CLARK COUNTY MEDICAL SOCIETY In this Issue: THE VAPING EPIDEMIC As more cases of pulmonary disease, severe respiratory disease, and even deaths are linked to e-cigarette use, local and national public health authorities speak out agains vaping products. Pages 8, 21, & 22 Local high school The Opioid Dilemma: students experience a Where We’ve Been and day in the life of a doctor Where We’re Going Students interested in a career in medicine CCMS President Dr. Daniel Burkhead will get to shadow CCMS physicians looks back on the progress and pitfalls of during the Youth Wear the White Coat the past year of opioid regulation. Internship October 16-23. Inside Cover Page 19 PUBLISHED BY THE CLARK COUNTY MEDICAL SOCIETY PRESIDENT’S MESSAGE The Opioid Dilemma: Where We’ve Been and Where We’re Going 2019-20 BOARD OF TRUSTEES Executive Council By Daniel Burkhead, M.D. Daniel Burkhead, M.D. President President, Clark County Medical Society Jeffrey Roth, M.D. Member Since 2002 Past President When I look back over my 20-year career as a pain management physician, it is quite astounding Deborah Kuhls, M.D. President Elect how many philosophical changes the field has gone through. When I was finishing my training Nicholas Fiore, M.D. in the late 1990s, there was a huge cry for patient advocacy that led to the dictum that no patient Secretary should ever suffer from pain while under the care of a physician. Pain was considered the “5th Vital Staci McHale, M.D. Sign” and at that time, a doctor might suffer significant consequences from hospitals and insurance Treasurer carriers for “under treatment.” Larry Lehrner, M.D. Delegate Chair Now that we are amid an opioid crisis the pendulum has swung in the opposite direction, and Trustees at Large physicians are now encouraged to curtail their prescription of opioids for the treatment of pain. Hugh Bassewitz, M.D. Eric Brimhall, M.D. Nearly every state in the nation has passed laws regarding the prescription of opioid medications, H.L. Greenberg, M.D. Thomas Hunt, M.D. and some have imposed very strict limitations on what a physician can prescribe. By comparison, Eva Littman, M.D. Nevada’s Opioid Law (AB474) was fairly reasonable about allowing the doctor to make decisions Derek Meeks, D.O. Edmond Pack, M.D. regarding the dosing range and duration of medication prescribed. However, the law did present Mark Penn, M.D. Ferenc Puskas, M.D. some administrative challenges for physicians to face, including cumbersome documentation of Jerry Reeves, M.D. Informed Consent, Prescription Medication Agreements, and PDMP checks. When the law was Helene Nepomuceno, M.D. Medical Resident implemented in January of 2018, there was a looming threat (which has since been reconsidered by Savannah Spataro Medical Student NBME) that a medical doctor might lose his license if five violations occurred. Many physicians Howard Baron, M.D. decided that it was just not worth the risk and they would no longer prescribe any opioids for the Highest Ranking Officer of NSMA treatment of pain. However, to the credit of doctors across our state, most physicians realized that EX-OFFICIO BOARD MEMBERS Jim Daggett opioids are a necessary part of the treatment plan for some patients, and they took painstaking CCMS Executive Director efforts to educate themselves regarding the new law. CCMS and some of its members also held Catherine O'Mara NSMA Executive Director several educational events to assist in that effort. Larry Lehrner, M.D. MedPAC Co-Chairs Wolfgang Gilliar, D.O. The Department of Health and Human Services in coordination with the Governor’s office recently Touro University College of Medicine John Fildes, M.D. held the second Opioid Summit on August 14 and 15 in an effort to bring together community UNLV School of Medicine Bruce Morgenstern, M.D. stakeholders to discuss the successes and struggles of our overall attempts to battle the opioid crisis Roseman University College of Medicine in Nevada. One statistic that was gleaned from the updated epidemiological research was that the John Ellerton, M.D. Scholarship Chair number of opioid prescriptions in Nevada had been reduced significantly over the past several years. Aury Nagy, M.D. This seemingly positive statistic must be viewed in context of the possibility of other unintended Nevada State Board of Medical Examiners Ronald Hedger, D.O. consequences, such as legitimate patients being denied prescriptions and subsequently suffering, or Nevada State Board of Osteopathic Medicine Joseph Iser, M.D. worse, turning to illicit drugs such as heroin in order to self-medicate, either to prevent withdrawal, Southern Nevada Health District or to actually help with their chronic pain symptoms. These are statistics that will continue to be Florence Jameson, M.D. AMA Delegate viewed very carefully over the next several years. Joseph Adashek, M.D. AMA Alternate Delegate I feel it is imperative that doctors fight for the autonomy to be able to make clinically relevant CCMS STAFF Jim Daggett decisions about their patients, and there is no way to legislate what is right for any individual patient. Executive Director Lisa Duran But one thing is clear, the doctors in Nevada are doing their part to abide by the law, and to use Office Manager thoughtfulness, prudence, and patient involvement whenever considering the use of an opioid. In Josh MacEachern Communications & Marketing Manager addition to following the law, physicians can help protect themselves and their patients by discussing County Line Editor and documenting the following general principles of opioid prescription: 2019-20 ALLIANCE CO-PRESIDENTS Ginger Allen Michele Volker • Encourage patients to try alternative treatments (physical therapy, chiropractic, TENs unit, acupuncture, etc.) or alternative non-opioid medications (acetaminophen, NSAIDs, anti- CCMS CONTACT INFORMATION convulsants, anti-depressants, lidocaine patches, etc.) prior to the initiation of an opioid. Tel: 702.739.9989 Fax: 702.739.6345 Email: [email protected] www.clarkcountymedical.org PRESIDENT'S MESSAGE CONTINUED... • Discuss the risks and benefits of an opioid with the patient UPCOMING EVENTS: and their family. • Have a plan for the probable duration of opioid treatment, CCMS & NSMA and how you intend to taper the opioids when the pain has subsided. Use function as a primary endpoint. • Use the lowest effective dose possible, and avoid rapid October 2 escalation of opioid dosages. Resident/Fellow and Medical Student Committee Meeting • Avoid long-acting formulations of opioids unless the patient 5:30 p.m. | Conference Call has been taking opioids for pain on an ongoing, chronic basis. October 9 • Consider referral to a pain management specialist if warning Community Health & Public Relations Committee Meeting signs appear, or if dose escalation is apparent. 6:00 p.m. | CCMS Office • Consider the co-prescription of Naloxone for patients on higher dosages of opioids. October 14 • If tapering, do not be too aggressive. A 10% weekly opioid Membership Committee Meeting reduction is considered standard, but if withdrawal symptoms 6:00 p.m. | CCMS Office occur, consider being less aggressive in tapering plan. • Consider referral for Medication Assisted Treatment (MAT) October 15 if opioids are no longer necessary, but patient is unable to taper and/or discontinue. CCMS Board of Trustees Meeting 6:00 p.m. | CCMS Office If physicians continue to exercise sound judgement in prescribing, then we will hopefully preserve our ability to use our medical October 16-23 decision-making skills to determine what is best for our patients, Youth Wear the White Coat Internship without having to be faced with further pressures of legislative changes and possible persecution by regulatory bodies. October 23 Youth Wear the White Coat Internship Recognition Dinner Inappropriate prescribing goes both ways. It is inappropriate 6:00 p.m. | Southwest Career & Technical Academy to prescribe opioids without considering alternative and being responsible with the prescriptions, but it is also inappropriate November 6 to refuse to prescribe opioids altogether out of fear. We must Resident/Fellow and Medical Student Committee Meeting continue to treat our patients with the dignity and respect 5:30 p.m. | Conference Call they deserve, by providing them with the medications that are deemed necessary, while still taking the appropriate measures to November 11 minimize risk. Membership Committee Meeting Sincerely, 6:00 p.m. | CCMS Office November 13 Community Health & Public Relations Committee Meeting 6:00 p.m. | CCMS Office Daniel Burkhead, M.D. CCMS President 2019-20 November 19 CCMS Board of Trustees Meeting 6:00 p.m. | CCMS Office November 20 CCMS Resident Job Fair SEPTEMBER 2019 • COUNTY LINE MAGAZINE | 1 FOR SALE & LEASE 2601 N Tenaya Way Las Vegas, NV 89128 HIGHLIGHTS • Entire Property Available for Occupancy December 1, 2019 • Standalone Wet Medical Office For Sale and For Lease! • Excellent Condition and Great Floorplan for Patient Flow • Located in the Highly Desirable Northwest Medical District • 5.68:1000 Parking Ratio with Covered Spaces • Frontage and Signage on North Tenaya Way • Minutes from Mountainview Hospital, Major Retailers, and Interstate 95 $3,200,000 $2.00 NNN ±8,800 SF Ryan McCullough Tyler Jaynes Connor Watson Office Partner Senior Sales Associate Sales Associate LIC#00176931 | 702.815.1982 LIC#0184357 | 702.815.1983 LIC#00186976 | 702.815.1984 [email protected] [email protected] [email protected] INVESTMENT GROUP CCMS BOARD OF TRUSTEES MINUTES A synopsis of the August 20th Board of Trustees Meeting The meeting was called to order by Dr. Burkhead at 6:00 p.m. (IAMSE) for her research titled “Determining the Best Strategy to Integrate Clinical Nutrition and Culinary Action Items: Medicine for Preventative.” Minutes: by Dr. Burkhead • Joanne Muellenbach was elected Chair, Bylaws, Elections The minutes from the July 27, 2019 meeting were reviewed.
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