VOL.83 NO.5 June 2010 SAN FRANCISCO MEDICINE J O U R N A L O F T H E S A N F R A N C I S C O M E D I C A L S O C I E T Y Addiction and Recovery From Neurons to National Policy Unparalleled Service and • Another large dividend - $20 million back to MIEC policyholders For 35 years, MIEC has been steadfast in our protection of California physicians. With conscientious Underwriting, excellent Claims management and hands-on Loss Prevention services, we’ve partnered with our policyholders to keep premiums low. Added value: At MIEC we have a long history of big dividend distributions. Because of excellent financial results and low overhead, MIEC has been able to return dividends to our California policyholders 17 of the last 20 years with an average savings on premiums of 25.5%. For more information or to apply contact: n www.miec.com or call 800.227.4527 * (On premiums at $1/3 million limits. Future dividends cannot be guaranteed.) MIEC 6250 Claremont Avenue, Oakland, California 94618 MIEC 800-227-4527 • www.miec.com SFmedSoc_ad_02.11.10 Owned by the policyholders we protect. In ThIs Issue SAN FRANCISCO MEDICINE June 2010 Volume 83, number 5 Addiction and recovery: from neurons to national policy 10FEATURE Physician ARTICLES Invictus 4MONTHLY Membership COLUMNS Matters 12 ADon Time Kurth, of Critical MD Change: Drug Addiction, Addiction Services, and 7 President’s Message Public Policy Michael Rokeach, MD, and Steve 14 PhilipSan Francisco R. Lee, MD, Roots: and Dorothy The Evolution Lee of Addiction Medicine 9 EditorialHeilig, MPH 16 DavidIntegrating E. Smith, Substance MD, FASAM, Abuse FAACT and Mental Health Treatment into David Pating, MD, and David E. Primary Care 40 HospitalSmith, MD News 38 In Memoriam 18 RobertHealth M. Care McCarron, Reform DO; and Sergio Substance-Use Aguilar-Gaxiola, Disorder MD; Parityand Caitlyn Meltvedt 38 ClassifiedNancy Thomson, Ad MD 20 ThomasAdolescent J. Brady, Substance MD, MBA Abuse: A Blueprint for California 22 MarijuanaTimmen L. Cermak,Facts: The MD Risk of Addiction 36OF INTERESTBook Review: The Pain Behind Addiction—and a Miracle Cure? 24 NotTimmen the Right L. Cermak, Prescription MD 37 PublicSteve Heilig, Health MPH Report: SFDPH Public Sector Services for 25 LynnNew Frontiers:Ponton, MD, Treatment and Sam Judice, for Homeless MD Substance Abusers under the Substance Abuse Disorders Mental Health Services Act Robert P. Cabaj, MD, and David 27 BarryOpioid Zevin, Analgesics: MD, and Addressing David Pating, Risks MD and Benefits in Clinical Practice 39 BookHersh, Review: MD In the Realm of for Treatment of Chronic, Nonmalignant Pain Hungry Ghosts 29 PropositionElinore F. McCance-Katz, 36: Ten Years MD, Later PhD Can We Learn from Experience? 42 FromErica Goode,the CMA MD Foundation: Diabetes and Cardiovascular Disease Guide for Physicians 31 BigMargaret Alcohol’s Dooley-Sammuli New Products: and New Peter Media Banys, for MD, Youth MSc Carol A. Lee, Esq. 33 LessonsSarah Mart, in Urban MS, MPH Survival: A Hustler Tells All Editorial and Advertising Offices: 1003 A O’Reilly Ave., San Francisco, CA 94129 Phone: (415) 561-0850 extension 261 e-mail: [email protected] Web: www.sfms.org Eisha Zaid Advertising information is available by request. www.sfms.org April 2010 sAn frAncisco medicine 3 MeMbershIp MaTTers June 2010 Volume 83, number 5 A SAmpling of ActivitieS And ActionS of intereSt to SfmS memberS Guest Editors David Pating and David E. Smith Managing Editor Amanda Denz sfms provides online classified Copy Editor Mary VanClay Ads to the medical community! notice set in at least 14-point type and placed immediately above the patient’s EDItORIAl BOARD The SFMS now offers online classi- signature line. Obituarist Nancy Thomson fied ads for health care-related postings, The SFMS will provide its members Stephen Askin Shieva Khayam-Bashi such as medical office space for rent, with sig nag e; you can also obtain print- Toni Brayer Arthur Lyons job openings, and more. They’re afford- able signage directly from the Medical Linda Hawes Clever Ricki Pollycove able, and SFMS members receive a great Board. If you are interested in receiving a Gordon Fung Stephen Walsh discount! sign, contact Therese Porter in the Mem- Erica Goode Contact Jonathan Kyle at jkyle@sfms. bership Department at (415) 561-0850 org or (415) 561-0850 extension 240, or fTc Again delays implementation extension 268 or [email protected]. SFMS OFFICERS see www.sfms.org/classifieds, for more of red flag rule President Michael Rokeach california information. physicians will Be President-Elect George A. Fouras required to notify patients of Secretary Peter J. Curran license AMA has filed a lawsuit to stop the Treasurer Keith E. Loring Federal Trade Commission from extend- ImmediatePastPresident Charles J. Wibbelsman ing its “Red Flag Rule” to physicians. The A new regulation, effective June 27, rule, after yet another delay, is now sched- SFMS Executive Staff 2010, will require physicians in Califor- uled to take effect on December 31, 2010. Executive Director Mary Lou Licwinko nia to inform their patients that they are As you know, the Red Flag Rules re- DirectorofPublicHealth&Education Steve Heilig licensed by the Medical Board of Califor- quirefinancial institutions and “creditors” Director of Administration Posi Lyon nia, and to include the board’s contact to implement identity theft detection and Director of Membership Therese Porter information. The information must read prevention programs. Despite objections Director of Communications Amanda Denz as follows: from CMA, AMA, and others in organized medicine, the FTC insists that physi- Board of Directors NOTICE TO CONSUMERS cians who regularly bill their patients Term:Jan2010-Dec2012 Roger Eng Medical doctors are licensed and regu- for services (including copayments and Gary L. Chan Thomas H. Lee lated by the Medical Board of California coinsurance) are considered “creditors” Donald C. Kitt Richard A. Podolin (800) 633-2322 and must develop and implement written Cynthia A. Point Rodman S. Rogers www.mbc.ca.gov identity theft prevention programs for Adam Rosenblatt their practices. Lily M. Tan Term:Jan2008-Dec2010 The purpose ofthis new requirement AMA’s lawsuit asks for a declaratory Shannon Udovic- Jennifer H. Do is to inform consumers where to get in- judgment finding the rule is unlawful and Constant Shieva C. Khayam-Bashi formation or go with a complaint about void as applied to physician members of Joseph Woo William A. Miller California medical doctors. medical associations and state medical Jeffrey Newman Physicians may provide this notice societies. The lawsuit does not, however, Term:Jan2009-Dec2011 Thomas J. Peitz through one of three methods: suspend the December 31 deadline. Prominently post a sign in an area of See the CMA members-only sec- Jeffrey Beane Daniel M. Raybin Andrew F. Calman Michael H. Siu their offices consp icuous to patients, in at tion at www.cmanet.org for a free Red Lawrence Cheung least 48-point type in Arial font. Flag tool kit and a webinar detailing the Include the notice in a written state- clinic regulations. by the Bay medical CMA trustee Robert J. Margolin ment, signed and dated by the patient director: part-Time position AMA Representatives or patient’s representative, and kept in H. Hugh Vincent, Delegate that patient’s file, stating that the patient Robert J. Margolin, Alternate Delegate understands the physician is licensed and Clinic by the Bay (www.clinicby- regulated by the Medical Board. thebay.org) is a free, volunteer-powered Include the notice in a statement health care clinic in San Francisco. Slated on letterhead, discharge instructions, to open in late summer 2010 in the Excel- or another document given to a patient sior, the clinic is based on the successful 4 sAn frAncisco medicine April 2010 or the patient’s representative, with the national model Volunteers www.sfms.org in Medicine MeMbershIp MaTTers A public Health and safety Ap- proach To drug policy (www.volunteersinmedicine.org), which generous endowment to UCSF upon engages retired and practicing doctors, his death. The award, which includes a nurses, and nonmedical volunteers to substantial cash prize, goes every other July 8, 2010 9:30 a.m. to 4:30 p.m. provide compassionate care free of year to two Bay Area psychiatrists, one The Center for Healthy Communities charge to the working uninsured in their a community-based practitioner and the The California Endowment communities. We have secured a facility other an academic psychiatrist. Los Angeles, CA and have a volunteer Medical Advisory The Royer Award for excellence in With 30,000 people locked up for Board that is planning clinic services and academic psychiatry will be awarded a nonviolent drug offense in California, protocols. We plan to open on Tuesdays to Dr. Kristine Yaffe, who has made ex- prisons are bursting at the seams and and Thursdays. We seek a seasoned and traordinary contributions to the field of busting our budget. And yet drug preven- dedicated primary care physician to lead geriatric psychiatry. The Royer Award tion and treatment funding is suffering the final phase of clinic development and for excellence in community psychiatry devastating cutbacks, making treatment oversee ongoing quality assurance and goes to Dr. Steven Walsh. Dr. Walsh has hardertofindthanever. Californiaisover - clinical care of patients. This salaried devoted his career to public service. He due for a new approach to drug policy. Co- position is part-time (16 hours per week). is an outstanding clinician and teacher hosted by the Drug Policy Alliance and the Competitive salary based on experience. who has served in multiple leadership California Society of Addiction Medicine, For more information, please contact roles, including the presidencies of the New Directions California will convene a former Eliza Gibson sfms at [email protected].