Current work, and Effects of COVID-19


Currently Dr. Mario is working as the National Medical Director of Substance Use Disorder and Social Determinants of Health at Molina Healthcare. He is also the treasurer on the Board of Directors for the California Society of Addiction Medicine (CSAM), Co-Chair for the American Society of Addiction Medicine (ASAM), and the Committee for Practice Management and Regulatory Affairs. Locally, he works with the coalition of community clinics to assist Federally Qualified Health Centers (FQHCs) with their Addiction Medicine needs. In particular, he has done recent work with Korean Community Services (KCS) Healthcare in Orange County. 
The COVID-19 pandemic impacted many physicians, including Dr. Mario, by pushing a transition to telemedicine. Dr. Mario believes that telemedicine has improved the access of care during these times, and has proved to be a useful tool for many providers and patients who need long term treatments and are at high risk to COVID-19. Nowadays Dr. Mario assists in the efforts of the Opioid epidemic through training individuals to get X-waivered, mentoring providers, and improving Addiction Medicine programs across the state.

Accomplishments, Future plans, and More

Some of Dr. Mario’s accomplishments include his work at Molina Healthcare, where he helped lead the creation of both the Pain Safety Initiative and an Opioid Usage Model of Care which has helped redesign care management across 15 states. It helped create uniformity in opioid care for providers, policymakers, and treatments. In the short term, Dr. Mario looks to continue to support the development of opioid prescribers in the OC area, such as at correctional facilities. Working with the Coalition of Community clinics he looks to improve the impact of the OC’s FQHCs by educating his colleagues on the necessary training to prescribe these opioid treatment plans. In the long term, and the bigger picture Dr. Mario looks to improve state and national policies around substance abuse from addiction medicine nomenclature to aligning policies to benefit patients with OUDs and their families.
Some of the organizations Dr. Mario would like to recognize include CSAM for having some of the most amazing individuals that want to improve the lives of folks with substance use disorder.  Also the Be Well Initiative from MindOC that is a collaborative group of providers in Orange County that exemplifies the team effort that is quintessential for the efforts against the Opioid Epidemic.
Overall, if you were to ever receive a piece of Dr. Mario’s wisdom you will feel his passion radiate throughout the room regardless if it is in person or through a Zoom call. Dr. Mario’s ability to help his patient’s have the courage to self actualize and overcome their challenges they initially did not believe they could overcome is amazing and something only gained through the years of experience he has gone through. 

March 2021 - Dr. Chun Chiang



Current work, and how COVID-19 has affected work
    Now providing healthcare in these correctional facilities, Dr. Chiang has learned how these populations are significantly underserved. During their time there Dr. Chiang and his team do their best to get a baseline of these patients’ health, and to educate these patients as much as possible on the importance of follow-up, and routine check-ups once they are released and need to go towards other providers. Some of the challenges Dr. Chiang faces treating these patients with opioid use disorder (OUD) is the long term treatment of these patients, and the development of healthy networks to help these patients maintain sobriety beyond their treatment. COVID-19 impacted Dr. Chiang’s work by causing an immediate transition towards more strict precautions when treating these patients. It was difficult to educate these patients on better lifestyles because of the conditions they were already in, and it was difficult to do things such as social distancing.

Accomplishments, Future plans, and Shoutouts
    Some accomplishments Dr. Chiang has accomplished in his work include initiating more patients on MAT in the last 12-15 months than most single correctional facilities in the same time period. This has provided patients across Orange County the opportunity of recovery that they deserve. Dr. Chiang’s short term plans for the future include increasing the amount of x-waivered providers and getting more providers more comfortable initiating MAT programs with more of their patients. In the long term, Dr. Chiang would like to create a program outside of these facilities for his patients to transition if they do choose to transition to long term care after they are released. He would also like to move towards a low barrier approach where we can provide medication to patients with OUD with less barriers than with a high barrier approach that requires a longer standardized assessment. Dr. Chiang understands that this is something difficult to introduce to many providers, but with the perseverance and support from him and his team they look forward to being able to lighten the fear providers may have with this approach. Some organizations and individuals Dr. Chiang would like to shout out are the California Society of Addiction Medicine, the Orange County Sheriff’s Department, Dr. Brian Hurley, and Dr. Mario san Bartolome. Dr. Hurley has helped Dr. Chiang set up the program they are currently using in the correctional facilities in Orange County, and Dr. Mario has helped be a subject matter expert for their providers to consultat with. We have seen both of these physicians on SafeRxOC in our previous two highlights if you would like to check them out. Overall, Dr. Chiang is a significant figure in the Orange County community that’s not only helped improve our MAT programs in the correctional facilities, but has served as an amazing advocate for pushing towards more MAT services for all types of patients.

Opioid Epidemic Hero of the Month

Introduction and Path to Addiction Psychiatry

For our next Opioid Hero of the Month, we would like to introduce Dr. Brian Hurley! Dr. Hurley is an Addiction Psychiatrist who attended medical school at the USC Keck School of Medicine in the joint MD/MBA program with the Marshall School of Business, and completed his residency at Massachusetts General Hospital and McLean Hospital. Dr. Hurley grew up in Los Angeles, and after training in Boston and New York, returned to LA County to work on expanding access to addiction treatment. He first became involved in addiction treatment as an undergraduate working towards the methamphetamine epidemic. When Dr. Hurley was a resident in 2009, the national conversation around opioid usage began to be described as an ‘epidemic,’ and years later, as a 4th year resident he was the chief resident in Addiction Psychiatry. Dr. Hurley went on to complete an Addiction Psychiatry fellowship which allowed him key, front-line opportunities to treat those with Opioid Use Disorder (OUD). Dr. Hurley conceptualized his work as helping those with OUD through the use of technology in the form of medications such as buprenorphine to treat addiction.

Is there an Opioid Epidemic Hero in your community in Orange County? If so, let us know at saferxoc@gmail.com!  We would love to include them in our series.

Introduction 

For our first Opioid Hero of the Month we would like to introduce Dr. Mario san Bartolome! He is a triple boarded physician in family medicine, addiction medicine, and preventive medicine. He attended medical school at UC Irvine’s School of Medicine in the joint MD/MBA program, and completed his residency at Long Beach Memorial Hospital. Growing up, Dr. Mario was exposed to some of the challenges that vulnerable populations faced, such as, limited access to healthcare and language barriers -- often having to translate for his family members at local health clinics. These challenges inspired Dr. Mario to pursue medicine.  Dr. Mario began his efforts against the Opioid Epidemic during his medical training where he frequently saw patients with substance use disorders. Although these patients presented with addiction problems, Dr. Mario understood that they struggled with a range of other issues including homelessness or domestic abuse. While some providers asked what their patients needed, Dr. Mario asked how these needs arose. Although many see Addiction Medicine as part of the field of Psychiatry, Dr. Mario sees it as an extension of family medicine in that the patient needs to be treated holistically. His experiences have helped him understand the challenges low socioeconomic groups face when they add a substance use disorder on top of their already vulnerable positions in society.



Introduction and upcoming to OC and efforts against opioids
  

 For this Month’s Opioid Epidemic Hero of the Month we would like to introduce Dr. Chun Chiang who is the Medical Director for Correctional Health Services at the Orange County Healthcare Agency. He is responsible for the healthcare services to patients at the detention facilities in Orange County. He started his journey in Orange County when he first attended undergrad at UC Irvine. He attended medical school at the Medical College of Wisconsin and did his residency at Long Beach Memorial Hospital in Family Medicine. Dr. Chiang’s efforts against the Opioid Epidemic started with mainly pregnant patients at these facilities who needed treatment not only for themselves but for their child as well. In 2019, he has helped many prescribers receive their x-waiver to create a larger MAT program in Orange County.

The Opioid Epidemic Hero of the Month is a new series we're starting in 2021 to recognize and appreciate the providers and heroes who are contributing to the battle against the Opioid Epidemic. Each month we will be highlighting a new Hero that has helped the community of Orange County be a safer place.

Current Work and Impacts of COVID-19

    Dr. Hurley works for the county of Los Angeles as the Director of Addiction Medicine and is involved in a variety of efforts and initiatives surrounding providing medications for addiction treatment of those with alcohol, tobacco, and opioid use disorders. COVID-19 has impacted Dr. Hurley’s work by pushing both administrative and most clinical meetings to a virtual setting. However, Dr. Hurley continues to see patients at the LA County jail in person. Dr. Hurley has observed a worsening of opioid overdose during the global COVID-19 pandemic and he explains that many who were previously in remission have unfortunately relapsed in recent times. He suspects that lifestyle stability is a key factor in OUD remission during the pandemic as many lack access to telephones and housing. 

Accomplishments, Future Plans, and Advice for Students

    One of Dr. Hurley’s major accomplishments during the pandemic is working with LA County to arrange local sites where those suffering from homelessness can both quarantine and shelter during the pandemic. By spacing individuals out and providing them with housing at these sites, Dr. Hurley believes that this is a both novel and promising way to assist the homeless during the pandemic that provides increased lifestyle stability. In addition, Dr. Hurley has been able to expand medication assisted treatment of OUD during the pandemic due to suspended federal regulations that required waivered providers to be physically present with patients in order to prescribe medications such as buprenorphine and naloxone. He has worked with the city to train a group of outreach workers to quickly link people to these types of medications through a phone line, enabling patients to get started on life saving medications much quicker than before.

    Dr. Hurley’s future plans surround the challenge presented by the prevalence of patients with OUD seen in various settings. He explains that people with OUD present in hospitals, ERs, clinics, and many medical settings but access to OUD treatment is not necessarily available in all of these settings. As such, Dr. Hurley aims to work with local leadership in LA and OC to prepare clinics and other medical establishments to treat or link patients with OUD to the appropriate resources.

    For students interested in Addiction Medicine and/or Addiction Psychiatry, Dr. Hurley suggests to rotate and get involved in multiple different experiences. He explains that students are often only able to have one or two experiences and it is not always enough. He recommends getting as much exposure as possible to the field which will enable students to understand the different parts of Addiction Medicine more thoroughly - whether it be care directed at reducing opioid use or harm reduction care (i.e. needle exchange programs). Dr. Hurley recommends that students attending meetings such as the California Society of Addiction Medicine (CSAM), American Society of Addiction Medicine (ASAM), and the American Academy of Addiction Psychiatry (AAAP) in order to network with others in the field. He suggests the book: Slaying the Dragon: The History of Addiction Treatment and Recovery in America by William L. White as an insightful read for those interested in the field. Overall, Dr. Hurley has been vital in combating addiction in Southern California and continues to have a momentous impact on the Opioid Epidemic.

Is there an Opioid Epidemic Hero in your community in Orange County? If so, let us know at saferxoc@gmail.com!  We would love to include them in our series.

February 2021 - Dr. Brian Hurley

Is there an Opioid Epidemic Hero in your community in Orange County? If so, let us know at saferxoc@gmail.com!  We would love to include them in our series.

January 2021 - Dr. Mario san Bartolome