September-October 2017, Vol. 8, Issue 3
In This Issue

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From the Newsletter Editor-in-Chief

Mona Amini, MD, MBA, FAPA

Warm Autumn Greetings! (quite literally)
Colleagues and Peers - the last several months have been quite riddled with legislative and reform advocacy issues. This, coupled with the multiple natural disasters devastating our country and its citizens, has likely taken a toll on our own well-being.  I hope by further assisting our readership on the current state of affairs that directly effect our profession, interest may spark in those willing to aid --whether financially or via volunteer-ship.  Information on disaster aid is provided below.
With POTUS Trump's recent declaration of the opioid crisis being a public health emergency, our newsletter edition shares a similar focus. We will meet a fellow APS member, Dr. Elena Volfson and learn of her impressive career highlights.  Dr. Michel Sucher discusses medication-assisted treatment and reminds us of the recent Arizona mandate on checking a patient's PMP report prior to prescribing certain controlled substances. Haley Coles, executive director of Sonoran Prevention Works, discusses their strategic partnerships within the Valley in an effort to promote harm reduction in the opioid crisis directly effecting our population.  

We share thanks for your active voices on health care reform and report on some key efforts made through physician groups and Arizona legislators.  We include a call to action to extend CHIP (KidsCare) in Arizona and an invitation for those interested in impacting advocacy by serving as a key contact with Arizona legislators to serve as Congressional Advocacy Network delegates.  
Highlights and a full report from my and Dr. Payam Sadr's visit to Vancouver, BC for the Area 7 Assembly meeting are provided. Dr. Espinoza reports from his summer meeting in Las Vegas on Dementia, and the potential traumatic effects of brain trauma.
Lastly, though several months away, the Arizona Psychiatric Society's Annual Meeting and information is set for April 14, 2018 at the Wild Horse Pass Hotel and Casino in Chandler, AZ. We hope to garner interest in our readership and beyond for poster submissions, as well as nominate someone who is worthy of our APS Career Achievement in Psychiatry award, to be presented at the conference. Information for such submissions is provided below.

Thanks to Dr. Mary Nowlin for sharing photos from the the 2017 APA Annual Meeting, where she was recognized for adding Life to her Distinguished Fellow status and also enjoyed an impromptu meet-up with Dr. Monica Taylor-Desir, recently relocated to North Dakota.  If you attended IPS this Fall or plan to attend the APA Annual Meeting in May of 2018 in New York City, we welcome photographs of your highlights from those meetings.   


Aaron Wilson, MD
President, Arizona Psychiatric Society, 2017-2018

Watching the waves of natural disasters (Hurricanes Harvey, Irma, and Maria), followed by the tragic Las Vegas shooting in neighboring state of Nevada, we are all reminded that disasters and trauma happen without warning and their after effects can be long-reaching.  It is affirming to see the rallying of support in the aftermath, but having been involved in prior disaster response in my residency training state of Louisiana, I know those efforts require a lot of work and coordination.  If you would like to join me as a member of the Disaster Response Committee of the Society, please e-mail me or Teri.  We will be working to coordinate a meeting of the Committee before the end of the calendar year.  We have also included (below) information regarding assisting with ongoing relief efforts.

Looking ahead to 2018, I hope you will plan now to join us in January for the planned opioid education event, jointly sponsored with Arizona Society of Addiction Medicine, on January 20, 2018 at the University of Arizona College of Medicine, Phoenix campus in Downtown Phoenix.  

The Society is also working collaboratively on a social and advocacy reception with the Interprofessional Behavioral Health Collaborative of Arizona, a joint group of all mental health providers, including behavioral analysts, counsellors, marriage and family therapists, social workers, school counsellors, occupational therapists, psychologists, and psychiatrists.  That tentative date is January 25, 2018.  Please stay posted.  

Finally, the Education Committee is working on an engaging and timely Update in Psychiatry for the 2018 Annual Meeting, which will be held on Saturday, April 14, 2018 at the Wild Horse Pass Hotel & Casino Conference Center in Chandler, Arizona.  As you know, this event is free for APS Members.  I hope to see you all there!  

Hurricane Maria was the second major hurricane to hit Puerto Rico this month and the strongest storm to hit the U.S. territory in nearly 90 years, leaving much of the island destroyed with no electricity, food, or clean water.   The following resources are being provided to members who want to help in the aftermath of Harvey, Irma, and Maria.  

The APA Foundation has created a fund to provide needed services to those impacted by major disasters. To contribute, please visit the Foundation's Disaster Relief page.
If you're looking for a local charity to support in the wake of the Hurricanes in Puerto Rico, please consider the following:
Cash:  Most organizations are asking for cash, rather than supplies, so they can route help to where it's needed more quickly.

Supplies:  The government of Puerto Rico has also  launched a guide   that details how individuals or companies can donate emergency and construction supplies (from bottled water, hand sanitizer and formula to extension cords, tarp and safety glasses). The National Voluntary Organizations Active in Disasters (VOAD) is coordinating individual and corporate donations  here .

Volunteers:  Once infrastructure is stable, the island will also need volunteers.  Voluntary Organizations Active in Disasters is a good place to start .  They can help connect you with organizations with efforts already underway.

The Red Cross has deployed funds and volunteers to Houston, the Florida Keys, and Puerto Rico.  The APA and APA Foundation have assisted with these efforts.  The Red Cross is not currently taking volunteers given the outpouring of help but is accepting donations
APA also has educational resources on the APA Disaster and Trauma webpage, including a link to disaster mental health training (online modules) from the American Red Cross: https://www.psychiatry.org/psychiatrists/practice/professional-interests/disaster-and-trauma.  

These useful resources were contributed by the APA Committee on Psychiatric Dimensions of Disaster and others. Thank you for your generous support and kindness in these difficult times of need.  
PRMS_ Inc.

Brunch at University Club Image

Place:  University Club, Garden Room , 39 East Monte Vista, Phoenix
Time:  10:30 am to 12:30 pm on Saturday, January 13, 2018
Register:  CLICK HERE to register; CLICK HERE for a printable flyer

Plan to start 2018 on a positive note!  Join fellow Women in Psychiatry for collegial connection and socialization, brunch, and a presentation by Dr. Robin Reesal, with a discussion about happiness, stress, and positive lifestyle c hanges. Dr. Reesal's goal is to leave each attendee with more evidence-based choices for a quieter mind and healthier body.  

Share the invitation with your female peers.  Non-members are welcome!  

Elena Volfson, MD, MPH
General Adult and Addiction Psychiatrist
Mayo Clinic Arizona
Gateway Institute of Addiction Medicine and Rehabilitation, Mesa, AZ
I graduated from St. Petersburg Pavlov Medical University in Russia. Then I completed residency in Internal Medicine at the St. Petersburg Medical Academy for Postgraduate Studies in 1998.  This internal medicine training laid a solid foundation for my future psychiatric career. The following year, I came to the United States on a US Congress Scholarship to study for a Master's in Public Health in Epidemiology.
In 2006 I completed residency in general psychiatry and in 2007 - addiction psychiatry fellowship at the UMDNJ Robert Wood Johnson Medical School in New Brunswick/Piscataway, NJ. Then I became the Medical Director of the Collaborative/Integrated Care program called "the Behavioral Health Lab" in Philadelphia VAMC and joined University of Pennsylvania as an assistant professor of psychiatry.  In 2011, I opened my own part time solo private practice in Haverford, PA, where I managed the whole variety of patients from college students to business and law executives.
In December of 2015 I became a consultant at Mayo clinic Arizona. It is a great honor for me to be first addiction and integrated care psychiatrist to become part of this amazing psychiatry department chaired by Dr. Cynthia Stonnington.
This summer of 2017 I have joined the Gateway Institute of Addiction Medicine and Rehabilitation in Mesa, AZ, where my partners and I manage the broad range of substance use disorders, behavioral addictions, obesity and chronic pain using innovative and evidence-based approaches. We also perform evaluations and treatment of impaired professionals. Our vision is to create a state-of-the -art professional rehabilitation and monitoring program for the state of Arizona.
I am happily married with three children. My husband is a urologist in the Valley.
Career Highlights 
  • Getting a US Congress Scholarship in 1998.
  • Getting a Fogarty Foundation research scholarship in 1999.
  • Becoming an assistant professor of psychiatry at Perelman Medical School of University of Pennsylvania and at the Mayo College of Medicine.
  • Writing a chapter on addiction neurobiology in the APA Textbook of Geriatric Neuropsychiatry published in 2011.
  • Teaching fellow physicians, residents, fellows, medical students, nurses, psychologists, social workers, physician assistants, medical technicians across multiple health specialties while directing the collaborative care program.
  • Making a difference in the lives of thousands veterans in Philadelphia VA.
  • Being honored to speak nationally at multiple VA conferences, Women's Health Congress and American College of Physicians meetings.
  • Being recognized as a Distinguished Fellow at the American Psychiatric Association.
  • Being selected as a Top Doc of Main Line in 2013, then as a regional Top Doc by Castle Connoly in 2013-2015.
  •  Being voted as a Top Doc of Phoenix in 2017.
What do you like most about psychiatry?
I love the study of human life, complexity of a human brain and challenges of human development. I admire resilience, perseverance and grit. Why do some people crumble with mild or moderate impact, while others successfully prevail through incredible hardship? My favorite quote from psychiatrist Dr. Victor Frankl is " He who knows why can bear any how".  The two most important questions we psychiatrists ask are "why" and "how". I consider myself to be a "why and how MD".
I cherish the fact that during the course of one psychiatric interview I am often trusted with the most private and meaningful details of a person's life that are rarely shared with anyone else.
I consider psychotherapy, often neglected in our age of "there is a pill for everything", to be the most important part of treatment of any mental health and substance use disorders. The work of improving one's life skills and perspectives through psychotherapy is paramount to patients' long-term optimal mental health maintenance.
What trends do you like in psychiatry?
I like the latest technological advances that connect patients with wide variety of mental health services through telemedicine on a flexible and convenient schedule.
I am really excited about the collaborative/integrative care model that revolutionized mental health care delivery to previously underserved population by spreading psychiatric expertise. I was so fortunate to work with Dr. Oslin, who was a pioneer of the US collaborative care development.
I am fascinated by the newest imaging technologies that detail the complexity of brain function and the differences between male and female brains.
I am intrigued with the development on brain stimulation technologies, including TMS and ECT. I am also fascinated by the prospects of ketamine infusions treatment.
What trends do you do not like?
I don't like heavy reliance on medications, over-medicating and poly pharmacy especially when it leads to weight gain and sexual dysfunction.  I am very weight conscious when it comes to choosing medications.  I don't like reducing psychiatrists to "pill pushers" while the psychotherapy is done by other providers often without any communication between involved parties.
Personal history
I was born in St. Petersburg, Russia, arguably one of the most beautiful cities in the world that looks like Amsterdam, Paris and Venice mixed together.  My mother was double-boarded in Pediatrics and Internal Medicine.  My father was a very accomplished shipbuilding engineer.  They are both retired now.
Whom would you like to thank?
I was fortunate to meet quite a few amazing people in my life journey. I would like to thank my parents for giving me life and showing me the examples of successful, accomplished, and busy professional life.  I am grateful to my husband and children for enriching and enlightening my life.
I would also like to thank the following individuals:
  • Dr. Graeme Hammond, the founder of cardiothoracic surgery in Yale, for inspiring me to take the USMLE exams and providing me with study materials.
  • Dr. Barbara Palmeri, my psychiatry residency program director, who taught me about the art of psychotherapy and applying common sense to the analysis of human life, as well as my inspiring residency mentors Dr. Marshall Schwartsburg and Dr. Naomi Vilko.
  • Dr. Douglas Ziedonis and Dr. Gill Williams, directors of my Addiction Psychiatry Fellowship, both multitalented charismatic people who taught me a lot about addiction medicine and professional collaboration.
  • Dr. Neal Schofield, the Medical Director of the Princeton House, who taught me how to detox anybody from anything under any circumstances.
  • Dr. Arnold Washton, who allowed me to be a co-therapist for the group of addicted physicians and lawyers in Princeton, NJ, who instilled the deep appreciation of recovery process in those very challenging and fascinating patients.
  • Dr. Charles O'Brien, the Chairman of the Penn Addiction Psychiatry, who lead the whole country in the use of anti-craving medications.
  • Dr. David Oslin, the father and the leader of Integrated Care in the US who I learned a different vision of mental health care delivery from.
  • Dr. Cynthia Stonnington, the Chair of Mayo Psychiatry Department, for believing in me and being an inspiring role model of successfully combining academic, leadership and clinical career with family and motherhood and creating a diverse and all inclusive department.
  • All of my Penn and Mayo colleagues.
  • All of my patients for challenging me to be a better human being.


After the efforts that stopped BCRA in the Spring, physician organizations continued to fight united to protect access to care, and the efforts of Arizona members in stopping the "skinny bill" and the Graham-Cassidy legislation were key in those efforts.  Thank you for your collective individual efforts--together they make a difference!  

The Society participated in many joint efforts and letters to Senators McCain and Flake on making effective bipartisan reforms.  In a key effort led by the Arizona Medical Association, the Society joined physician organizations across the state of Arizona in a letter outlining opposition to the Graham-Cassidy legislation in the U.S. Senate, citing the devastating impacts to the state Medicaid program, AHCCCS, and loss of health insurance coverage for thousands of patients around the state.

The physician organizations represented in the letter included:  
Arizona Academy of Family Physicians
Arizona Chapter of the American Academy of Pediatrics
Arizona Chapter, American College of Physicians
Arizona Medical Association
Arizona Osteopathic Medical Association
Arizona Psychiatric Society
Arizona Section of the American Congress of Obstetricians and Gynecologists
Maricopa County Medical Society

The full text of the letter is attached hereto.  Arizona House Health Committee Chair Representative Heather Carter, House Health Committee Vice Chair Representative Regina Cobb, Senate Health Committee Vice Chair Kate Brophy-McGee, and House Health Committee Member Representative Michelle Udall also wrote to Senator McCain in support of his vote in opposition to Graham-Cassidy.  

On Wednesday, October 11, APA members Katherine Kennedy, M.D., and Tobias Wasser, M.D., attended a fundraiser for Sen. Chris Murphy (D-Conn.) on behalf of APAPAC, APA's political action committee They used it as an opportunity to speak on behalf of low-income children whose stable access to health insurance is in jeopardy as a result of Congress's failure to reauthorize the Children's Health Insurance Program (CHIP). Kennedy and Wasser had the opportunity to attend this event as members of the Congressional Advocacy Network (CAN). CAN members serve as "key contacts" for their federal lawmakers so that when important issues come up before Congress, APA can quickly get its message to targeted members of Congress through direct and personal contact from their constituents. APA provides CAN members with talking points and one-on-one support so that they can build a relationship with their federal lawmakers. APS is looking for members interested in being contacts for the following Arizona legislators:

Rep Tom O'Halleran (1st District);  Rep Raul Grijalva (3rd);  Rep Paul Gosar (4th);  Rep Andy Biggs (5th);  Rep Ruben Gallego (7th);  Rep Trent Franks (8th).

The following Arizona legislators have members who have volunteered to be contacts, but APS would welcome additional support if you are registered in their district and have an interest in serving:

Rep Martha McSally (2nd);  Rep David Schweikert (6th);  Rep Krysten Sinema (9th);  Sen John McCain; and  Sen Jeff Flake.  

Learn more about CANE-mail Teri if interested in contributing to this important advocacy effort.  

Join the conversation and tweet your Senators today!  #extendCHIP  8.9 million children currently rely on CHIP to access health coverage including mental health services.  Funding for this vital program has expired so it is urgent that Congress acts to extend CHIP for 5 years.  Write your members of Congress today!


Michel A. Sucher, MD FASAM FACEP
Chief Medical Officer
Community Bridges, Inc.

CBI Responds

Community Bridges, Inc. (CBI) has been acutely aware of the opioid epidemic for some time and has continued to develop and adapt programs to ensure we are utilizing evidence-based and best practice programs to tackle this societal concern. CBI has a comprehensive Opioid Intervention program designed to treat opioid addiction while meeting the behavioral and physical health needs of the individual. The Opioid Intervention program utilizes trauma-informed care, a combination of medical and multidisciplinary approaches, to help those persons who struggle with opioid addiction recover their lives.  There are three important aspects of the model (including detoxification and maintenance): medication assisted treatment, therapeutic counseling, and family and friends support. 

Medication Assisted Treatment (MAT) allows the individual to regain a normal state of mind, absent from drug-induced highs and lows freeing the person from thinking all the time about the drug while reducing withdrawals and cravings. This assists the individual in making treatment and recovery their primary focus.  Some of the medication utilized at CBI includes buprenorphine , naltrexone (oral and injectable) and methadone. Along with MAT is counseling and education, which can include family and friends.  At CBI, we know those relationships can be a powerful part of one's journey to recovery. We find the more supports involved in someone's treatment, the more likely they are to be successful in their recovery.
Additionally, CBI developed the UnScript program to target individuals who have become dependent on opioids or other medications, as a direct result of treatment for a legitimate medical condition(s) and then being unable to stop the use of the medication. The UnScript program takes a comprehensive and holistic approach to assist individuals in tapering off of the pain medications and utilizes non-habit forming medications to treat the physical pain. Through education and alternative treatment approaches, patients increase pain management skills while decreasing the use of medication and reliance on medical services.  This program also includes extensive coordination of care with all associated treatment professionals.

CBI takes a "no shaming and no blaming" approach to working with individuals experiencing addiction.  Each of CBI's UnScript facilities employs a comprehensive team that treats holistically, medically, and behaviorally to support positive change. 

CBI practices a "no wrong door" policy and anyone seeking treatment will be received with dignity, compassion, and respect. Many of the individuals we see have no one else to turn to. At CBI, we utilize a team approach to identify how we can enact a treatment plan that will foster patient success.

CBI Identifies What is Working through Data

CBI does go through data outcome measures: patient abstinence of opioids, sustained reduction in patient substance use, patient functioning (e.g., return to school, return to work), readmission inpatient rates, ED utilization, medication adherence, and compliance with behavioral and medical appointments, improved legal status (no re-arrests), and reduction of crisis episodes. CBI takes every opportunity to help individuals who are facing a chronic illness that is the result of a lifestyle involving opioid dependence. We ensure that our facilities are accessible and heighten patient engagement. 

When a member of the community enters one of our facilities and expresses an interest in undergoing medication assisted treatment, we begin the process by having one of our physicians provide a history and physical exam. The physician begins by ordering lab tests to determine if any medical risks need to be managed to provide the most effective and efficient treatment. CBI medical professionals provide comprehensive treatment and monitoring. Our integrated teams facilitate "trauma informed care," highlighted by their extensive training while adhering to evidence-based practices. At CBI, we embrace the opportunity to serve persons struggling to recover from opioid use disorders and never stop believing that a person can achieve recovery. We believe in maintaining the dignity of human life, and we do so by providing a continuum of care that begins with community education and outreach and continues for individuals and families through treatment and recovery. 

For more information on programs available through CBI, visit   http://communitybridgesaz.org/
Current Reporting, Draft Recommendations, and  Updated Arizona Controlled Substance Prescription Monitoring Program (PMP) Compliance Checklist
Arizona Opioid Epidemic Recommendations
For the first time, statewide opioid data is available in real time. Here are the statistics through October 2017:

471 suspect opioid deaths
3,599 suspect opioid overdoses
306 neonatal abstinence syndrome
3,108 naloxone doses dispensed
2,353 naloxone doses administered

New emergency rules for Opioid Poisoning-Related Reporting

Opioid Action Plan

Opioid Recommendations Infographic (included at left; CLICK HERE for printable pdf of the Opioid Recommendations Infographic).  

Draft Opioid Prescribing and Treatment Rule 

Recently released Opioid Emergency Rulemaking notice and Emergency Rules Q & A.

Compliance with PMP:   Learn more about mandate components!
The Arizona Controlled Substance Prescription Monitoring Program (PMP) is now integrated with Health Current, the statewide health information exchange (HIE). The new requirements to check the PMP went into effect on October 16. The PMP is an important tool to reduce morbidity, mortality, misuse, and abuse related to prescription drugs, specifically opioids. The primary function of the PMP is to provide a central database of all prescriptions dispensed for Schedule II, III, and IV controlled substances in Arizona. What are the new guidelines? Read on!
EFFECTIVE OCTOBER 16, 2017: All prescribers are required to obtain a patient utilization report from the PMP prior to prescribing an opioid analgesic or benzodiazepine controlled substance. It is the prescriber's responsibility to understand the new law and the requirements before the mandate goes into effect beginning October 16, 2017.
Download the updated PMP Compliance Checklist and learn about the components of the mandate. The Arizona Board of Pharmacy is making more information about electronic health record (EHR) integration available online, including what EHR vendors they have contacted to determine compatibility.


Early Bird Rates through November 3; Register Today

The AzSAM Annual  Conference will provide an extended program focusing on key aspects of the addiction field. Topics will highlight latest trends, new approaches to treatment and provide a great opportunity for you to network with others in the field.  

The Friday, November 17, 2017  Pre -  Conference is a full day conference (separate registration required) on  2017 Buprenorphine Advanced Training and Office-Based Opioid Treatment.

For more information on the AzSAM Annual Conference, or to register, CLICK HERE.  

PRIVATE PRACTICE OPPORTUNITY IN TUCSON, AZ.  Take over practice of retiring psychiatrist,  in an overhead sharing arrangement with  two other psychiatrists, a psychologist  and a master's level therapist.  Contact Shari at 520-795-0309.

TUCSON OPPORTUNITY:  TWO CLASS A PSYCHOTHERAPY OR PSYCHIATRIC OFFICE SPACES ARE AVAILABLE ON OR BEFORE AUGUST 1, 2018.  Share space and expenses with three other collegial independent psychologists, psychiatrists, and therapists in an attractive spacious quiet leased setting in midtown Tucson, Arizona conveniently located two miles from UA/UMC. Five large first floor offices share front office, reception area, kitchenette, storage for medical records and small supplies, two restrooms, ample patient/client parking, front and back entry/exits, and covered parking for the clinicians. Additional office expenses such as phone, janitor, utilities, supplies, and receptionist/office manager payroll are shared by the 5 clinicians. Billing services are inexpensively available thanks to the computerized scheduling and billing program. Vacancy or part time space available by late 2017 or early 2018 to allow sooner transition, if you wish. For questions and to express interest please contact Kevin Leehey MD at 520-296-4280.  

NORTH SCOTTSDALE OPPORTUNITY.  Seeking Board Certified Psychiatrist to rent unique office space in North Scottsdale part-time.  There will be an opportunity early next year to expand practice there.  This is a very desirable location in The Citadel at intersection of Pima and Pinnacle Peak Road.  Call 602-349-0025  John Liebert, MD, Psychiatrist.  

The most recent Mental Health Association of Association's meeting session's topic was Behavioral Health Integration in Arizona. Starting on October 1, 2018, AHCCCS intends to offer fully integrated contracts to manage the whole individual. AHCCCS envisions these Integrated Contractors offering behavioral health and physical health services to children and adult AHCCCS members not determined to have SMI. At the MHA Association of Associations meeting, stakeholders discussed the importance of these changes with 13 different health plans. A panel spoke to the crucial components of a system that manages the whole individual. The panel included Emily Jenkins, Director of Arizona Council of Human Service ProvidersKristina Sabetta, Executive Director of MHA of AZJane Kallal, Executive Director of Family Involvement Center, and Marcus Johnson, Director of State Health Policy and Advocacy at Vitalyst Health Foundation. MHA of AZ's position statement on Behavioral Health Integration is available here.  

For more information on AHCCCS Planning the Future of Integration Health Care Delivery, CLICK HERE.  
Vancouver, Canada - August 2017   

Payam Sadr, MD, FAPA, Arizona Assembly Representative
Mona Amini, MD, MBA, FAPA, Arizona Assembly Representative

The August Area 7 Assembly Meeting was held in Vancouver, Canada.  The Western Canada District Branch made all feel very welcome.  

A major discussion point of the meeting was the role of the Area Councils and the funding required to support the travel expenses for the same.  As a result of budget concerns, the Area 7 Spring 2018 meeting planned for Alaska (as a means of providing outreach and support to that DB) will instead be a call-in or video meeting, with those able to self-fund travel to Alaska during the originally scheduled date to do so as personal outreach.  Fall 2018 will be held in Nevada with thanks for some financial support from that District Branch.  

The November Assembly in Washington, DC will be held from November 4-6, 2017.  The APA has budget for the two Arizona Assembly Representatives to attend.  

For a full report on the Area 7 Assembly August Meeting, please CLICK HERE.

SONORAN PREVENTION WORKS: Reducing Preventable Opioid-Related Deaths In Arizona

Haley Coles, Executive Director
Sonoran Prevention Works

A Robert Wood Johnson Culture of Health Leader

In the midst of an increasing drug abuse epidemic, one Arizona nonprofit is embracing unconventional tactics. Sonoran Prevention Works operates from a harm reduction framework to meet patients where they're at in their cycles of drug use in order to improve their health and outcomes. Through legislative advocacy, collaborative partnerships, and dedicated staff and volunteers, SPW has been able to provide free overdose prevention kits and education statewide, implement a syringe access program in Phoenix, and push forward the conversation on health equity for people who use drugs.

In 2016, nearly 1500 Arizonans lost their lives to an overdose. Because of this unacceptable statistic, SPW and AHCCCS partnered at the beginning of 2017 to expand naloxone accessibility statewide. SPW received support to distribute free naloxone to Arizonans at risk of an overdose, or those who may be in a position to assist in the event of an overdose. In addition to distributing naloxone, they are working with community partners in each region to assist in developing their own programs, policies, and procedures surrounding overdose prevention education, naloxone prescribing, and when appropriate, naloxone dispensing. As a small organization with only 3.5 paid staff, they rely wholeheartedly on community members to become leaders in the fight against accidental overdose. They train and certify community distributors to teach locals about overdose prevention and naloxone use. Once trained, these community distributors can also dispense naloxone to their community members. SPW has trained community members and distributed naloxone in every Arizona county and nearly half of the reservations. Recipients vary from active opioid users, to law enforcement, to family members, to taxi drivers. In the first year of their naloxone distribution program starting in September 2016, SPW has distributed 15,142 naloxone kits and received 1420 reported uses of naloxone to revive an overdose victim.

Sonoran Prevention Works also understands that the current drug abuse epidemic is about more than just overdose. Rates of HIV and Hepatitis C are on the rise among people who inject drugs, posing a significant public health threat. Additionally, some of the most vulnerable Arizonans do not engage with the mental or physical health systems that many partners have worked so hard to build capacity with. In partnership with Phoenix police, Sonoran Prevention Works opened up a syringe access program once a week on the west side of Phoenix in January 2017. The syringe is only the stepping stone to building relationships with high-risk Arizonans who have very few opportunities to participate in therapeutic interactions. Since January, the program has distributed 27,000 syringes, 307 naloxone kits, received reports of 41 overdose reversals, and had 898 interactions with clients. Sonoran Prevention Works is in the midst of conversations with law enforcement in other parts of the state to implement similar programs in order to draw people out of the shadows and provide them with tools and resources to stay safe and seek care.

The concept of harm reduction gives service providers the ability to build relationships with some of our most vulnerable citizens by talking truthfully about drug use and affirming the right to life for those who use drugs both legally and illicitly. SPW is working hard to build capacity among Arizona agencies and foster empowerment and hope among people who use drugs. Overcoming stigma is an uphill battle, but one that is becoming a little easier due to overwhelming support for overdose prevention programs and naloxone availability. Thanks to the partnerships forged throughout the state, SPW is reducing preventable death and giving Arizonans another shot at life.  
CME AND EVENTS:  APA Free Course of the Month; PCCS-O and PCSS-MAT Free Opioid Education; Save the Date: Opioid Education Event - January 20, 2018

Each month APA makes available a free CME course exclusive to members only through its Learning Center. November's Course is "The Past, Present, and Probable Future of Violence Risk Assessment," presented by John Monahan, Ph.D., University of Virginia School of Law. CLICK HERE for more information.


PCSS-O and PCSS-MAT have trained more than 100,000 clinicians in preventing, identifying, and treating opioid use disorder, but did you know that these free resources are available to you through these two federal grant projects. VIEW THE FLYER for more information on the training (including podcasts) and mentoring, all by experts in the field.  

opioid education calendar
SAVE THE DATE:  Opioid Live Education Event sponsored by the Arizona Psychiatric Society in conjunction with the Arizona Society of Addiction Medicine, University of Arizona College of Medicine, Phoenix - Saturday, January 20, 2018.  For more information, contact
J&J and Janssen Logo

Community Service Information from Janssen Pharmaceutical Companies of Johnson & Johnson

Following are informational flyers that may help your patients change to the Medicare plan that best suits their needs in 2018.  Open enrollment began October 15, 2017 and ends on December 7, 2017.

June 10, 2017 - Las Vegas, Nevada

Brian Espinoza, MD, FAPA
Interventional Psychiatry
APS CME Contributing Editor

This is an annual conference that is attended in order to help appreciate the overlap between Psychiatry and Neurology.  I attended the June 10th session at the Lou Ruvo Center for Brain Health in Las Vegas.
Dementia from Brain Trauma: Concussion, Traumatic Brain Injury and Chronic Traumatic Encephalopathy
CTE (Chronic Traumatic Encephalopathy)--the hot topic.

Moving towards a definition; a neurodegenerative disease with unique neuropathology;  caused by repetitive brain trauma, including concussions and subconcussive blows;  characterized by tau deposition including neurofibrillary and astrocytic tangles, in addition to diffuse plaques of amyloid...

Clinical Features include Four Primary Domains:
                        Cognition: memory & executive impairments, dementia;
                        Behavior: impulsivity, explosivity, aggression;
                        Mood: depression, hopelessness, suicidality; and
                        Motor: "Post Traumatic Parkinsonism", dysarthria, ataxia.

Youth Football--something to think about:

Age 9-12 players incur up to almost 600 impacts of a magnitude like high school  and college players; the brain has a peak developmental rate between the ages  of 10-12; myelination, cortical thickening and blood flow  MRI White Matter changes are seen in high school and college players.   In studying retired NFL players, the younger the starting age, the poorer the p erformance on Cognitive Testing.  I n a survey of professional fighters, asking the question of motivation to return to fighting  after a Head Injury, the "love of fighting" and "the desire to win" took precedence  over "the money."

A Professional Fighters Brain Health Study began enrollment in 2011; some  preliminary findings:   A reduction of the thalamus and corpus callosum by MRI volumetrics; M ixed Martial Arts fighters show a gradual increase in plasma Tau.
Dementia from Inflammatory Disorders

A 2004 Netherland study showed elevated levels of inflammatory proteins before the  onset of dementia; the term "autoimmune dementia" is being used in academics s ome coexisting factors; younger age of onset, a subacute onset, a fluctuating course,  coexisting immunologic disorder(s), a family history of autoimmune disease, and a  response to immunotherapy.  

The Mayo Clinic offers a CSF (Cerobrospinal Fluid) Autoimmune Dementia Panel.   The first randomized trial is underway using IV IG for NMDA receptor encephalitis,  involving a protocol which includes steroids, IV IG, plasmapheresis, and chemotherapy.  

The future may hold 2 categories of dementias, those with, and those without, an i mmunologic component; accordingly, the Lumbar Puncture is making a comeback.  
Dementia from Vascular Disease

The preferred terminology now is Vascular Cognitive Impairment (VCI).   Neuropsychiatric symptoms predominate with thalamic and caudate involvement with  areas involved correlating with pathology; the posterior thalamus involves the concept of  "neglect" (? our patients whom deny their psychiatric illness ?).   The MoCA is becoming preferred over the mMSE given higher sensitivity in Executive  Functioning, and may be a quick screen for concerns in impaired driving abilities  Obstructive Sleep Apnea is now being considered a potential contributor; white matter  lesions are observed on MRI.  T here are no suitable animal models for replicating VCI so the pipeline is "pretty dry" for  developing novel treatments; acetycholinesterase inhibitors show a modest benefit on  cognitive testing, but no functional benefits; calcium channel blockers have preliminary  evidence of improving cognition; cerobrolysin, cholinergic stimulants, vasodilators,  platelet aggregation inhibitors and delta-9-THC are being studied.  
Dementia from Metabolic Disturbances

The list here is exhaustive so just the high points:

Up to 50% of Vitamin B-12 tests are false positive or negative; may need to measure  methylmalonic acid and/or total homocysteine if clinical suspicion is high.  
Chemotherapy; up to 75% of patients experience cognitive impairment during or after  treatment.
Chronic opioid abuse; accelerates inflammatory mechanisms with Alzheimer's like Tau p athology.  
Cognitive Cure-Alls: Separating Fact From Fiction

Vitamin E; it is estimated that 90% of Americans do not meet the average requiremental  intake, though current data suggest only a delay in deterioration in Activities of Daily  Living; consider 400 IU daily of d-alpha-tocopherol.

Fish Oil (Omega-3-Fatty Acids); no apparent benefit in the prevention of Alzheimer's  Disease; a probable functional benefit in MCI (1-2 g DHA/day), no apparent benefit in  the healthy over the short term.

Prevagen; manufacturer currently being sued by the Federal Trade Commission.

Curcumin; currently, no apparent benefit in the treatment of Alzheimer's Disease; more  studies needed in MCI and the healthy; consider incorporating into an antioxidant rich d iet.

Coconut Oil; no clear data on this at the present time; unclear benefits over  monounsaturated fats like olive oil.

Exercise; in Alzheimer's an improved functional ability; in MCI possible cognitive  improvements; in the healthy, a reduced risk of MCI and dementia.

 "Brain Training"; the Federal Trade Commission fined Luminosity $2 million for  unwarranted claims; an NIH study showed that using a program involving reasoning  and speed of processing (Brain HQ training "Double Decision") showed a "probable" r isk reduction in the development of dementia; more studies needed and are ongoing.  
The next report will be from the 23rd Annual Nevada Psychiatric Association Psychopharmacology Update Conference in February of 2018.

If I can be of any help in sorting out the above, please contact me.

Dr. Espinoza is an APS Member and an Interventional Psychiatrist specializing in Electroconvulsive Therapy (ECT), IV Ketamine for Depression, Genetic Testing, Enhanced Medication Management, and Pharmaceutical Research.   


RFM and Medical Student Invitation.  The Arizona Psychiatric Society invites all Arizona psychiatric residents or Arizona medical students to submit an abstract for consideration for a judged and scholarshipped poster presentation at the Arizona Psychiatric Society Annual Meeting, to be held on Saturday, April 14, 2018 at the Wild Horse Pass Hotel & Casino Conference Center, 5040 Wild Horse Pass Blvd, Chandler, AZ 85226.  Please review the APS Resident-Fellow and Medical Student Poster Guidelines for complete information regarding participation and prizes. 
Physician Invitation.  The Arizona Psychiatric Society invites all Arizona psychiatric physicians to submit an abstract for consideration for a peer juried poster presentation at the Arizona Psychiatric Society Annual Meeting, to be held on Saturday, April 14, 2018 at the Wild Horse Pass Hotel & Casino Conference Center, 5040 Wild Horse Pass Blvd, Chandler, AZ 85226.    Please review the APS Psychiatric Physician Peer Poster Guidelines for complete information regarding participation. 
Visit the submission link at:  https://www.surveymonkey.com/r/APSPosters2018 and provide the requested authorship information and submit your abstract of 3000 characters or less (including spaces).
We welcome all to present their best work from recent meetings or preview new work.  The submission deadline is midnight on April 1, 2018.  View the full Call for Abstracts here.  


The Arizona Psychiatric Society invites you to nominate a deserving APS Member for c Career Achievement and pleased to announce the creation of the Career Achievement in Psychiatry Award. This award will be presented annually to an Arizona Psychiatric Society member who best exemplifies the following award criteria. 
The award recipients will meet one or more of the following American Psychiatric Association values:
*           Compassion, as evidenced by exemplary patient care and/or compassion to colleagues and in the workplace.
*           Leadership in the field of psychiatry as evidenced by holding leadership roles in individual residency programs, at the District Branch level of the APA and/or at the national level.
*            Community service on the local or national level.
*            Political action on behalf of their patients, their profession, and/or their community.
*            Clinical excellence as evidenced by exemplary patient care.
*            Research to advance the field of psychiatry.
The membership of the Arizona Psychiatric Society will be encouraged to nominate the worthiest of its members for this distinction.  The nominated psychiatrist must be a member of the APA and APS and must be in licensed to practice medicine and in good standing with the Arizona Board of Medical Examiners.  Members are encouraged to nominate the fellow APS member that best exemplifies the APA values.
Nominations must be postmarked or e-mailed by March 1st and include a nomination letter and a copy of the nominee's current curriculum vitae (if available).  Submit to teri@azmed.org, Arizona Psychiatric Society, 810 West Bethany Home Road, Phoenix, Arizona  85013.  
Arizona Psychiatric Society Newsletter Committee
Mona Amini, MD, MBA, FAPA, Editor-in-Chief
Brian Espinoza, MD, FAPA, CME Features
Robin Reesal, MD, FAPA,Global Psychiatry Features
Gagandeep Singh, MD, Assistant Editor