Posts Tagged ALBME

ALBME Names New Executive and Associate Executive Directors

ALBME Names New Executive and Associate Executive Directors

MONTGOMERY – The Alabama Board of Medical Examiners has named Sarah H. Moore as its new executive director and William M. Perkins as its associate executive director. Moore and Perkins, both of Montgomery, are the first female and first African American to serve the ALBME in executive roles.

“We are fortunate to have individuals of their caliber on board,” ALBME Chairman Joseph Falgout, M.D., said. “We have a tremendous responsibility to protect the public and are confident Mrs. Moore and Perkins not only share our commitment to that duty but with their knowledge and skills, will be instrumental in helping fulfill that mission.”

Moore officially assumed her new position on Feb. 1 and the Wilcox County native, an accountant by training, brings with her a wealth of experience as a state regulator and in large organizational management and public administration. Since 2014, Moore has served as chairman of the board and administrator of the Alabama Credit Union Administration, the entity responsible for licensing, regulating and supervising state-chartered credit unions.

Prior to joining ACUA, she served as an executive of an NYSE bank holding company for 13 years in numerous roles, including senior executive vice president and chief financial officer. As well, Moore worked for nearly a decade with the predecessor to PricewaterhouseCoopers, auditing financial, governmental, real estate and insurance industry clients.

In addition to her professional achievements, Moore has been active in civic affairs, including serving as current president of the Montgomery Area Food Bank, past president of the Montgomery Rotary Club (first female president in the club’s 83-year history) and past Advisory Council member of the Auburn University Business School, among others. She holds a degree in Business Administration and Accounting from Auburn University.

“I am honored the Board has placed its confidence in me,” Moore said. “I’m humbled by the opportunity to serve in this important position and to work with the dedicated physicians and staff of this agency to continue striving to uphold high standards for medicine and protect the patients of this state.”

Perkins began his new position with the ALBME as associate executive director in mid-January. A Montgomery native, Perkins has more than 30 years’ experience in leadership roles in law enforcement, military and regulatory organizations. His professional history includes serving as an officer with the U.S. Army Alabama National Guard; serving as a police captain, investigator, executive officer to the mayor, and other roles in the Montgomery Police Department; and, as Company Commander for the 1203rd Engineering Battalion of the U.S. Army National Guard.

Prior to accepting the position of associate executive director for the ALBME, Perkins worked for eight years as an investigator with the agency before in May 2018 becoming office director and overseeing the agency’s daily operations. For his military service, Perkins was awarded the Bronze Star for Operation Iraq Freedom, the Desert Award, four Army Medals of Merit and two Army Commendation Medals.

He is deeply involved in his community, most actively working through the Omega Iota Iota Chapter of Omega Psi Phi Fraternity, Inc. of which he is a life member, focusing on at-risk youth. Perkins is also a lifetime member of True Divine Baptist Church, where he’s served as a deacon since 2012. He earned a degree in Business Administration from Faulkner University.

“My entire career, whether with the military, the police department or the ALBME, I’ve been involved in some way in public protection,” Perkins said. “It’s been my life’s calling, and I appreciate the faith the Board has placed in me with this new position. Moving forward, I’d like to see this agency continue leading the way for health professional licensing boards in Alabama through increased adoption of improved protocols and cutting-edge investigatory techniques.”

The ALBME is the state regulatory agency tasked with licensing, certifying and regulating the practice of medicine and osteopathy in the State of Alabama. The Board’s duties include: qualifying physicians for licensure, approving collaborative and supervised practices between physicians and mid-level practitioners, registering physicians, physician assistants and advanced practice nurses to prescribe and dispense controlled substances and investigating and prosecuting violations of the Controlled Substances Act and the Medical Practice Act. To manage its more than 18,000 licensees, the Board employs a workforce of 31 trained investigators, attorneys and affiliated staff. The Board’s mission and purpose are to protect the safety and welfare of the public through the appropriate regulation of its licensees.

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It’s Not Just About Opioids…

It’s Not Just About Opioids…

According to the National Institute on Drug Abuse, more than 30 percent of overdoses in the United States involving opioids also involve benzodiazepines, or “benzos.” Statistics from the Centers for Disease Control and Prevention show more than 115 Americans die each day from an opioid-related overdose.

However, between 1996 and 2013 the number of adults who filled a benzodiazepine prescription increased by 67 percent from 8.1 million to 13.5 million. In 2015, 23 percent of people who died of an opioid-related overdose also tested positive for benzodiazepines.

In a study published in the British Medical Journal in March 2017 of more than 300,000 continuously insured patients receiving opioid prescriptions between 2001 and 2013, the percentage of persons also prescribed benzodiazepines rose to 17 percent in 2013 from nine percent in 2001. The study showed those concurrently using both drugs are at higher risk of visiting the emergency department or being admitted to a hospital for a drug-related emergency.

In March 2016, the CDC issued new guidelines for the prescribing of opioids, which included a recommendation to avoid prescribing benzodiazepines concurrently with opioids when possible. In October 2016, the Food and Drug Administration issued a “black box” warning for prescription opioids and benzodiazepines highlighting the dangers of administering these medications together. (See

Let’s talk about benzos.

As with all medications, benzodiazepines have their usefulness. If prescribed and taken correctly, this class of medications can be extraordinarily helpful to patients. Benzodiazepines calm or sedate a person by raising the level of the inhibitory neurotransmitter GABA in the brain. Common benzodiazepines include alprazolam (Xanax), diazepam (Valium) and clonazepam (Klonopin).

Alprazolam is the most prescribed benzodiazepine in Alabama, according to the Alabama Board of Medical Examiners.

“Benzodiazepines are very effective medications for the treatment of acute anxiety just as opioids are very useful for the treatment of acute pain. But also like opioids, benzodiazepines will cause the development of physiologic tolerance if used regularly, and this often causes a loss of therapeutic effect if the dose is not continuously escalated. For this reason, they are not ideal medications as the primary treatment of chronic anxiety,” said Luke Engeriser, M.D., Assistant Professor of Psychiatry at USA Health College of Medicine and Deputy Chief Medical Officer, AltaPointe Health Systems in Mobile. “Benzodiazepines are most useful when prescribed for brief periods when someone is going through a major crisis or exacerbation of symptoms, for example after the loss of a loved one. Ideally, regular use of the medication would only be for one or two weeks. We
also sometimes will use a benzodiazepine for a time-limited period when we are initiating an antidepressant medication like an SSRI or SNRI for treatment of chronic anxiety. Although these antidepressant medications are very effective for anxiety, it sometimes takes a few weeks before the medication has a sufficient therapeutic effect.”

Other physicians, like David Herrick, M.D., of Montgomery, agree with Dr. Engeriser that as physicians prescribe benzodiazepines, extra care should be taken in monitoring the patient.

“All medications have their place, but it’s the way they are used or misused that’s creating a deadly problem. While using opioids and benzos together is not completely forbidden, it is something that has to be done very, very carefully. Most people don’t have to be on benzodiazepines all the time. If the patient has a real anxiety disorder, then that patient should be under the care of a psychiatrist,” Dr. Herrick said. “Benzos are intended to be used for the short term. I think the medical community should consider benzodiazepines just as risky as opioids and monitor and treat their patients who are using them just as carefully as their patients who are taking opioids…with the same amount of care and concern.”

Going back to school.

According to Dr. Merrill Norton, PharmD., ICCDP-D, Clinical Associate Professor at the University of Georgia College of Pharmacy, although benzodiazepines have been in use since the 1950s, education about their proper use and potential harm has not kept up with the times.

“The problem with opioids and benzodiazepines, even at prescribed levels, is understanding which opioid interacts with which benzo?” Dr. Norton explained. “This is where the physician has to be very astute. What needs to happen now is a consistent training mechanism for physicians who prescribe buprenorphine, methadone, or have patients on these medications. What the benzo is doing is helping modify the anxiety that is being triggered by the opioid withdrawal. That’s why they use it. And this is why the physician needs to be better trained not only in the prescribing of the opioid but also with benzos and how they react to one another.”

Dr. Norton suggested before prescribing a benzodiazepine, physicians should evaluate the patient for tendencies to misuse drugs and/or alcohol or if the patient has a history of misuse. Depending on the complexity of the patient’s care needs, consultation or referral to an addiction medicine physician may be necessary. Certain aberrant behaviors also may be a feature in some patients who are prescribed benzodiazepines and may include diversion of valid prescriptions, illicit sale or use in manners alternate to the prescribed dosage, route and frequency.

“Physicians need to know that benzodiazepines are useful short term but have extreme dangers to medication safety to patients who are placed on long-term regimes. Physicians also need to be aware of each benzodiazepine medication’s half-life, tolerance curves, basic pharmacodynamics and pharmacokinetic properties of each, and how to identify and manage benzodiazepine withdrawal when it occurs. Basically, physicians need to re-educate themselves on these medications. I’m finding that most physicians are already very cautious when it comes to prescribing benzodiazepines, but I don’t know how aware they are of the many types of drug interactions that can happen,” Dr. Norton said.

The Medical Association will again offer three live Prescribing and Pharmacology of Controlled Drugs courses in 2019. Drs. Engeriser, Herrick and Norton have all participated in these lectures in the past as guest faculty members and stress the importance of presenting evidence-based information and case studies to the attendees. The courses in 2019 will be March 2-3 in Auburn, Aug. 2-4 in Destin, and Nov. 23-24 in Birmingham. More information about specific topics and faculty will be available from the Association’s Education Department at a later date.

The Medical Association recently unveiled its new online OnDemand Education Center, which includes seven Alabama Opioid Prescribing courses that meet the Alabama Board of Medical Examiners’ requirements for holders of an ASCS and are free to members. One course specifically deals with benzodiazepines: Use and Misuse of Benzodiazepines.

What tools can physicians use to avoid potentially deadly medication interactions?

There are many tools physicians can use to help screen their patients for a history of alcohol and/or drug addiction before prescribing benzodiazepines. Physicians agree that adding a benzodiazepine into the mix of medications for a patient who has a history of addiction may only be adding fuel to the fire.

“Prescribing a benzodiazepine to a patient with a history of addiction to other substances increases the risk that a patient could develop an addiction to benzodiazepines or that the benzodiazepine could trigger a relapse on the drug of choice. When prescribing any controlled substance, we should also regularly check the PDMP,” explained Dr. Engeriser.

The Prescription Drug Monitoring Program was developed to promote the public health and welfare by detecting diversion, abuse and misuse of prescription medications classified as controlled substances under the Alabama Uniform Controlled Substances Act. Under the Code of Alabama, 1975, § 20-2-210, et seq., the Alabama Department of Public Health was authorized to establish, create and maintain a controlled substances prescription database program. This law requires anyone who dispenses Class II, III, IV, V controlled substances to report daily the dispensing of these drugs to the database. For more information about the Alabama PDMP, or to set up an account, log on here:

Another helpful tool Dr. Norton suggested physicians can have at their fingertips to help spot bad drug interactions is the app, UpToDate. This app is one of the fastest apps physicians can use to double-check for drug interactions as they are writing prescriptions. It is, however, a subscription service, but the app comes with clinical decision support with evidence-based clinical information, including drug topics and recommendations. To learn more about UpToDate, services, subscription options, and how to download the app for your mobile device or EHR, log on here:

Medical Association members can also subscribe to The Medical Letter on Drugs and Therapeutics at a reduced rate. The Medical Letter is a biweekly publication that provides evidence-based, peer-reviewed evaluations of new FDA-approved drugs with conclusions reached by a consensus of experts; new information on previously approved drugs including pivotal clinical trials, new indications, and safety warnings; consensus recommendations for
the preferred and alternative treatments for common disorders; and comparative reviews of drugs for a given indication with particular attention to clinical efficacy, adverse effects, drug interactions, and cost. A subscription includes online and print access, a mobile app, and CME opportunities. To learn more about The Medical Letter, log on here:

What’s next?

A new study by the University of Michigan and published in the Journal of General Internal Medicine maps out county-by-county the prescribing habits of benzodiazepines. The South ranks at the top of the spectrum.

The study is based on data about all prescriptions written in 2015 by primary care providers for patients in the Medicare Part D prescription drug program. The researchers combined that information with county-level health and socioeconomic data from the County Health Rankings project, a project of the Robert Wood Johnson Foundation and the University of Wisconsin.

In the single year studied, the 122,054 primary care providers included in the study prescribed 728 million days’ worth of benzodiazepines to their patients, at a cost of $200 million.

The states with the highest intensity of prescribing — which the researchers defined as prescription days of benzodiazepines relative to all prescribed medication days — were Alabama, Tennessee, West Virginia, Florida and Louisiana. States with the lowest intensity were Minnesota, Alaska, New
York, Hawaii and South Dakota. Across all types of providers, primary care and otherwise, benzodiazepines accounted for 2.3 percent of all medication days prescribed to Part D participants by those providers that year.

Physicians agree it’s time to take another look at these medications.

“Benzos have as many problems as opioids do — they are addictive, sedating and deadly if they are not prescribed and used properly.” Dr. Herrick said. “We as physicians need to be more aware of these dangers and treat benzos the way we treat opioids with a lot more respect than we are right now. If you write the prescription and sign your name to it, you had better understand what you’re writing before you hand it off to your patient because it could cost that patient his life. We have gotten a bit cavalier about how we prescribe benzos, and we need to take a look at how and why we prescribe them. This is a real issue, and we need to take it more seriously. It’s time we take a hard look at how these are prescribed and why.”

Dr. Engeriser, however, offered a word of caution. Where physicians who prescribe opioids may have instinctively wanted to stop prescribing them altogether as the national epidemic was on the rise that cannot be the case with benzodiazepines.

“As providers become more careful about prescribing practices, there will likely be an increase in the desire to stop using benzodiazepines for certain patients. Benzodiazepine withdrawal is similar to alcohol withdrawal and can lead to seizures, delirium tremens, and death. For that reason, it is critical that patients not have their benzodiazepines abruptly stopped. There are different strategies for the tapering of benzodiazepines. The important thing in the outpatient setting is to taper the benzodiazepine slowly enough that severe withdrawal symptoms do not emerge. This is often done more easily with a benzodiazepine with a longer half-life such as clonazepam than a shorter half-life like alprazolam. On an inpatient unit, benzodiazepine taper can be more rapid, using as needed benzodiazepines to treat emergent withdrawal, with dosing guided by a scale, such as the Clinical Institute Withdrawal Assessment for Alcohol-Revised (CIWA-Ar).” Dr. Engeriser said.

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ALBME Names New Executive Director

ALBME Names New Executive Director

Norris Green was recently named executive director of the Alabama Board of Medical Examiners. Green originally joined the ALBME in July 2015 as the associate executive director and was officially named director following the retirement of Larry Dixon in December 2016.

Prior to coming to the ALBME, Green worked for 39 years with the Alabama Legislative Fiscal Office and served as its director for his last four years with the organization.

“Since joining the ALBME, I’ve enjoyed working with our staff members and getting to know Alabama’s physicians who serve as members of the board,” Green said. “We are all working together to shape our state’s health care future. This can be challenging, yet very rewarding work, and I’m excited about continuing to move Alabama forward in our changing health care climate.”

Green has a Bachelor’s degree in Business Administration from Auburn University, a Juris Doctor degree from Jones School of Law, and is a member of the Alabama State Bar. During his career, he received recognition by the National Association for Legislative Fiscal Offices for outstanding contributions to the Alabama Legislature as well as recognition of the fiscal office by the Center on Budget and Policy Priorities as a model legislative agency.

“The Medical Association is excited to work with Norris and continue our strong relationship with the ALBME,” said Association Executive Director Mark Jackson. “His ability to work with complex issues with his experience of the inner workings of state government will be a tremendous asset to our physicians.”

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Larry Dixon to Retire as Executive Director of the Alabama Board of Medical Examiners

Larry Dixon to Retire as Executive Director of the Alabama Board of Medical Examiners

MONTGOMERY – After serving as executive director of the Alabama Board of Medical Examiners for more than 35 years, Larry Dixon has announced his retirement at the end of the year.

“We are like family here,” Dixon said. “It has been my privilege to serve Alabama’s physicians and our staff because we are so much like family. We’ve been a part of each other’s lives for so many years, and I’m going to miss that. We’ve done great things together, but I know there are still great things to come.”

Dixon brought his experience with continuing education to the Medical Association of the State of Alabama in 1972 and established the Association’s education department, which has continued to flourish by producing original continuing medical education programs for Alabama’s physicians, as well as nurse practitioners and certified registered nurse practitioners.

“The Medical Association has one of the strongest education departments in the country due largely to the foundation on which it was given when Larry Dixon created it,” said Medical Association Executive Director Mark Jackson. “Since then, he has been the driving force behind the ALBME and making the organization one of the best in the nation year after year. He put his stamp of excellence on both organizations, and we are equally better for it.”

Dixon served four terms on the U.S. Federation of State Medical Boards and was the first president of the Administrators in Medicine, an organization he helped charter. He has also served on committees of both AIM and FSMB. In 2009 he received the Meritorious Service Award from FSMB, and in 2014 FSMB awarded him the Lifetime Achievement Award. He was inducted into the Alabama Healthcare Hall of Fame in 2016, and also earlier this year, the Medical Association honored him by renaming the building that houses the Alabama Board of Medical Examiners to the Dixon-Parker Building.

During the years, Dixon has watched as downtown Montgomery has grown up outside his office window, both figuratively and literally. After serving a term on the Montgomery City Council in 1975 to 1978, he was elected to the Alabama House of Representatives. In 2010 Dixon retired after serving seven terms in the Alabama Legislature – four years in the Alabama House of Representatives before being elected to the Alabama Senate.

His many accomplishments include being a member of the board of directors of the Montgomery Airport Authority; board member of the finance committee and past member of the administrative board of First United Methodist Church; charter member of the Certified Medical Board Executives; member of the advisory committee of the Prescription Drug Monitoring Program; and member of the board of directors of the FSMB Research and Education Foundation.


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