Interview with Tipu V. Khan, MD, FAAFP, FASAM; Addiction Medicine Fellowship Director, VCMC
Tell us about your background: education, residencies, and career path.
I attended the University of Washington where I got a certificate in underserved pathways, caring for the underserved, on top of my MD degree. I came back to southern California and did a residence at Harbor UCLA and trained in the county hospital. l then went to USC and did high- risk OB fellowship. Then at a FQHC in full spectrum primary care, mix of all underserved. In 2014, I joined VCMC.
What is your current role and what was your initial role with the county, if different?
I always wanted to go back to academics, wanted a couple of years under my belt and I had real world experience after two years. I realized I liked full-spectrum care, all of it, high-risk OB, and began looking for jobs for this and there wasn’t a lot. There were two, one in Riverside county and one at VCMC. VCMC had name recognition, and a stellar reputation. I had three children who were 9, 6, and 3 years old at the time, and it felt like the right place for us to be.
What was it that interested you in this work?
For me, growing up I saw the lack of care for patients who had limited medical access. Friends who wouldn’t get diabetes check-ups until they were in dire need of foot care. One friend didn’t get proper care and that led to a bad outcome. The underserved need more high-level care. That’s why I went down that pathway. The ability to be an advocate for those who need a voice in the system was what interested me in this work.
Is there a ‘typical’ patient who comes to see you?
That’s what I love about my job, every week is different. One week I’m on the addiction consult service and it’s intense, high intensity. Then I’m in the ER, then a delivery, and the next week on primary care. The breadth and scope of practice is very different. Literally cradle to grave.
What do you see as the most urgent issue in the world of addiction at this time?
That’s a tough question: Fentanyl, if I had to put it into one word. That’s why the Prescriber’s Care Discussion Series for medical providers in Ventura County is a great approach. It’s not going to happen with just law enforcement. It will require a complete revision on how we approach the issue of addiction, with fentanyl overdoses. Every person or a family member knows at least two people who have overdosed or died. Not just one avenue to care will work here. We need to look at this in a different way. We’ve tried increasing access to care; addiction is not something like small pox that comes and goes away. We’ve struggled with this issue since the beginning of time. It will never be entirely gone. We need to learn to live with it, with as little impact as possible.
What (if anything) do people most misunderstand about a person addicted to substances?
People who haven’t experienced an addiction, don’t understand it’s not under their control. We want to say, ‘Just say no’, or ‘let god, let go.’ They have a disease; it’s disconnected from the pleasure pathway. You’ve got an adolescent brain running your entire life. That’s the neurobiology of the disease/brain. When I have that conversation with patients about the disconnect from the front of their brain, it clicks. A good amount of it is out of their control. A lot of these people have a lot of underlying trauma from when they were much younger, and you’re not going to fix those pathways. They don’t have that executive function. They need education to help with skills to learn to cope without the use of substances. Not a simple task. In the world of addiction care there’s medication care and addiction medicine, which we approach from the medicine side; we use a lot of pharmacy care, medications Suboxone and Buprenorphine, along with all the behavioral part of it. We have a good relationship with drug court and primary care, public health nurses, and for years we were the only addiction medicine group in the county; now we are the largest, though there are others in the county. We take all insurance, self-referral from Gold Coast, word of mouth.
Tell us about the team you work with at VCMC?
We have five faculty and fellows, docs in trainings, and a strong behavioral health team in the clinic and great nurses. Also, a good Substance use navigator at the hospital. It’s the whole team and picture, great relationship with VCBH, we work with a woman and children residential treatment center, a house for women to detox and stay with their children. This treatment center is the only such medical place in the county.
What do you feel is the most beneficial aspect of the Prescriber’s Care Discussion Series you recently facilitated?
What I really appreciated from the first one is that you’re not hearing one side of the story, it’s really encompassing all sides of the substance abuse scene. Law enforcement, coroner, we’re all trying to do the right thing but everyone approaches it from a different lens. We don’t all see things the same way. Sgt. Hadjucko from VCSO might say, put more people in jail; that’s how they approach it from their lens. The second series we talked about safely prescribing.
Anything else you’d like us to know about you and the work that you do?
We’ve built a community presence and even if someone hasn’t met with us they have heard about it. Depends on where they are in their process. Where they are in their change. Some are not ready to have a discussion. But it is easier to have those conversations now than, say four years ago. And that’s a win.
Prescribers Care Discussion Series – August 31, 2022
August 31, 2022
DEPRESCRIBING IS GOOD PRESCRIBING
5:30–7:30 PM
Sterling Hills Golf Club, Camarillo
Just as safe prescribing is an integral and effective strategy to prevent opioid use disorder, safe deprescribing is also key. In this workshop, we’ll discuss when, and how to safely and effectively taper patients from opioid usage. Is the deprescribing plan not working? Let’s talk about how to talk with patients about opioid use disorder and effective referrals to substance use treatment.
REGISTER HERE
PRESENTED BY
- Tipu V. Khan, MD, FAAFP, FASAM; Addiction Medicine Fellowship Director, VCMC
- Kyle Stephens, DO, Family Medicine Specialist, Primary Care
- George C. Chang Chien, DO, Director of Pain Management, Ventura County Medical Center
For more information: Ashley.Nettles@ventura.org
Prescribers are key to creating change in our community.
Thanks to exceptional local collaboration, Ventura County has seen a decrease in opioid prescribing in recent years – a 24% reduction between 2017 and 2020 – as providers have employed safe prescribing practices and increased use of non-narcotic pain management strategies.
Unfortunately, overdose deaths continue to climb, largely due to illegal fentanyl, which has replaced much of the local heroin use and is contributing to the rising number of overdose emergencies. As a concerned local provider, we invite you to join the Prescriber Discussion Series:
- Hear from local experts and discuss with peers the latest trends and best practices.
- Get provider-focused resources to reduce misuse and opioid use disorder (OUD).
- Learn the new State guidelines and latest tools for patient care and provider coordination.
Connecting because we care. For our patients and for our community.
UPCOMING DISCUSSIONS IN THE SERIES
- September 21, 2022 • 5:30-7:30pm
Person-Centered Strategies to Reduce Opioid Overdose
PREVIOUS DISCUSSIONS
- May 11, 2022 • 5:30–7:30 PM
Latest Trends in Overdose: What Prescribers Need to Know About Illicit Fentanyl
- June 8, 2022 • 5:30–7:30PM
Evidence-based Safe Prescribing
LEARN MORE AND REGISTER:
Prescribers Care Discussion Series – June 8, 2022
June 8, 2022
EVIDENCE-BASED SAFE PRESCRIBING
5:30–7:30 PM
Sterling Hills Golf Club, Camarillo
Join us for a review of local opioid prescribing trends. We’ll discuss how safe prescribing and use of CURES can prevent or reduce opioid misuse and opioid use disorder (OUD) in our patients. Hear from Tipu Khan MD, an author of the newest California Guidelines for Safe Opioid Prescribing, on how to utilize the newest guidelines in our practices. Learn how other local Primary Care and Pain Management Specialist use effective safe prescribing strategies to treat patients at risk of opioid misuse or opioid use disorder (OUD).
REGISTER HERE
PRESENTED BY
- Tipu V. Khan, MD, FAAFP, FASAM; Addiction Medicine Fellowship Director, VCMC
- Kyle Stephens, DO, Family Medicine Specialist, Primary Care
- George Chang Chien, DO, Director of Pain Management, Ventura County Medical Center
For more information: Ashley.Nettles@ventura.org
Prescribers are key to creating change in our community.
Thanks to exceptional local collaboration, Ventura County has seen a decrease in opioid prescribing in recent years – a 24% reduction between 2017 and 2020 – as providers have employed safe prescribing practices and increased use of non-narcotic pain management strategies.
Unfortunately, overdose deaths continue to climb, largely due to illegal fentanyl, which has replaced much of the local heroin use and is contributing to the rising number of overdose emergencies. As a concerned local provider, we invite you to join the Prescriber Discussion Series:
- Hear from local experts and discuss with peers the latest trends and best practices.
- Get provider-focused resources to reduce misuse and opioid use disorder (OUD).
- Learn the new State guidelines and latest tools for patient care and provider coordination.
Connecting because we care. For our patients and for our community.
UPCOMING DISCUSSIONS IN THE SERIES
- August 31, 2022 • 5:30 7:30 PM
Deprescribing is Good Prescribing
- September 21, 2022 • 5:30-7:30pm
Person-Centered Strategies to Reduce Opioid Overdose
PREVIOUS DISCUSSIONS
- May 11, 2022 • 5:30–7:30 PM
Latest Trends in Overdose: What Prescribers Need to Know About Illicit Fentanyl
LEARN MORE AND REGISTER:
National Fentanyl Awareness Day May 10, 2022
The first ever National Fentanyl Awareness Day launches tomorrow, Tuesday, May 10, 2022. The purpose is to raise public awareness about the growing fentanyl public health crisis. People are dying at alarming rates due to illegally made fentanyl, a dangerous synthetic opioid. Founded by parents who have lost loved ones to the drug overdose epidemic, National Fentanyl Awareness Day is supported by a group of subject matter experts, corporations, nonprofits, schools, families, and elected officials who are coming together to amplify the issue via social media. The date was purposely set during Mental Health Awareness Month to amplify the warning message about self-medication at a time when counterfeit pills have flooded the illicit drug market. The goal is to leverage as many organizations and communication channels as possible to reach the most vulnerable demographics.
Learn more:
SENATE RESOLUTION DESIGNATES MAY 10 AS NATIONAL FENTANYL AWARENESS DAY
Interview with Dr. Renee Higgins, COO, Administrator, Ventura County Medical Examiner’s Office
What year did you start with the county Health Care Agency and what was your role?
In January 2013, I started working for the County’s Health Care Agency as the Chief Hospital Operations (CHO) for the Ambulatory Care department. My role, along with my fellow (CHO) colleague, was to oversee the operations of the county’s vast clinic system. At the time, this included public private partnership clinics which were Federally Qualified Health Centers, Specialty clinics and county campus clinics onsite at Ventura County Medical Center.
Did you come to the agency from the private sector?
Yes, I worked in the private sector as a health care administrator for many years prior to becoming a public servant. I worked in the fields of elder care, home health, home care and medical transportation. Becoming a public servant was something that I had desired to do for many years.
How (and when) did you transition to the MEO, and describe your role?
I started working for the MEO in 2015, in tandem with my role in Ambulatory Care for three years. I eventually came to work fulltime at the MEO in 2018. My current role is Chief Operating Officer for the Medical Examiner’s Office.
What’s the most gratifying part of your work?
There are many gratifying parts of my job. Being a leader in this agency is both challenging and rewarding. I was able to be a part of the counties inaugural LEAP program (Trailblazers) which honed my Servant leadership style and better prepared me to face the challenges and sorrows that the MEO faces every day. I honestly enjoy coming to work each day and being a part of a team that cares so much about their jobs. Our team has integrity and strength. People do not necessarily want to encounter our office; we interact with individuals on the worst days of their lives. If I can help a family member either directly or indirectly, in some way during this time of grief, it is very gratifying.
What are your observations about the increase in overdose deaths in your time with the MEO?
Out of the four manners of death: Natural, Accident, Suicide and Homicide, I recall when natural deaths accounted for most of the deaths in our jurisdiction annually. This has been replaced by Accidental deaths mainly due to the opioid crisis. I recall when the drug fentanyl was a problem on the periphery of our county, but we knew it was coming. The good thing is, we had the COAST and Rx Drug and Heroin Work Group teams already in place to help combat this dangerous drug when it hit our county. These collaborative teams led by Behavioral Health and composed of many partners, have been key in strategizing prevention initiatives to combat this crisis. A few observations are that the opioid crisis does not discriminate. It crosses all socioeconomic, race and ethnic lines. Also, the drug fentanyl can come in many forms, our Chief Medical Examiner called it “the great imitator” thus, a person taking the drug may not even be aware of it. Very concerning.
What would you like people to know about the work done at the MEO? What might surprise people?
For one thing, our work helps the living. The findings learned from the work of our investigators and forensic pathologists can contribute to public health questions and offer insight into medical practice and specific disease processes that otherwise would not be explored. A wealth of data is generated by our office. We were selected along with five other counties in the state to partner with CDPH to provide data on violent deaths as well as overdose deaths in real time. This data is sent to the state within 30 days of death. This helps to provide information that can be analyzed earlier to see trends and plan prevention strategies. In order to prevent deaths in our county, we have to accurately identify what is causing the deaths.
Anything else you’d like to share?
I am honored to work for the County of Ventura and more specifically the Medical Examiner’s Office. I recently was sworn into the California State Coroner’s Association as a board member. Although Ventura County is only one of six Medical Examiner systems in our state of 58 counties, this board represents all three types of forensic death investigation offices: Medical Examiner, Coroner, and Sheriff/Coroner. Working together to ensure best practices and representing the ME systems in our state is an honor.