Western Occupational & Environmental Medical Association
Leading Occupational & Environmental Medicine

Welcome to the WOEMA WINDOW, our e-newsletter sent to members by email on a monthly basis. The newsletter links to this page. Below are the items that appeared in the February 2018 issue.


WOEMA Guidance: Recreational Cannabinoids in the Workplace




California Proposition 64 went into effect on January 1, 2018, decriminalizing cannabinoids and permitting recreational use.  This presents great challenges and opportunities for the Occupational Physician charged with preventing workplace injuries and assuring a safe, productive environment. Proposition 64 specifies who can buy cannabinoids and amounts that can be in possession in addition to other regulations. This discussion is intended to examine options for recreational cannabinoids only.



Seeking Feedback on CA Formulary Update




Attention WOEMA Members in California!

WOEMA is conducting a short survey to obtain feedback regarding the impact of the recently implemented CA DWC Formulary. We would appreciate your responses. The survey will take 2-5 minutes to complete. Please click here.

Thank you,

The WOEMA Legislative Affairs Committee


Thinking About the California Workers’ Compensation Formulary

by Sarah Mansell, MD, WOEMA Member



After much anticipation, the new California Workers’ Compensation guidelines came into action on January 1st of this year in response to the passing of the Assembly Bill 1124.

The implementation had been delayed six months due to the complexity of the changes, questions about appropriate medications to be included in the formulary, and to give insurers time to incorporate the recommendations into their formularies. The MTUS Formulary is based on the evidence based ACOEM guidelines and can be accessed through The Reed Group. The Reed Group is available to physicians in California on a subscription basis for $100.00.

California is now the tenth state to adopt a workers’ compensation formulary. The use of a formulary for workers’ compensation began with North Dakota in 2006. Since then Texas, Arkansas, Delaware, Nevada, Ohio, Oklahoma, Tennessee, Washington, and Wyoming have adopted or are in the process of adopting workers’ compensation formularies.

The expected benefits of the new formulary are threefold. Firstly, and most importantly, it aims to improve quality of care for all patients by following evidence based guidelines. It will reduce drug costs by reducing use of brand name drugs in favor of generics, as well as limiting the use of compounded formulations. Thirdly, the formulary will reduce the use of opioids by requiring authorization for prescriptions of greater than four days length.

With the new changes there is likely to be some difficulty in weaning long term opioid users. Prescribers have until April 1, 2018 to implement plans for weaning or provide justification as to why this is not possible.

The structure of the California Formulary is unique as it categorizes care by condition, body part, and stage of care. In each guideline there may be conditions for which the drug is recommended, not recommended, or has no recommendation. One needs to use the guideline to determine the recommendation for the condition to be treated and be sure that it is appropriate for the particular phase of care, either acute or chronic.

This formulary is unique in its structure. As a result, it will be imperative that physicians understand the medical treatment utilization schedule and subsequent MD Guideline references.



FREE CME: WOEMA Webinar Series
Thursday, February 22 • 12:00 PM PST

Phenotyping Asthma: Environmental and Occupational Asthma

Presented by: Nicholas Kenyon, MD



Environmental and occupational triggers are major concerns in the persistence of adult severe asthma, particularly for those patients with “T2 low” asthma. With the recent approval of multiple novel biologic therapies for severe asthma, it is important that physicians understand how to appropriately phenotype such patients, and consider who may be a candidate.  In this presentation, we will review the present thoughts on phenotyping patients with asthma, and how this impacts the evaluation and management of patients with occupational and environmental triggers.

Learning Objectives –  After this webinar, participants will be able to:

  • Describe the epidemiology and trends for asthma and occupational asthma
  • Describe how phenotyping of asthma allows for prescribing novel biologics for asthma
  • Outline the evaluation and phenotyping for occupational asthma

Dr. Nicholas Kenyon is division chief in Pulmonary/Critical Care and a physician-scientist with a translational research focus in adult severe asthma. Areas of emphasis are asthma therapeutics, the role of nitric oxide in airway inflammation, and environmental triggers of asthma. He completed an NHLBI-funded Phase II clinical trial of L-arginine supplementation in severe asthma based on 10 years of hypothesis-driven mouse model work. Dr. Kenyon is Co-PI on a U01 PRISMS grant to develop wearable environmental sensors for children with asthma. In addition, he has collaborated with environmental health UC Davis investigators to run intervention trials in asthma, test novel therapeutics in animal models, develop novel breath sensor technologies and identify the environmental triggers for patients with asthma. He is PI & Director of the CTSC TLI Pre-Doctoral Training Program, and Co-Lead of the Career Development Program for the UC Davis NIEHS-funded Environmental Health Center.


Dr. Dean Gean’s MedTech Corner



BBP Next–Know What to Do Quickly after OPIM Exposure

To my horror, a few years ago I discovered after the patient I had sutured left the urgent care clinic, that I had penetrated my skin with the needle. This major Medical Center’s ED and safety office had no protocols to guide post-exposure prophylaxis (PEP) and no one knew what to do! I ended up OK, but I (or they!) really could have used the BBP Next App. This App provides simple and direct access to the relevant hepatitis B, hepatitis C and HIV guidelines for PEP and testing and covers test interpretation, transmission and risk counseling.

Intended for medical professionals, the information provided is referenced in the App literature as being consistent with current Center for Disease Control and Prevention (CDC) guidelines (as applicable) and provides a quick-call link to the National Clinician Consultation Center “PEP Line” for expert consultation. The App was co-developed by a Board Certified Occupational Medicine Physician and sponsored by a grant from the Maine Technology Institute.

If you are as anxious as I was during my own experience, you know that wading through the voluminous text available on the CDC website is no simple task – particularly if people are anxious (i.e., you and the patient!) and in a hurry.

One of the best parts of the app is that it uses an algorithmic approach for rapid focus on your patient’s exact circumstances. Through a series of YES/NO questions and simple menu choices, it allows rapid focus on exposure assessment, treatment algorithms, baseline and follow-up testing, specific HIV PEP medications, and does this all with a very rapid and simple to use interface.

When you open the app, you are presented with the following menu choices:

  • skip to CONTACT INFORMATION NCCC Consultation PEPLine



If you follow the exposure assessment algorithm, it takes you through a series of YES/NO questions familiar to all who have read the CDC risk assessment guidelines concerning exposure to Blood or Bodily Fluid Exposures (BBFEs), Blood Borne Pathogens (BBP) and Other Potentially Infectious Material (OPIM). With just 3 YES/NO questions, it takes you to a menu with a series of choices asking, “How was the patient exposed to potentially infectious fluid?” (menu choices: splash with nonintact skin, percutaneous, splash on mucous membranes, bite with break in skin, none of the above). From any one of these menu choices a hyperlink takes you to recommendations for testing (e.g., “baseline HIV, baseline Hep C, Hep C antibody [if positive reflex test hep C RNA/PCR], hep B [if indicated, see questions below]”.



After using the EXPOSURE ASSESSMENT algorithm, you can choose the TREATMENT ALGORITHM. This takes you to an actual flowchart algorithm, then by hitting continue, it takes you to a choice screen as follows:

  • Source is HIV positive or reasonable suspicion of HIV-positive
  • Source Unknown HIV status
  • Source is HIV negative

If you choose “Source is HIV positive or reasonable suspicion of HIV-positive” you go to a screen with an immediate answer “RECOMMEND THREE DRUG PEP” – it then proceeds to lists the drugs (TRUVADA and ISENTRESS), the doses and the duration of treatment. It also suggests, “Consider call National Clinician Consultation Center PEP line 1-888-448-4911 (USA only, 9 AM-8PM EST 7 days per week) or consult with infectious disease specialists especially of drug resistance, toxicity concerns, alternative regimen considered, pregnancy, or delayed or unusual circumstance.

The app has a 30 day free trial. And then becomes an application service where you are charged $12.99 per year for the subscription. The app content is updated from the developer every time you open it up on your smart phone or tablet – this keeps it current. The app also works on your phone or tablet even if you are out of range of network or cellular connection. Thus it can be used in remote areas.



This app takes a large mass of guideline information and makes it quickly accessible, and responds to the concerns that patients exposed to BBFEs are often not medically managed appropriately and often are treated without the most up to date recommendations.

I liked it a lot. I have this App. And though I have become much more cautious in my suturing technique, and I hope never to need to use it, it’s a true comfort to know that it’s there.


The BBP Next Mobile Application (App) serves as a quick reference guide for physicians and APPs for the medical management of patients with blood or bodily fluid exposures (BBFEs).

Reference guide.

BBP Next is offered on the Apple App Store for a free 30 day trial and $12.99 per year and can be used on the Apple iPhone and iPad.



Free 30 day trial and $12.99 per year.

The app can be purchased from an Apple link at www.topdocapps.com

or by searching “BBP Next” at the Apple App Store.


**Disclaimer: Please note, the material at www.topdocapps.com and the material on the BBP Next App has not been vetted against CDC Guidelines, infectious disease textbooks or current literature and is referred to here strictly for awareness purposes. If you intend to rely on this site or App for clinical information as a health practitioner to treat or advise patients, you are advised to verify the accuracy and current relevance of the information by assessing current standard medical texts and relevant scientific literature.

Reserve your Room for WOHC 2018



The early bird gets the worm! Book your accommodations for the Western Occupational Health Conference, September 12-15, 2018 at the WOHC 2018 host hotel, The Park Central San Francisco, today! WOEMA is pleased to offer a special rate of $269++/night to our WOHC attendees. This price won’t last long – book before the August 13, 2018 cut-off date.