PHARMACIST STEVE

https://kingfish1935.blogspot.com/2017/12/mississippi-doctors-on-opioid-regs.html

More than a few Mississippi doctors objected to proposed opioid prescription regulations.  The Mississippi Board of Medical Licensure proposed new regulations that will overhaul how physicians prescribe and administer narcotics.* JJ obtained copies of the comments through a public records request.  Several are posted below.  More will be published in future posts. Earlier post covering proposed regulations.   Words such as dangerous, idiots, absurd, ridiculous, and burdensome are used.  Keep reading.

Congratulations! You are about to penalize everyone for the actions of a few! To burden everyone to take the time to contact the PMP on every prescription and then maintain documentation forever is absolutely ridiculous! There is already too much time, money and effort spent on overreaching regulations to add this to the mix.  As a surgeon who writes only postoperative prescriptions for 5 day (10 pill) , these regulations will ,for better or worse ,make me stop writing pain meds altogether. As I talk to my colleagues they are incredulous that you have chosen regulations so burdensome. You know who the outliers are, you should address these individual’s prescribing patterns and leave the rest of us alone!! And less I forget to mention it, take action against the criminal acts  of the patients in their drug seeking behavior and stop trying to hang everything on hard working physicians.

Dr. Jeff Cook

A few of these recommendations are overly burdensome and costly. Hopefully the board members wont reflexively incorporate all these recommendations to the detriment of patient care in order to address political objectives.

While initial prescribing of opioids it is reasonable to obtain prescription monitoring and UDS, to require UDS testing at every follow up for stable compliant chronic pain patients is unreasonable and unnecessary, as well as a significant expense to patients.

“Benzodiazepines and opioids may not be prescribed concurrently, with limited exception for an acute injury and for no more than 7 days. “   This is absurd and dangerous to patient care. While physicians should seriously consider the risk of concurrent prescribing, to absolutely prohibit concurrent use will result in severe, possibly life threating withdrawal as well as cause patients in pain to not receive appropriate pain medicines. Frequently, benzo’s are written by other physicians who refer to us to take over opioid pain medicines. While we endeavor to address the concurrent use and encouraging weaning of both classes, this proposal is outright dangerous and ill conceived. It is upsetting to me that studies clearly demonstrate alcohol is involved in 50% of opioid deaths, and benzo’s involved 30% but nothing has been said of concurrent alcohol use, nor do the CDC guidelines even mention concurrent alcohol use….

Ken Staggs
MD Total Pain Care
Meridian

As an orthopedic surgeon, I treat multitrauma patients and shoulder surgery patients that require post surgery opioids for a month or longer. Only allowing pain scripts post op for a seven day supply will place an unfair burden on those patients and our clinical staff. Please consider making some exceptions with regards to sometimes VERY painful surgeries.

Many times opioids are required for successful therapy to be obtained after these surgeries as well.  The proposed rule would require patients to come back weekly which again isn’t fair to patients or our clinical staff.

Thank you for consideration for these patients. Please feel free to contact me for further discussion as required.

D. Ross Ward, MD

I am a board certified emergency medicine physician practicing with the Singing River Hospital System here on the Mississippi coast. I’ve been licensed in Mississippi for 17 years. Although I wholeheartedly agree  there is an opioid abuse issue in the United States and Mississippi is no exception, I must vehemently protest the following clause in the MS State Board of Medical Licensure’s plans on regulating narcotic
prescription writing:

“Every licensee regardless of practice specialty must review the MPMP at each patient encounter in which an opioid is prescribed for acute and/or chronic noncancerous pain”

This rule would be way too burdensome in a busy emergency department. Patients are already waiting hours to get seen by an Emergency Physician and this rule would simply add to our already busy workload. This will inevitably, significantly add to the patient wait times if we have to run a MPMP check on every patient we see who receives a narcotic prescription in the emergency department. Pain, not surprisingly, is by far the most common complaint seen in the emergency department (ED). This would yet again be another uncompensated mandate put upon us by government. You must understand the vast majority of patients receiving a narcotic prescription in the ED are not abusers. All of these innocent patients and doctors are going to pay a heavy price for this massively sweeping rule just to weed out a handful of narcotic abusers. Do we really need to run a background check on a 8 year old who has a fractured forearm before we prescribe codeine? Or even on an adult who has an obvious legitimate reason to receive a narcotic pain medicine, regardless of his prescription history? Am I not going to prescribe a narcotic to an adult who has acute 2nd degree burns even if he has filled several narcotic prescriptions in the past?

Please seriously reconsider the wording of this clause and consider the impact on all the patients who are waiting to receive care in our busy emergency departments. Please don’t hesitate to contact me for any concerns or questions.

Thanks
Matthew L. Emerick. MD, FACEP

1. The requirement for all licensees to run a PMP report is too burdensome. The BOML should have the ability to login to the PMP and see if it has been checked remotely. It takes an average of 90 sec. to login and search for each patient-(try it and you will see). This will add over an extra hour, not included scanning to each provider, and unecessary burden. If implemented by BOML, an extra cost may have to passed to the patient for this.

2. Agree completely with opioid and benzodiazepines not to be prescribed concurrently.

3. Disagree with only a 7 day supply of opioids for acute pain. Rationale: As an orthopedist treating acute complex fractures, these patients have acute post surgical pain for fracture treatment. I service a rural community. It is not realistic to have them travel long distances each week to retrieve a opioid prescription.

Regards,
W.Todd Smith, MD
Starkville Orthopedi   Clinic

Once again a bunch of bureaucratic idiots making a bunch of rules without reasonable judgement. No
balance at all.

Dr. Lance Line
Southern Bone & Joint Specialists (Hattiesburg)

I have a pain mgt. patient who is well controlled on methadone for 8 years.   May he continue his high functioning on methadone or must I no longer prescribe him methadone?

Dr. Ed Aldridge
OnCall Medical Clinic

This is patently ridiculous, a public bandaid for a problem CREATED by government policy. Yet another hurdle to taking care of my oncology and postoperative patients.

Dr. Phillip Ley

I am a Physician Assistant working in Mental Health. The only change that I don’t entirely agree with is not prescribing Benzodiazepines with Opioids. I have several military veterans that have suffered injuries that have severe PTSD that really need both medications to have a semblance of a normal life. I also work with PTSD patients that have chronic pain and were physically abused for 20 years. I understand the black box warnings and I understand this is an attempt to combat the epidemic in this country, but to take away the provider’s discretion is taking away the treatment some people need. Thank you for taking my comments into consideration.

Sincerely,
Heather Huguley, PA-C

I maintain my license in Mississippi, though I am not currently practicing there. I am a full time emergency
physician in Dallas, Texas.

The proposed legislation is so restrictive, it is another reason for physicians to MOVE OUT OF MISSISSIPPI and not return to practice.

Increasing the labor and documentation burden for physicians will not have a significant impact on the drug problem in Mississippi. It will have an impact on your physician work force. Best of luck.

Dr. Walter Green

I am very much in favor if this ruling. However, there need to be stiffer penalties for prescribers who do not
adhere. Great work!

Dr. Gerry Morrison

This proposed policy will be an efficiency problem for all surgeons if we have to stop after every
operation/procedure to check website before writing prescription for post‐op pain relief.

Dr. John Bailey

I am very much in favor of making it harder for drug seeking patients to get opioid prescriptions. I am also in favor of making it harder for physicians who are enabling patients with their opioid dependence. However, of the
proposed changes that the Medical Licensure Board is recommending, I must disagree with the proposal to require all licensees to run a Prescription Monitoring Program (PMP) report at each encounter when prescribing opioids, especially for acute pain. I use the PMP regularly for patients who have any drug seeking behavior, but because patients who are having major surgery usually need a narcotic post operatively, it will not make a difference what the PMP report says when treating a patient with post operative pain. The PMP site is not the most user friendly site and can be very time consuming. To run a PMP on every surgery patient will be difficult for busy practitioners.

Dr. Ronald Young
OB/GYN

As a medical doctor who daily sees the harm caused by the over-prescribing of opioids and benzos, it is clear that certain physicians and NPs in our state are irresponsible or careless in prescribing these medications.

At our hospital, we have removed the automatic sleeping pill off all standing orders. We have developed a step-wise approach to pain management for which opioids are a second or third line choice and not a first line choice. We have developed rules that limit the number of days an opioid can be prescribed for acute pain management.

I fully support developing these proposed guidelines for responsible use of opioids and benzodiazepines as they primarily address patient protection and safety, and secondly address the epidemic of diversion that affects us all. Thank you for taking a bold step to be a strong advocate of responsible health care within our state.

Dr. Barry Bertolet

20 Emergency Physicians that treats over 100,000 patients in the two ED’s of Singing River Health Systems feels the same. The Board of Directors of the Mississippi Chapter of the American College of Emergency Physicians is also opposed to these rules.

Our setting in Emergency Medicine is unique in that we treat patients with acute conditions on a daily basis at a fast pace that is episodic, chaotic and time demanding. These requirements are onerous in our setting.

When we do write for opiates or benzodiazepines in this acute setting, they are for smaller doses and fewer numbers of pills than our colleagues utilize in private practices and clinics. It has been shown that our setting is not responsible for the large numbers of these types of medicines being prescribed.

However, we definitely do selectively use the Prescription Monitoring Program website on a frequent, as needed, and case by case basis. This is appropriate, as some of our patients clearly do not have an acute condition and some are clearly in our departments inappropriately seeking prescription medications. Please consider exempting Emergency Departments from these proposed rules.

Dr. Lawrence Leak
Past President MSACEP

*Here is the nutshell version of the proposed regs that have drawn so much controversy:

1. Narcotic prescriptions must be limited to seven days for non-cancerous acute pain.  The patient must see the physician again to obtain a prescription for another seven days.  This includes patients recovering from major surgeries.

2. All physicians must run a PMP (Prescription Monitoring Report) on each new patient and every three months afterwards if the patient is prescribed controlled substances.  This includes patients suffering from non-cancerous pain or psychiatric conditions.

3. Rule 1.7 (K)  Point of service drug testing must be done each time a Schedule II medication is written for the treatment of non-cancer pain…..

There are other changes that are covered in the December 7 post but these are the ones addressed by the letters published in this post.

 

Filed under: General Problems