Wednesday, December 27, 2017

Bomgar on opioids: "We have a death problem, not a prescription problem."

State Representative Joel Bomgar (R-Xanadu) told the Mississippi Board of Medical Licensure last month that cutting off opioid prescriptions will kill more Mississippians. He said Mississippi ranked in the top five states for opioid prescriptions but in the bottom ten states for opioid overdoses.  He said over 200,000 Mississippians use opioids yet little provision was being made for them once the Board's opioid amendments become law.

Users would switch to either "street drugs or injection drug use and they are going to start dying."  Mr. Bomgar said that opioid deaths have risen while opioid prescriptions have fallen since 2010.  When the number of prescriptions "stayed flat, opioid deaths stayed flat."  His presentation to the board (posted below) stated:

After 2010, there is a near perfect but opposite correlation (-0.99) between the DECREASE in opioid prescriptions and the INCREASEin overall opioid deaths. The correlation is so incredibly close it is eerie. Prescriptions go down, deaths go up. Almost in exact mathematically-mirrored lockstep. With a negative correlation that is that close, you could predict the death rate in future years just by knowing the rate of prescriptions for a given year and forecasting the opposite of that in deaths....

"Supply controls" are killing 4 times as many lives as they are saving. In the absence of universally available Medication Assisted Treatment {MAT) -which all states severely lack, rather than saving lives, our policies are now killing three additional people per 100,000. It is true that one (1) fewer is overdosing on prescription drugs but now four {4) more are overdosing from Heroin or Heroin+ Fentanyl. And in fact, the person who we think we are saving is probably just overdosing on street drugs, so we are not even saving that person....
Thus the lack of a safety net for the addicts means more will die when their supply is cut off.  He said Board regulations prevented physicians from using opioids or other drugs to wean users off of drugs or work towards a solution with the patient.  The state lacks the facilities to handle the users who will be cut off if they seek treatment.  He said "they are about to be pushed off of a cliff and we have no safety net."    He said in every state where the supply was turned off, "overdose deaths spiked from that year forward."

The State Representative argued that "we don't have an opioid abuse problem" until prescriptions were reduced in 2010.  Opioid overdoses fell in 2009 and 2010 and then rose in subsequent years.  The death rate fell in "three of four years leading up to 2012."  He said heroin and fenatyl deaths rose at four times the rate of opioid deaths once the opioid prescriptions began to decrease.  "We essentially traded one death on opioids for four deaths on heroin and fentanly," Bomgar said.

Several heads in the audience shook their heads in agreement as Mr. Bomgar addressed the board.   He said that West Virginia showed what would probably happen in Mississippi is the Board has its way.  Mr. Bomgar claimed prescriptions fell 53% while opioid deaths skyrocketed 243% in that state.  He said "We have a death problem, not a prescription problem."

The  State Representative's address echoed comments made at the same hearing by State Health Officer Dr. Mary Currier.   JJ reported on December 12:

Mississippi has a high prescription rate compared to the rest of the country but actually has a low death rate as well "although I know it doesn't seem like that every day."   She expressed her concern about the proposed rules creating "unintended consequences."  "There is a large group of people who are already addicted," she said.  Dr. Currier said over 200,000 Mississippians had opioid prescriptions that were over 30 days.

Dr. Currier is worried that suddenly cutting off the prescriptions to opioid addicts will cause opioid deaths to skyrocket as many will get more deadly drugs from the street.  "We will also have more HIV and Hepatitis C out the wazoo," she said.

She pointed out to the medical board that opioid deaths have risen nationwide as opioid prescriptions have been reduced.  Dr. Currier predicted that cutting off opioid addicts in Mississippi without a plan for their treatment will cause more opioid deaths. Earlier post.

Earlier post on Board of Medical Licensure's opioid amendments
"Stop the nonsense. Talk to real doctors."  
 It would be nice if we could do this behind closed doors.
 Medical Board approves opioid regs with little notice.
Never let a good crisis go to waste.  
Board of Medical Licensure calls meeting yesterday to discuss opioid regs tomorrow.
State Health Officer warns of unintended consequences    
Doctors on proposed opioid regs: "dangerous", "Ill-conceived", "idiots" (Letters)
How much pain will proposed opioid regs create for doctors?  (Regs analyzed)
Can medical weed fight opioids?  
Opioids prescription: Mo' taxes, mo' spending, mo' jail (Gov.'s task force report)


Anonymous said...

I can't understand this report, and I am pretty sure I am a lot smarter than approximately 98% of those in the legislature. You need to really dumb it down if you want to reach them.

Anonymous said...

Poor Joel is trying to use facts and logic on politicians and bureaucrats.

Anonymous said...

I understand the "report" easily. While it supposed that correlation is cause, it does utilize factual assumptions more than the board's actions do.

We have an "opioid" epidemic that has increased since the time when prescriptions for opioids started decreasing, so the idea that decreasing prescriptions is likely to increase the "epidemic".

The problem is that someone decided to lump everything together. Every death considered an "opioid" death, because that is what this is supposedly about, should be categorized. The over-riding theme that someone gets "hooked" on opioids by prescription and then has to resort to street drugs is a minor portion of the whole thing, but it's that minor portion that is driving change for everyone.

It's the whole "make changes that affect everyone under the guise of helping the few"

Anonymous said...

In this case, wouldn't more deaths be a GOOD thing? Once people are addicted, their lives are ruined, and their family's lives are ruined. Wouldn't more deaths mean a lessened burden upon this, the poorest state?

I suppose that the Mississippi branch of Big Pharma, is afraid of losing customers...

Anonymous said...

I heard that Rep. Bomgar argued for increased Mental Health funding.

Anonymous said...

Still waiting for Rep. Bomgar to help build a stronger coalition for medical marijuana. The elephant in the room that none of these half-brained pols want to even consider.

Anonymous said...

11:43 YES! Legalize marijuana, and you can manage the opioid problem, if not eliminate it.

Anonymous said...

Regulation without [adequate] representation. 10:57 is evil. Needs to go work for Kim Jong Un.

Anonymous said...

Joel sees issues as black-and-white, and often they're shades of grey. I often don't agree with him.

However, on this issue, he's right.

If you can't follow along the e-mail, just look for the red and green highlights.

The crux is this: there is a mathematical certainty that the board's actions will lead to more Mississippians dying at a rate of 4:1 over regulations that allow doctors to be doctors and provide pathways to getting folks medication and behavioral health for addiction.

For every 1 patient you 'save' with tightening control of Opioid prescriptions, you lose 4 who move to street drugs.

Anonymous said...

Ah, yes, marijuana. The solution to all our problems.

Anonymous said...

The drug cartels are likely already pushing more product to MS to fill the demand that's coming.

Anonymous said...

I'm not a doctor, so my example may not be accurate. I have been following this thread on JJ. I would honestly like to know the answer to a couple of questions. This is a tough subject.

The basic assumption for my questions is that a Dr., such as Dr. Hosemann, prescribes his knee replacement patient a 60 day supply of an opiod and the patient has the prescription filled an goes home to recuperate.

1. If the patient takes the medication as prescribed for 5 days but his pain continues. The patient decides decides to double his intake of pills. Then, it's going so well, the patient decides to double his intake again after 10 more days, and he runs out before the 60 days is up. When he calls the Dr. for more pills, does the Dr. give him another prescription to "prevent him going to the street?"

2. Same as 1, but what is Dr.'s responsibility to this "addict" after the standard 60 day prescription is gone? If the standard of medical care is a 60 day prescription and no more does the fact that Dr. recognizes his patient is addicted allow him to prescribe more or does the Dr. become responsible for his detox?

3. If the patient's daughter steals 30 days of the supply and she overdoes, is the Dr. responsible for the opiod death?

4. If the patient's daughter steals all 60 days of the supply and gives them to her friends, does the Dr. have to write another prescription to the patient and does the Dr. have any obligation (per Mr. Bomgar) to prescribe opiods to the thief or his friends to avoid an opiod death?

5. If the patient can get by without using the opiods, does the patient have any responsibility to return the excess to the pharmacy, or may he sell/give them to friends? Yes, I know it's a felony.

6. If the patient doesn't use any of the opiods but returns for his 60 day post op visit and tells the Dr. that the pain continues, and the Dr. writes another opiod prescription for 30 days. If a drug test would have shown the patient was not taking the drug precribed, would the Dr. be involved in a conspiracy to sell a controlled substance?

How would the Board's regulations would deal with these issues.

What is Mr. Bomgar's solution?

Anonymous said...

i suggest you all do the same as i did recently with my 20, 18, and 15 year old kids. i prepared them for their first brushes with heroin because it will happen. i was no angel and saw and did a lot coming up. HOWEVER, i never crossed paths with heroin because it was so taboo and never around. this next generation of kids won't be so lucky. thanks to these dip shits, as 1:58pm said, the cartels are already loaded up and ready to flood the market. the coming demand will start the tap flowing freely, which will of course make its way to the recreational scene and our kids. unlike so many of the lies told to scare kids away from drugs, what they say about heroin is true. the first time may be the last, especially with the introduction of fentanyl into the mix. so yes, 4 to 1 increase in death is likely, but introducing our youth as part of the stat needs to be contemplated as well. odds are that the certainly coming blood on the hands of these dolts will be tainted with that of school kids who would have never gotten the chance had these guys let doctors doctor.

so, as i said, go warn your kids, because within the next year, odds are they will now be exposed to heroin/fentanyl. aren't unintended consequences grand?

Anonymous said...

5:00 PM, If you've waited to indoctrinate your kids against drugs, until they're 20, 18, and 15, then you've waited WAY TOO LATE.

Those sorts of talks should have started before your kids were out of PRESCHOOL. And why, considering your "not an angel" past, which apparently included extensive drug "experimentation", did you conclude that it was appropriate for you to bring children into this world?

Anonymous said...

My back has been bothering me.

Anonymous said...

Any death to an overdose is a preventable tragedy. And we should try to prevent those deaths. However, this issue, at least in Mississippi, is more the pet political project of John Dowdy and now-defeated State legislature candidate Dr. Randy Easterling than it is a proportionately measured response to the actual problem. Dowdy kicked off this opioid panic with his trademark hyperbolic “the sky is falling” and “I’m John, Jesus Christ / Wyat Earp, Dowdy and I give a great press conference” ego trip. He quickly backed off his initial threats to go after doctors who had patients die from an overdose after having the absurdity of that threat thrown in his face. The fact is, Bomgar and Currier are correct about the comparatively low death rate in MS. Just look at the number of opioid overdoses per year (as calculated by Dowdy, not the Dept. of Health) to the number of car wreck deaths in MS per year. Car wreck deaths far exeeed the number of opioid overdose deaths here. That stat is reversed nationally, and has been used as a rallying cry in places that are exprriencing a true epidemic of opioid deaths. The “super pandemic” Dowdy claims is coming to MS just isn’t happening here. (BTW Johnny, in order to have a pandemic, the outbreak has to spread to more than one Continent. Pretty sure that means we can’t have a pandemic in MS, much less a “super” one.) I’m afraid the results of this solution won’t be nearly as positive as the prescription requirement for pseudoephedrine was on clandestine meth labs. I hope Bomgar is wrong for everybody’s sake.

Anonymous said...

Man 7:35pm, you sure did add a lot to 5pm's comments and who the hell made your pretentious ass the decider on who should and shouldn't breed according to how much they partied growing up. What a fucking tool you are. I see no mention of the extent of his lack of angelic behavior, nor do I see any statement that would make one think he had never spoken to his kids about drugs before now. I see that he has recently made his kids more aware that heroin is coming (because it has never been common around here and therefore a true immediate and often quickly deadly concern) and the serious dangers therein. You have a severe reading comprehension problem and a most likely incurable case of assholery.

Anonymous said...

"I understand the report easily, correlation is not cause and assumptions will drown out your engine".

How about a little appeal to authority mixed with a good measure of arrogance.

"The rest of youpretenders and plebes are not quite as smart as I am and, for you, I have mixed the purple Kool-Aide."

Anonymous said...

why are people so lathered up over this issue? overdosing and dying is what junkies do. its part of their lifestyle and an inherent risk they take when they decide to become junkie. this i not some sort of contagious disease like whooping cough or influenza. this debate reminds me of when dale earnhardt was killed in a auto racing accident. everyone walked around sayin 'i cant believe he is gone'. well when you get in a racecar and hurtle around a track at 200mph with 50 other cars doing the same thing , one can get dead. if people want to OD thats their business.

Anonymous said...

4:27 pm I'm taking you at your word.
You have shifted responsibility away from the person to whom it belongs now, the patient.
You are assuming the patient can't take the dosage properly and notify the doctor if the medication is not working.
You are assuming the patient can't secure his medication or notice that pills are missing.
If the patient notices pills are missing, he needs to find out who took them, and deal with his family/friend problem and report the theft to the police. Indeed, making clear to your children old enough to steal pills that you will call the police can be a deterrent. You can also start drug testing your children. There are kits you can buy for that.
Frankly, the patient/ parent should know enough about symptoms of drug addiction and his child to take extra measures to prevent access long before that parent is prescribed an opiod. There's information out there and parents should be informed before their children reach puberty.
You should also know enough about addiction to inform your children of the dangers and risks long before they leave the house without your supervision. There are books with age appropriate guidance on how to do that.
You also need to count your pills when you fill the prescription. I did that in caring for my father and learned he was being shorted in the pharmacy and it was an employee problem that the pharmacy quickly discovered after I reported the problem to them.
You can't control other people, only yourself. Your doctor will try to help if you have the problems you describe, but you have to inform the doctor and the pharmacists but they are limited in what they can do if you can't deal with your own family members.
By the way, insurance companies have shifted more responsibility to the patient by reducing hospital stays. Just a few decades ago, patients wouldn't have been released while still on meds that needed to be monitored and when infection was still a risk if the doctor didn't have certainty the patient and his caretaker could monitor themselves.

Anonymous said...

7:57 am There is a cost to society. It drives up medical and emergency costs as well as crime.
And, the fact is that addiction is starting before the " junkie" is old enough to make an informed decision and once on " junk" is incapable of making an informed decision.
Dale Earnhardt made an informed decision and as a young person ,had adult supervision at every step. He also never got into a car where the seller had put in a defect that deliberately increased his chance of getting killed.

Anonymous said...

The only person to blame for an opioid habit is the person taking the stuff.
No one is forcing them to take it. They have to put some effort into it to get the drugs to begin with. They are the ones to blame for taking so much they become hooked on it.

Anonymous said...

to 9:05 am.......... you are just one more bleeding heart libtard who want to blame everybody except the person responsible. you just cant seem to strap on the concept of an inherently dangerous lifestyle .

Kingfish said...

Remember, we are talking about people who are suffering from medical problems in most cases.

What started this discussion is the Board of Medical Licensure decided to tighten up its opioid prescription regulations. Apparently, some readers have no problem with a patient who gets a major hip replacement surgery suffering without pain meds for several months after the 2 week supply runs out.

The State Health Officer and a State Representative pointed out that deaths will probably rise, which is ironic because Marshall Fisher and the Board claim, that is right, claim, they want to prevent deaths. But some of you want more to die and are happy if that indeed does happen.

Anonymous said...

On this and many other issues facing our state, Joel is the only adult in the room when it comes to our lawmakers and state officials. Mississippi would do well to elect more conservative-leaning libertarians who view issues with common sense. Joel should consider a run for governor in the future.

Anonymous said...

Senators Watson and Hill have been very vocal in opposing this ridiculous plan, as well. Mississippi is gaining another strike against it, especially for retirees who consider health care of the utmost importance.

Anonymous said...

It's difficult to take Bomgar seriously when he dresses and acts like a seventeen year old.

Anonymous said...

He's right, you know!

Anonymous said...

9:56PM, you sound like someone who's been a druggie since Seventh Grade.

I recognize the style. We had one of those in our family. When she finally died, the few people who attended her funeral, were unable to find anything nice to say about her, except, "Well, at least she didn't have any children."

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