Tuesday, December 19, 2017

Medical board approves opioid amendments with little notice.

The Mississippi Board of Medical Licensure approved several amendments to its prescription regulations to combat opioid abuse.  The amendments drew no small amount of criticism from doctors as they substantially change how they can prescribe opioids.    The Board approved the amendments on a unanimous vote even though the meeting was a work session. 

The Board met Friday afternoon with little notice.  The Board did not schedule the meeting until Wednesday.  It thus did not appear on the schedule of board meetings that is published once a year.  The notice was issued Wednesday afternoon.

The main changes to the current regulations are:

*Doctors must not provide greater than a seven day supply for acute non-cancer pain. Licensees may issue an additional seven day supply if clinically necessary. Rule 1.7 (H) A discussion took place on expanding the restriction to ten days for each prescription but no vote was taken.

*Every doctor, regardless of specialty, must use the PMP upon "initial contact with new patients" and every 90 days afterwards for patients who receive controlled substances.  Many doctors protested  this amendment as they argued it would add an hour of paperwork to their daily practice and keep them from seeing patients.  Several told the Board it takes more than 15 minutes to run a PMP report.  The board rejected their arguments and kept the amendment without change.

* Point of service drug testing must be done each time a Schedule II medication is written for the treatment of non-cancer pain (Rule 1.7 (K)).  Drug testing must be done every 90 days for patients prescribed benzodiazepines for chronic medical and/or psychiatric conditions as well.  This amendment generated the most debate.  Board member Dr. Ken Lippincott pushed hard to exempt psychiatrists from the new regulations.  However, Dr. Randy Easterling said he opposed the exemption.   Dr. Claude Brunson moved to exempt the shrinks but the motion died on a 5-4 vote (1:40:30).

*Prescriptions for Benzodiazepines  must be limited  to a one (I)  month supply with no more  than  two (2)  refills. The   MPMP  must  be  checked  each  time a  prescription  for Benzodiazepines is authorized  and evidence of such check  must be noted  within the patient file.  Rule 1.10 (H)

The amendments also changed the regulations for pain management practices, bariatric medicine, and chronic pain. See earlier post for more information about these changes.

The Board approved the amendments on a  unanimous vote (9:00 in second video).

The amendments will be posted on the Secretary of State's website for a 28-day public comment period.  The Occupational Licensing Board will review the amendments.  The Board meets every three months.  The amendments will return to the Board of Medical Licensure if the Occupational Licensure Board makes any changes to the amendments.   The amendments passed Friday have not yet appeared on the Secretary of State's website.

Kingfish note: Several board members made it quite clear that they were not happy discussing these amendments in public.   They seem to have forgotten that it is they who serve the public, not the public who serves them.  The rushed meeting with no notice of a vote taking place is very troubling.  Many emails and letters were submitted to the Board by Mississippi physicians that were overwhelmingly against these new regulations. 

Dr. Easterling defended the Board in an impassioned speech (37:12 in second video):

There seems to be a disconnect and I continue to be amazed by this that someone derived from these rules and regs that you could no longer write for opioids.  There is nothing in this that prohibits the responsible, evidence-based writing of opioids for legitimate pain. If asking someone to jump through a few extra hoops prevents them from doing it, shame on them....  There are things you do and we arrived at this epidemic in large measure because the writing of these medications in large number unnecessarily has resulted in the number one public health crisis in this country. So what this board and other boards across the country, and don't think for one minute we are the only board doing this, what we are saying is if you want to treat chronic, non-cancer pain with opioids, this is what you must do under certain circumstances. If you do it, fine, keep doing it, but people don't want to hear that.  People want to hear that this board is stopping you from doing something. There is nothing in here that says if someone comes into the emergency room you can't give them dilaudid or morphine. There is nothing that says if you have a total hip, you can't go home with 20 days and if you need more, go back to your doctor for another 20 days. I just think my experience in dealing with this for the last year or so a lot of the comments that are being made in the press and otherwise are irresponsible, they're not what we are saying,  and we just ought to stand up and tell the truth.  We just ought to say what the rules say and let it be.  If a doctor decides they are not going to follow the rules and let their patients go without treatment for chronic pain, that is unfortunate, in my opinion.  
All JJ is doing is posting the regs.  Any coverage is based on those regs. 

29:30: Rule 1.7 discussion begins.  7-day limit for opioid prescriptions for acute, non-terminal pain.
1:10: Discussion on drug testing.
1:12: Discussion begins on exempting psychiatrists from drug testing requirements (Rule 1.7(K)).  


Anonymous said...

Didn't Easterling run for the legislature and get stomped? Highly qualified to be authoring regulations, isn't he?

Anonymous said...

As a person who can personally testify to the effects of the "opioid" prescription limitations, I applaud the restrictions put on the medical professionals. This addiction is insidious and does immeasurable harm not only to the "druggie" but also to the person's family, friends, and others with whom they come in contact. Pain relief is one thing but prescribing drugs that are sure to keep the patient returning over and over again forever is sinful.....I have been there....I know!!

Anonymous said...

its somewhat ironic that law enforcement has been a big force in this farce to limit doctors' authority to prescribe medications. the same law enforcement that has brilliantly waged the war on drugs for the last 40 years with seldom arresting and imprisoning major traffikers. the same law enforcement that has seldom investigated, arrested, and convicted the slim percentage of doctors intentionally fraudulently over prescribing pain meds simply for profit. it seems law enforcement wants to deflect attention to its failings and redirect fault to 100% of doctors, not just the small percentage of quacks overprescribing.


Retired Law Enforcement Official

Anonymous said...

Get ready to see a boom in heroin usage and overdoses in 3...2...1....

Anonymous said...

Did Dr. Randy Easterling say Sickle Cell was not a chronic pain illness?

Anonymous said...

1:45 - The fact that you fell out of the boat is no reason for the government to require two foot rails around the perimeter of all fishing vessels with motors exceeding 9.9 hp.

Anonymous said...

I went to an orthopedic clinic here recently in the metro and surgery was recommended. In addition to getting clearance from my insurance company, the clinic wanted to know if I would be willing to buy my opioid prescription from them following my procedure. I declined. But it certainly points to what part of the problem may be.

Anonymous said...

UAB ain't that far and they have a great medical school with clinics. They will also fill your prescription before you leave.

Anonymous said...

Take a look at the news coming out of Memphis. Pharmacies are being robbed on an almost daily basis. It won't be long before it happens in the Jackson area. These types of regs don't stop crime. They make the crime of stealing opiods that much more lucrative. When MeeMaw has to turn to street pharmacists for her pain meds, the crime will increase.

Anonymous said...

The civil forfeiture profiteers are revving their engines. More addicts, more black market drugs, more people’s stuff to seize.

Anonymous said...

I'm sure Dr. Easterling's large and lucrative Suboxone (a medication used to maintain opiate addicted patients) practice will in no way benefit from these prescribing rules.

Anonymous said...

Dead on, 5 pm. I am chronically ill. I may go 2 years without severe enough pain to need prescription pain meds, but when it happens, it may last a month or two. I currently need a joint replacement that I won’t have in this state. I also have children who need medication, one of whom always will. Between the onerous state income tax burden we shoulder as a Mississippi based LLC with projects in multiple states at all times, where we often pay heavy taxes, as well... My husband said last night that the tax issue is only a problem in really good years, but 2017 has been one. We are currently looking at our options for relocation. We built our business from nothing, 20 years ago. Twenty years of paying taxes in this state. Almost every year, we paid income tax on $350,000-800,000. We are done contributing to this stupidity. My children and I have to jump through more hoops than a chronically ill person has the time or money to do, just to get medical treatment. None of us take opioids, except for surgery or rare flares that I have every few years. I take a medication that falls under this, as well as two of my children. I spoke with a legislator who told me, before I mentioned my anger, that many who are on the fence about leaving the state will do so, according to talk amongst their constituents. I run a profitable business, I am getting old, I have health problems and my suffering will only increase, under these laws. Guess my loss will be the the drug testing companies, suboxone clinic owners and drug cartels’ gain.

Unknown said...

The Mississippi Prescription Monitoring Program is a great tool only if the pharmacies upload the info. Also, The MPMP website does not always list every person.

Anonymous said...

This is like the GOP tax bill, when folks find out what it really does, good bye current office holders...

Anonymous said...

3:28 - I've used New South Neuro Spine (Flowood) several times for back issues, including bilateral disc surgery. On a number of occasions, I've had prescriptions written with the option of having them filled right there in their pharmacy on the ground level. Nothing was required - only a convenient option. And the copay for opioid pills is about seven cents apiece. So what are you bitching about?

Anonymous said...

Suboxone is a drug that the treatment industry has been pushing for 10 years.. It was never meant to be used as a maintenance medication, only a detox drug. But wait, in 2016 the ASAM was finally recognized as a real board and syncophants like Randy and the rest of the addiction community have made a push to essentially make writing pain meds a crime. The recovery crowd has even been sending educational experts to doctors offices about the need for suboxone. The new idea is that opiate addicts were born that way and have insufficient amounts of internal opiate molecules (endorphins) and dysfunctional receptors, and pain meds make them feel normal so write suboxone instead. This of course along with all the ASAMs literature is complete pseudoscience and religious hogwash. Don’t believe for a minute anything these fools tell you as they only got inducted as a legit speciality by getting enough brainwashed doctors in recovery on boards to get their bullshit accepted. The recovery crowd has done much to ruin this country all in the name of good. The road to hell is always paved with good intentions.

Anonymous said...

Pmp is also watched by law enforcement so if they think you are doctor shopping or get too much pain medication they will pay you a visit.

Anonymous said...

These regulations are far overreaching the opioid epidemic they're supposedly for. If the regulations dealt strictly with pain management that would be one thing, but they do not. Sensible changes don't seem to be an option for the rulers of our great state.

Law abiding tax paying minions need to just shut up and comply, endure the impending outbreak of heroin overdoses, or just move out of state. Like sudafed. Nobody in charge gives two cents about what these proposed regulations mean to non pain med seeking law abiding citizens.

Anonymous said...

I am so glad that government has finally stepped in and instructing my doctor how to treat me.

You Couldn't Be MORE Wrong said...

This is like the GOP tax bill, when folks find out what it really does, good bye current office holders...

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AT&T was quick to respond to news of U.S. tax reform, announcing it would give some employees bonuses once the legislation is signed into law.

The telecom giant said in a press release Wednesday that it would give more than 200,000 of its U.S. workers **who are union members** a special bonus of $1,000. The company also increased its capital expenditures budget by $1 billion in the U.S.

Anonymous said...

Maybe Mississippi should just legalize medical marijuana... the Opiod addicts could just get a bong instead... The Chronic pain crew could just supplement ibuprofen with a few tokes.. Problem solved.
You're Welcome.

And I hope all of the participants of the Jackson Jambalaya thread have a very Merry Christmas !!

Anonymous said...

KF won’t post crap I write. I’ll know boycott your site. I only provided street prices astronomically increasing due to opiod amendments.

Anonymous said...

9:24, he wouldn’t post mine either! Woah and I loved this site..damn KF? C’mon man? I even read your site almost every morning and I live in FL now!!

Kingfish said...

Weird. I just went back and approved a bunch. See if yours was one. A bunch were in spam filter and others I thought I had approved them.

Anonymous said...

Good morning KF, I have posted multiple times in which you have approved, so thank you! But one is still missing. Last try here. I am in no way trying to support, condone, advertise, etc anything! I simply aim to inform the state I care and love.

As 9:24 said, my post simply shedding light on the other side of the fence (street prices and situations quickly developing with heroin/suboxone in Jackson and EVERYWHERE else in MS because of these “amendments” was not posted).

I’ll take time out again and write it. Please post.

I’m worried about our state genuinely. Worried for those who actually need pain medication. Worried for my family members and friends who work/own pharmacies. Worried about violent crime because BIG money is coming here in the form of “rehabs, suboxone, and heroin). ONE 30mg Roxycontin used to be $30 on the street. One Loratab 10/325 or ONE Percocet 10mg used to be between $7 and $10 on the street. ONE PILL. Triple those prices, IF you can even find someone who has them now.

Unfortunately I still have a friend who procures and despenses said wares (no I don’t condone his actions and I pray fervently for him a lot) but....I called to ask him about this whole ordeal..

His response is beyond frightening. Yes opiod pill prices have skyrocketed but he said that’s old news as of ONLY a few days ago. He said the state is now full of extremely high grade heroin and for $150 you get half a gram. $300 a whole gram. Pure.

Folks, fellow Mississippians, this is no coincidence. Little Detroit, systematic destruction of Jackson, “opiod amendments”, Suboxone, clinics, a huge influx of high grade heroin, and greedy “doctors/lawmakers”.

Terrible “amendments” doesn’t even begin to describe what’s about to happen here in the Magnolia State. I bought my sister who is a pharmacist a judge for her car and a governer for her purse. Lord protect our medical staff on the side of despensing pharms. Robberies abound.

Good day KF and Jacksonians I am back off to my new home state of Florida. Y’all are in my prayers.

Kingfish said...

Sorry. Never saw this one.

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Trollfest '09

Trollfest '07 was such a success that Jackson Jambalaya will once again host Trollfest '09. Catch this great event which will leave NE Jackson & Fondren in flames. Othor Cain and his band, The Black Power Structure headline the night while Sonjay Poontang returns for an encore performance. Former Frank Melton bodyguard Marcus Wright makes his premier appearance at Trollfest singing "I'm a Sweet Transvestite" from "The Rocky Horror Picture Show." Kamikaze will sing his new hit, “How I sold out to da Man.” Robbie Bell again performs: “Mamas, don't let your babies grow up to be Bells” and “Any friend of Ed Peters is a friend of mine”. After the show, Ms. Bell will autograph copies of her mug shot photos. In a salute to “Dancing with the Stars”, Ms. Bell and Hinds County District Attorney Robert Smith will dance the Wango Tango.

Wrestling returns, except this time it will be a Battle Royal with Othor Cain, Ben Allen, Kim Wade, Haley Fisackerly, Alan Lange, and “Big Cat” Donna Ladd all in the ring at the same time. The Battle Royal will be in a steel cage, no time limit, no referee, and the losers must leave town. Marshand Crisler will be the honorary referee (as it gives him a title without actually having to do anything).

Meet KIM Waaaaaade at the Entergy Tent. For five pesos, Kim will sell you a chance to win a deed to a crack house on Ridgeway Street stuffed in the Howard Industries pinata. Don't worry if the pinata is beaten to shreds, as Mr. Wade has Jose, Emmanuel, and Carlos, all illegal immigrants, available as replacements for the it. Upon leaving the Entergy tent, fig leaves will be available in case Entergy literally takes everything you have as part of its Trollfest ticket price adjustment charge.

Donna Ladd of The Jackson Free Press will give several classes on learning how to write. Smearing, writing without factchecking, and reporting only one side of a story will be covered. A donation to pay their taxes will be accepted and she will be signing copies of their former federal tax liens. Ms. Ladd will give a dramatic reading of her two award-winning essays (They received The Jackson Free Press "Best Of" awards.) "Why everything is always about me" and "Why I cover murders better than anyone else in Jackson".

In the spirit of helping those who are less fortunate, Trollfest '09 adopts a cause for which a portion of the proceeds and donations will be donated: Keeping Frank Melton in his home. The “Keep Frank Melton From Being Homeless” booth will sell chances for five dollars to pin the tail on the jackass. John Reeves has graciously volunteered to be the jackass for this honorable excursion into saving Frank's ass. What's an ass between two friends after all? If Mr. Reeves is unable to um, perform, Speaker Billy McCoy has also volunteered as when the word “jackass” was mentioned he immediately ran as fast as he could to sign up.

In order to help clean up the legal profession, Adam Kilgore of the Mississippi Bar will be giving away free, round-trip plane tickets to the North Pole where they keep their bar complaint forms (which are NOT available online). If you don't want to go to the North Pole, you can enjoy Brant Brantley's (of the Mississippi Commission on Judicial Performance) free guided tours of the quicksand field over by High Street where all complaints against judges disappear. If for some reason you are unable to control yourself, never fear; Judge Houston Patton will operate his jail where no lawyers are needed or allowed as you just sit there for minutes... hours.... months...years until he decides he is tired of you sitting in his jail. Do not think Judge Patton is a bad judge however as he plans to serve free Mad Dog 20/20 to all inmates.

Trollfest '09 is a pet-friendly event as well. Feel free to bring your dog with you and do not worry if your pet gets hungry, as employees of the Jackson Zoo will be on hand to provide some of their animals as food when it gets to be feeding time for your little loved one.

Relax at the Fox News Tent. Since there are only three blonde reporters in Jackson (being blonde is a requirement for working at Fox News), Megan and Kathryn from WAPT and Wendy from WLBT will be on loan to Fox. To gain admittance to the VIP section, bring either your Republican Party ID card or a Rebel Flag. Bringing both and a torn-up Obama yard sign will entitle you to free drinks served by Megan, Wendy, and Kathryn. Get your tickets now. Since this is an event for trolls, no ID is required. Just bring the hate. Bring the family, Trollfest '09 is for EVERYONE!!!

This is definitely a Beaver production.

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Trollfest '07

Jackson Jambalaya is the home of Trollfest '07. Catch this great event which promises to leave NE Jackson & Fondren in flames. Sonjay Poontang and his band headline the night with a special steel cage, no time limit "loser must leave town" bout between Alan Lange and "Big Cat"Donna Ladd following afterwards. Kamikaze will perform his new song F*** Bush, he's still a _____. Did I mention there was no referee? Dr. Heddy Matthias and Lori Gregory will face off in the undercard dueling with dangling participles and other um, devices. Robbie Bell will perform Her two latest songs: My Best Friends are in the Media and Mama's, Don't Let Your Babies Grow up to be George Bell. Sid Salter of The Clarion-Ledger will host "Pin the Tail on the Trial Lawyer", sponsored by State Farm.

There will be a hugging booth where in exchange for your young son, Frank Melton will give you a loooong hug. Trollfest will have a dunking booth where Muhammed the terrorist will curse you to Allah as you try to hit a target that will drop him into a vat of pig grease. However, in the true spirit of Separate But Equal, Don Imus and someone from NE Jackson will also sit in the dunking booth for an equal amount of time. Tom Head will give a reading for two hours on why he can't figure out who the hell he is. Cliff Cargill will give lessons with his .80 caliber desert eagle, using Frank Melton photos as targets. Tackleberry will be on hand for an autograph session. KIM Waaaaaade will be passing out free titles and deeds to crackhouses formerly owned by The Wood Street Players.

If you get tired come relax at the Fox News Tent. To gain admittance to the VIP section, bring either your Republican Party ID card or a Rebel Flag. Bringing both will entitle you to free drinks.Get your tickets now. Since this is an event for trolls, no ID is required, just bring the hate. Bring the family, Trollfest '07 is for EVERYONE!!!

This is definitely a Beaver production.

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