The Mississippi Society of Orthopedic Surgeons futilely protested the opioid amendments proposed by the Mississippi Board of Medical Licensure. The Board passed the amendments earlier this month. Society President Dr. Kurre Luber said the amendments would violate federal guidelines and force patients to suffer needlessly. A copy of the letter was obtained through a public records request and is posted below. Dr. Luber minced no words in addressing the Board:
On behalf of 140 orthopaedic surgeons providing quality care to patients throughout our state, the Mississippi Orthopaedic Society (MOS), has reviewed the recently approved changes to the MSBML Proposed Changes to Prescribing Regulations. While the MOS shares concerns regarding the misuse and abuse of opioids, we have significant concerns with these regulations as currently written due to the excessive and unrealistic administrative burden these changes would make to our clinical practice of medicine. The measures proposed are not in alignment with the currently accepted prescribing guidelines and practices as established by the DEA and are not in the best interests of our patients.The Society provides more reasons in opposing the opioid amendments.
*The Board wants to limit patients who suffer from post-surgery pain to seven-day opioid prescriptions and a seven-day refill. The orthopedic surgeons took strong issue with this proposed mandate:
A significant number of post-operative patients require weeks to several months of narcotics after invasive surgery to recover. Federal regulations require that Schedule II substances cannot be called into the pharmacy, which requires a prescription to be directly provided to the patient. This will require weekly prescriptions to all active post-operative patients requiring narcotics. This places an excessive and unrealistic administrative burden on the clinical practice of medicine. This is not in accordance with the current common practice of narcotic prescribing or recommendations of the DEA as referenced from Section V of the DEA Practitioners Manual which states the following concerning Schedule II substances "While some states and many insurance carriers limit the quantity of controlled substances to a 30 day supply, there are no specific federal limits to quantities of drugs dispensed via a prescription".*Forcing doctors to review the PMP (Prescription Monitoring Program) each time an opioid is prescribed will place "an excessive and unrealistic administrative burden" on practicing medicine. Numerous physicians have stated this requirement will add an hour or more of labor to their individual practices each day. The Board also wants physicians to print out an annual PMP report and keep separately at the office for inspection even though the state already has this report.
*The opioid amendments decree that doctors will prescribe the lowest effective does of "immediate release opioids" and are not able to provide long-acting opioids. This amendment is apparently in direct conflict with federal law. The letter states "As a DEA schedule II registered prescribing physician, this is in direct violation of my Federal
prescribing rights to be denied by the state from judiciously prescribing long acting opioids. It is not appropriate for the MSMBL to dictate what Schedule II substances a physician can provide if appropriate licensed with the DEA."
The Board discussed none of these concerns at the December 15 work session when it approved the amendments.
Earlier posts
Bomgar on opioids: We have a death problem, not a prescription problem.
"Stop the nonsense. Talk to real doctors." (Letters)
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)
Kingfish note: So that makes it the Orthopeds, the State Health Officer, a State Representative, numerous doctors all opposing these new regs. More letters and emails will be posted.
Didn't see this in the media, did you?
25 comments:
Jackson Media=Fake News. Thanks for telling the real story.
Has the Secretary of State’s website posted this for the 28 day public comments window yet? I’ve searched but cannot find the link if it is posted. Who else can we, as the public, complain to that has authority to change/influence this? The limits scare me but the part about making it illegal to prescribe opiods and benzos to the same patient is insane. Many patients with chronic, long-term pain obviously suffer from anxiety as well. Why should someone have to suffer because they were in the most unfortunate situation in life to have an anxiety disorder and to get hurt or have surgery at the same time? We are already one of the poorest states in the nation, why are we trying to artificially inflate medical costs here higher with excessive doctor’s visits and tests???
I do not live in Mississippi but my State is not passing rules such as this.Why is this State??
These restrictions exceed the board’s regulatory authority and deal with matters that are reserved exclusively to the legislature. Is anyone gearing up for a legal challenge?
The Board discussed none of these concerns at the December 15 work session when it approved the amendments.
Hell Kingfish. In the video you posted the Chair mentions that the Board was meeting for the first time as the full board to discuss the mess they are hell-bent to create.
This is a larger dictatorial takeover of medical care in Mississippi than Obamacare ever attempted. All the Mississippi Republican lip service about not allowing Obamacare to insert governmental regulations and bureaucracy between the doctor and patient is laid to waste by these regulations.
Does it really surprise anyone that doctors oppose any regulations on opioids?
Sort of cuts into their wallet. With so many doctors owning pharmacies any regulations are bad for business.
One would hope. I was seriously injured in an industrial accident a few years ago and when I got out of the hospital I was on opiod prescriptions for fully ten months, stepping down in the last couple of months as the pain allowed. No problems getting off the meds due to monitoring of their use and a plan to avoid problems. Some injuries do require these levels of narcotics to alleviate severe, long lasting pain. And what of someone who had injuries worse than mine, and the pain becomes chronic? Tough it out? Ever had a rib broken? Multiple ones? That pain scale at the doctors office is a relative thing according to your experience, believe me, and is something addressed best by people who have experience dealing with it.
2:05pm....sort of like the board president standing to gain a financial windfall from the passage of this and the use of the detox shot? like that?
There are other options to prescribing oral opioids. Not saying it's the only answer, but there are ways to reduce 650,000 prescriptions written every day.
https://www.fool.com/investing/2017/04/19/can-pacira-pharmaceuticals-exparel-reduce-opioid-a.aspx
"Sort of cuts into their wallet. With so many doctors owning pharmacies any regulations are bad for business. "
"so many doctors"? You're lying, and we know you're lying.
After practicing for 28 years I have NEVER met a doctor who owned a pharmacy. "So many" my gluteus maximus.....
I am a long time career pharmacist and I agree these regs place undue hardships on patients and their physicians. However, with opioids, the national trend will go towards more restrictive prescribing to some extent. Under these provisions, all providers will suffer for the sins of others. Not the best written policy for sure. Of course the trial lawyers will start making much bank from prescribers, pharmacies, distributors and opioid manufacturers secondary to the national opioid holocaust and some are trying to stay ahead of it. The barn door was left open too damn long...
I'd like to see some facts as to what kind of doctors have over prescribed. I'd bet you would find OBY/GYNs.
It's easier to get it on the street now, just wait until these regulations go into effect. There are going to be more Lil white boys and girls going to rehab to avoid jail.
I thought republicans want to get government out of our lives.
hey@ 2:05
DO YOU HAVE ANY EVIDENCE TO SUPPORT YOUR ASSERTION that many doctors own pharmacies and are reaping windfalls from prescribing opiods? I have practiced in MS 28 yrs and know of NO physicians who are owners in pharmacies (esp since most are now large chains). These regulations will only harm the majority of pts requiring opioid legitimate prescriptions. Should be very easy to track who prescribes the majority of prescriptions and how many pills per prescription, etc to determine outliers for much more scrutiny and review. I can tell you I will no longer prescribe for my cancer pts suffering in pain and refer them to their other doctors.Maybe providing the home and cell phone numbers of the assholes on the board just as Dr Easterling and Brunson who devised this miess would provide some appropriate karma...
7:37 pm
Lawyer here.
Represented several pharmacies against doctor co owners.
Doctors own shares of entities which own parts of pharmacies.
Doctors even cut out sales reps inserting their names in chain to make more money.
You don’t know every doctor or every pharmacy I’m afraid.
Also....doctors own parts of rehab facilities too.
You’ve not been hanging out at the club And working I bet.
Good on the Ortho docs for standing up to these opiod restrictions. They know a little something about pain.
As far as a doc owning part of a pharmacy? So what ! Good for them.
I feel sure most who have an interest in this thread have seen the words "undue pain and suffering". This will be the core of the legal argument against these regulations. The members of this board are either sadists or fools. If they want to see people leave the state in greater numbers than they are already leaving then tell them in the pre op meeting for the hip replacement, "oh by the way I can only treat your pain for 7 days so you better be back on the tennis court by then!
After reading his letter twice, my take is he's just bitching about 'administrative burdens' and couching that complaint carefully in a fog of patient care.
Each time I've had back surgery (and knee) several follow up visits were at no charge; however, with a recent surgery by an ortho on another body part, he charged every damned time I went back for his required, scheduled followup for four months.
The administrative burden only applies to those visits that are not charged, probably, so they will start charging for every visit. That should 'ease' the burden. But, it will cut into the ability to see new patients who need high-dollar surgeries.
The board must be fools and so are those of you who don't understand that the addict or his parents have responsibility if any prescription is not taken as directed. The patient and the parent are also supposed to advise the doctor if pain continues beyond the follow up visits. Something else could be wrong dummies.
No law can fix stupid but apparently stupid can make laws.
Easterling started this whole thing to benefit himself. He got his ass whipped in the election - that tells you what the people of Vicksburg think of him. He carried one box and the vote was 12-11. If I were Easterling, I would stay away from the Capitol from now on!
Finally, a sensible post has risen from this fog like a smoke-puff over the Vatican (not that those are sensible).
Amongst all the bullshit, hype, self-serving diatribes and accusatory blabberings, 1:47 has suggested something very important and that is this: These people have exceeded their authority and this crap will not stand.
Have three different doctor clients (I'm a financial planner) who own pharmacies. Don't know if that's directly related to this issue, but it's certainly not rare for physicians to own pharmacies in MS.
Doctors owning pharmacies is common. I have known doctors that had to own the pharmacy because they gave out prescriptions like candy and no other pharmacy would fill them.
They had the people coming and going. A doctor's visit got the prescription for what ever you wanted and had to be filled in their pharmacy.
Very common here in Mississippi and many other states.
99.5% of doctors do not own a pharmacy. Give it a rest.
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