Wednesday, January 31, 2018

Leading pediatrician questions opioid amendments

One of the leading pediatricians and experts on child development in Mississippi, Dr. Susan Buttross, questioned the opioid amendments that were later passed by the Mississippi Board of Medical Licensure in December.  Add Dr. Buttross to the ER docs, orthopedic surgeons, ob/gyns, pediatricians, and a plethora of doctors who oppose these amendments to the Board's prescription regulations.Dr. Buttross submitted this letter to the Board on October 17, 2017.



To whom it may concern,

Though I appreciate the need to gain control of the epidemic that is spreading across the nation and out state, and applaud your efforts to tackle this very important issue, as a practicing developmental and behavioral pediatrician for over 30 years I feel compelled to ask that you reconsider two issues.

1. Licensees are bound by new guidelines for prescribing any controlled substance (pg 25, at the top "those licenses who practice is not pain management...    all patients who are prescribed, administered, dispensed controlled substances”). These changes will require a huge amount of additional time for those pediatricians who treat children with ADHD. I implore you to think about the consequences of including all controlled substances. Stimulants that are used appropriately and at the doses for ADHD are not addictive and are medications that are often given throughout the child’s school career. The prescriptions are filled monthly and already, parents have difficultywith getting the prescriptions needed for their children. There are times that working parents cannot pick the medication up themselves nor can they always pick them up on the day the prescription was written.

2. Prescriptions may not be written outside of a valid licensee‐patient relationship (pg 41, Rule1.11, first paragraph and section “A”)

 Of great impact to pediatricians, a major concern is the changes that will take place with the prescribing of ADHD medications, requiring additional administrative time and effort with patients. In addition, included in their proposed regulations there is a stipulation that physicians are not allowed to write ANY prescriptions for people that are not in a “physician‐patient” relationship with them. If interpreted correctly, that means that a child whose physician is out on leave or who is ill will not be able to get their prescriptions for the ADHD medication until that physician is back in the office. This would be a travesty for the child whose life has been changed by the treatment of their ADHD. We are aware that physicians should help address this problem by taking on some responsibility for the prescription opioid crisis, but adding “any controlled substances” to the list will lead to unintended consequences. Keep in mind, regulations that are too broad and expand opioid restrictions to other drugs used to treat children’s common ailments will create a barrier for care of these children. Already the services throughout the state are sparse. This may lead to fewer services for children. Clearly this is not your intent. I do hope that you will find it appropriate to take those medications used to treat ADHD out of this regulation. 

 Respectfully submitted, 
Susan Buttross

Susan Buttross, M.D., FAAP
 Professor of Pediatrics
Medical Director, Center for Advancement of Youth (CAY)
University of Mississippi Medical Center

Read a summary of Dr. Buttross's impressive professional biography. 

The Board pretty much blew off Dr. Buttross and the other doctors who submitted a multitude of letters when it approved the opioid amendments at its December 15, 2017 meeting.  

Kingfish note: Meanwhile, the Clarion-Ledger locks arms with DPS Commissioner Marshall Fisher and  amps up the opioid crisis coverage.  Newspaper readers would never know what the medical community in Mississippi thinks about this subject.  Don't worry, this website is going to publish more letters from the medical community. 

 Earlier posts
Sissy to Medical Board: You've done enough. Stop now.  
Mississippi Sports Medicine Clinic speaks out (letter) 
 Pediatricians oppose opioid amendments. (Letters)
ER Docs oppose opioid amendments. (letters) 
 Ob/gyn's oppose opioid amendments.
Medical Board releases approved opioid amendments 
 Irresponsible!  Orthopedic surgeons oppose opioid regs
 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)

23 comments:

Anonymous said...

Senator Sally Doty has a bill that would undo some of this damage. From what I can tell it would go a long way towards addressing the opioid problem the RIGHT WAY. Namely, it would expand treatment and allow doctors more discretion to wean these folks off. Hoping she is able to see it through. What would be great is a provision that undoes ALL of these harmful regulations the board has made.

Anonymous said...

I don't think she has a pending bill, she was on SuperTalk today talking on the issue.

Anonymous said...

Possibly, we should wonder why so many children are on ADHD medication. I question whether that is an epidemic that is unnecessary.

Anonymous said...

Doty has a SB 2840 dealing with opioids, passed out of committee yesterday.

Anonymous said...

You obviously don't have a clue 2:11 about ADHD.

Anonymous said...

Meanwhile, Michael Guest is having his SUV detailed next door to his offices in Canton.

Anonymous said...

It is useful to a degree to hear the perspective of the practitioner (i.e., non-PhD-holding physicians who are engaged in private practice or some type of academic system). However, their hardship should not weigh more heavily than those who are experts on opioids themselves and the methods by which opioid consumption is curbed. That is like listening to Exxon on why offshore drilling in Mississippi is a positive economic benefit versus its social costs.

Physicians can't effectively weigh the costs to society from their standpoint. We need an outside board that serves the interest of the state overall...oh wait, we already have one.

Anonymous said...

So who exactly are the "who are experts on opioids themselves and the methods by which opioid consumption is curbed"? Surely not the clowns being consulted in Mississippi like Easterling, Dowdy and Fisher.

Your Exxon analogy is a joke.

Anonymous said...

Ok, 3:34PM, if you don't like my EXXON analogy, then how about this one:

Asking a physician's opinion on opioids is like asking a fat guy on what healthy snack to have for dessert!

Physicians don't learn the social costs and other alternatives to opioids in med school....especially not UMC's curriculum.

Anonymous said...

I have (unfortunately) had to witness people I care about turn into opiod addicts.

They were all getting their pills the same way - convenient online orders placed with overseas sellers in Asia.

They may have initially been issued a few legitimate prescriptions, but that channel soon became too limited and expensive to keep up with their growing compulsion and tolerance.

Until someone staunches the ABSOLUTE DELUGE of cheap, convenient, and sometimes lethal illicit pills being shipped to the US, all of this is just pissing in the wind. Addicts are getting them by the hundreds, every month... they don't need a doctor or a prescription.

Johnny Won't Sit Still... said...

"You obviously don't have a clue 2:11 about ADHD. January 31, 2018 at 2:47 PM"

I wouldn't go quite that far, but, most of us do wonder about the astronomically high incidence of kids diagnosed and immediately put on meds to keep them zoned out. How did we manage to live through this crisis as kids ourselves fifty years ago?

Anonymous said...

Letting a guy who owns a suboxone clinic write regulations that give him unfair advantage over all other physicians, because suboxone is “different” than other opioids, is putting the Fox in charge of the henhouse. He is ensuring a constant flow of patients that are suddenly in desperate need of detox from the bad opioids from the good doctors and their wonderful suboxone clinics.

Anonymous said...

Amen, Randy needs to recuse himself from these proceedings. He has a huge conflict of interest and putting him in charge of the opioid crisis is like putting and alcoholic in charge of a liquor store. And if that analogy cuts a little too close to the bone, I would suggest looking into Randy’s bar tabs with his drug rep pals. He is a real hypocrite.

Anonymous said...

every doctor on that board has a conflict in every decision they make. it is conflict by default.

Anonymous said...

... most of us do wonder about the astronomically high incidence of kids diagnosed and immediately put on meds to keep them zoned out.

Link?

Link This! said...

At least one in ten kids in the United States is diagnosed with ADHD. The actual figure in a study a couple of years ago was 11% and it's become so popular it's even higher now. In Kentucky, the figure is one in five....20%. Think about that. And consider how many are placed on meds by their pediatricians.

80% of ADHD kids in Mississippi are on prescription medications.

https://www.cdc.gov/ncbddd/adhd/data.html

Anonymous said...

The DSM-IV expanded the definition of ADHD diagnosis so that now teachers are referring children who they observe just pumping their heel up and down to be medicated,when the child is most probably unconsciously fidgeting out of boredom. So happy those same DSM-IV authors and teachers weren't subjected to that "diagnosis" when they were in school...or if they were it explains a lot about our current problem.

Anonymous said...

Childhood trauma floods the brain w hormones that mimic ADHD. amhetamines shrink the brain. When you add the crappy food options of GMO and sugar, what the hell are we doing to the children? Seems like someone is intentionally creating a dumbed down unthinking population bc it's the easiest manipulated. Scares the bejeesus out of me.

Anonymous said...

So y'all are saying ADHD isn't a real problem?

Anonymous said...

2:11 here. I do understand about ADHD medication. Had a teacher advise us to get one child on medication. Looked at it, and talked to Docs, and there was ABSOLUTELY no reason to do so. Bad teachers use ADHD as an excuse for not controlling their classroom. We are medicating our boys through school. It is wrong, and we will pay for it one day.

Just ask some kids how easy it is to get ADHD meds at school. It's sickening.

Parents, be VERY careful before some teacher or school administrator gets your kids hooked on ADHD meds. Dangerous.

Oh yea, my kids are not on ADHD medications and made in the 30's on ACT.

Anonymous said...

4:36 pm If you had written that the current business relationship and the role that has played in the opioid crisis reduces the credibility of physicians on this issue, I would agree with you.
However, it's more than a little clear that it is a small group of physicians, not board certified in specialties, who have become no more than drug dealers to make money.
Those who have formally objected to this bill do not fall in that category. Nor is there any evidence that a 30 day supply of opioids after surgery or an injury,used as prescribed causes addiction.
While I agree that anger , depression, unemployment, PTSD and ignorance in our society are among the many causes of this epidemic, these problems are not solved by increasing the cost of health care at the doctor's office or further government and insurance industry interference in the relationship between a doctor and his patient.
The government does have an important interest and thus a role in maintaining a healthy and therefore , productive citizenry. It also has a role in seeing that laws, law enforcement, and justice are as fair and equally applied so that citizens have confidence in the rule of law.
Making decisions based on protecting pharma's profits and reducing government's cost in paying for a problem they created by not adequately regulating a powerful industry in the creation of potentially dangerous drugs and how that industry profits is the action that would have the most impact.
Unfortunately, our politicians now require huge amounts of money to be elected ( that was once not true) and our citizens are so poorly educated that they cannot recognize propaganda or their own self-interest. They expect a " savior" in the form of a politician or political party.
If you know anything about sociology and how societies rise and fall, you know you rarely get a savior and get tyranny instead.
You are right that the study of what makes a society thrive or fail is important knowledge. Sadly, those who seek power have chosen to use that knowledge to enhance their wealth and power and care not one whit for the good of our Nation.


Anonymous said...

The changes have not been approved yet by the board. The board is meeting today and approval was on the agenda, but that item has been removed. They will have another open meeting for public comment soon. The date will be posted on the Medical Licensure Board's website.

This Boy Fidgets.. said...

A few years ago I wrote my old high school and requested (and received) copies of any and all records they had on me. Remember the dreaded 'permanent record' we were threatened with?

The notes written by teachers on various documents and on report cards are frightening. Frightening to realize those people were actually in control of our young lives and they were in positions to make 'recommendations' to our parents and permanent notes affecting, in some cases, our futures. They managed to get a teaching degree from a college 3/4 of a century ago.

And these 'teachers' and 'principals' had had no more medical or psychology training or ability to diagnose or comment than a damned goat tied up behind the pool room.

We really haven't advanced very far from that paradigm in our classrooms today.

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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!!!

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