Monday, January 1, 2018

Medical Board releases final opioid amendments

The Mississippi Board of Medical Licensure submitted its proposed "Opioid Amendments" to the Secretary of State Friday.  They are posted below. The Board proposed the amendments after the Governor's task force on opioid abuse issued several recommendations in September.  The amendments have been strongly opposed by many doctors and several health-care provider organizations.  A hearing was held on November 15.  The Board approved them on December 15 at an unscheduled meeting after giving a public notice less than 48 hours prior to the meeting.


The public has 25 days to submit comments to the Secretary of State for the approved regulations.  The amendments will then be submitted to the Occupational Licensing Review Commission.  However, the Commission can only alter or reject amendments if it determines that competition in an industry is affected.  The legislature created the Commission earlier this year to prevent licensing boards from using their powers to limit competition since such boards are usually comprised of members of the regulated industry.  The Governor, Secretary of State, and Attorney General or their appointed designees comprise the Commission (The procedures are posted below.).

The Board of Medical Licensure did make one major change to the amendments.   The Board's original proposal would limit the opioid prescriptions to seven days and allow doctors to only renew the prescription for another seven days for acute, non-terminal/non-cancerous pain.  The approved amendment expands the restriction to ten days.  Rule 1.7(H) of Regulation 2640 states:

 When opioids are prescribed for acute pain, the licensee must prescribe the lowest effective dose of immediate release opioids, as the use of long acting opioids for acute non-cancer/non-terminal pain is prohibited.  Licensees must prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids.  Licensees are discourage from prescribing or dispensing more than a three day supply of opioids for acute non-cancer/non-terminal pain, and must not provide greater than a ten day supply for acute non-cancer/non-terminal pain.  Licensees may issue an additional ten day supply if clinically necessary, but said supply me be issued in accordance with Title 21 CFR 1306.12 Refilling prescriptions, issuance of multiple prescriptions (i.e. the prescription must be dated on the date of issuance with 'do not fill until' noting the date the prescription may be filled), and such need for an additional ten day supply must be documented in the chart go evidence that no other alternative was appropriate of sufficient to abate the acute pain associated with that medical condition.   


Some other major features of the amendments are:

* 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.

*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)

*Physicians must first establish a relationship with the patient before writing any prescription, not just those for controlled substances.   A physical exam is required before a relationship can be established.  Rule 1.11

 *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.

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



Earlier posts
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)





30 comments:

Anonymous said...

Who is on the Occupational Review Board?

Anonymous said...

Adderall is a cat 2 but isn’t used to treat any kind of pain, how will it be handled? I have no problem with limiting the amount of opiates people get for short term pain but I strongly disagree with drug screening for acute pain. What I am supposed to do with a positive cannabanoid? The requirements for chronic pain are just pain stupid. One a month office visits are fine, and so are drug screens, but the CME requirements are crazy. I don’t need 100 hours of crap to know that an old patient with renal insufficiency can only take drugs like tramadol for osteoarthritis. I hope the occupational review board hears the voices of regular doctors in the trenches. I equally hope Randy gets investigated for a number of issues.

Who said...

The Occupational Review Board consists of the Governor (as chairman), the Secretary of State (as secretary) and the Attorney General OR their designees. Takes 2 to make a quorum and 2 to make a decision.

Anonymous said...

Control freak Republicans herald in their own more onerous version of Obamacare that squarely places the government and regulatory bodies directly in the middle of doctor-patient relationships.

Drain the swamp in Jackson.

Anonymous said...

The numerous negative comments on this topic, questioning both the integrity and the competence of the licensing board, are all warranted.

A much more reasonable approach to this problem is being undertaken in more intelligent states:

https://www.yahoo.com/news/armed-data-officials-target-drug-dealing-doctors-143554668.html

It's a pity common sense is not valued here in the worst-in-everything-good state.

Anonymous said...

Everyone is guilty first and has to jump through needless hoops to prove their innocence. Here come the lawsuits and deservedly so.

Anonymous said...

I smoke weed and couldn't pass a drug test in 3 months if I stopped today. I guess I am going to have to get my meds on the street now.

Anonymous said...

My mother is approaching 80, has a foot amputation, lost a kidney to cancer, has a total hip replacement, has stents in her legs, has her bottom three vertebrae fused by arthritis. She is not a candidate for any further surgical procedures. She was also hospitalized a dozen years ago for a mental breakdown. Oh yeah, she's had the same primary doctor for 15 years, in addition to seeing numerous specialists from St. D's and UMMC.

Amazingly, she still lives alone because, in part, her pain is managed by opioids. I take off work every month to take her to her primary Doctor. Now, I am supposed to take her every 10 days and she can't remain on the opioid/benzo-whatever mix? And she takes drug tests? And that's if her primary isn't scared to prescribe now.

Screw the quality for her remaining life. Bass ackward. Thank you State of Mississippi. No wonder we are dead last in so damn much.

Anonymous said...

We haven't hit rock bottom on drug policy yet with Feel and crew. Dead last in just about everything is right. Maybe they ought to look out west a little bit.

Anonymous said...

Shocking how people just 20 years ago SURVIED without all the opioids that are prescribed today.

Anonymous said...

KF - Are you telling us comments submitted to Dibert for or against these amendments are a waste of time based on the limited capacity in which the Commission can act in response? As in the "Commission can only alter or reject amendments if it determines that competition in an industry is affected"? If so, it's basically a done deal, correct? Or am I missing something? Thanks for your reporting on this issue.

Anonymous said...

I hadn’t thought about the fact that anyone who has used marijuana, the only drug that stays in your system for many weeks or longer, will be unable to get any kind of medicine for anxiety, ADD, insomnia or pain. As the person stated earlier, that will send a large number to the street, immediately. I always thought it was ironic that the most harmful drugs exist your system so quickly. I could smoke crack for a month, lay off for a couple of days and test fine. Smoke weed, one time and no meds for you for at least a month. I know middle aged, professionals who indulge on occasion, don’t abuse anything, but this will ensure that they will have to go a month or so without any prescriptions to make sure they test clean. Not my biggest problem with this idiocy, not by a long shot, but a fact that will cause even more issues than I had considered.

Anonymous said...

My doctor already told me I would be subject to monthly, random drug tests to get my ADD medicine. This is ridiculous. I have never been under any suspicion or arrested for anything, but instead of getting 3 months at a time, I now I have to go to the other side of town every 30 days, pay for office visit and drug testing. I hate this backwards state.

Anonymous said...

And how does this affect the VA?...arguably one of the largest dispensaries of opioids in the state.

Anonymous said...

Supposedly, the only thing that will changes in regards to ADHD medication is that the licensee will have to check the PMP every 90 days. Even though ADHD medications are Schedule 2, they are not opioids or benzodiazepines. The only drugs requiring drug test are for opioids and benzodiazepines. So, you shouldn't be required to be drugged tested for ADHD medications unless the licensee wants you to be. Easterling and another board member are on video clarifying this to a physician who was asking about how the new regulations would affect ADHD medications.

Anonymous said...

Can patients go to other states (TN, AL, LA) for treatment without being subjected to these police state rules? Obviously patients can’t go to their doctors here for care without pretty much being investigated by the DEA. What if patients on benzodiazepines or opiates started traveling for treatment? Anyone know the answer to that question?

There's always hope said...

Maybe Governor Phil will reach out to General Mills for an alternative solution.

Anonymous said...

May I sum this up for the common folks. Randy thinks all other health care providers are idiots, and all patients are drug addicts. Randy, thanks for confirming that your ego is greater than your compassion for anyone but Randy. Sad

Anonymous said...

Who appoints members to the Board of Medical Licensure?

Anonymous said...

The Governor appoints the board. So much for limited government...

Anonymous said...

An entire state hoisting isself on its own retard.

Anonymous said...

Was that intentional, 12:22? LOL.

As to the comment about the weed user testing positive and, therefore, being unable to get an opioid prescription, how insane is that? If a person is scheduled for surgery he will not be denied post op pain meds regardless of whether he has used weed.

Regarding the duncidedly-ignorant comment at the third position on this board, above, how long have you lived in these parts and were you unaware that we were under the thumb of 'control freak democrats' for a hundred or more of those years?

Plain ol' Catfish said...

Difference being the Democrats tell you in advance that they plan to screw you over.

Anonymous said...

7:36 am So what was it about having one party in complete power for a hundred years that you didn't understand?

You are now surprised that a "do over" just changing the party ends up the same?

Did you miss all the former Dems that suddenly became Republicans when the wind shifted, too?

Good Lord people, it's believing that any political party , when given complete power , will not abuse it that is insane.

Anonymous said...

"An entire state hoisting isself on its own retard. "

Come for the political discourse; stay for the poetry :-)

Anonymous said...

SSR Easterling. Wonder why he didn't get elected as a Republican.

Anonymous said...

What can we as citizens and consumers do to voice our concerns about this? Is it too late?

Anonymous said...

@12:14--Call the Governor, SOS and Attorney General's office. They have more power than the Board. They just need to hear from consumers.

Anonymous said...

War on drugs? Definitely "catch" more pot smokers if the ABC drug tested liquor store operators and employees.

Anonymous said...

It's time for the Legislature to step up to the plate. Last year Senate Pro Tem Terry Burton offered a bill the would have allowed Nurse Practitioners the right to go beyond the 75 mile limit the Board had stipulated. About the time Burton was bringing the bill out of committee, Easterling and his merry men and women contacted him and told him they would make an administrative rule where the 75 mile limit would be done away with it. Burton believed that the Board would do the right thing and do what they had promised. Well, guess what - THEY DIDN'T and snubbed Terry C. Easterling better stay away from the Capitol - where is not wanted! This is the same Board that does not like the "Open Meetings Act". This law was passed to make government open to the citizens, but this Board wants to have closed meetings - so the public has no idea what they are up to. It looks like it's time to sunset the Board and send them back home where they belong. Phil even gave Easterling enough money that he could report it and he still got his ass beat. He beat Kevin Ford in the Bovinia district and that vote total was 12-11! Ford beat Easterling in the rest of the county!


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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.


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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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