Tuesday, January 9, 2018

Ms. Sports Medicine Clinic speaks out on opioid amendments

Mississippi Sports Medicine Clinic opposed the opioid amendments in a letter sent to the Mississippi Board of Medical Licensure.   The Board approved new regulations that will make it tougher to prescribe opioids and impose new requirements for doctors who choose to do so.*  18 doctors signed the letter.  The letter was obtained through a public records request.

The clinic's main concern is the new requirement to use the prescription monitoring program.  The amendments state "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."  It also requires doctors to print out and place into the file a written copy of the PMP report even though the Board has access to the same information in the PMP.  The letter states:

While we advocate for increased use and monitoring of patients through the Prescription Monitoring Program, we respectfully disagree with your approach to the problem. If the goal is to reduce the number of opioid prescriptions written then it is unfair to put expensive and over burdensome requirements these new rules would add. Please take note of the two attached charts. The first one is from the FDA and shows of the estimated 250 million prescriptions dispensed in 2014, 56% of these were dispensed by primary care providers including mid levels. The second one shows the changes surgeons have already made to their practices and subsequently the positive impact it has had on the ongoing problems. Providers like ourselves who only use opioids for acute pain management should not be subject to the same mandated policies as others and we would hope that as you take comments and move forward with policy change that this you recognize the additional burden you will be putting on us.
The Board approved the amendments with little change to the proposed PMP requirements.  No mention was made during the discussion of the concerns voiced by doctors. 

*The major features of the amendments are:

*A ten-day schedule II prescription can be written for acute non-cancer/non-terminal pain.   The prescription can be refilled for an additional ten days.

* 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
 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)


Anonymous said...

They have about 726,000 reasons to oppose any rew regulations.

Anonymous said...

Now that they have been found to be in violation of the old requirements, and agreed to (in addition to paying a fine) institute better record keeping wonder why they think these new regs would require an "expensive and burdensome" administrative record keeping system.

Could it be that they have not yet started the record keeping requirement of the 1970 law that they agreed to with there federal settlement?

Anonymous said...

Yea, everybody hates those terrible pain killers until they get a good dose of post op surgery.

Milburn Stone said...

Such pussies. During surgery all you need is some whiskey and a leather strap to bite down on. Post op all you need is more whiskey. Two days later, get back in the saddle. I don't want to hear any more of this whining.


Anonymous said...

I'm interested in the requirement to establish " a relationship with the patient" that is followed with the requirement for a physical exam.
Are there some other legal requirements in existence which define " a relationship"?
Is there a list of minimum requirements for a physical exam? Doctors haven't needed to look in my ears or down my throat or listen to my heart when I've needed stitches or broken a bone. Indeed, I didn't feel I needed a "relationship" with the physicians at all when I needed 30 stitches for a sports injury at age 12.
This law defies common sense and practicality. It assumes every patient and every doctor is likely is part of the opioid crisis instead of a small percentage of both given the universal number of patient visits where opioids are prescribed.
It would be far more practical to deal with this problem within the prescription system which is computerized everywhere now and where tagging multiple refills and reporting those would be far more simple.
Who the hell will be tracking all these PMPs and how?

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