While positive steps were made in addressing concerns with the original opioid regulations, there is still work to be done to protect Mississippians with legitimate chronic pain
. Unfortunately, regulations that are aiming to protect addicts and prevent future addictions are causing responsible Mississippians to fall through the cracks. Regulations must be effective as to not push opioid users into illegal drug users. This epidemic is something that we must all work to correct but not at the expense of Mississippians. We must ensure that we are not turning patients to the streets for drugs.
Please consider modification of the following regulations:
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Rule 1.2(K) - Pain Management Practice - We would ask that the percentage of patients receiving prescriptions be increased to 40%. This would be a compromise for the current and proposed percentage that would allow the doctors overwriting opioids to be classified as a pain management practice and protect the doctors in rural areas who treat legitimate pain patients at a higher rate in practice due to the lack of Pain Management Clinics and/or specialists no longer filling controlled substances as a result of proposed regulations.
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Rule 1.7(H) - Opioids Prescribing for Acute Pain - Limiting this to a 10-day supply is a one size fits all regulation. Many patients have a much lower pain tolerance and require longer periods of treatment. Complex surgeries, broken bones, and other aliments must be adequately treated and an explanation of how this is to be accomplished. We would ask for the following modifications:
A Licensee shall limit the prescription to a 7-day supply. Prescriptions for a greater than 7-day supply of a Schedule II opioid may be written to treat the patient's acute pain when needed in the professional medical judgment of the licensee and the following conditions are met:
- The duration of pain is expected to exceed 7 days;
- The condition is documented in the patient's medical record; and
- The licensee documents that no alternative to a Schedule II opioid was appropriate or sufficient to abate the acute pain associated with that medical condition
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Rule 1.7(J) - Opioid and Benzodiazepine Prescriptions - We feel that these can be prescribed concurrently if physicians are given the ability to use their professional judgment in making the best decision for the patient. Because the regulation references 1.7(H), physicians are limited in the amount they can prescribe. We would ask that you remove the requirement of prescribing these drugs in accordance with 1.7(H).
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Rule 1.7(M) - Use of Methadone - Physicians outside of a pain management practice are capable of using methadone to adequately treat addiction.
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Rule 1.7(L) - Point of Service Drug Testing - Further clarification is needed on what doctors are suppose to do with the results of the drug test. In Rule 1.7(E), physicians are instructed to not prescribe any controlled substance to any patient who has consumed any controlled substance or other drug not in the treating licensee's directions; however, the CDC recommends utilizing the drug screen to open dialogue and strengthen the physician-patient relationship. One of the unintended consequences of this proposed rule would result in termination of a patient from practice, resulting in the patient's seeking an alternative method of pain control including street drugs. Also, we maintain our concerns regarding the cost of drug testing and patients having to choose between paying a bill or paying for a drug test.
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Additionally, we would ask that these regulations apply to new patients beginning in 2018, as it would be a challenge to get patients who have been stable on a pain regimen for a number of years comfortable on another medication.
We strongly believe that engaging in this dialogue has already modified the prescribing habits of physicians. Further discussion and education instead of hand-cuffing doctors to a one size fits all practice of prescribing medications might be more beneficial to Mississippians.
Recent data shared by the Mississippi Bureau of Narcotics suggest overall death by prescription medications have decreased while deaths by illegal drugs have increased. It is the responsibility of Mississippi Board of Medial Licensure and physicians across the state to protect not just addicts but also the legitimate pain patient who doctors have spent years helping managing agonizing, daily pain. These regulations create prescribing barriers and limit patient access when the need for pain relief exits.
We continue to take measures to educate our members on evidence based pain management treatment and regulatory adherence by having experts present talks and exhibits as well as featuring educational pieces in our news articles.
Most doctors are doing the right thing to take care of patients and balancing the necessity of helping their patients who experience chronic pain with the risks of substance abuse and addiction. We urge you not to punish the physicians and patients who are acting appropriately. Together and with slight modification we can address the problem and find workable solutions.
