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October 5, 2017

Proposed New Opioid Prescribing Rules from State Board of Medical Licensure

Last week, the Mississippi State Board of Medical Licensure proposed changes to its  Administrative Code Part 2640: Prescribing, Administering and Dispensing. The rules are open for public comment until Tuesday, October 17, after which the MSBML will consider all comments and may make changes before adopting a final rule.

Highlights of proposed changes are here, with the page numbers mentioned below:
  1. Each licensee must run a Prescription Monitoring Program (PMP) report at each encounter when prescribing opioids for acute/chronic pain. (pg 25)
  2. Licensees must keep PMP reports in the patient's file and available for inspection. (pg 25)
  3. Licensees must conduct point-of-service drug testing each time a Schedule II prescription is written for treatment of chronic non-cancer pain and every 90 days for patients who are prescribed Benzodiazepines for chronic medical and/or psychiatric conditions. (pg 37)
  4. Licensees are prohibited from prescribing more than a 7-day supply of opioids for acute pain. (pg 36)
  5. Licensees may not prescribe Benzodiazepines and opioids concurrently, with limited exception for an acute injury, and for a maximum of 7 days. (pg 37)
  6. Licensees whose practices advertise themselves as treating chronic pain, and issue controlled substances to 30% of patients, are now designated Pain Management Practices. (This was previously 50%, and those in Pain Management Practices must meet a higher level of CME annually.) (pg 45)
Your MAFP Board met over the weekend and voted to send a letter to the MSBML. We ask our members to send individual letters and comments directly to MSBML by e-mail to  mboard@msbml.ms.gov, by  FAX to (601) 987-4159, or in writing to: MSBML, 1867 Crane Ridge Drive, Suite 200B, Jackson MS 39216.

We would appreciate a copy of your letter e-mailed or faxed to MAFP as well -- beth@msafp.org or FAX (601) 853-3002.

Below, we are including a list of concerns MAFP members have shared with us this week after seeing the proposed regulations:
  • These rules will disproportionately affect patients with legitimate chronic pain.
  • There are few pain management specialists in rural areas.  We are concerned about the opioid and Benzo withdrawal from patients who are appropriately taking medications if their medication is abruptly stopped by their family physician. This would create undue burden and cost on our already fragile healthcare system. 
  • 100 hours of interactive live CME required for pain management certification puts a considerable time and financial burden on a family doctor with a full-time practice.
  • Family physicians are already overladen with regulations and these rules would take away even more time from our patients.
  • Because the MSBML does not regulate Advanced Practice Registered Nurses (APRN), we are concerned patients with chronic pain or even recurrent acute pain will self-select APRNs to manage their chronic pain due to physician access issues.  This would further affect physicians' willingness to collaborate with APRNs and potentially lead to quality of care issues.
  • We are concerned the amount of opioid overdose deaths due to heroin will continue to increase because of these regulations.
  • For patients stable on a pain regimen for a number of years, it would be a challenge to get them comfortable on another medication.
Thanks for taking action. You are welcome to contact Beth Embry at beth@msafp.org with any questions.
Mississippi Academy of Family Physicians
755 Avignon Drive, Ridgeland MS 39157
(601) 853-3302   FAX (601) 853-3002