Doctor Comments 01 Part 2640 Public Comments Sep 29 - Oct 6

Frances Carrillo
From: RHONDA FREEMAN

Sent: Friday, September 29, 2017 10:00 AM
To: Frances Carrillo
Subject: FW: opioid proposals
Categories: Regulation
From: Ken Staggs [mailto:kenstaggs@hotmail.com]

To: RHONDA FREEMAN
Cc: Joey Daugherty (jdaugherty@totalpaincare.org); rbriggs@totalpaincare.org; novaboone@gmail.com;
K.hogan2@aol.com
Subject: opioid proposals
LastThursday,theMississippiBoardofMedicalLicensureproposedchangestoregulationsinPart2640:Prescribing,
AdministeringandDispensing.
Afewoftheserecommendationsareoverlyburdensomeandcostly.Hopefullytheboardmemberswontreflexively
incorporatealltheserecommendationstothedetrimentofpatientcareinordertoaddresspoliticalobjectives.
WhileinitialprescribingofopioidsitisreasonabletoobtainprescriptionmonitoringandUDS,torequireUDStestingat
everyfollowupforstablecompliantchronicpainpatientsisunreasonableandunnecessary,aswellasasignificant
expensetopatients.
Benzodiazepinesandopioidsmaynotbeprescribedconcurrently,withlimitedexceptionforanacuteinjuryandfornomorethan7
days.Thisisabsurdanddangeroustopatientcare.Whilephysiciansshouldseriouslyconsidertheriskofconcurrent
prescribing,toabsolutelyprohibitconcurrentusewillresultinsevere,possiblylifethreatingwithdrawalaswellascause
patientsinpaintonotreceiveappropriatepainmedicines.Frequently,benzosarewrittenbyotherphysicianswhorefer
toustotakeoveropioidpainmedicines.Whileweendeavortoaddresstheconcurrentuseandencouragingweaningof
bothclasses,thisproposalisoutrightdangerousandillconceived.Itisupsettingtomethatstudiesclearlydemonstrate
alcoholisinvolvedin50%ofopioiddeaths,andbenzosinvolved30%butnothinghasbeensaidofconcurrentalcohol
use,nordotheCDCguidelinesevenmentionconcurrentalcoholuse.
KenStaggsMD
TotalPainCare
Meridian
1
Frances Carrillo

Subject: FW: Proposed opioid rules
-----Original Message-----
From: Ross Ward [mailto:bondoc01@hotmail.com]
Sent: Thursday, September 28, 2017 6:53 PM
To: RHONDA FREEMAN
Subject: Proposed opioid rules
As an orthopedic surgeon, I treat multitrauma patients and shoulder surgery patients that require post surgery
opioids for a month or longer. Only allowing pain scripts post op for a seven day supply will place an unfair
burden on those patients and our clinical staff. Please consider making some exceptions with regards to
sometimes VERY painful surgeries.
Many times opioids are required for successful therapy to be obtained after these surgeries as well. The
proposed rule would require patients to come back weekly which again isn't fair to patients or our clinical staff.
Thank you for consideration for these patients. Please feel free to contact me for further discussion as
required.
D. Ross Ward, MD
Sent from my iPhone
2
Frances Carrillo

Subject: FW: Opoid Prescribing Rules
From: matthew emerick [mailto:mattle@cableone.net]

To: RHONDA FREEMAN
Cc: Gregory Patino
Subject: Opoid Prescribing Rules
Dear Ms. Rhonda: My name is Matthew Emerick. I am a board certified emergency medicine
physician practicing with the Singing River Hospital System here on the Mississippi coast. I've been
licensed in Mississippi for 17 years. Although I wholeheartedly agree there is an opioid abuse issue
in the United States and Mississippi is no exception, I must vehemently protest the following clause in
the MS State Board of Medical Licensure's plans on regulating narcotic prescription writing:
"Every licensee regardless of practice specialty must review the MPMP at each patient encounter in
which an opioid is prescribed for acute and/or chronic noncancerous pain"
This rule would be way too burdensome in a busy emergency department. Patients are
already waiting hours to get seen by an Emergency Physician and this rule would simply add to our
already busy workload. This will inevitably, significantly add to the patient wait times if we have to
run a MPMP check on every patient we see who receives a narcotic prescription in the emergency
department. Pain, not surprisingly, is by far the most common complaint seen in the emergency
department (ED). This would yet again be another uncompensated mandate put upon us by
government. You must understand the vast majority of patients receiving a narcotic prescription in
the ED are not abusers. All of these innocent patients and doctors are going to pay a heavy price for
this massively sweeping rule just to weed out a handful of narcotic abusers. Do we really need to run
a background check on a 8 year old who has a fractured forearm before we prescribe codeine? Or
even on an adult who has an obvious legitimate reason to receive a narcotic pain medicine,
regardless of his prescription history? Am I not going to prescribe a narcotic to an adult who has
acute 2nd degree burns even if he has filled several narcotic prescriptions in the past?
Please seriously reconsider the wording of this clause and consider the impact on all the patients who
are waiting to receive care in our busy emergency departments. Please don't hesitate to contact me
for any concerns or questions.
Thanks
Matthew L. Emerick. MD, FACEP
3
Frances Carrillo

Subject: FW: New opioid rules
From: Massie Headley [mailto:massieheadley@att.net]
To: RHONDA FREEMAN
Subject: New opioid rules
I agree with all these proposals except for the proposal regarding a PMP be run on each encounter. This is
unnecessarily burdensome on the physicians and is not feasible from a time management perspective. Maybe
quarterly PMP checks would be more reasonable.
Massie H. Headley MD
Sent from my iPhone
4
Frances Carrillo

Subject: FW: Prescribing Benzos and Opioids Together
RhondaFreeman
OfficeDirector
LicensureDivision
MississippiStateBoardofMedicalLicensure
1867CraneRidgeDrive,Suite200B
Jackson,MS39216
(601)9873079
(601)9874159fax
www.msbml.ms.gov
From: Bill Cook [mailto:wcook69596@gmail.com]

Sent: Thursday, September 28, 2017 6:05 PM
To: RHONDA FREEMAN
Subject: Prescribing Benzos and Opioids Together
I strongly feel that that decision should be deferred to the treating physician, especially if the physician is
Board-Certified in Psychiatry
With many years experience.
My experience is that many patients on Suboxone also have significant anxiety that
Require benzodiazepines to treat.
William S Cook Jr MD
Board-Certified in Psychiatry
4500 I 55 North
Suite 256
Jackson MS 39211
--
Sewwq w nt from Gmail q
5
Frances Carrillo

Subject: FW: comments
From: William T Smith [mailto:wtsmith1464@me.com]

To: RHONDA FREEMAN
Subject: comments
1. The requirement for all licensees to run a PMP report is too burdensome. The BOML should have the ability
to login to the PMP and see if it has been checked remotely. It takes an average of 90 sec. to login and search
for each patient-(try it and you will see). This will add over an extra hour, not included scanning to each
provider, and unecessary burden. If implemented by BOML, an extra cost may have to passed to the patient for
this.
2. Agree completely with opioid and benzodiazepines not to be prescribed concurrently.
3. Disagree with only a 7 day supply of opioids for acute pain. Rationale: As an orthopedist treating acute
complex fractures, these patients have acute post surgical pain for fracture treatment. I service a rural
community. It is not realistic to have them travel long distances each week to retrieve a opioid prescription.
Regards,
W.Todd Smith, MD
Starkville Orthopedic Clinic
100 Wilburn Way
Starkville, MS 39759
Office: 662.320.4008
Fax: 662.323.6007
www.starkvilleortho.com
Email: wtsmith1464@me.com
6
Frances Carrillo
From: THE MISSISSIPPI STATE BOARD OF MEDICAL LICENSURE

Sent: Tuesday, October 03, 2017 11:57 AM
Subject: FW: IMPORTANT PROPOSED RULE UPDATES
From: Lance Line [mailto:lline1@comcast.net]

To: THE MISSISSIPPI STATE BOARD OF MEDICAL LICENSURE
Subject: Re: IMPORTANT PROPOSED RULE UPDATES
Onceagainabunchofbureaucraticidiotsmakingabunchofruleswithoutreasonablejudgement.Nobalanceatall.
OnOct3,2017,at4:32PM,THEMISSISSIPPISTATEBOARDOFMEDICALLICENSURE<Mboard@msbml.ms.gov>wrote:
TheBoardofMedicalLicensurehasfiledaproposedruleamendmentwiththeSecretaryofStatefor
reviewandcomment.MSBMLAdministrativeCodePart2640Chapter1:RulesPertainingtoPrescribing,
AdministeringandDispensingofMedicationhasbeenupdatedtoreflectchangesasproposedbythe
GovernorsOpioidandHeroinStudyTaskForceandotherguidelinespreviouslypublishedbytheCDC.A
copyofthisproposedrulecanbelocatedontheBoardswebsiteunderRegulation
Filings,http://www.msbml.ms.gov/msbml/web.nsf/webpageedit/Updates_Filings_9
21RX/$FILE/Part%202640_Prescribing_Proposed_WEB.pdf?OpenElement.

Questionsandcommentsregardingtheproposedrulemaybesubmittedtomboard@msbml.ms.govor
totheaddressbelow.

Jackson,MS39216

(601)9873079
(601)9874159fax

www.msbml.ms.gov

DISCLAIMER: This email and any files transmitted with it are confidential and intended solely
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1
Frances Carrillo

Sent: Tuesday, October 03, 2017 1:33 PM
Subject: FW:
From: OnCall Medical Clinic [mailto:oncallmedicalclinic@yahoo.com]

Subject:
I have a pain mgt. patient who is well controlled on methadone for 8 years. May he continue
his high functioning on methadone or must I no longer prescribe him methadone?
Ed Aldridge,M.D.
OnCall Medical Clinic

3091 Bienville Blvd.
Ocean Springs, MS 39564
(228) 818-5155 phone
(228) 818-5159 fax
www.oncallclinic.com
1
Frances Carrillo

From: Phillip Ley [mailto:phillipley@gmail.com]

This is patently ridiculous, a public bandaid for a problem CREATED by government policy. Yet another
hurdle to taking care of my oncology and postoperative patients.
Phillip Ley MD FACS
On Oct 3, 2017 10:33 AM, "THE MISSISSIPPI STATE BOARD OF MEDICAL LICENSURE"
<Mboard@msbml.ms.gov> wrote:
The Board of Medical Licensure has filed a proposed rule amendment with the Secretary of State for review and
comment. MSBML Administrative Code Part 2640 Chapter 1: Rules Pertaining to Prescribing, Administering
and Dispensing of Medication has been updated to reflect changes as proposed by the Governors Opioid and
Heroin Study Task Force and other guidelines previously published by the CDC. A copy of this proposed rule
can be located on the Boards website under Regulation
Filings, http://www.msbml.ms.gov/msbml/web.nsf/webpageedit/Updates_Filings_9-
Questions and comments regarding the proposed rule may be submitted to mboard@msbml.ms.gov or to the
address below.
Mississippi State Board of Medical Licensure
1867 Crane Ridge Drive, Suite 200-B
Jackson, MS 39216
(601) 987-3079
2
Frances Carrillo

Subject: FW: Proposed rule
From: Brittanie Neaves [mailto:brittanie.neaves@gmail.com]

Subject: Proposed rule
I think it's a bad idea to make a guideline a statewide policy. Specifically, the frequency of PSM checks. Where
is the evidence that states that checking it this frequently prevents diversion or overprescribing? Also, will this
apply to ERs, hospitalists, and urgent cares or am I to assume this is just primary care clinics? Based on thr
current verbiage, essentially, any covering night physician would have to run a PM in the middle of the night
for acute pain if we want to order a pain med. Please, find another way to regulate.
Dr. Neaves
4
Frances Carrillo

Subject: FW: Opioid prescribing changes
From: Heather Huguley [mailto:truthedup@hotmail.com]
To: RHONDA FREEMAN
Subject: Opioid prescribing changes
To Whom it May Concern:
I am a Physician Assistant working in Mental Health. The only change that I don't entirely agree with is not
prescribing Benzodiazepines with Opioids. I have several military veterans that have suffered injuries that have
severe PTSD that really need both medications to have a semblance of a normal life. I also work with PTSD
patients that have chronic pain and were physically abused for 20 years. I understand the black box warnings
and I understand this is an attempt to combat the epidemic in this country, but to take away the provider's
discretion is taking away the treatment some people need. Thank you for taking my comments into
consideration.
Sincerely,
Heather Huguley, PA-C
Sent from my iPhone
5
Frances Carrillo

Subject: FW: New legislation for Controlled Substances
From: Doctor Green [mailto:greenmder@gmail.com]

Subject: New legislation for Controlled Substances
I maintain my license in Mississippi, though I am not currently practicing there. I am a full time emergency
physician in Dallas, Texas.
The proposed legislation is so restrictive, it is another reason for physicians to MOVE OUT OF MISSISSIPPI
and not return to practice.
Increasing the labor and documentation burden for physicians will not have a significant impact on the drug
problem in Mississippi. It will have an impact on your physician work force.
Best of luck.
--
Walter L. Green, MD
6
Frances Carrillo

From: Renate D. Savich [mailto:rsavich@umc.edu]

Does this only apply to outpatient opioid prescriptions or does this also pertain to inpatient orders?
Renate Savich, MD FAAP

Professor of Pediatrics
Chief, Neonatology and Newborn Medicine Division
Department of Pediatrics
Childrens of Mississippi
University of Mississippi Medical Center
2500 North State Street
Jackson MS 39216
Phone: 601-815-7158
Mobile: 505-400-8174
rsavich@umc.edu
Past Chair, American Academy of Pediatrics

Section on Neonatal Perinatal Medicine
From:THEMISSISSIPPISTATEBOARDOFMEDICALLICENSURE<Mboard@msbml.ms.gov>
Date:Tuesday,October3,2017at10:44AM
To:THEMISSISSIPPISTATEBOARDOFMEDICALLICENSURE<Mboard@msbml.ms.gov>
Subject:IMPORTANTPROPOSEDRULEUPDATES
TheBoardofMedicalLicensurehasfiledaproposedruleamendmentwiththeSecretaryofStateforreviewand
comment.MSBMLAdministrativeCodePart2640Chapter1:RulesPertainingtoPrescribing,Administeringand
DispensingofMedicationhasbeenupdatedtoreflectchangesasproposedbytheGovernorsOpioidandHeroinStudy
TaskForceandotherguidelinespreviouslypublishedbytheCDC.Acopyofthisproposedrulecanbelocatedonthe
BoardswebsiteunderRegulation
7
Frances Carrillo

Subject: FW: Proposed ruling
From: Gerry Morrison [mailto:gerrygmorrison@gmail.com]
Subject: Proposed ruling
I am very much in favor if this ruling. However, there need to be stiffer penalties for prescribers who do not
adhere.
Great work!
Gerry G Morrison MD
Sent from my iPhone
9
Frances Carrillo

From: arg50a@aol.com [mailto:arg50a@aol.com]

I agree with the proposal. I do not nor will I prescribe controlled substances in the State of Mississippi
From: THE MISSISSIPPI STATE BOARD OF MEDICAL LICENSURE <Mboard@msbml.ms.gov>
To: THE MISSISSIPPI STATE BOARD OF MEDICAL LICENSURE <Mboard@msbml.ms.gov>
Sent: Tue, Oct 3, 2017 10:24 am
Subject: IMPORTANT PROPOSED RULE UPDATES
Questionsandcommentsregardingtheproposedrulemaybesubmittedtomboard@msbml.ms.govortotheaddress
below.
Jackson,MS39216
(601)9873079
(601)9874159fax
www.msbml.ms.gov
DISCLAIMER: This email and any files transmitted with it are confidential and intended solely for the use of the individual
or entity to whom they are addressed. If you have received this email in error, please notify the system manager.If you are
not the named addressee you should not disseminate, distribute, or copy this email. Please notify the sender immediately
by email if you have received this email by mistake and delete this email from your system. If you are not the intended
recipient you are notified that disclosing, copying, distributing or taking any action in reliance on the contents of this
information is strictly prohibited.
10
Frances Carrillo

Subject: FW: Part 2640 Prescribing, Administering and Dispensing
Attachments: LMHPCO comments regarding changes to Part 2640 Prescribing, Administering and
Dispensing.pdf
Importance: High
From: Jamey Boudreaux [mailto:jboudreaux@lmhpco.org]

Subject: Part 2640 Prescribing, Administering and Dispensing
Importance: High
MrFreeman
Onbehalfofthe15,000Mississippipatientsreferredtohospiceeachyearandthe76Mississippihospice
providermembersofwhoservethosepatientsandfamilies,LMHPCOisrequestinganexemptionforhospice
andpalliativecareendoflifeprovidersfromtheproposednewopioidrules.Ourformalcommentsare
attached.
Pleaseletmeknowifyouhaveanyquestions.Icanbereachbycellphoneat504.491.6133.
jamey
Jamey Boudreaux, msw, m.div

Executive Director
717 Kerlerec
New Orleans, LA 70116
toll free: 888.546.1500/ext 7
tel 504.945.2414/ext 7
fax 504-948-3908
jboudreaux@LMHPCO.org
www.LMHPCO.org
ThemissionofLMHPCOistoimprovethequalityofhospice&palliativecareinLouisiana&Mississippi.
LMHPCOisa501(c)3educationalcorporation,networkinghospiceagenciesforthepurposeofimprovingendoflifecareandservices
foreveryonelivinginLouisianaandMississippithroughresearch,professionaleducation,publicawarenessandadvocacy.
11
LMHPCO recognizes the important role Mississippi physicians have in curtailing the opioid
addiction in the state and applaud the Mississippi State Board of Medical Licensures Opioid
Taskforce for its work in bringing about a significant change to current practice. However,
terminally ill patients in Mississippi have a unique dependency upon quick access to these same
opioid medications in order to manage pain at the end of life, as well as enhance the quality of
their end of life care.
Most attending physicians are unfamiliar with the skills required to adequately manage pain at
the end of life. Attending physicians regularly rely upon hospice medical directors to assume
responsibility for the pain and symptom management and care of their patients enrolled into
hospice programs. This new regulation, as proposed by the Mississippi State Board of Medical
Licensure would make it virtually impossible for hospice medical directors in the state to assume
care for these patients. Most patients are referred to hospice very late in the progression of
their terminal illness.
In 2015, 25% of all Mississippi Medicare beneficiaries enrolled into hospice programs died
within 7 days; half of all Mississippi patients expire within 30 days of enrollment. To require
these terminally ill patients to meet with a new physician in literally their last days of life in
order to maintain an acceptable comfort level is not only unconscionable but cruel.
While hospice medical directors are well versed in pain and symptom management at the end of
life, most serve as part-time hospice employees, with busy practices within their local
community. Practically speaking, this new requirement is unworkable for hospice patients and
would therefore result in fewer hospice appropriate patients having access to quality hospice
care in the state. Hospice healthcare professionals applaud Mississippi State Board of Medical
Licensures actions to bring an end to the opioid crisis in Mississippi, we strongly recommend
(as other states have done), that hospice and end of life palliative care providers be granted
an exemption from this new requirement.
We encourage hospice medical directors throughout the state to contact Rhonda Freeman with
the Mississippi State Board of Medical Licensure at 601.987.3079 with their comments on this
proposed regulation.
www.LMHPCO.org
888.546.1500 ext 7
LMHPCO@aol.com
Frances Carrillo

Subject: FW: Opiods
From: Dr. John Bailey [mailto:jbailey@SMSurgeons.com]

Sent: Monday, October 02, 2017 2:48 PM
To: RHONDA FREEMAN
Cc: Don Davenport; Dr. Jason Payne; Dr. William Avara; Dr. Jeremy Simpler; Dr. Edward Dvorak; Dr. Nicholas J. Fayard;
Dr. Brooks Gray; Dr. Mark Lyell; Dr. Scott Brashier; Dr. David Spencer Jr.; Marcia Goff
Subject: Opiods
Thisproposedpolicywillbeanefficiencyproblemforallsurgeonsifwehavetostopaftereveryoperation/procedureto
checkwebsitebeforewritingprescriptionforpostoppainrelief
JohnBailey
13
Frances Carrillo

Subject: FW: Opioid Prescribing Proposed Changes
From: Young, Ronald [mailto:RYoung@nmhs.net]

Sent: Sunday, October 01, 2017 2:26 PM
To: RHONDA FREEMAN
Subject: Opioid Prescribing Proposed Changes
ToWhomItMayConcern:
Iamverymuchinfavorofmakingitharderfordrugseekingpatientstogetopioidprescriptions.Iamalsoinfavorofmakingit
harderforphysicianswhoareenablingpatientswiththeiropioiddependence.However,oftheproposedchangesthatthe
MedicalLicensureBoardisrecommending,ImustdisagreewiththeproposaltorequirealllicenseestorunaPrescription
MonitoringProgram(PMP)reportateachencounterwhenprescribingopioids,especiallyforacutepain.IusethePMP
regularlyforpatientswhohaveanydrugseekingbehavior,butbecausepatientswhoarehavingmajorsurgeryusuallyneeda
narcoticpostoperatively,itwillnotmakeadifferencewhatthePMPreportsayswhentreatingapatientwithpostoperative
pain.ThePMPsiteisnotthemostuserfriendlysiteandcanbeverytimeconsuming.TorunaPMPoneverysurgerypatient
willbedifficultforbusypractitioners.
Thanksforconsideringthismatter.
Sincerely,
RonaldA.Young,MD
OB/GYNAssociates
Tupelo,MS
16
Frances Carrillo

Subject: FW: Proposed opiod prescribing regulations
From: Jeff Cook [mailto:huntindoc@aol.com]
Sent: Saturday, September 30, 2017 10:06 PM
To: RHONDA FREEMAN
Subject: Proposed opiod prescribing regulations
Congratulations! You are about to penalize everyone for the actions of a few! To burden everyone to take the
time to contact the PMP on every prescription and then maintain documentation forever is absolutely
ridiculous! There is already too much time, money and effort spent on overreaching regulations to add this to
the mix. As a surgeon who writes only postoperative prescriptions for 5 day (10 pill) , these regulations will ,for
better or worse ,make me stop writing pain meds altogether. As I talk to my colleagues they are incredulous
that you have chosen regulations so burdensome. You know who the outliers are, you should address these
individual's prescribing patterns and leave the rest of us alone!! And less I forget to mention it, take action
against the criminal action of the patients in their drug seeking behavior and stop trying to hang everything on
hard working physicians. Jeff Cook MD
Sent from my iPhone
17
Frances Carrillo

Subject: RE: controlled sub guidelines

Subject: FW: controlled sub guidelines
From: rob [mailto:rcarter3378@hotmail.com]

To: RHONDA FREEMAN
Subject: controlled sub guidelines
Dotheguidelinesalsoapplytopatientsinlongtermcarefacilities(nursinghomes)?
RobCarter
1
Frances Carrillo

Subject: FW: State Board of Medical Licensure New Opioid Prescribing Rules
Rhonda Freeman
Office Director
Licensure Division
Jackson, MS 39216
(601) 987-3079
(601) 987-4159 fax
www.msbml.ms.gov
From: Bertolet, Barry [mailto:bbert@nmhs.net]
Sent: Saturday, September 30, 2017 5:44 PM
To: RHONDA FREEMAN
Subject: State Board of Medical Licensure New Opioid Prescribing Rules
As a medical doctor who daily sees the harm caused by the over-prescribing of opioids and benzos, it is clear
that certain physicians and NPs in our state are irresponsible or careless in prescribing these medications.
At our hospital, we have removed the automatic sleeping pill off all standing orders. We have developed a
step-wise approach to pain management for which opioids are a second or third line choice and not a first line
choice. We have developed rules that limit the number of days an opioid can be prescribed for acute pain
management.
I fully support developing these proposed guidelines for responsible use of opioids and benzodiazepines as
they primarily address patient protection and safety, and secondly address the epidemic of diversion that
affects us all.
Thank you for taking a bold step to be a strong advocate of responsible health care within our state.
Barry Bertolet, MD
18
Frances Carrillo

Sent: Wednesday, October 04, 2017 7:19 AM
Subject: FW: MSBML proposals for controlled substances
From: Lawrence Leake [mailto:edocleake1@juno.com]
To: RHONDA FREEMAN
Subject: MSBML proposals for controlled substances
To The Mississippi Board of Medical Licensure:

I believe strongly that Emergency Departments should be exempt from these proposed rules. Our group of
20 Emergency Physicians that treats over 100,000 patients in the two ED's of Singing River Health Systems
feels the same. The Board of Directors of the Mississippi Chapter of the American College of Emergency
Physicians is also opposed to these rules.
Our setting in Emergency Medicine is unique in that we treat patients with acute conditions on a daily basis
at a fast pace that is episodic, chaotic and time demanding. These requirements are onerous in our setting.
When we do write for opiates or benzodiazepines in this acute setting, they are for smaller doses and fewer
numbers of pills than our colleagues utilize in private practices and clinics. It has been shown that our setting
is not responsible for the large numbers of these types of medicines being prescribed.
However, we definitely do selectively use the Prescription Monitoring Program website on a frequent, as
needed, and case by case basis. This is appropriate, as some of our patients clearly do not have an acute
condition and some are clearly in our departments inappropriately seeking prescription medications.
Please consider exempting Emergency Departments from these proposed rules.
Thank you for your consideration,

Lawrence Leake, MD FACEP
Past President MSACEP
Ocean Springs, MS
Sent from my iPhone
1
Frances Carrillo

Subject: FW: Proposed Opioid prescribing changes
From: James Woodard [mailto:jsw1@cableone.net]
To: RHONDA FREEMAN
Subject: Proposed Opioid prescribing changes
Will the proposed changes apply to patients in long term care facilities?
I am an outpatient primary care physician but also have a small nursing home practice. Several of these
patients take low doses of hydrocodone and/or benzodiazepines on a daily basis. All of these medications are
administered by the nursing staff in a very controlled fashion.
Thank you for your assistance,
James S Woodard, MD
Columbus, MS
Sent from my iPad
2
Frances Carrillo

Subject: FW: Opioid restrictions
From: Dudley & Niki Burwell [mailto:golfdoc56@gmail.com]

Subject: Opioid restrictions
I am an orthopedic surgeon in Gulfport and I am strongly opposed to the regulations as they are written. I have
no problem with restricting narcotic use but in a normal orthopedic surgery practice some procedures such as
large joint replacements require healing times of two and sometimes occasionally three months. Requiring a
patient to return to his or her surgeon every 7 days is overbearing not only for the patient but the surgeon and
disruption of ones practice. At least 2-3 thirty day prescriptions should be allowed.
Respectfully,
Dudley Burwell, M D
3
Frances Carrillo

Subject: FW: rule proposal
From: Harriet Jones [mailto:doctorhatmd@bellsouth.net]
Subject: rule proposal
Is there a 'summary' available that reflects the content of the proposed change re: narcotics? I just received an
email w/ a link to a 60+ page article....I opened it & found it is quite cumbersome to read. Would appreciate
something concise if the board has a statement regarding he 'jist' of it...
Harriet Jones, MD, FACP
4
Frances Carrillo

From: kenneth reid [mailto:kjreid_1@hotmail.com]

IhavenoideawhatthismeansasaPediatricianandawfulyouputsuchaburdenonusandpatientswith
ADHDwhenwemaybehavetoterminatepatientsonshortnotice,Haveyounoshame?
Sent:Tuesday,October3,201710:41:13AM
To:THEMISSISSIPPISTATEBOARDOFMEDICALLICENSURE
below.
Jackson,MS39216
(601)9873079
(601)9874159fax
www.msbml.ms.gov
DISCLAIMER: This email and any files transmitted with it are confidential and intended solely for the use of
the individual or entity to whom they are addressed. If you have received this email in error, please notify the
system manager.If you are not the named addressee you should not disseminate, distribute, or copy this email.
Please notify the sender immediately by email if you have received this email by mistake and delete this email
5
Frances Carrillo

Subject: FW: New rulings

Subject: New rulings
IhopeyoucanlivewithyourselvestryingtoputPediatriciansintoprisonorterminatingtheirpatientsunless
youcanaffordamedicolegalattytoguideyouthroughthebookofnewregulationsbefore10/22
7
Frances Carrillo


Icannotcomprehendthelegaleesofthebookofnewregulation,noritismyresponsibility,totrytoavoid
prison.AgainIwilltellmypatientstocontactyouandthepoliticians
Sent:Tuesday,October3,201710:41:13AM
To:THEMISSISSIPPISTATEBOARDOFMEDICALLICENSURE
below.
Jackson,MS39216
(601)9873079
(601)9874159fax
www.msbml.ms.gov
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8
Frances Carrillo

Subject: FW: Clarifications
From: Bobby L. Graham, MD [mailto:blgraham2@comcast.net]

Subject: Clarifications
I have read through the proposed prescription requirements and am still unclear on the specific regulations I
must follow as a Medical Oncologist. It will be very challenging for my practice if I am required to check the
MPMP every three months on all my patients who receive opiate prescriptions. I do check regularly, but this
requirement will put an unnecessary burden on me as well as certainly jeopardize my ability to provide
prescriptions to terminally ill patients in a timely fashion. Also, to suggest that all my patients on
benzodazepines and opiates should be weaned off their benzodiazepines in order to remain on their opiates is
inhumane. Obviously, whoever came up with these requirements has never dealt personally with cancer. I hope
I am reading these requirements wrong. Maybe the Board could publish a separate set of
guidelines/requirements for those of us who treat cancer. I am also Board certified in Palliative Medicine which
at times requires me to write opiates and benzodiazepines for non-cancer terminal disease such as end-stage
cardiomyopathy and COPD. Separate guidelines for Palliative Medicine would also be helpful. I refer to the
following paragraphs in the proposed guidelines:
Every licensee, regardless of practice specialty, must review the

MPMP at each patient encounter in which an opioid is prescribed for acute and/or chronic
noncancerous pain. Those licensees whose practice is not a pain management practice as defined
previously must actively utilize the MPMP upon initial contact with new patients and at least
every three (3) months thereafter on any and all patients who are prescribed, administered, or
dispensed controlled substances.
Reports generated on such patients should span the length of

time from the previous review of the MPMP so that adequate information is obtained to
determine patient compliance with treatment. Documentation, such as a copy of the report itself
and/or reflection in the chart dictation and/or notes, must be kept within the patients record and
made available for inspection upon request. In addition, licensees required to register under this
section must also utilize the MPMP to generate a global report to review their entire practice as
a whole at least yearly. Documentation of the global report must be kept in a separate file to be
available for inspection upon request.
When prescribing opioids for either chronic or acute pain, it is a contraindication to

prescribe opioids concurrently with Benzodiazepines and/or Soma. However, opioids and
10
benzodiazepines may be prescribed concurrently on a very short term basis, and in
accordance with section H of this rule, when an acute injury requiring opioids occurs.
The need for such concurrent prescribing must be documented appropriately in the chart.
Patients who are currently on an established regimen of concomitant opioids and
benzodiazepines may be allotted a reasonable period of time to withdraw from one or
both substances.
Prescriptions for Benzodiazepines must be limited to a one (1) 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.
Additional guidance or correction of any misunderstanding on my part would be appreciated.
Thank you,
Bobby Graham, MD, FACP
Jackson Oncology Associates, PLLC
11
Frances Carrillo

Subject: FW: new opioid rules
From: ammgpt@aol.com [mailto:ammgpt@aol.com]

To: THE MISSISSIPPI STATE BOARD OF MEDICAL LICENSURE; RHONDA FREEMAN
Subject: new opioid rules
October 2, 2017
RE: New Narcotic rules, filled September 22, 2017
To: Mississippi State Medical Board
I am sure a lot of work has gone into these new rules. I have read these new rules twice. Below are my initial concerns.
I understand there is a problem. Requiring 5 hours of CME every other year has not made any difference I
suspect. Increasing the documentation requirement outside pain management and weight loss practice is not going to
have much change in drug abuse in Mississippi. Continuing narcotics month after month is legalized addiction in my
opinion. The "pill mill" in Biloxi ran for years before it was shut down. The lack of access to appropriate care, especially
for uninsured and rural patients, is a huge issue in poor state. Narcotic addiction recovery is less than 20% after rehab,
and addiction is rampant in our State. This new regulation does not address any of those issues.
In my mature urology practice, I am already required to ask about pneumonia shots, colonoscopy, flu vaccinations, etc. It
is my understanding under the new regulation, you are requiring me, not office staff, to personally check the PMP on all
new patients, anyone trying to pass a stone, any post op patient going home after day surgery, etc., and keep that
documentation outside the medical record for Board review at a moment's notice.
Does this mean I am required for a post surgery patient...(never mind that I am asked to use an EHR to do post op orders
now that takes ten to fifteen minutes to negotiate on a good day).
1. query the PMP before I write post op pain meds?

2. document an exam post op ?
3. have a discussion of pro and cons with the patient in the recovery room , I guess after anesthesia , and document that
discussion ?
4. produce that documentation outside the medical record for the Board if requested for every controlled substance
script?
5. continue HIPPA compliance outside of the medical record ...two charts?
All set up by the first of November?
Has there been a discussion with the MSMA about these changes ?
I am very much against e scribing narcotics. Pain requiring controlled substances needs a face to face encounter in the
office, ER, or Urgent Care. While expensive and inconvenient, a personal encounter has to be the safest way to use
controlled drugs. Why the change to a system that can be forged?
12
It is disappointing these new rules are available for our comment essentially 20 days after filling with the Secretary of
State. It would seem the Medical Board should signal its intentions several months before
filling to increase our reporting responsibilities and requirements for patient care. Is there any evidence these new rules
will affect opioid availability outside chronic pain and weight control practices from other states?
I may have more comments as I read this again.
Arthur M. Matthews, Jr.
13
Frances Carrillo

Subject: FW: Rule
From: Alan [mailto:laserme@aol.com]
Subject: Rule
This rule will inhibit me from prescribing narcotics to patients who need them and refer the patients with severe
pain to the emergency room
While substance abuse is a problem, why should all patients with pain have to suffer. In medical school we
were taught to treat pain. This regulation will cause many patients to lose access to treat acute pain Sent from
my iPhone
14
Frances Carrillo

Subject: FW: Proposed rule changes for opioid management
From: Kevin Vance [mailto:lkevinvance@yahoo.com]
To: RHONDA FREEMAN
Subject: Proposed rule changes for opioid management
Rhonda,
Would really like a chance to address the Board regarding the new proposed regulations regarding opioid
prescribing for chronic noncancer pain. I feel the DME requirements are appropriate for primary care--but TOO
RESTRICTIVE for some of my patient population. As well, the use of Methadone should be prohibited for
primary care--but I have patients with no other viable options in 2017 for both cancer and noncancer pain.
Also, patients with intrathecal pain pumps often need higher DME dosing--or they wouldn't have intrathecal
pain pumps. And obviously, if other affordable options for pain control short of opiates were available, I'd
never write another opioid again.
I believe these sweeping changes are not appropriately considering the ramifications to many patients with
intractable neuropathic, somatic visceral, and somatic musculoskeletal pain like CRPS, Crohn's disease, post
laminectomy syndrome, peripheral neuropathies, central pain syndromes from stroke, inflammatory arthritises
like rheumatoid arthritis, post thoractomy syndrome-- to name a few.
At least put those decisions on board-certified fellowship-trained pain specialist like me-one of the few
interventionalist in the State willing to tackle these difficult patients when more injections won't help.
Sincerely,
L. Kevin Vance, MD
Comprehensive Pain Center of Mississippi Madison, MS
Sent from my iPad

.
15
Frances Carrillo

Subject: FW: new opioid rules
From: ammgpt@aol.com [mailto:ammgpt@aol.com]

To: THE MISSISSIPPI STATE BOARD OF MEDICAL LICENSURE; RHONDA FREEMAN
Subject: new opioid rules
October 2, 2017
RE: New Narcotic rules, filled September 22, 2017
To: Mississippi State Medical Board
I am sure a lot of work has gone into these new rules. I have read these new rules twice. Below are my initial concerns.
I understand there is a problem. Requiring 5 hours of CME every other year has not made any difference I
suspect. Increasing the documentation requirement outside pain management and weight loss practice is not going to
have much change in drug abuse in Mississippi. Continuing narcotics month after month is legalized addiction in my
opinion. The "pill mill" in Biloxi ran for years before it was shut down. The lack of access to appropriate care, especially
for uninsured and rural patients, is a huge issue in poor state. Narcotic addiction recovery is less than 20% after rehab,
and addiction is rampant in our State. This new regulation does not address any of those issues.
In my mature urology practice, I am already required to ask about pneumonia shots, colonoscopy, flu vaccinations, etc. It
is my understanding under the new regulation, you are requiring me, not office staff, to personally check the PMP on all
new patients, anyone trying to pass a stone, any post op patient going home after day surgery, etc., and keep that
documentation outside the medical record for Board review at a moment's notice.
Does this mean I am required for a post surgery patient...(never mind that I am asked to use an EHR to do post op orders
now that takes ten to fifteen minutes to negotiate on a good day).
1. query the PMP before I write post op pain meds?

2. document an exam post op ?
3. have a discussion of pro and cons with the patient in the recovery room , I guess after anesthesia , and document that
discussion ?
4. produce that documentation outside the medical record for the Board if requested for every controlled substance
script?
5. continue HIPPA compliance outside of the medical record ...two charts?
All set up by the first of November?
Has there been a discussion with the MSMA about these changes ?
I am very much against e scribing narcotics. Pain requiring controlled substances needs a face to face encounter in the
office, ER, or Urgent Care. While expensive and inconvenient, a personal encounter has to be the safest way to use
controlled drugs. Why the change to a system that can be forged?
16
It is disappointing these new rules are available for our comment essentially 20 days after filling with the Secretary of
State. It would seem the Medical Board should signal its intentions several months before
filling to increase our reporting responsibilities and requirements for patient care. Is there any evidence these new rules
will affect opioid availability outside chronic pain and weight control practices from other states?
I may have more comments as I read this again.
Arthur M. Matthews, Jr.
17
Frances Carrillo

Sent: Wednesday, October 04, 2017 1:59 PM
Subject: FW: Opiod proposal
From: Yahoo [mailto:lmason7376@yahoo.com]
To: RHONDA FREEMAN
Subject: Opiod proposal
My practice supports Dr. Rigdon's response to the opiod proposal. I also affirm that my practice will have to
stop any prescribing of anxiety medications in the form of benzodiazepines if point of care drug screening is
required as the cost of such testing is too burdensome for our small practice. This will significantly increase the
burden on psychiatry and primary care in our geographic location, and the patient care will definitely suffer. I do
believe that there can be amendments to these guidelines that allow for the small amount of these types of
medications to be prescribed while regulating those prescriptions that are written for large quantities or
dosages. Sincerely, Leslie Mason, MD
Sent from my iPhone
1
Frances Carrillo

Subject: FW: Emailing: licensure_20171004105140
Attachments: licensure_20171004105140.pdf
From: Administrative Assistant LIC
To: RHONDA FREEMAN
Subject: Emailing: licensure_20171004105140
Your message is ready to be sent with the following file or link attachments:
licensure_20171004105140
Note: To protect against computer viruses, e-mail programs may prevent sending or receiving certain types of
file attachments. Check your e-mail security settings to determine how attachments are handled.
2
Frances Carrillo

Subject: FW: Medical Licensure - Email from Online Application Contact Us
From: Bill Haddox [mailto:bhaddox@bellsouth.net]
Subject: Medical Licensure - Email from Online Application Contact Us
Information from Medical Licensure Contact Us
Name: Bill Haddox

Address: 304 Barrington Cove
City: Byram
State: MS
Zip: 39272
Phone: 601-371-1036
Email: bhaddox@bellsouth.net
Comments:
Opiates: the 'overhaul' apparently makes it more difficult for older(65 +) patients to acquire pain medication.
Frankly, if what I am reading is correct it's just damn 'silly'. To require an older patient to pick up a script(Dr.
Office) every 7 days makes zero sense--I have taken hydrocodone(7.5/10) one daily for about 12 yrs. for back
pain(not surgical)and have tried every crackpot & ethical treatment available. Took a little more hydrocodone
with a recent knee replacement surgery. NOT EVERYONE IS AN ADDICT AND WON'T BE. How bout a bit of
consideration for those of us that are old(I am 75)? (Also to be fair I was a SAPAA for 20 years & am more
knowledgeable than most about drgs/addiction).
3
Frances Carrillo

Subject: FW: Public comment
Attachments: MSBML 10-4-17.docx.doc
From: EDWARD RIGDON [mailto:edrigdon@hotmail.com]

To: RHONDA FREEMAN
Subject: Public comment
SentfromMailforWindows10
4
Edward E. Rigdon, M.D., F.A.C.S.
348 Crossgates Boulevard
Suite 2500
Brandon, Mississippi 39042
Phone (601) 825-1975 Fax (601) 825-4127
Board Certified in Vascular Surgery Fellow of the American College of Surgeons
October 4, 2017

Jackson, MS 39216
To the Mississippi State Board of Medical Licensure:
I am writing in response to the recent proposed changes in regulations by the Mississippi State
Board of Medical Licensure regarding the prescription of opioid medications. While I support
reasonable measures to alleviate the crisis of over prescription and abuse of opioids, I believe the
proposed changes will have unintended adverse consequences. My comments are directed to the
use of opioids for relief of acute pain following surgery, which appears to have been left out of the
considerations in formulating the proposed rule changes.
I prescribe opioids only immediately after surgery for patients who need vascular access for chronic
hemodialysis and other major vascular reconstructive operations. These patients will ALL get cut
and will ALL be in pain afterwards. These operations are only performed to preserve life and/or
limb. Even if there is the rare patient with potential for opioid abuse, these are not the appropriate
circumstances to deny them relief of the pain they will certainly experience. Most of these patients
also have contraindications to the use of nonsteroidal anti-inflammatory drugs (NSAIDs) at doses
effective for postoperative analgesia. Acetaminophen likewise generally does not provide effective
pain relief after surgery of this magnitude.
Caring for these patients already places a burden of regulatory and administrative time and costs
that it is frustrating and makes their care marginally attractive for surgeons. The number of us
willing and capable of providing their surgery is decreasing significantly, in no small way directly
attributed to these hassles. Additional regulations that add time and expense to providing their
care will make surgeons less likely to prescribe opioids or even provide their surgery.
Opioid prescriptions for acute postoperative pain are written at inpatient or outpatient surgical
centers and are recorded in their facility record. Requiring the prescriber to maintain in their office
an additional PMP report for each of these prescriptions will add another unreasonable
administrative burden, as will the requirement that providers generate a global PMP report each
year. The PMP information is already available to the MSBML to identify prescribing patterns that
need closer inspection, and the cost of routine on-site inspections by the MSBML will be substantial
for both the providers and the MSBML.
These regulations will place a significant administrative burden on practices providing acute
surgical services and will be a significant impediment to providing the care for these patients. It is
1
likely that surgeons will simply refuse to prescribe opioids, even for patients who really need them.
You should anticipate a major public outcry and backlash should these rules be implemented in the
proposed forms. Physicians can anticipate an onslaught of liability claims from adverse effects
alleged to be the result of use of nonopioid analgesics in these patients. There will be few winners
(proably more lawyers than patients), and many losers.
There are other proposed changes that I believe need some clarification and reconsideration. The
first is the regulation requiring informed consent. Does this mean that an informed consent
specific for the prescription of opioids after surgery will be required? What would this informed
consent entail? Have medical-legal experts commented on this proposal? How are our liability
carriers going to view this? Having practiced in Mississippi for almost 40 years, I foresee a long
future of chaos and legal wrangling over this regulation and the documents that will be generated as
a result, with no meaningful contribution to easing the opioid abuse crisis.
The definition of a "Pain Management" practice is unclear. How is the 30% threshold for patients
receiving opiod prescriptions to be calculated? Is it the number of prescriptions divided by the
number of clinic visits or just new patients? How does one define chronic pain? Is a single
prescription for a small number of doses after surgery considered treating chronic pain? What about
my dialysis patients, many of whom require multiple operations each year to maintain their vascular
access? Will they be considered chronic pain patients? Even if this were calculated based on new
patients only, most surgeons will be determined to be providing chronic pain management.
Certainly not all patients referred to surgeons need an operation and opioid prescriptions, but
Mississippi physicians referring patients to surgeons are not so bad that fewer than 30% of those
they refer will need surgery.
I respectively submit that you consider altering the proposed regulations to EXCLUDE the
prescriptions of small numbers of opioids with no refills for the management of acute postoperative
pain. These exclusions should specifically state:
1. Physicians will NOT be required to check the PMP for every encounter when prescribing an
oral opioid for a limited amount for acute postoperative pain. I suggest allowing a limited
prescription of 30 DOSES WITH NO REFILLS for acute postoperative pain, WITHOUT
CHECKING THE PMP, would not contribute to the opioid abuse crisis and would be a reasonable
and fair compromise.
2. An "informed consent" document should NOT be required when prescribing opioids in small,
limited amounts for acute postoperative pain.
3. The definition of a "Pain Management" practice should clearly exclude the prescription of
opiods in small, limited amounts for acute postoperative pain.
Finally, I want to again emphasize my support for reasonable regulations regarding the prescription
of opioids. However, I strongly believe some of the proposed regulations, rather than
accomplishing these objectives, will be a significant regulatory burden, create more problems than
they solve, and impede the care of many patients with acute postoperative pain.

2
Frances Carrillo

Sent: Thursday, October 05, 2017 2:32 PM
Subject: FW: Public Comment of Medical Assurance Company of Mississippi (MACM) on
MSBML's Proposed Changes to Part 2640 Chapter 1: Rules Pertaining to Prescribing,
Administering and Dispensing of Medication
Attachments: Public Comment on MSBML.pdf
From: Stephanie C. Edgar [mailto:sedgar@macm.net]

Cc: Rob Jones; Gerry Ann Houston; Kathy Stone
Subject: Public Comment of Medical Assurance Company of Mississippi (MACM) on MSBML's Proposed Changes to Part
2640 Chapter 1: Rules Pertaining to Prescribing, Administering and Dispensing of Medication
ToWhomItMayConcern:
OnbehalfofMedicalAssuranceCompanyofMississippi(MACM),pleaseaccepttheattachedPublicCommentonthe
MississippiBoardofMedicalLicensuresProposedChangestoPart2640,Chapter1:RulesPertainingtoPrescribing,
AdministeringandDispensingofMedication.Wethankyouinadvanceforyourconsideration,andshouldyouhave
questionsaboutourcomments,pleasedonothesitatetocontactus.
Sincerely,
Stephanie
Stephanie C. Edgar, J.D.

General Counsel
404 West Parkway Place

Ridgeland, MS 39157
P (601) 605-4882 (800) 325-4172
F (601) 605-8386
sedgar@macm.net
www.macm.net
CONFIDENTIALITY NOTICE: The information contained in this communication is PRIVILEGED AND CONFIDENTIAL and intended only for the use of the individual
to whom it is addressed. If you are not the intended recipient, you are hereby notified that any dissemination, distribution, or copying of this communication is
strictly prohibited. Immediately notify the sender by reply e-mail if you have received this communication in error. Please delete this communication and any
copies thereof. This email (including attachments) is covered by the Electronic Communications Privacy Act, 19 USC Sections 2510-2521.
1
Frances Carrillo

Subject: FW: Part 2640 changes
From: Luc Michaud [mailto:lucmichaud63@gmail.com]

Sent: Thursday, October 05, 2017 8:42 AM
Subject: Part 2640 changes
I have been a Registered Pharmacist for 27 years and I have concerns with these new regulations. I truly
understand that there is an opioid problem in this state but every solution causes negative consequences. Let
me explain some side effects that these regulations will cause. These examples are taken from real patients.
I have one patient that was in a severe car accident a few years ago and almost died. This accident was so
severe, this patient now has Post Traumatic Stress Disorder. This patient is in a lot of pain and therefore on
chronic pain medicine and obviously is extremely nervous. These new regulations will force this patient to stop
anxiety medicine. Does this patient not suffer enough without this added burden?
I have another patient in mid-70s who suffers from chronic pain but also has severe restless legs at night and
cannot sleep without clonazepam. This patient, according to new regulations, will have to discontinue the
restless leg medicine and return to sleepless nights. Is that the compassion that we want to demonstrate to out
elderly?
I think the bottom line is that these regulations make very generalized assumptions that may be true for most but
definitely not true for all. These regulations actually add suffering to innocent patients who are simply trying to
live the best quality of life while suffering pain.
Here are some of my thoughts.

Luc Michaud, RPh
662-816-8617
Sent from my iPhone
2
Frances Carrillo

Subject: FW: prescribing for acute post uperative pain
From: Stephen W. Tartt [mailto:swt@medicalartssg.com]

Subject: prescribing for acute post uperative pain
Howwillwemanageprescriptionsforacutepostoperativepainatdischargefromthehospital.Willwehavetocheck
thedatabaseandkeepledgeratouroffice?
3
Frances Carrillo

Subject: FW: proposed opioid prescribing laws
From: htliddle@comcast.net [mailto:htliddle@comcast.net]

To: RHONDA FREEMAN
Subject: proposed opioid prescribing laws
I have read the proposed regulatory measures regarding opioid prescribing. While I realize that the
opioid epidemic is a burden to taxpayers and even our way of life, I am strongly opposed to the
manner in which this problem is being addressed. The proposed regulations will constitute an
additional administrative burden for practitioners, and will do little to stem the flow of prescription
drugs into the hands of patients who are obtaining them.
Every few weeks, another administrative task is assigned to our physicians. There is already limited
time to interact with patients, because of the necessary time spent interacting with the electronic
medical record and other required elements related to oversight of care. While this new proposal may
not seem like much of a burden to those making the laws, I can assure you that it will raise the level
of burnout that we hear so much about in recent years.
Please consider allowing physician education to have a chance to be effective. It has only been about
2 months since we were threatened with having our licenses to practice encumbered if we were to
prescribe to those patients deemed to be doctor shopping. Also, please consider inserting a sundown
clause so that if indeed you decide to pass this legislation, there will be a time of evaluation at the
close of which, the regulations will not be renewed if there is no objective evidence based on
measurable parameters, that the laws have been effective. And finally, if the legislation is to be
passed in its current form, consider backing off (repealing) some of the other past legislation that is
apparently not having a beneficial effect (based on my observation that the opioid epidemic is
worsening). The required CME course on narcotics prescribing comes to mind.
There was a time in the past when the physicians guilty of overprescribing were singled out for
punishment. Now, the preferred method of addressing any problem seems to be to add regulations to
all providers in a relatively nonconfrontational manner. There are already means for the State Board
of Health to go after the ones responsible for this opioid crisis. However, simply adding laws may be
easier than mustering the fortitude to proceed with punishing those responsible.
Respectfully,
Hal T. Liddell M. D.
MS 09147
4
Frances Carrillo

Subject: FW: new regulations
From: bennie [mailto:benniewright@hotmail.com]
To: RHONDA FREEMAN
Subject: new regulations
I see that Dr Ed Rigdon has sent in a letter with his concerns. I would like to second that letter as I too am a
surgeon and I can see that this new regulation will be burdensome to my practice. I agree with all the points
he is making and ask that more thought be put into implementation of this regulation.
Thank you, Bennie Wright
5
348 Crossgates Boulevard
Suite 2500
Brandon, Mississippi 39042
Phone (601) 825-1975 Fax (601) 825-4127
Board Certified in Vascular Surgery Fellow of the American College of Surgeons
October 4, 2017

Jackson, MS 39216
To the Mississippi State Board of Medical Licensure:
I am writing in response to the recent proposed changes in regulations by the Mississippi State
Board of Medical Licensure regarding the prescription of opioid medications. While I support
reasonable measures to alleviate the crisis of over prescription and abuse of opioids, I believe the
proposed changes will have unintended adverse consequences. My comments are directed to the
use of opioids for relief of acute pain following surgery, which appears to have been left out of the
considerations in formulating the proposed rule changes.
I prescribe opioids only immediately after surgery for patients who need vascular access for chronic
hemodialysis and other major vascular reconstructive operations. These patients will ALL get cut
and will ALL be in pain afterwards. These operations are only performed to preserve life and/or
limb. Even if there is the rare patient with potential for opioid abuse, these are not the appropriate
circumstances to deny them relief of the pain they will certainly experience. Most of these patients
also have contraindications to the use of nonsteroidal anti-inflammatory drugs (NSAIDs) at doses
effective for postoperative analgesia. Acetaminophen likewise generally does not provide effective
pain relief after surgery of this magnitude.
Caring for these patients already places a burden of regulatory and administrative time and costs
that it is frustrating and makes their care marginally attractive for surgeons. The number of us
willing and capable of providing their surgery is decreasing significantly, in no small way directly
attributed to these hassles. Additional regulations that add time and expense to providing their
care will make surgeons less likely to prescribe opioids or even provide their surgery.
Opioid prescriptions for acute postoperative pain are written at inpatient or outpatient surgical
centers and are recorded in their facility record. Requiring the prescriber to maintain in their office
an additional PMP report for each of these prescriptions will add another unreasonable
administrative burden, as will the requirement that providers generate a global PMP report each
year. The PMP information is already available to the MSBML to identify prescribing patterns that
need closer inspection, and the cost of routine on-site inspections by the MSBML will be substantial
for both the providers and the MSBML.
These regulations will place a significant administrative burden on practices providing acute
surgical services and will be a significant impediment to providing the care for these patients. It is
1
likely that surgeons will simply refuse to prescribe opioids, even for patients who really need them.
You should anticipate a major public outcry and backlash should these rules be implemented in the
proposed forms. Physicians can anticipate an onslaught of liability claims from adverse effects
alleged to be the result of use of nonopioid analgesics in these patients. There will be few winners
(proably more lawyers than patients), and many losers.
There are other proposed changes that I believe need some clarification and reconsideration. The
first is the regulation requiring informed consent. Does this mean that an informed consent
specific for the prescription of opioids after surgery will be required? What would this informed
consent entail? Have medical-legal experts commented on this proposal? How are our liability
carriers going to view this? Having practiced in Mississippi for almost 40 years, I foresee a long
future of chaos and legal wrangling over this regulation and the documents that will be generated as
a result, with no meaningful contribution to easing the opioid abuse crisis.
The definition of a "Pain Management" practice is unclear. How is the 30% threshold for patients
receiving opiod prescriptions to be calculated? Is it the number of prescriptions divided by the
number of clinic visits or just new patients? How does one define chronic pain? Is a single
prescription for a small number of doses after surgery considered treating chronic pain? What about
my dialysis patients, many of whom require multiple operations each year to maintain their vascular
access? Will they be considered chronic pain patients? Even if this were calculated based on new
patients only, most surgeons will be determined to be providing chronic pain management.
Certainly not all patients referred to surgeons need an operation and opioid prescriptions, but
Mississippi physicians referring patients to surgeons are not so bad that fewer than 30% of those
they refer will need surgery.
I respectively submit that you consider altering the proposed regulations to EXCLUDE the
prescriptions of small numbers of opioids with no refills for the management of acute postoperative
pain. These exclusions should specifically state:
1. Physicians will NOT be required to check the PMP for every encounter when prescribing an
oral opioid for a limited amount for acute postoperative pain. I suggest allowing a limited
prescription of 30 DOSES WITH NO REFILLS for acute postoperative pain, WITHOUT
CHECKING THE PMP, would not contribute to the opioid abuse crisis and would be a reasonable
and fair compromise.
2. An "informed consent" document should NOT be required when prescribing opioids in small,
limited amounts for acute postoperative pain.
3. The definition of a "Pain Management" practice should clearly exclude the prescription of
opiods in small, limited amounts for acute postoperative pain.
Finally, I want to again emphasize my support for reasonable regulations regarding the prescription
of opioids. However, I strongly believe some of the proposed regulations, rather than
accomplishing these objectives, will be a significant regulatory burden, create more problems than
they solve, and impede the care of many patients with acute postoperative pain.

2
Frances Carrillo

Subject: FW: Opposing certain parts of opioid proposal
From: Rick Rhoden [mailto:rrhoden@flavordoctor.com]

To: RHONDA FREEMAN
Cc: DR. BILL GRANTHAM; alexaivancic@hotmail.com; Charmain H. Kanosky; Mpa
Subject: Opposing certain parts of opioid proposal
Sir/Madam of MSBML:
"FIRST do no harm" comes to mind as I read over this proposal. Rules concerning opioids make sense but there
is a vast overreach here that will do more harm than good, especially to physicians and their patients. Although
premature, the Oct 4th front page Clarion-Ledger story fortunately got it right: it referred to new rules
concerning "the opioid crisis" on prescribing "opioids", not other drug classes. MSBML needs to stick with this
narrow public narrative and not attempt to drag other drugs into the fray. That becomes a slippery slope!
My critique:
1) The problem at hand is an OPIOID crisis that is killing people and is fairly recent in severity, having been
accelerated initially in part by Government urging physicians to treat pain, treat pain! It is NOT an Every Other
Control Drug crisis that requires rigid regulation with inadequately parsed measures that further diminish and
demean the value of physicians' clinical judgment, honed through many years of rigorous training, continuing
education and clinical experience.
2) As I heard from Dr. Grantham, speaking October 3rd as President of MSMA, overregulation of physicians is
a real problem. This is especially true of unproven, hasty ones enacted under political pressure to do something,
anything, whether good or bad--and often more bad than good.
3) Every extra 'little' requirement on physicians becomes another straw to break the camel's back, especially
when its value is questionable. Perhaps it seems like a small amount of time to check PMP, but at several
hundred patients a month, this is either an electronic intrusion into a session or time spent away from patients
who only have a few minutes left after already addressing their angry confusion over insurance denials, 'PAs'
and limited drug formularies. I am quite sure with my redundant practice controls that I would rarely, if ever,
reap any positives from time based, non-indicated PMP checks--that is, if my practice could even survive with
the reduced patient care time lost to the increased mandate time;
4) Requiring certain limitations and PMP checks for opioids--which should be generally short term and are the
ONLY class of drugs with a sudden 'crisis' of mortality--makes some sense clinically, ethically and politically.
MSBML, however, will be opening a veritable Pandora's Box of unintended but predictably onerous
consequences by trying to address complicated, long-standing substance use and abuse problems with a broad,
unproven risk/benefit brushstroke of mandated, routine, non-indicated PMP checking of drugs other than
OPIOIDS!
6
5) Setting and keeping up with arbitrary time intervals for MANDATED PMP checks for NON-OPIOID drugs
when there are no individual indications of necessity will be a time-consuming administrative nightmare for
physician practices, especially small ones, piling on yet another layer of punitive threat;
6) Wording in this proposal should not refer to controlled/scheduled drugs as a general term which could lead to
interpreting all Schedule ll-V drugs as needing intrusive regulation, with the subsequent exposure of well-
meaning physicians to new time constraints and punishments. This could be resolved by always and only using
the words "opioids" or "narcotic pain medicine" and directing all requirements toward opioids, which are only a
part of a scheduled class. Other scheduled drugs do not have the same deadly issues as opioids. Regulating just
opioids will alleviate the public and political pressures.
7) By being overinclusive of drugs besides opioids, MSBML will help perpetuate the common misperception by
legislators and the general public that all controlled drugs are narcotic opioids, leading to draconian legislation;
8) UNLIKE opioids, many scheduled drugs NEED to be long-term or recurrent in treatment; they should be
carefully and frequently monitored clinically with proper documentation, prescription copies and so forth. Such
measures will usually show when PMP checks are necessary as a part of treatment; MSBML could offer
guidelines--not mandates--for clinical monitoring of non-opioids. That is, unless our role is changing from that
of clinical caregivers to law enforcers looking to boost incarceration rates;
9) Required PMP checks of non-opioids on a routine, non-indicated basis will be yet another impediment to
clinical time with patients and boost to physician burnout;
10) One example of Schedule II drugs that are very different from opioids are the psychostimulants used to treat
such chronic conditions as ADHD, narcolepsy and sleep phase disorders. When properly diagnosed and treated,
psychostimulants should be given regularly over a long period of time, resulting in much improved patient
function, as opposed to the dysfunctions occurring with opioids. Psychostimulants are some of the safer drugs
out there comparatively. They are not causing mass death and destruction but actually help prevent such.
Careful diagnosis, monthly no-refill prescriptions with copies, requiring frequent visits, physically checking pill
amounts, documentation, and clinical assessment for history and signs of abuse, are much more useful than
some routine PMP checks which will reduce patient care time even further. The PMP as an optional tool in the
clinician's armamentarium, however, should be part of recommended guidelines;
11) Family practitioners, pediatricians, some psychiatrists like myself, and the many patients with ADHD we
treat, will be negatively impacted needlessly, as more time is eroded and liability increased, with little, if any,
patient benefit;
12) There is nothing like one more overinclusive regulation to cause attorney/prosecutor salivation!
13) By adding drug classes other than opioids, MSBML will be encouraging expanded criminalizing laws from
legislators who have little understanding of the intricacies of medicine but are quite adept at gaining popularity
by creating tough laws and punishments, whether or not they solve the problem;
14) By a clear, tightly composed regulation on JUST opioid drugs alone, MSBML would be addressing with
laser focus the actual opioid crisis of death. Including other drug classes muddles the message;
15) Mandating PMP checks goes against the recently stated American Medical Association's policy against
such mandates. Physicians checking PMP for non-opioids when indicated by careful history and evaluation,
however, IS good clinical practice.
7
16) Within this proposal MSBML should acknowledge and encourage the vast majority of physicians in using
and continuing to use careful clinical judgment with all drugs that can be abused or otherwise hazardous if
incorrectly used. Without such a caveat this proposal carries the implication that physicians ARE the primary
culprit in the opioid crisis and, therefore, need evermore micromanagement by governmental and regulatory
bodies; I hope we don't believe that.
17) I realize this is a long response, but there are so many problematic parts to this proposal that it is mind
boggling! I have to wonder if the authors actually treat people that have pain, anxiety, insomnia, ADHD,
narcolepsy, seizures, phobias, combinations and complexities of disorders that are the rule, not the exception?
Or do they just have the luxury of large staffs or institutions that can do their legwork? As I read in more and
more detail, parts of this proposal are TERRIBLE! Are you kidding me? Someone who takes an occasional
benzo or benzo-receptor sleeping aid for situational but periodic symptoms, or successfully functional lawyers,
teachers, attorneys, administrators, technicians, nurses, accountants and others who happen to have ADHD well
managed with a psychostimulant for 10 or more years without a whiff of drug misuse now have to have PMPs
checked every 3 month visit? and yearly summaries? And special records? Pediatricians with many kids and
possibly parents treated for ADHD are going to be checking the PMP out the wazoo with no clinical
justification? ARE YOU KIDDING ME?! Doctors, including me, will have to deny treating many patients, or
just throw in the towel with this final last straw from their own colleagues--an intrusive level of mandate with
no proof of doing more good than harm.
18) The here-we-go-again discriminatory inclusion of psychiatric patients deserves its own numbered paragraph
here. At least one section of the proposal appears to require that PSYCHIATRIC patients taking ANY control
drug (that includes ll all the way through V!) must have these mandated checks, yearly summaries and special
separate records open for inspection. This is even lawsuit-worthy. Do you have any idea how many patients
have to be seen in a day in many private and public clinics? Routine checks without indications are not going to
do more good than harm. MSBML, stick to opioid/narcotic pain medications that KILL people and routine
checks might be valuable!
19) If the end goal is to absolutely quantify every patient's use of all schedule drugs, MSBML is not the best
player. There are too many other providers, forgers, addicts and con artists that are not managed by MSBML.
The obvious gatekeeper with the necessary personnel and electronic systems at the point of distribution, is the
pharmacist.
In short, I am vehemently opposed to MSBML promulgating regulations mandating new, specific demands on
physicians, particularly checking PMP with routine, time-based requirements, EXCEPT for the OPIOID drug
class that is SOLELY responsible for this specific crisis of death among prescription drugs!
Rick Rhoden, M.D.

Past President,
Central Medical Society
8
Frances Carrillo

Subject: FW: New Regulations Regarding Opiods
From: Anne K. Pinkerton [mailto:apink1@exede.net]
Subject: New Regulations Regarding Opiods
I was just wondering if you ever talk to patients about their use of prescription pain medicines before you pass
or consider new regulations. I am a 64 year old great grandmother and I suffer from Fibromyalgia and Arthritis
pain daily. My doctor currently prescribes pain medicines for me. Some days require that I take 4 pills and
some days I am able to get by without taking any. My husband has Pulmonary Fibrosis and is in dire need of a
double lung transplant. The stress of this, I'm sure, contributes to my pain. Your new regulations will be the
equivalent of punishment to me for something others are abusing.
Please consider the repercussions of proposed legislation to some of us elderly people (for whom I know the
government is not very concerned.) It is cruel to just leave us in pain because there are some that abuse their
privilege.
I refuse to go to a pain management clinic. My mother and my daughter have both gone down that path and
they never got ANY relief from them.
In fact, both came out in more pain that what they had when they went in. Just PLEASE, consider people like
me. I don't know what other recourse to take but to write you this note. Thank you for your time.
Not everyone taking pain medication is an addict or abuser!
Anne Pinkerton
Coldwater, MS
---
This email has been checked for viruses by Avast antivirus software.
https://www.avast.com/antivirus
9
Frances Carrillo

Subject: FW: From: John Huntwork, M.D., Pascagoula, MS 39581
From: John Huntwork [mailto:john@jchmd.net]

Subject: From: John Huntwork, M.D., Pascagoula, MS 39581
Sirs:
This is a comment on the rules for prescribing of controlled substances recently submitted by the Mississippi
Board of Medical Licensure.
Although I am a rheumatologist whose patients, almost by definition, have pain, I do not prescribe,according to
my best estimates, controlled substances to more than about 20%-25% of the patients I see. However, this
percentage has resulted from my best medical judgment; it is not a matter of policy. Also, many, if not most, of
the registered drug prescriptions I write are for Lyrica for fibromyalgia or neuropathic pain, and small quantities
of tramadol, for breakthrough pain due to various causes.
Since I do prescribe small quantities of these registered drugs to between 20 and 25% of the patients I see, the
arbitrary guideline that 30% of my patients receiving prescriptions for controlled substances would make me a
pain clinic, creating an additional regulatory burden, may push me to place regulatory concerns above my
patients' concerns in the future.
Even if it were a much lower number than 30%, if this rule gave weight to the prescribing of multiple controlled
substances to the same patient, or to the prescribing of opioids above the level of regulatory concern identified
by the Center for Disease Control's Guidelines for Prescribing Opioids for Chronic Pain, I could certainly
understand it, but to give the same weight to a prescription for Lyrica for a fibromyalgia patient, or a
prescription for 30 tramadol per month, as to a prescription for 120 Percocet 10 per month, strikes me as
chilling to conservative and responsible patient management, plus it tends to blur the very meaningful and
important distinctions between the schedules of registered drugs.
I hope this rule is refined to exclude lower doses, quantities and classes of registered drugs from the same
regulatory concern as 30 mgm and above morphine equivalent opioid dosages. I further hope that it is refined to
distinguish between the intermittent treatment of patients whose chronic, painful diseases flare intermittently
and those that require continuous use of registered drugs.
I understand that most patients who abuse registered drugs start out with lower doses and quantities, so it is
never unimportant when one writes a prescription for a registered drug. However, the metric for a provider or
practice, particularly a practice in which by definition almost every patient has pain, should be not how many
10
patients receive small quantities of registered drugs, but how many patients receive quantities that escalate over
time or approach the CDC's levels of regulatory concern.
11
Frances Carrillo

Subject: FW:
Attachments: Letter from Rigdon regarding opioid crisis regulations.doc
From: William Ashford [mailto:Ashforddr@aol.com]

To: RHONDA FREEMAN
Subject:
Sent from my iPad
12
Frances Carrillo

Subject: FW: Proposed opioid crisis regulations
Attachments: Letter from Rigdon regarding opioid crisis regulations.doc
From: Phillip Ley [mailto:phillipley@gmail.com]

To: RHONDA FREEMAN
Subject: Fwd: Proposed opioid crisis regulations
Dr Rigdon, with whom I fully and completely agree, is much more tactful than I am. These proposed changes
are ridiculous and poorly considered, as are most proposals that are reactionary in nature ....
Phillip Ley M.D. FACS

Flowood, MS
---------- Forwarded message ----------
From: <CBushMD@aol.com>
Date: Oct 4, 2017 8:51 PM
Subject: Proposed opioid crisis regulations
To: <cbushmd@aol.com>
Cc: <phillipley@gmail.com>
Dear Colleagues,
Attached is a letter written by Ed Rigdon to the Mississippi State Board of Medical Licensure regarding the
State Board's response to the opioid crisis. It is very well written and points out a number of unintended
consequences of the proposed regulations.
I would encourage you to read the letter and forward it on to your partners and other interested physicians. If
you agree with Ed's position, please forward a copy of the letter, along with your endorsement to the State
Board of Medical Licensure at Rhonda@msbml.ms.gov , and encourage your colleagues to do the same.
The public comment on this issue ends October 17, 2017, so please don't delay.
Sincerely,
Charles C. Bush, M.D.
13
Frances Carrillo

Subject: FW: Proposal for the regulation of the opioids prescribing
Attachments: MSBML 10-4-17.docx.doc; ATT00001.txt
From: Kristen Crawford [mailto:kcox_mc@yahoo.com]
To: RHONDA FREEMAN
Subject: Proposal for the regulation of the opioids prescribing
To whom it may concern:
As a physician, I agree that there needs to be regulation with opioid prescribing, but the proposal that was
suggested will be very burdensome. I also fear for my safety, as well as my colleagues safety, whenever
patients who are dependent are no longer able to continue getting opioids. There will be doctor shopping and
we will bear the brunt of these angry patients. There has already been a reports of violent crimes committed
against physicians across the country with recent prescribing changes (pain management physicians in NY
murdered earlier this year by unhappy patient, as well as others). What is going to be done to help the patients
who are addicted? Will the state set up a detox program? Will we get more addiction medicine physicians
recruited to the state to help?
I believe that physicians and law makers can come up with better regulation than this. I agree with the stance
taken in Dr. Rigdon's letter, which is attached.
Thank you.
Kristen Crawford, MD
14
Public Comment of Medical Assurance Company of Mississippi (MACM) on MSBML's
Proposed Changes to Part 2640 Chapter 1: Rules Pertaining to Prescribing, Administering
and Dispensing of Medication
MACM insures approximately 2,500 physicians practicing in the State of Mississippi, which will
be impacted by these proposed regulations. While this Boards efforts in this regard are
commendable, it is imperative that other boards such as the dental and nursing boards undertake
similar efforts. In other words, the overall efficacy of these proposed rules is doubtful if other
professions do not make similar strides.
1. Proposed Rule 1.2 (J): Pain Management Practice is defined as a public or privately
owned practice for which 30% or more of the patients are issued, on a regular or recurring
basis, a prescription for opioids, barbiturates, benzodiazepines, carisoprodol, butalbital
compounds, or tramadol for the treatment of chronic noncancerous pain.
How does the Board wish for the 30% threshold to be determined? Is this to be determined by
patient encounters during a given timeframe or is it to be calculated by total patient population
during a specific timeframe?
2. Proposed Rule 1.7 (C)(1): This subsection dictates that a risk benefit analysis, which
includes a review of records of prior treatment, must be accomplished.
What are the parameters for records of prior treatment? Is the physician required to review only
his/her prior records? Is the physician expected to query other providers that may have treated the
patient, and if so, how far back in time does this search need to stretch?
3. Proposed Rule 1.7 (C)(4): This provision details certain elements of informed consent
such as using one licensee and pharmacy, urine/serum medication level monitoring when
requested, pill counts, and the grounds for which the treatment must be terminated (e.g.,
doctor shopping behavior, adverse urine/serum screens, etc.).
Is the Board dictating that the following must be in every informed consent when prescribing
controlled substances for chronic pain: 1) using one licensee and pharmacy; 2) urine/serum
medication level monitoring when requested; 3) pill counts; and 4) the grounds for which the
treatment must be terminated?
4. Proposed Rule 1.4 (B) and Proposed Rule 1.11 (A)(2) and 21 C.F.R. 1306.12(b)(1):
21 C.F.R. 1306.12(b)(1) specifically addresses schedule II prescriptions and provides that
a practitioner may provide individual patients with multiple prescriptions for the same
schedule II controlled substance to be filled sequentially. The combined effect of these
multiple prescriptions is to allow the patient to receive, over time, up to a 90-day supply of
that controlled substance. The federal Rule goes further to indicate that individual
practitioners must determine on their own, based on sound medical judgment, and in
accordance with established medical standards, whether it is appropriate to issue multiple
prescriptions and how often to see their patients when doing so. By contrast, the proposed
MSBML Rules 1.4(B) and 1.11 (A)(2) seem to remove the practitioners discretion as
reflected in 21 C.F.R. 1306.12(b)(2) as the proposed rules suggest that a physical
examination is required every time a controlled substance prescription is written.
How does the Board envision these rules working in tandem? Is there, in fact, a requirement that
a history and physical must be done every time a prescription for a controlled substance is written,
even though it is permissible to do so without a physical examination pursuant to 21 C.F.R.
1306.12(b)(1)?
5. Proposed Rule 1.11(A)(2): Physical examination is listed as one of the Boards

requirements for a valid licensee-patient relationship.
MACM respectfully requests that the Board consider including an exception for hospice and
palliative care insofar as the requirement of a physical exam is concerned. Hospice patients must
be medically certified by two physicians to have a life expectancy of six months or less. If the
physical examination requirement were applicable to hospice physicians, there will be unintended
consequences. For example, if a patient is referred to hospice by a hospitalist, the hospitalist can
prescribe controlled substances upon discharge. If these medications do not work or if the patient
runs out of the medications, the hospice medical director should be permitted to either refill or
order a different prescription. Similarly, the hospitalist may discharge the patient with no
medications, and the hospice medical director should be able to prescribe a controlled substance
to relieve the patients pain.
Tennessee has authored Clinical Practice Guidelines for Outpatient Management of Chronic Non-
Malignant Pain, many of which mirror the rules proposed by this Board. However, the patients in
a hospice program or in a palliative care setting with a life expectancy of six months or less are
specifically excepted.
Likewise, the Louisiana State Board of Medical Examiners has taken the position that a medical
director of a hospice need not see a hospice patient before prescribing opioids.
While we commend this Board for making such an effort to curb drug abuse and diversion, we are
concerned that these particular patients will be deprived of vital pain control during perhaps the
most vulnerable point in their lives.
6. Proposed Rule 1.10 (H): This proposed Rule limits the supply of Benzodiazepines to a
one (1) month supply, with no more than two (2) refills.
MACM requests that the Board consider including an exception for hospice and palliative care.
Extreme anxiety, agitation, and delirium are frequently seen in hospice and palliative care
patients. Again, the concern here is that these particular patients will be deprived of vital relief
during end-of-life treatment if their Benzodiazepines are not available throughout their entire
illness.
7. Proposed Rule 1.11(A)(2): Another issue related to Rule 1.11 (A)(2) is that the
requirement for a physical examination applies to all prescriptions, not just controlled
substances.
What impact, if any, will this have on the ability of physicians to prescribe medications via a
telemedicine visit? Does it prohibit physicians from prescribing based only on a phone call
complaint from a well-known, established patient especially for a recurring but episodic
complaint such as UTI? Will the Board agree that an actual physical examination is no longer the
standard of care for minor illnesses diagnosed and treated via telemedicine encounters (even phone
only)?
Medical Assurance Company of Mississippi
By:
Robert M. Jones
President and Chief Executive Officer
Gerry Ann Houston, M.D.

Medical Director
Stephanie C. Edgar, J.D.

General Counsel
Kathy Stone, BSN, RN

Vice President of Risk Management
Frances Carrillo

Sent: Friday, October 06, 2017 7:18 AM
Subject: FW: Acute pain
From: John F Pappas, MD [mailto:johnfpappasmd@aol.com]
To: RHONDA FREEMAN
Cc: Charmain H. Kanosky
Subject: Acute pain
To the licensure board,
Thank you for your excellent work in addressing the opioid crisis in our state.
I would respectfully urge you to consider in the acute pain setting:
1) Only prescribe the lowest doses of the opioid analgesia (No Norco 10s; only Norco 5s, etc, etc) in
management of acute pain medicine.
2) Please limit to 5 days and not 7 days. This change will make for a much more effective policy.
3) Also, put a strict limit on what ER docs can prescribe. This is not a knock on them; on the contrary, the
patients will quickly get the message that the ER is not dispensing opioids for more than 48 hours for acute
pain if the patient is discharged from the ER. The ER will therefore operate more efficiently and the patients
will get better care.
Thank you,
Dr. John F. Pappas
Sent from my iPad
1
Frances Carrillo

Subject: FW: Proposed Board Regulations
From: David Booth [mailto:davbooth@aol.com]
Subject: Proposed Board Regulations
Dear Board Members:
I would like to comment on the proposed opiate and benzodiazepine regulations.
I have incorporated the newly released CDC Opiate Guidelines into my practice and have found them to have
a profoundly positive impact on my prescribing habits. My focus on use/misuse of opiates as well as
benzodiazepines has increased dramatically. I have doubled down on my efforts to taper when possible,
watch for diversion, maximize non-opiate treatments for pain and avoid prolonged opiate use for acute pain.
The CDC guidelines along with the prevailing culture of avoiding opiate/benzodiazepine combinations should
be adequate to safely curtail unnecessary prescribing while allowing compassionate care of pain patients,
many of whom are the elderly and the vulnerable of our state.
The proposed regulations will be so burdensome to my family practice that I will be unable to care for
legitimate pain patients who have been stable for years on low MME regimens. My concern statewide is that
an abrupt non-scientifically obtained regulatory reaction to the current opiate crisis will prevent most family
practitioners from providing reasonable pain management. This short-fall in care would most likely increase the
use of illicit drugs and increase the deaths from heroin overdose.
Many of my patients have no insurance or inadequate means to travel from Eupora to Starkville, Tupelo,
Jackson, Meridian or Greenville for pain management. I also have concerns that referrals to pain management
will quickly escalate to much higher MMEs than I would have used to manage their pain.
I am a strong advocate for getting drugs off the streets and good safe opiate guidelines for the protection of the
citizens of MIssissippi. However, lets not loose sight of our duty to care for the legitimate non addicted pain
patients who have been caught up in this opiate crisis.
I urge you to consider the time and effort that was put into the CDC Advisory Committees systematic review of
scientific evidence in order to put together a set of guidelines for the safe use of opiates. I think the scientific
application of evidence based medicine would be much safer for the citizens of Mississippi than a proposed set
of regulations, albeit well intentioned, that would have a high likelihood of unforeseen adverse consequences.
Sincerely,
David Booth, DO
Diplomat American Academy of Family Practice Davbooth@aol.com
2
NMMC Medical Clinic Eupora
1301 Veterans Memorial Blvd
Eupora, MS 39744
662-552-0270
3
Frances Carrillo

Subject: FW: Burden of restrictive pain medication guidelines
From: Brian Harris [mailto:banthony03@me.com]
Subject: Burden of restrictive pain medication guidelines
To whom it may concern,
My name is Brian Harris. I am writing you to ask for a change in attitude toward people in chronic pain who
need improved access to treatments. I want my voice to be heard when actions are taken to curb the opioid
abuse problem.
I need your help. I am a completely healthy person living with undetectable HIV but also live with chronic pain.
Ive also been diagnosed with fibromyalgia, osteoarthritis, and osteopoikilosis. What started out as tolerable
pain developed into debilitating pain that has impacted every aspect of my life. From my mood, appetite,
emotional stress, and my overall outlook on life. Ive spent many nights with little-to-no sleep where the only
thing I could focus on was how awful I felt.
I have struggled with daily chronic pain for over a decade and have relied on pain medications as a means of
management, however, due to the current guidelines to curb opioid abuse my physician is reluctant to
prescribe me the very dosage of medications I need in order to live a more fulfilling and functioning life. These
new prescribing dosage limitations are causing me harm and are interfering with my patient-provider
relationship. There has to be a balance between both prescription drug abuse and the treatment of chronic
pain, one that doesnt only fixate on one problem at the expense of the other.
Today I am faced with the reality that if current legislation and perceptions of treating people with a chronic
pain do not change, I will be forced to suffer.
Sincerely,
Brian Harris
408 Green Tree Place
Flowood MS 39232-8348
601-992-3746
Sent from my iPad
4
Frances Carrillo

Subject: FW: MSBML Administrative Code Part 2640 Chapter 1: bariatric clinic question and
comment
From: Matt George [mailto:matthewgeorgemd@gmail.com]

Cc: Ann George
Subject: MSBML Administrative Code Part 2640 Chapter 1: bariatric clinic question and comment
MS Board of Medical Licensure,
I have some questions re: the proposed bariatric medicine rules that I hope you can answer.
My wife, Jessie George, M.D., board certified in Internal Medicine, works 2 days a week at the Baptist
Nutrition & Bariatric Center. Who would be the licensee for this clinic, as Baptist is the owner? Would all
physicians and nurse practitioners be required to obtain 100 hrs of CME in core content bariatric medicine, or
become board certified in obesity medicine, to continue practicing in the clinic? Or only the licensee? Dr.
Jessie George just completed 13 hrs CME last week at the Cleveland Clinic Obesity Summit in Biloxi, but 100
hrs is a very high threshold. The amount of time required is substantial, and I fear that it may result in fewer
providers treating obesity. MS is the 2nd most obese state in the nation, and Jackson is the most obese city in
the country (per study cited by Cleveland Clinic). I am sure that there are weight loss clinics with questionable
prescribing practices, and I agree with the need to regulate the field. Please make sure that the proposed
regulations do not have the unintended consequence of limiting care from reputable bariatric clinics. Perhaps a
lower CME threshold would ensure patient safety without adversely impacting patient access to bariatric
medicine practitioners.
Respectfully,
Matthew George, M.D.

License # 22585
317 Culleys Stand
Madison, MS 39110
Cell 318-816-09887
5
Frances Carrillo

From: Joe Jackson [mailto:drjaj1251@gmail.com]

IaminreceiptoftheseproposedrulesbutnowwonderifImaybeinviolationofexistingrulesonMethadone.IhaveRx
Methadoneforchronicpainforalongtime.Ifitwasprohibited,Ididntknowthatnorunderstandwhyitshouldbe.I
havemetDEAstandardsandthoseofthepainBoardnoneofwhichhaveprohibitedtheRxofMethadone.
Isthisrulenowineffect?HaveIbeeninviolationandifsoistherearemedy?
WewillimmediatelydiscontinuewritingMethadoneevenifIviolentlydisagreewiththisrule.
SentfrommyiPhone
OnOct3,2017,at10:28AM,THEMISSISSIPPISTATEBOARDOFMEDICALLICENSURE<Mboard@msbml.ms.gov>wrote:
TheBoardofMedicalLicensurehasfiledaproposedruleamendmentwiththeSecretaryofStatefor
reviewandcomment.MSBMLAdministrativeCodePart2640Chapter1:RulesPertainingtoPrescribing,
AdministeringandDispensingofMedicationhasbeenupdatedtoreflectchangesasproposedbythe
GovernorsOpioidandHeroinStudyTaskForceandotherguidelinespreviouslypublishedbytheCDC.A
copyofthisproposedrulecanbelocatedontheBoardswebsiteunderRegulation

Questionsandcommentsregardingtheproposedrulemaybesubmittedtomboard@msbml.ms.govor
totheaddressbelow.

Jackson,MS39216

(601)9873079
(601)9874159fax

www.msbml.ms.gov

DISCLAIMER: This email and any files transmitted with it are confidential and intended solely
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6
intended recipient you are notified that disclosing, copying, distributing or taking any action in
reliance on the contents of this information is strictly prohibited.
7
Frances Carrillo

Subject: FW: Prescription changes
From: Christopher Capel [mailto:capelsurgicalclinic@gmail.com]
To: RHONDA FREEMAN
Subject: Prescription changes
I feel that prescription changes that require refills every seven days put a burden on the patient and the
physician and are not reasonable and should not be put into affect. Sincerely Dr. Christopher Capel, M.D.,
F.A.C.S
Sent from my iPhone
8
Frances Carrillo

Subject: FW: New opioid prescribing rules
From: Randall Sherman [mailto:shermanrandall@gmail.com]
To: RHONDA FREEMAN
Subject: New opioid prescribing rules
Outstanding. Excellent work by the board.
Randy Sherman, MD, FACS, DFASAM
Sent from my iPad
9
Frances Carrillo

Subject: FW: Opioids
From: Will Thompson [mailto:willpthompsonmd@me.com]
To: RHONDA FREEMAN
Subject: Opioids
Questions: does this apply to nursing home care? And hospice care of terminal patients with non cancerous
illness?
Thank you
Will P Thompson MD
Yazoo City
Sent from my iPhone
10
Frances Carrillo

Subject: FW: Proposed changes for opioid prescribing
From: Kentkirchner [mailto:kentkirchner@bellsouth.net]
To: RHONDA FREEMAN
Subject: Proposed changes for opioid prescribing
The requirement for drug testing each time a schedule 2 is prescribed will be a problem as several of my
patients are on hemodialysis and do not make urine This would prevent me from prescribing schedule 2s to
these individuals and remaining in compliance
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11
Frances Carrillo

Subject: FW: Comments
From: Jennifer Trihoulis [mailto:adultpsych@gmail.com]

To: RHONDA FREEMAN
Subject: Comments
I screen every suboxone patient with urine point of care testing at each monthly visit. Every month I check a
PMP on my suboxone patients. My non-addiction medicine patients are at lower risk (not zero!). They dont
need a UDS at each visit (most come q 3 months). I think its reasonable to check a PMP at each visit. UDS
should be random for chronic benzo patients in my opinion. I work hard to get every benzo patient on the
lowest effective dose of medication. That said, some of them have come to me on 6 and 8 mg of klonopin,
Ativan and Xanax. It takes time and trust to wean them down.
I have one of my own patients on 6mg a day of Xanax and am convinced its one of the only protections from
him killing himself and other people. This isnt easy or straight forward. There are exceptions to every rule and
norm. To practice safe medicine is the goal. I think a PMP for any controlled medicine patient at every visit is
reasonable. After that you need to go with the nuance of risk stratification. Addiction medicine patients needs a
UDS at each visit. Non-addiction medicine patients should be screened with UDS at random.
Jennifer Trihoulis MD
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Doctor Comments 01 Part 2640 Public Comments Sep 29 - Oct 6

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Frances Carrillo

From: RHONDA FREEMAN

From: Ken Staggs [mailto:kenstaggs@hotmail.com]

From: RHONDA FREEMAN

From: RHONDA FREEMAN

From: matthew emerick [mailto:mattle@cableone.net]

From: RHONDA FREEMAN

Sent from my iPhone

From: RHONDA FREEMAN

From: Bill Cook [mailto:wcook69596@gmail.com]

From: RHONDA FREEMAN

From: William T Smith [mailto:wtsmith1464@me.com]

2. Agree completely with opioid and benzodiazepines not to be prescribed concurrently.

From: THE MISSISSIPPI STATE BOARD OF MEDICAL LICENSURE

From: Lance Line [mailto:lline1@comcast.net]

From: THE MISSISSIPPI STATE BOARD OF MEDICAL LICENSURE

From: OnCall Medical Clinic [mailto:oncallmedicalclinic@yahoo.com]

OnCall Medical Clinic

From: THE MISSISSIPPI STATE BOARD OF MEDICAL LICENSURE

From: Phillip Ley [mailto:phillipley@gmail.com]

Phillip Ley MD FACS

Mississippi State Board of Medical Licensure

1867 Crane Ridge Drive, Suite 200-B

From: THE MISSISSIPPI STATE BOARD OF MEDICAL LICENSURE

From: Brittanie Neaves [mailto:brittanie.neaves@gmail.com]

From: RHONDA FREEMAN

To Whom it May Concern:

Heather Huguley, PA-C

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From: THE MISSISSIPPI STATE BOARD OF MEDICAL LICENSURE

From: Doctor Green [mailto:greenmder@gmail.com]

From: THE MISSISSIPPI STATE BOARD OF MEDICAL LICENSURE

From: Renate D. Savich [mailto:rsavich@umc.edu]

Renate Savich, MD FAAP

Past Chair, American Academy of Pediatrics

From: THE MISSISSIPPI STATE BOARD OF MEDICAL LICENSURE

Sent from my iPhone

From: THE MISSISSIPPI STATE BOARD OF MEDICAL LICENSURE

From: arg50a@aol.com [mailto:arg50a@aol.com]

From: THE MISSISSIPPI STATE BOARD OF MEDICAL LICENSURE

From: Jamey Boudreaux [mailto:jboudreaux@lmhpco.org]

Jamey Boudreaux, msw, m.div

From: RHONDA FREEMAN

From: Dr. John Bailey [mailto:jbailey@SMSurgeons.com]

From: RHONDA FREEMAN

From: Young, Ronald [mailto:RYoung@nmhs.net]

From: RHONDA FREEMAN

Sent from my iPhone

From: RHONDA FREEMAN

From: RHONDA FREEMAN

From: rob [mailto:rcarter3378@hotmail.com]

From: RHONDA FREEMAN

From: RHONDA FREEMAN

To The Mississippi Board of Medical Licensure:

Thank you for your consideration,

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From: RHONDA FREEMAN

Thank you for your assistance,

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From: THE MISSISSIPPI STATE BOARD OF MEDICAL LICENSURE

From: Dudley & Niki Burwell [mailto:golfdoc56@gmail.com]

From: THE MISSISSIPPI STATE BOARD OF MEDICAL LICENSURE

Harriet Jones, MD, FACP