Desperation and doubt on display as Ark. State Medical Board considers rules to help curb over-prescription of opioids. | Arkansas Blog

Desperation and doubt on display as Ark. State Medical Board considers rules to help curb over-prescription of opioids.

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Chronic pain patient Kelly Cole, who relies on opioid medications, is called to address the medical board - BRIAN CHILSON
  • Brian Chilson
  • Chronic pain patient Kelly Cole, who relies on opioid medications, is called to address the medical board
At a meeting of the Arkansas State Medical Board this morning, board members heard from doctors, patients and state leaders on proposed rules changes for physicians, designed to help curb the state's opioid epidemic.

The proposed changes would give the Arkansas State Medical Board the option of revoking or suspending the medical license of any doctor found to have prescribed "excessive amounts of controlled substances to a patent, including the writing of an excessive number of prescriptions for an addicting or potentially harmful drug." As defined in the proposed rule, "excessive" wouldn't include medications given to patients in hospice, being treated for active cancer, emergency inpatient care or end-of-life care. For the treatment of acute pain from surgery or an injury — as opposed to chronic, ongoing pain from an incurable condition — the regulations would define "excessive" as any pain medication prescription written for more than seven days "without detailed, documented medical justification."  A PDF of the full, proposed changes can be read below.

Though the board didn't fully discuss the proposed rules changes today — they will hold a public hearing on the proposed rules changes in April -- they did open the floor for public comment, with chronically ill patients, doctors and state drug director Kirk Lane all taking the opportunity to address the board.

Dr. Carlos Roman, a Russellville physician who heads the board's subcommittee on pain,  spoke at length of pharmacists turning away his chronic pain patients who come in with legitimate prescriptions, effectively overruling doctors as to what patients should be prescribed. Roman spoke of a chronic pain patient who was diagnosed with cancer of the kidney last month after the ailment showed up in a full body scan. After he prescribed Xanax for the patient to help her cope with the new diagnosis prior to surgery to remove her kidney, Roman said, the woman's pharmacist refused to fill the Xanax prescription. Patients, Roman said, shouldn't have to explain their medical conditions to a pharmacist to have a prescription filled. "I love the pharmacists," Roman said, "but something needs to be done about pharmacists injecting themselves into the practice of medicine." 

Among several patients who spoke to the board was Joe Phillips, a small business owner who said he hurt his back over 20 years ago. Phillips, who said he takes opioids just to stay mobile, told the board he fears he'll be rendered totally disabled and will be forced to close his business without continued access to his medications. Phillips was the first of several patients who told the board their primary care doctors have drastically scaled back their pain medications after expressing fear the medical board will revoke their licenses if they continued to prescribe high doses of opioids — a worry members of the board repeatedly shot down as uninformed, encouraging several patients who spoke to have their doctors call the board so they could assure them their licenses won't be revoked for medically necessary prescriptions of pain meds. Another patient, Rick Maynard, said his pain from a 23 year old spinal injury was well maintained with high doses of opioids until his doctor, also worried about losing his license, tapered back his dosage. Now, Maynard said, he's on a daily "roller coaster" of pain. "What am I to do now?" Maynard asked the board members, who told him to have his doctor call. 

Noting new CDC data that shows Arkansas has the second highest prescription rate in the U.S., and a spate of recent drug overdoses in the state — including 16 people saved by Little Rock Police Department officers with the overdose antidote Naloxone in January alone — state drug director Kirk Lane told the board that he'd like to see the proposed guidelines lower the acute pain prescription levels from seven to five days.

UAMS psychiatrist Dr. Rick Smith, who founded the hospital's Psychiatric Research Institute, which studies and treats addiction, told the board the he is 'very concerned" that if the state's medical community doesn't find solutions to the opioid crisis, "very restrictive laws will be passed" by the state legislature that will limit the ability of doctors to care for their patients. "We need to take action," Smith said, "rather than someone else taking action." 

Here's the Medical Board's proposed regulation.


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