The Journal of the Arkansas Medical Society Med Journal July 2019 Final 2 | Page 22

by Casey L. Penn
Prescription Drug Regulations in Arkansas
and DEA Investigation and Enforcement
Presented by: Kevin O’Dwyer, JD, MPA, BA;
General Counsel, Arkansas State Medical Board &
Justin C. King, Assistant Special Agent in Charge, Drug Enforcement Agency
R
epresentatives from Arkansas
State Medical Board and the Drug
Enforcement Agency in Arkansas
provided members with updates
related to the ongoing opioid epidemic and
related policies.
Regulatory
ASMB General Counsel Kevin O’Dwyer has up-
dated AMS members before on Regulation 2.4 (see
Nov 2018 Journal). During this year’s Annual Mem-
bership Meeting, he was there in person to clear up
misconceptions about the rule and provide a brief
update on changes made in April 2018. He also
discussed the role of the ASMB Pain Management
Committee and related matters.
During its April 2018 meeting, the ASMB ad-
opted changes to Regulation 2, which states and
governs the standard of care expected of physicians
in Arkansas, and amended section 2.4, which directs
the prescribing of scheduled medications. Post-
changes, the rule accomplishes two things: it defines
once and for all what is “excessive” when prescrib-
ing narcotics and it establishes some stipulations for
prescribers to follow.
O’Dwyer stressed that Regulation 2.4 doesn’t
set any hard limits on prescribing. Rather, it calls for
more detailed documentation from physicians pre-
scribing more than 50 Morphine Milligram Equiva-
lents (MME) per day of a scheduled drug. O’Dwyer
covered details on the regulation, which can be read
in full at armedicalboard.org.
He also talked about the Board’s difficult job of
looking at opioid prescribing complaints. The rule
changes have helped, but there are other ways the
Board is addressing the situation. “It’s been a bal-
ancing act between dealing with what the Medical
Board felt was adequate medical care for patients
and dealing with the opioid epidemic that has really
come to light over the last few years,” he said. “One
way we’ve done this is to increase the usage of the
Pain Management Committee.
“As we review complaints pertaining to over-
prescribing, the Board is always looking to see if
the practitioner reached the threshold of gross neg-
ligence and ignorant malpractice, which is a pretty
high standard. The vast majority of cases we review
don’t quite reach that threshold.”
Over time, O’ Dwyer indicated, a pattern began
to develop. “We would review a particular doctor,” he
said, “and wouldn’t really do anything. We’d then re-
view him again [at a later date], and eventually, years
later, he would finally reach that threshold.”
By utilizing the Pain Management Committee,
the Board tries to make a difference earlier in the
prescribing practices of physicians who are just be-
low the threshold of negligence. He explained, “So,
we make them take a day off work to come sit be-
fore the pain management committee, who will re-
view five or six charts with them, and get a corrective
action plan together.”
Enforcement
Kevin O’Dwyer
The ASMB and the Arkansas Drug Enforcement
Agency are working as partners as much as possible
to curb the opioid epidemic. To update members on
the enforcement side was DEA Assistant Special
Agent in Charge Justin King.
22 • THE JOURNAL OF THE ARKANSAS MEDICAL SOCIETY
Justin C. King
King cautioned physicians to keep talking to
their patients as the drug crisis continues to grow in
severity. With more sophisticated drug labs in Mex-
ico, more fentanyl, and more diversion with higher
return on investments for drug makers and sellers,
the problem has not yet peaked here in Arkansas,
King indicated. “Arkansas is still on the rise,” he said.
“Our NARCAN saves are off the charts.
“I don’t want to tell you you’re doing something
wrong. What I would ask you to do is think of ways
you can help us move that needle. Keep talking to
your patients. When you have a patient who comes
into your office, ask them, ‘Do you have a problem?
Are you addicted?’ I can tell you a tell-tale sign [of
a problem]. If you say, ‘I’m considering lowering the
amount I’m giving you,’ watch their reaction. It will
[show]. They are terrified of not having that [dosage].
A heroin addict knows to the minute when he needs
his next high. You’re going to have people try to ma-
nipulate you. You’re going to have patients who try
to take advantage of your healing spirit. That’s what
you’re faced with.”
For more information from King or O’Dwyer,
contact them through the Arkansas Medical Soci-
ety at [phone].
William “Trey” Whatley
VOLUME 116