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Dear Gov. Bullock:

"But pain patients are particularly vulnerable. They die by suicide at twice the rate of the general population. In 2014, 28,000 took their lives." (

This article points out the crisis -- currently invisible -- of suicides in pain patients. Given that Montana leads the nation in suicides per capita, would it not be prudent to take whatever measures we can to prevent them?

There are several high profile suicides that have been noted in the press (Bryan Spece, Bob Mason). Many, of course, are not found in the press, but the agony for their families is no less. Perhaps you could call for hearings on this very subject. Get to what is so, and respond appropriately.

As you already know from all the hundreds of emails and articles I have sent you, and from this article above, palliative care of the 100,000,000 pain patients in America is disappearing, and that would be 100,000 patients in montana. (See the IOM report on pain in America 2011 for the data).

In Montana, as I have noted before, opiate refugees actually have been seeing doctors outside the state, and killing themselves as access has been withdrawn. This is a public health crisis right under our noses, and I am again sounding the alarm today. Please look into this.

As you know, the Board of Medicine takes no policy actions, just punitive ones. They have cast a pall over pain care by punishing doctors for "over-prescribing," though no one has ever defined that term. And no one has been sanctioned for "under prescribing," which must exist if over-prescribing does!

"The Board seeks to assure that no Montanan requiring narcotics for pain relief is denied them because of a physician's real or perceived fear that the Board of Medical Examiners will take disciplinary action based solely on the use of narcotics to relieve pain. Although improper use of narcotics, like any improper medical care, will continue to be a concern of the Board, the Board is aware that treatment of malignant and especially nonmalignant pain is a very difficult task. The Board does not want to be a hindrance to the proper use of opioid analgesics. Treatment of the chronic pain is multifactorial, and certainly treatment with modalities other than opioid analgesics should be used, usually before long-term opioids are prescribed. Use of new or alternative types of treatment should always be considered for intractable pain periodically, in attempts to either cease opioid medications or reduce their use."

This was the board's policy on pain management until it disappeared from the BOME's website somewhere around 2013, with no fanfare and no notice to physicians in the state. The MMA has been notified of this issue, and unfortunately has not acted either, as they are controlled more by specialty intervention doctors. This is a sad truth. I learned from MMA leadership courses that "What Don't We Know?" Is a useful question to use to manage crises.

This problem can be solved by increasing safety in medicine (like was done with cars), sharing knowledge and using good evidence. Since legislators and federal agencies have made this a political issue, I again bring it to your attention.

We need a pain patient bill of rights in Montana, patterned on those of other states and compassion toward the 100,000 patients in pain in our state, as well as the 10,000-15,000 pain refugees that suffer daily here.

-- Mark Ibsen, MD, Helena


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