Root of the Problem
Christopher T. Dietrich, MD
SDSMA President

A question that is often asked is “What does SDSMA do for me?” One significant benefit of membership is the advocacy the association provides on numerous political, medical, and legislative issues. 

Recently I had to opportunity to attend both the South Dakota State Medical Association (SDSMA) and American Medical Association (AMA) annual meetings. In addition to collegiality and networking, some great advocacy work was accomplished. 
 
Our organization continues to lead the way in responsible opiate prescribing education. In addition to webinars and live education presentations, we hosted a panel of experts at our annual meeting. South Dakota Attorney General Marty Jackley, Robert E. VanDemark, Jr., MD, Matt Stanley, DO, South Dakota Division of Criminal Investigation officer Pat Kneip, South Dakota Rep. Jean Hunhoff, and Kentucky Rep. Kim Moser led an amazing and interactive discussion about curtailing opiate prescription numbers and morphine milli-equivalents (MME) doses. Overall, prescribers are gaining a deeper understanding of this issue and prescribing patterns are changing. Unfortunately, an overwhelming consensus is that psychology and addiction services are inadequate and difficult to access. 

Just decreasing the dose or eliminating prescription opiates does not eliminate our problem. The root of our problem remains addiction and mental health disorders. South Dakota Medicaid has begun covering these services July 1, 2018. Several other state and federal programs are also being created. In addition, these is much political discussion regarding creation of a west river addiction and mental health facility. Federally the plan will focus on three areas: Law enforcement and interdiction, prevention and education through a sizable advertising campaign, improving the ability to fund treatment through the federal government, and helping find jobs for those fighting addiction. 

At the AMA meeting, gun control was a topic heavily debated and discussed. Numerous policy statements and positions were created. At the end of the day there are typically mental health disorders at the root of most violent gun events. Taking away guns without addressing the mental health problems does not solve the problem. The general consensus is that much more needs to occur on the mental health front.
In addition to opiates and gun control, prescription drug pricing was a hot topic addressed by the SDSMA Policy Council. Both sides of the prescription drug pricing issue were presented. The Policy Council then decided to form an Ad Hoc Committee on Prescription Drug Pricing. This committee will be chaired by E. Paul Amundson, MD. 

There are numerous ways for physicians to become active and involved on both the local and national levels. It is refreshing to see passionate and dedicated physicians working hard for both physicians and patients. I encourage you to participate, in your local medical chapters, in the SDSMA, or nationally with your specialty society or the AMA.

Resources:
CDC/NCHS, National Vital Statistics System, Mortality. CDC Wonder, Atlanta, GA: US Department of Health and Human Services, CDC; 2017. https://wonder.cdc.gov.

Center for Behavioral Health Statistics and Quality (CBHSQ). 2015 National Survey on Drug Use and Health: Detailed Tables. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2016.

Vowles KE, McEntee ML, Julnes PS, Frohe T, Ney JP, van der Goes DN. Rates of opioid misuse, abuse, and addiction in chronic pain: a systematic review and data synthesis. Pain. 2015;156(4):569-76.