Opioid fight might see limits on use
NASHVILLE — As he seeks remedies for Tennessee’s opioid abuse epidemic, Gov. Bill Haslam says his administration will explore whether to restrict longterm prescriptions of the powerful and addictive painkillers for many TennCare patients.
“Should we ever be long-term prescribing opioids in TennCare in a non-cancer situation? That’s a question we’re going to explore,” Haslam said last week. “There’s a lot of things we think we can do. So we’re going to put together a working group there.”
He spoke after returning from a Chattanooga event where U.S. Health and Human Services Secretary Tom Price sought to highlight the nation’s opioid crisis and the Trump administration’s approach to battling it.
Tennessee ranks No. 2 nationally in the share of opioid prescriptions per capita, and is near the top in overdose deaths.
Chattanooga is 20th among the worst 25 cities in the U.S. for opioid prescription abuse. Johnson City, Tenn., ranks ninth. Jackson, Tenn., ranks 22nd.
The governor said the “working group” includes the heads of TennCare, the departments of Health and Mental Health and Substance Abuse, the Tennessee Bureau of Investigation and others.
“We’re not going to defeat this on the supply side,” Haslam said. “There’s too many ways for the ‘bad guys’ to win in terms of getting drugs in people’s hands. So we’re going to have to beat it on the demand side.
And I think that means having a lot more treatment options available as well as prevention.”
But state Rep. JoAnne Favors, D-Chattanooga, a retired registered nurse and health administrator, urged the governor to exercise caution.
“I think we have to be very careful of putting together a group unless we have physicians who are still practicing” with specific knowledge about intractable pain issues, Favors said.
While Health Commissioner John Dreyzehner is a physician, as is TennCare head Wendy Long, Favors said they “have been out of the practice of medicine for several years and it does not take long to not be up to date. We want to have people who are actually practicing.”
“I wish we had something other than the opioids,” Favors said, but added that for people with chronic pain, such as someone with degenerative joint disease, it’s the only relief they can find.
Favors said she knows a number of people with chronic pain, including an aunt.
In a quarterly report issued last winter titled “No Easy Fix: Tennessee’s Doctors Take on the Opioid Abuse Epidemic,” the Tennessee Medical Association said efforts to combat opioid abuse in the state were showing results.
The report cited a decline of 14.3 percent in “opioid morphine milligram equivalents” dispensed to patients in Tennessee between 2012 and 2015.
The TMA said morphine milligram equivalents from the top 50 prescribers in Tennessee fell by 8.3 percent in 2015 compared to 2014. Moreover, TMA said, the Tennessee Controlled Substance Monitoring Database is being used more often, and that’s having a positive impact as well on prescriber practices.
Sixty-three percent of physicians said the database helped them identify and cut down on doctorshopping among patients.
Problems stem both from legal and illegal sources.
Last month, three district attorneys general in East Tennessee and the legal guardian for an infant born addicted to drugs filed a lawsuit accusing several drug manufacturers of fueling the epidemic through deceptive marketing that downplayed the addiction risks to painkillers. One of the DAs represents the Tri-Cities, which includes Johnson City.
Soon afterwards, Tennessee Attorney General Herbert Slatery announced he is leading a bipartisan coalition of states attorneys general to investigate the widespread prescribing and use of opioids, as well as whether manufacturers and distributors played a role in creating or prolonging the problem.
Tennessee House Speaker Beth Harwell, R-Nashville, who created a bipartisan legislative Opioid Task Force, had earlier urged Slatery, a Republican appointee, to join Ohio and Mississippi in their lawsuits suing drug manufacturers.
According to the Centers for Disease Control and Prevention, during 2015, drug overdoses accounted for 52,404 U.S. deaths; of those, 33,091, or 63.1 percent, involved an opioid.