Doctors: Haslam’s opioid plan ‘unfair’ to patients

NASHVILLE — The state’s largest doctors’ organization said Friday the strict limits on opioid prescriptions in Gov. Bill Haslam’s plan to fight Tennessee’s painkiller epidemic are “confusing, impractical and unfair.”

Following a vote, the Tennessee Medical Association’s board of trustees, representing one of the state Capitol’s most potent lobbying forces, issued the statement calling on Haslam to make changes to his proposed “TN Together” legislation.

The group said the plan to limit opioid prescriptions for new patients to a five-day supply with a few exceptions “fails to protect patients who are suffering from legitimate chronic pain.”

Doctors warned a “one-sizefits-all, five-day limit on opioid prescriptions could adversely impact some patients who do not respond to alternative pain treatments or other scenarios, such as those recovering from invasive surgery.”

They also said the bill places new burdens on physicians and staff who already are required to check the state’s Controlled Substance Monitoring Database.

The governor’s $30 million three-pronged bill was rolled out last month with great fanfare by Haslam, Lt. Gov. Randy McNally, the Senate speaker, House Speaker Beth Harwell and Tennessee Supreme Court Chief Justice Jeff Bivins.

It seeks to address the prevention side of the state’s crisis by strictly limiting the supply and dosage of opioid prescriptions.

Other provisions deal with boosting public education on the dangers of pain pills and beefing up the Tennessee Bureau of Investigation’s manpower.

Haslam Press Secretary Jennifer Donnals defended the administration’s approach, saying, “At least three people die each day in

Tennessee from an opioidrelated overdose.”

In 2016, she said, 7.6 million prescriptions for opioids were issued in Tennessee — enough “for every single person in our state to have one, with 1 million prescriptions left over.”

While acknowledging the governor’s TN Together plan “is aggressive,” Donnals said “so is the opioid crisis in Tennessee, and reasonably limiting the supply and dosage of opioid prescriptions will save lives.”

Officials “now know that after five days of opioids, the probability of long-term use increases at a much higher rate than previously thought,” Donnals noted. “We have an epidemic in this state and we must address it.”

The administration remains “hopeful all stakeholders, including the TMA, will partner with us to recognize the urgency and achieve meaningful results,” Donnals said.

The bill places what the administration calls “reasonable restrictions” largely aimed at limiting supply and dosage of the pills — “with reasonable exceptions” — and an emphasis on new patients.

Exceptions include cancer, end-of-life care and a few other instances.

Initial prescriptions for new patients would be limited to a five-day supply of drugs with daily dosage limits of 40 morphine milligram equivalent doses.

The bill also limits prescriptions for enrollees on the state’s Medicaid program, TennCare, to the initial five-day supply and dosage equivalent limits.

Current patients who use painkillers would not be impacted.

TMA trustees’ position statement says the governor’s proposal “unfairly labels and segregates patients. Definitions for ‘acute’ and ‘opioid naive’ patients in the draft bill are confusing, impractical and unfair.”

“Every person is different, yet the legislation would put some patients into multiple categories, set broad-brush restrictions and take away doctors’ medical discretion,” the statement adds.

Bill proponents say a standard trip to an emergency room as a result of an accident can result in a 30-day supply of the pain pills and lead to addiction among some “naive” patients.

But TMA said “the governor’s proposal fails to protect patients who are suffering from legitimate chronic pain.”

And they warned that “doctors should not be forced to refer patients to a pain management clinic when a five-day opioid supply is ineffective. There are not enough certified pain specialists in Tennessee to care for Tennesseans experiencing legitimate chronic pain.”

Trustees suggested the administration remove the bill’s “acute care” definition to avoid conflicts with the “chronic non-malignant pain” definition already in state law.

Other recommendations include:

Clarify “healthcare practitioners” instead as prescribers and dispensers, and give physicians” some flexibility “to determine reasonable exceptions to cookie-cutter labels.”

The TMA says it was “instrumental in the state’s developing, implementing and improving the Controlled Substance Monitoring Database [CSMD] and was the first state medical society in the U.S. to support mandated lookups by prescribers.”

The lookups are a check of the database to see if patients are doctor shopping.

TMA trustees argue data shows existing usage of the CSMD “is already working — we have reduced doctor shopping by more than 70 percent since 2012.”

But they say the number and frequency of mandated CSMD lookups in the governor’s proposed legislation “will add unnecessary administrative burden on prescribers without really helping prevention or expanding the supply of staff to perform those lookups.”

Contact staff writer Andy Sher at asher@ timesfreepress.com or 615255-0550. Follow him on Twitter @AndySher1.