TN: As of July 1, if you have a prescription for opioid drugs, you’ll see some changes when you go to the pharmacy

Here’s what new Tennessee opioid restrictions mean at your doctor’s office and pharmacy

As of July 1, if you have a prescription for opioid drugs, you’ll see some changes when you go to the pharmacy.

That’s the date legislation related to Gov. Bill Haslam’s sweeping TN Together opioid reform takes effect.

Haslam budgeted more than $30 million in state and federal funds to attack the opioid epidemic through prevention, treatment and law enforcement.

More: Haslam signs TN Together, gives lifeline to state beset by opioid epidemic

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Limits on supply, strength

The biggest change has to do with how much of a drug you can get and when.

Under the new law, pharmacists can only partially fill a prescription for no more than half of the number of days it’s written for.

And there are limits on prescriptions, too: General prescriptions are limited to a 10-day supply (and no more than 500 cumulative morphine milligram equivalents). Prescriptions after surgery are limited to a 20-day supply (maximum 850 cumulative MMEs). “Medical necessity” prescriptions are limited to a 30-day supply (maximum 1,200 cumulative MMEs). This law technically takes effect July 1, but it won’t be mandated until Jan. 1, 2019, to give pharmacies a chance to update their software.

Checking the database

When you bring an opioid prescription to be filled, the pharmacy is required by law check the Controlled Substance Monitoring Database, which logs each time you fill a prescription for a controlled substance. The database has to be checked when you first bring a prescription to a pharmacy, and then again at least once every six months as long as you’re getting refills.

The country is in the midst of an opioid epidemic. Did the FDA play a role in how we got here? Ayrika Whitney/USA TODAY NETWORK – Tennessee

Doctors’ documentation

When your doctor writes you a prescription for an opioid drug, the law now requires he or she document the specific reasons you’re getting the drug, as well as the fact that you’re getting it with informed consent — your prescriber has warned you it can be addictive.

Three-day supplies less restricted

However, doctors can write (and pharmacies can fill) opioid prescriptions for a three-day (or less) supply (maximum 180 MMEs) without these restrictions.

No ‘gag’ on pharmacists

Pharmacists no longer have any limits on discussing opioid-related issues with customers, including risks, effects and characteristics of the drugs; what to expect when you use it; the proper way to use it; and cost, with insurance or cash.

Some prescriptions exempt

Some prescriptions are exempt from the requirements and limits, though doctors must still write a diagnosis code and “exempt” on them: Prescriptions for people who are getting palliative cancer treatment or hospice care; who have sickle cell disease; who are inpatients at licensed facilities; who are seen by doctors who meet the state requirements to be “pain management specialists”; who were treated with opioids for 90 days or more; who have severe burns or “major physical trauma”; and who are on methadone, buprenorphine or naltrexone, which are drugs used to assist recovery from addiction.

Initially, the legislation was more restrictive — prompting concern from pharmacists that it would prevent “legitimate patients” from being able to get needed prescriptions and put a burden on pharmacists, said the Tennessee Pharmacists Association, which lobbied legislators for some changes.

But the organization said in a statement that decreasing the prescription drug supply must be combined with access to treatment and recovery services, or it may increase both the number of people using illicit street drugs and the number of pharmacy burglaries/robberies.

“While this legislation is well-intended, TPA remains concerned about the unintended consequences of the legislation on patients and the pharmacy profession,” the Tennessee Pharmacists Association said. “Decreasing the overall epidemic of prescription drug abuse and reducing patients’ risk of dependence are commonly shared goals of all pharmacy professionals and Tennesseans. However, the need for patient access to treatment and recovery services has never been greater, and our state must continue to seek solutions which help our patients struggling with dependence and addiction to get the help they desperately need.”

This is the first time that I have heard about this… but.. then again.. I don’t live in TN. I think that I need to place the state of TN and all the bureaucrats that are in charge of protecting the citizens of TN. at the TOP OF MY MORON LIST !  I just hope that other states don’t take TN’s policies as a guideline for other states to follow.

It sure sounds like the state of TN is only interested in addiction… those who have chronic pain issues .. they are left to deal on their own… if the numbers are correct…  it appears that chronic pain pts will be limited to 40 MME/day…  that is 4 Vicodin 10/day… I don’t think that would allow a Fentanyl patch 12 mcg nor would it allow the smallest Morphine SR 15 q 8 hrs.  This is LESS THAN HALF OF WHAT THE CDC GUIDELINES STATED FOR ACUTE PAIN..

4 Responses

  1. Here is TN Chronic pain patients rules for medical professionals.
    You can no longer get >119 from any doctor, they must refer to pain clinic. They make it sound as if a doctor decides that higher doses are needed they are to use their judgement and document it. But I think this is just the way to cover themselves from “practicing medicine without a license”. But I believe doctors will be too afraid to prescribe what they think is needed.

    Here is the doctors cheat sheet:

    Thankfully I do not live in TN, but I am afraid of even how FL new laws will be interpreted by insurance companies.

    It is interesting that Scott Gottlieb, Commissioner of FDA, listed “metastatic cancer and severe adhesive arachnoiditis” as two examples of diseases that only respond to opioids, but TN only recognizes Sickle Cell, which in my opinion, definitely belongs on this list along with many other diseases.

    These legislatures are going to kill many people or at the very least cause patients to suffer a torturous death!

  2. Why are those older patients who have been stable on the dr prescribed opiates being denied or lowered to a set minimum daily does? Now pain patient once stable are forced to suffer , lose basic daily function because of daily limits placed on patients who were stable ? Government states there’s no proof. But we have many. Decades of medical proof that safe stable opioid pain management has been established but denied because government needto prove their making a change in addiction abuse and death rate. The problem in the way they’re trying to change this by denying opioid pain
    Management is causing more street drug abuse addiction and death but continue to ignore the affects they’ve made to add to this problem

  3. how does one connect w/USA TODAY reporter?

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