This week, Tennessee's Medicaid program began enforcing a limit on first-time opioid prescriptions. TennCare patients can only get enough pills for five days. Legislative leaders say similar restrictions are in the works to regulate painkiller prescribing for all Tennesseans.
State laws capping prescriptions for addictive narcotics have been adopted in roughly half the country, including Kentucky and North Carolina, according to the National Conference of State Legislatures.
Aside from TennCare's new policy, Tennessee has not gone that route yet. But Governor Bill Haslam is expected to make a push this year. His office says there are no specifics to announce right now.
"But this session, the governor will work together with the General Assembly to find solutions to end the opioid crisis in our state," spokesperson Jennifer Donnals says in an email.
Chronic pain patients have been the most resistant to such regulations. But doctors have also pushed back. Pediatrician Nita Shumaker is president of the 9,000-member Tennessee Medical Association.
"I just think that we — who actually do medicine — need to be part of that conversation so that we can protect those people that will be hurt by the unintended consequences of anything that we bring forward," she tells WPLN.
Shumaker says physicians are fine with considering more aggressive rules, though they have not pushed for them. Rather, they're focused on re-educating doctors about newly understood addiction risks and improving data to root out the heaviest prescribers.
TennCare's new rule restricts opioid prescriptions to five days for patients with acute pain, like from a broken bone or recovering from surgery. They can come back for a 10-day refill. Chronic pain patients would not be affected.
"The goal of these limits is to reduce the risk of long-term chronic opioid use and misuse for all TennCare members," says a letter to physicians announcing the policy change.
According to the most recent data, roughly a third of adults on TennCare have a prescription for some kind of opioid. That's down from nearly half five years ago.