The Tennessee Medical Association says when it comes to opioids, a doctor still knows best. The lobbying group of 9,000 physicians released suggested revisions to Governor Bill Haslam's opioid bill late Friday. The specific language of the proposal had only become public this week.
Haslam wants to limit prescriptions for new patients — dubbed "opioid naive" — to just five days and only allow a second opioid prescription for 10 days in "exceptional cases." The physician would have to justify the second prescription in a patient's medical record, according to the bill. The legislation also requires doctors to use "trial and failure" with non-opioid treatments first. And the daily dosage has to be less than the equivalent to 40 milligrams of morphine. The combination would make Tennessee's opioid laws some of the strictest in the country.
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"I heard someone say if the tub's overflowing, what's the first thing you do? You turn off the faucet," TMA executive director Russ Miller said. The problem is when you cut off the supply of these drugs, the unintended consequences — the move to illicit drugs, the street drugs, the counterfeit drugs — can have a devastating effect and hurt many people."
The TMA is pushing back against prescriber regulations altogether. Rather, the organization's leaders want pharmacists to be the gatekeeper and only partially fill a prescription if its for more than a week. Physicians also want their staff to be able to check the Controlled Substance Monitoring Database rather than always doing it themselves. And doctors are asking to include some kind of mandate that insurance companies cover more alternative pain treatments, like acupuncture.
Physician lobbying groups say they still think something needs to be done this year. But they also want to revisit whatever passes in three years instead of making the rules permanent. Currently, the legislation only requires the Commissioner of Health to report on the affects in 2021.
"We can do better. We've got to use all the tools at our aid," Miller said. "We've got to keep a cool head about this. We didn't get there overnight. We won't get out of it overnight. But we have to do something."