TENNESSEE'S WAR ON PRESCRIPTION DRUG ABUSE
Over the past three years, the state of Tennessee passed a series of new laws to tighten regulations of controlled prescription drugs in order to combat the state's widespread problem of abuse. These are a few:
• New rules passed to more strictly certify and regulate pain clinics
• The Prescription Safety Act is passed, requiring doctors to register with and check the Controlled Substance Monitoring Database before prescribing opioids or benzodiazepine drugs.
• Pain management clinics can no longer dispense medications. Only pharmacies can dispense these medicines, and they cannot dispense more than a 30-day supply.
• Doctors at pain management clinics must conduct regular urine drug testing of their patients receiving medication for chronic pain. Other physicians are "strongly" encouraged to do so every six months for patients receiving regular doses of controlled substances, which could include medicine for anxiety, migraines or muscle spasms.
Source: Tennessee General Assembly
YOU MAY BE TESTED IF...
State law now requires pain management clinics and recommends that other doctors regularly perform drug screenings for patients who are regularly prescribed the following drugs:
Opioids - Used to manage pain. Examples: Oxycodone (OxyContin, Percocet); hydrocodone (Vicodin, Lortab); morphine; fentanyl; methadone.
Benzodiazepines - Depressant used in drugs to treat anxiety, panic attacks, seizures and insomnia. Examples: Xanax, Valium, Klonopin, Halcion and Ativan.
Barbiturates - Depressant used in a range of sedatives, hypnotics and anesthetics. Examples: Amytal, Nembutal, Seconal, Luminal.
Carisoprodol - A muscle relaxant. Examples: Soma or Rela.
Sources: Tennessee Code Annotated; National Institutes of Health; National Institute on Drug Abuse
Three years ago, it was pretty easy for a patient to walk into a doctor's office in Tennessee needing help with pain or anxiety, then walk back out with a prescription for a 90-day supply of Vicodin or Xanax.
But today, patients who require regular refills of painkillers, anti-anxiety medicine and other controlled substances often face a series of hoops to get them.
First, their drug history has to be checked in a statewide database. Every few months, they may be asked to take a urine sample for a drug screen. And even after all this, they will likely have to return to the doctor each time they need a 30-day refill.
POLL: Have you had trouble obtaining a prescription?
These are just a few of the new rules created in a wave of regulations drafted in the past three years by state lawmakers, all in the name of fighting Tennessee's prescription drug abuse epidemic.
While doctors and patients alike are still adjusting to these more stringent rules, there are now some signs that the new measures are making a dent in the problems of doctor-shopping and over-prescribing, state data released this summer show.
The number of doctor shoppers - people who got the same prescriptions from multiple doctors and pharmacies in a short span - has fallen steadily in the two years since doctors became required to use a new state drug database designed to flag possible abusers.
During the first year the database was required, it flagged more than 2,000 potential doctor shoppers
By early this year, that number had dropped more than 25 percent, a report from the Tennessee Department of Health shows.
Prescriptions for benzodiazepines like Xanax and Valium, used to treat such anxiety and panic attacks, decreased by more than 3 percent. Meanwhile, prescriptions for opioids - painkillers like Vicodin, OxyContin and morphine - fell by 0.7 percent.
And in a survey of Tennessee doctors, more than 70 percent said they have changed a patient's treatment plan after checking the patient's history in the database. More than half are now more likely to refer a patient for substance abuse treatment.
Most surveyed said they think the new measures have helped them identify people abusing the system.
"It's more time-consuming, and it adds expense, but at the end of the day it is probably better for practicing good medicine," said Dr. Brian Kalla, a physical medicine and rehabilitation doctor at Siskin Spine & Rehabilitation Clinic, which treats many patients requiring pain medicine.
In the year Kalla started doing regular drug screenings, he had to dismiss 12 patients after finding out they had been abusing the system.
His tests showed that some had not been taking the medicine he had prescribed at all - meaning it is likely falling into other hands.
Other patients paired his prescriptions with other drugs - cocaine, meth and other painkillers or controlled drugs that he hasn't prescribed.
"Some of these are people that I had suspicions about," Kalla said. "But others completely surprised me."
The wave of new laws aimed at prescription drug abuse began in 2011, as Tennessee became the poster child of a national prescription drug abuse epidemic.
The state is currently tied for first in the nation for having the highest per capita rate for painkiller use, the U.S. Centers for Disease Control and Prevention reports.
An estimated 69,100 Tennesseans are addicted to prescription painkillers. The number of unintentional drug overdose deaths in the state more than tripled in the last decade - a rate higher than the national average. And the number of babies born dependent on drugs also grew tenfold from 2001 to 2011.
Trying to curb these numbers, most of the new laws put doctors on the front lines of the battle against addiction.
One of the more recent changes has been the move toward drug screenings.
At pain management clinics, doctors are required to give regular drug screenings to all of their patients.
And law states that primary care doctors and others who prescribe controlled substances are also "strongly recommended" to perform such random tests on patients who require long-term drug therapy.
"It's not an absolute requirement that they do it, but it is becoming much more standard practice," said Rae Young Bond, executive director of the Chattanooga-Hamilton County Medical Society.
The biggest game-changer, both doctors and state officials say, came with the usage of the Controlled Substance Monitoring Database, which has allowed physicians to more readily spot patterns of addiction.
"Physicians are generally not well-trained in addiction. They are trained to treat the consequences of addiction," said William Swiggart, co-director at The Center for Professional Health at Vanderbilt University. "Many doctors have long been conned by their patients."
Swiggart and several colleagues at Vanderbilt wrote a paper earlier this year that unpacks the new laws for doctors, and also examines the financial burdens of the new rules. Some patients may find that the screenings and repeat visits make drugs they've long depended on "prohibitively expensive," the report said.
This worries physicians like Dr. Joseph Huffstutter, whose rheumatology practice prescribes a range of painkillers to help patients with different forms of arthritis - some who have required such treatment for 30 years.
"It really can become burdensome for patients; they have to comply with the law," Huffstutter explained. "It means they have to schedule more visits, and that they often have to pay for the extra screenings."
Huffstutter said he hopes Tennessee lawmakers and insurers will look to other states experimenting with such laws to find the right balance for treating patients with pain needs, curbing abuse, and connecting people with addictions to help.
That link to treatment is key in the war on drug abuse, health experts have said, since clamping down on prescription drug abuse can mean a return to other drugs like heroin.
Meanwhile, Swiggart said, the center at Vanderbilt has been offering new courses for doctors, training them on how to prescribe medicine in a new health environment.
Those classes are always full.
Contact staff writer Kate Harrison Belz at firstname.lastname@example.org or 423-757-6673.