A new report from the Tennessee Comptroller's Office found that 79% of opioid prescribers with abnormal prescribing patterns have not been recently disciplined and are not under investigation by the Tennessee Department of Health.

The report identified 62 prescribers — medical doctors, nurses, dentists and other licensed practitioners — worth investigating based on their 2017 prescribing patterns. Of those identified, 49 have not been disciplined by their licensing board since 2017 began. They're also not currently under investigation by the Department of Health. Eight have received some level of discipline, and the department is developing cases against the remaining five prescribers, according to the report.

Kristina Podesta, report author and legislative research analyst for the state comptroller's office, said someone who's identified isn't necessarily an inappropriate prescriber. However, the report provides insight into how often abnormal prescribers are flagged, investigated or disciplined.

"There are medically justifiable reasons for a lot of these prescribing patterns," Podesta said.

While doctors wrote the most opioid prescriptions overall, followed by advanced practice registered nurses, 17 of the abnormal prescribers identified in the report who were not investigated were dentists.

Before Tennessee started intensely monitoring prescribing patterns, the Department of Health relied heavily on complaints to open a query needed to prompt an investigation, she said. Now, better data allows the state to more proactively open queries about prescribers.


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Podesta said the report found that only half of all abnormal prescribers had a query opened about them.

"I think that really stood out to us, and how many cases were determined or closed by a consultant," she said. "[Consultants] decide whether or not something goes to investigation and, after an investigation, whether or not there's discipline."

In addition, the report found that concurrent benzodiazepine — a class of tranquilizers — and opioid prescriptions are not being looked at in the department's high risk prescribers list.

Fatal and nonfatal drug overdoses, fueled by both prescription and illicit opioids, have been on the rise in Tennessee since 2013. As part of the state's response, the governor in 2018 signed a law directing the comptroller's office to study opioid prescribing patterns. In 2017, 1,261 Tennesseans died of an opioid-related overdose and medical providers treated at least 23,600 nonfatal overdoses, according to state data.

John Dunn, a spokesperson for the comptroller, said the office will share the report's findings and analysis with the state's Senate Health Committee on Wednesday.

"The legislature is certainly going to be hearing about this and hearing the policy options," he said.

To complete the report, the Comptroller's Office of Research and Education Accountability analyzed data from the Tennessee Department of Health's controlled substances monitoring database, interviewed department staff and members of the licensing boards, and reviewed board meeting minutes, disciplinary orders and Department of Health investigation files.

Contact Elizabeth Fite at or 423-757-6673.