TN Opioid Program Erica Schlesinger, Pharm.D
Nothing to disclose Disclosures
TN Together Governor Haslam s Plan
Prevention Establishes limits, decreases supply and dosage of prescription opioids Limits TennCare coverage of opioids Increases prevention education for elementary and secondary schools Implements a public awareness campaign to raise awareness about potential dangers of opioid use and provides resources for those struggling with addiction Identifies women of childbearing age who are chronic opioid users and provides targeted outreach about risks, contraception and treatment in order to aid in prevention of NAS Establishes a commission to formulate current, evidencebased pain and addiction medicine competencies for adoption by medical and health care practitioner schools Creates a collaborative of health care stakeholders to study, formulate and implement best practices around pain management
Treatment Provides more than $26 million in funding (state and federal) for treatment and recovery services for individuals with opioid use disorder. Ensures TennCare members with opioid use disorder have access to high-quality treatment options Improves data access and sharing to better and more timely identification of critical hotspots for targeting resources and to increase information about patient and community risks Creates a statewide public/private treatment collaborative to collectively serve Tennesseans who are struggling with opioid addiction Within the state s correction facilities, expands residential treatment and services for opioid dependence and creates incentives for offenders to complete intensive substance use treatment programs while incarcerated Provides funding to the state s zero to three court programs for transportation needs relative to therapeutic and family support services Establishes three recovery compliance courts (one in each grand division) to facilitate accountability in recovery support services for offenders
Law Enforcement Increases state funding to attack the illicit sale and trafficking of opioids through additional law enforcement agents and training Updates the controlled substance schedules to better track, monitor and penalize the use and unlawful distribution of dangerous and addictive drugs including fentanyl analogues Provides every Tennessee state trooper with naloxone for the emergency treatment of opioid overdose prior to paramedic arrival
Public Chapter 1039 Establishes new limits on prescribing and dispensing of opioids for NEW HUMAN PATIENTS Goal: To place more guidelines for, and checkpoints between, healthcare practitioners and patients before an individual is put on a chronic regimen of opioids.
Public Chapter 1039 Important Prescriptions Limits
All Other Opioid Scripts Must be partially filled with no more than half the prescribed quantity Must have ICD-10 Code and Surgery or Medical Necessity written on prescription Dispensers must check the database before dispensing and at least every 6 months General Opioid Prescriptions o 10 day supply 500 MME cumulative limit (5 day partial fill) Surgery Opioid Prescriptions (defined as more than minimally invasive procedure ) o 20 day supply 850 MME cumulative limit (10 day partial fill) Medical Necessity Opioid Prescriptions o 30 day supply 1200 MME cumulative limit (15 day partial fill)
Requirements for Pharmacists
TN Together Summary
Public Chapter 1040 Establishes new classes of scheduled controlled substances o Fentanyl analogues are now in the schedule to help law enforcement when dealing with illicit fentanyl. Reschedules Gabapentin as a Schedule V Controlled Substance in Tennessee o Effective July 1 st, 2019 Interesting notes on kratom o o o The synthetic form of kratom is a Schedule I controlled substance The natural form of kratom is not a scheduled substance Restrictions for sale of kratom: Kratom must be in its natural form and labeled appropriately Purchaser must be at least 21 years old (seller must verify age)
Public Chapter 978 Establishes new licensing criteria and guidelines for nonresidential outpatient office-based opiate treatment (OBOT) facilities Establishes new reporting requirements for dispensers of buprenorphine A pharmacy and a distributor shall report to the department of health the quantities of buprenorphine that the pharmacy or distributor delivers to nonresidential office-based opiate treatment facilities in Tennessee. Establishes a prescriber task force to determine the minimum disciplinary action if the healthcare practitioner engaged in a significant deviation or pattern of deviation from sound medical judgment, the minimum disciplinary action that a healthcare practitioner's licensing board or committee must take shall be established and promulgated by rule by a task force
Buprenorphine Guidelines PC 978 also had the department reconvene the Buprenorphine Guideline Committee to revise the guidelines and address some key points o o Tapering conversations Addressing mono-product injections Tennessee Nonresidential Buprenorphine Treatment Guidelines o https://www.tn.gov/content/dam/tn/mentalhealth/documents/2018_bup renorphine_treatment_guidelines.pdf
How can we combat the crisis together?
COMMUNICATION IS KEY!
Questions? Erica.Schlesinger@tn.gov 615-218-7357
Special Thanks TPA for their infographics