By Dr. Elise Denneny
I hope this edition finds all of you well as fall and football season begins!
TMA along with the Knoxville Academy of Medicine has been working hard and a legislative report card was recently released. The link to this easily digested succinct report follows. I encourage you to scan it and reply with any questions you may have.
It has become apparent that many are interested in the problem of pain medication abuse and neonatal abstinence syndrome. The Knoxville Academy of Medicine along with Dr. Mitch Mutter of the TN Department of Health, and Karen Pershing of the Metropolitan Drug Commission, have been working tirelessly with the KAM Prescription Drug Task Force this past year and much has been accomplished. First, the group is tasked with addressing the problem of pain pill abuse, of which we are second in the nation, in all aspects. To effectively tackle this issue, we have brought all stake holders to the table including representatives from local and state law enforcement, healthcare providers of varied levels and disciplines, pharmacists, nursing, mental health, the Knox County Health Department, Tennessee Board of Health representatives, legislators and elected officials to discuss solutions and problems. Not all solutions require new legislation and frequently more ground is gained outside the legislative arena.
The recent pain management guidelines have been released and can be found at http://health.state.tn.us/Downloads/ChronicPainGuidelines.pdf
Since the committee’s inception, KAM President Pat O’Brien, MD and Past-President, Tara Sturdivant, MD have visited or contacted many of the pain clinics in our area to stress the importance of proper prescribing. We have seen a reduction of the number of pain clinics in Knox County from 36 to 34.
On the legislative front, the task force was successful in passing the “ID Bill” sponsored by Representative Ken Yager (R-Kingston) and Representative Bob Ramsey (R-Maryville). It seems like requiring proof of ID should have been required many years ago as ID is required when you purchase alcohol, nevertheless better late than never and this requirement of showing ID when purchasing narcotics should create a paper trail to help law enforcement. Unfortunately, the laws in place seem to protect the guilty and prosecution is extremely difficult and expensive. Getting bad laws off the books is just as hard, so the process is slow and tedious BUT WE ARE GAINING GROUND!
Since implementation of the Controlled Substance Monitoring Database (CSMD) we have seen a reduction in scripts written and ongoing “tweaks” to the CSMD, such as push notifications of high utilization, should help providers and continue to curb abuse.
Effective October 6, 2014, the DEA has published in the Federal Register the rule to transfer hydrocodone combination products from schedule III to schedule II. As you know, hydrocodone combination products are the most prescribed opioids, which may lead to increased abuse, especially considering the United States consumes 95% of the worlds’ hydrocodone. Additionally, HCP’s are responsible for 75% of drug-related deaths. Even though many hydrocodone products are already a C-II drug, this rule should capture other HCP and make record keeping in “pill mill” clinics more difficult. Also, all HCP now will need a written prescription, thus reducing phone prescription fraud.
In preventing and treating abuse, all physicians know compliance is an issue and newer delivery systems such as Probuphrine, which can deliver 6 month medication subdermal, may find good utility.
One note to keep in mind, as we gain tighter control over pain pill mills, we try to avoid unintended harmful consequences. I have learned much from my excellent colleagues who are on the front line fighting this epidemic. Not all pain is the same. Cancer pain is very different from back pain,etc. We must be cognizant of those who need medication. Also, as we gain tighter control, many patients may unintentionally find themselves acutely without their opioids and/or we may see an increase in heroin use.
Two more issues I would like to bring to your attention.
First, many of you already know the wonderful results of the recent primary election. Dr. Richard Briggs (Knoxville) won the republican primary for State Senator, beating incumbent Stacy Campfield; Dr. Sabi Kumar (Springfield) won the republican primary for House District 66 and Dr. Brian Terry (Murfreesboro) won the primary for House District 48. This took a lot of work and I encourage you to congratulate them on a well-run campaign. ALL three will be in the general election in November. VOTE THIS NOVEMBER!
We now have three more physicians in the state legislature!!!! I recall a time when a physician commented that if medicine were ever to change, doctors would have to unionize… whether or not we need to unionize, it is good for the house of medicine to now have three more docs fighting for us and our patients.
Secondly, recently Drs. Randal Dabbs, Charlie Barnett, and Pat O’Brien, along with Karen Pershing and Representative Bill Dunn met with representatives from Senator Lamar Alexander’s office to discuss the emerging problem of physician performance being tied to patient satisfaction surveys. It is ridiculous to think that patient satisfaction surveys as presently constructed can reflect quality of care. Physicians, like parents, often have to render advice and opinions that patients do not like to hear. No amount of statistical adjustments and psychometrics can fix bad metrics and bad data. Medicine is unique art, and to be measured as a business, although desirable for efficiencies in health care delivery models, will ultimately erode quality of care for patients!!!! We do not argue against “long waiting times” but patients need to be cognizant that more often than not, many office clerical dissatisfactions are out of the physician’s control. Senator Lamar’s staff received our comments in a favorable light and will work to help address the growing problem.
As always your comments and thoughts are welcome.
Be well and smile, for all of you work to make life better for our patients!