tn opioid program · collectively serve tennesseans who are struggling with opioid addiction •...
TRANSCRIPT
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TN Opioid ProgramErica Schlesinger, Pharm.D
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Disclosures• Nothing to disclose
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TN TogetherGovernor Haslam’s Plan
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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, evidence-based 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
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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
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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
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Public Chapter 1039• Establishes new limits on prescribing and dispensing
of opioids for NEW HUMAN PATIENTS
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• Goal: To place more guidelines for, and checkpoints between, healthcare practitioners and patients before an individual is put on a chronic regimen of opioids.
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Public Chapter 1039Important Prescriptions Limits
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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 Prescriptionso 30 day supply – 1200 MME cumulative limit (15 day partial fill)
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Requirements for Pharmacists
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TN Together Summary
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Public Chapter 1040• Establishes new classes of scheduled controlled
substanceso 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 Tennesseeo Effective July 1st, 2019
• Interesting notes on kratomo The synthetic form of kratom is a Schedule I controlled substanceo The natural form of kratom is not a scheduled substance o 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)
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Public Chapter 978• Establishes new licensing criteria and guidelines for non-
residential 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
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Buprenorphine Guidelines
• PC 978 also had the department reconvene the Buprenorphine Guideline Committee to revise the guidelines and address some key pointso Tapering conversationso Addressing mono-product injections
• Tennessee Nonresidential Buprenorphine Treatment Guidelineso https://www.tn.gov/content/dam/tn/mentalhealth/documents/2018_Bup
renorphine_Treatment_Guidelines.PDF
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How can we combat the crisis together?
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COMMUNICATION IS KEY!
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Special Thanks• TPA for their infographics