During a year where gun bills dominated the Tennessee General Assembly’s media focus, there were a number of bills passed assisting in the prevention of substance abuse. The MDC’s Prescription Drug Abuse Task Force introduced two pieces of legislation related to prescription drug abuse. One was changing the current requirements for pain management clinic certification. This bill passed, was signed by the Governor and will go into effect July 1, 2015. Previously there were no requirements for ownership of a pain management clinic. Anyone from any background, residing in any state could open a pain management clinic in Tennessee. Effective July 1st, a certificate holder must be a licensed medical provider (physician, nurse practitioner or physician’s assistant) in the state. The other big change is the qualifications for the medical director of a clinic. Prior to this change, any physician with any specialty could serve as a medical director. Effective July 1 2016, a medical director must be certified and trained in pain management from a qualifying certification body, such as the American Board of Medical Specialties (gold standard), American Board of Pain Management or the American Board of Interventional Pain Physicians. These changes are critical to insuring the most qualified physicians are serving as medical directors, which will improve the quality of pain management clinics throughout the state. Individuals suffering from long term chronic pain conditions should be afforded the same consideration and standards as we do other medical specialty areas. After all, you wouldn’t go to an obstetrician if you had a heart condition!
Another important piece of legislation is the Good Samaritan Law, which will allow criminal immunity under certain conditions for individuals who render aide to someone who is suffering from a drug overdose. Overdose deaths in our state now exceeds car crashes as the leading cause of accidental death. Many of these deaths could be prevented if bystanders did not fear criminal charges when calling 911. Many times individuals who experience an overdose are with others who are engaging in the use of drugs, which causes victims to be left to die and bodies to be abandoned or dumped off at the emergency room door. In order to save lives, emergency calls need to be placed immediately to allow the administration of a life-saving drug called Naloxone. This antidote can restore breathing in someone who has shallow respiration from an overdose. A bill was passed last year to allow medical providers to write prescriptions for naloxone for individuals who are concerned about a friend or loved one who is caught in the cycle of addiction and at risk of overdosing. In order for the new naloxone law to be effective, Good Samaritan was a necessary step. We would like to extend a special thanks to the Tennessee Medical Association (TMA) for including this important piece of legislation in their package. A companion bill was filed by the MDC task force, but was pulled to support the TMA bill.
As the efforts to combat prescription drug abuse continues, another important step occurred during the 2015 session and was the repeal of the Intractable Pain Treatment Act of 2001. This act placed medical providers in a somewhat tenuous position of weighing patient demands for pain treatment versus medical training and judgement when it came to prescribing narcotic pain relief. Although the intent of the Pain Patient’s Bill of Rights was to improve patient care, there were unintended consequences of the bill that may have contributed to the epidemic we are experiencing today. Persons who are active substance abusers, persons who are at risk and those who are in recovery should be evaluated carefully before being prescribed a controlled substance with a high potential for addiction. There are alternative therapies that should be considered. The repeal will allow the provider and patient to explore multiple options and make the best decision, based on medical history and current condition.
Although we continue to work on the prescription drug epidemic, we have to be cognizant of the fact that the most commonly abused drug among our youth is alcohol. As we all know, alcohol is a legal drug once you reach the age of 21. In spite of the legal drinking age, many young people find access through retailers who don’t appropriately check identification, adults over the age of 21 who purchase alcohol for those underage, and from home liquor cabinets. One plus to this fight is the fact that it is hard to conceal alcohol in its current form. But wait, just when you think you know what to look for, the alcohol industry introduces “Palcohol”, a powdered alcohol product that is portable and when mixed with water becomes a mixed drink. Several states have banned the sale of Palcohol and Tennessee also made that decision.
Senator Doug Overbey from Maryville sponsored a very important piece of legislation to regulate e-cigarette products in Tennessee. These products have exploded in the last several years in our state and country, but are yet unregulated by the federal food and drug administration (FDA), which means there is no requirement for product labeling, marketing restrictions or sales restrictions. Other tobacco products are regulated and require a person to be 18 years of age in order to purchase. Until this bill passed, anyone of any age could purchase e-cigarette vapor products. The new law requires that a person must be 18 years of age and that the vapor oil containers have child safety caps to prevent young child from accidental consumption of the oil, which contain nicotine and other chemical compounds. Since entering the market, the youth rates of e-cigarettes are now double that of traditional cigarettes.
Efforts continue to legalize medical marijuana in Tennessee and this legislative session was no exception. A bill was defeated to allow prescribing of medical marijuana in this state. Upon that bill’s demise, an eleventh hour attempt was made to attach an amendment to a palliative care bill in hopes that it would pass. This version was also defeated. In contrast, a bill to allow parents of children with seizure disorders who have tried all the other options for traditional medical treatment to control seizures to be allowed to provide the low THC Cannabis oil through a prescription. This essentially allows parents to purchase the oil from states that have legalized medical marijuana to obtain the oil (very specific criteria for the allowed levels of THC) and bring it into the state without violating state laws. One note is that any marijuana legalization is a violation of federal law.
And then there’s suboxone and subutex (buprenorphine), used to treat opiate addiction and to avoid the painful withdrawal symptoms of detoxification. Buprenorphine is an evidence-based treatment strategy to assist those individuals who want to break their dependence on opiates, such as prescription narcotics and/or heroin. The Drug Enforcement Administration (DEA) regulates buprenorphine and physicians who wish to prescribe these medications are required to take an online training course and then are limited in the number of patients that can be under the care of a provider at any given time; maximum of 30 the first year and up to 100 after that. Many providers were getting around these limitations by writing buprenorphine “off label” for pain management, which had no limitations on numbers. The Tennessee Medical Association sponsored legislation to not allow “off label” prescribing of buprenorphine products. There was also an attempt to require a Certificate of Need (CON) for suboxone clinics in our state. This bill was defeated in the House and would have required anyone wishing to open a suboxone clinic to apply with the state and gain approval before opening a clinic. This process allows input from local communities where these clinics are proposing to locate.
Special note of thanks to several bill sponsors or co-sponsors from our area: Representatives Bob Ramsey, Bill Dunn, Ryan Haynes; Senators Ken Yager, Doug Overbey, Becky Massey, Richard Briggs, and Randy McNally.
Thanks to all of the Knox County and East Tennessee legislators who continue to support legislation to prevent drug abuse and addiction in our state. We appreciate your support of the mission of the MDC and for your service to our great state.