Here's What New Tennessee Opioid Restrictions Mean at Your Doctor's Office and Pharmacy
Limits on supply, strength
The biggest change has to do with how much of a drug you can get and when. Under the new law, pharmacists can only partially fill a prescription for no more than half of the number of days it’s written for. And there are limits on prescriptions, too: General prescriptions are limited to a 10-day supply (and no more than 500 cumulative morphine milligram equivalents).
Prescriptions after surgery are limited to a 20-day supply (maximum 850 cumulative MMEs). “Medical necessity” prescriptions are limited to a 30-day supply (maximum 1,200 cumulative MMEs). This law technically takes effect July 1, but it won’t be mandated until Jan. 1, 2019, to give pharmacies a chance to update their software.
Checking the database
When you bring an opioid prescription to be filled, the pharmacy is required by law check the Controlled Substance Monitoring Database, which logs each time you fill a prescription for a controlled substance. The database has to be checked when you first bring a prescription to a pharmacy, and then again at least once every six months as long as you’re getting refills.
When your doctor writes you a prescription for an opioid drug, the law now requires he or she document the specific reasons you’re getting the drug, as well as the fact that you’re getting it with informed consent — your prescriber has warned you it can be addictive.
Three-day supplies less restricted
However, doctors can write (and pharmacies can fill) opioid prescriptions for a three-day (or less) supply (maximum 180 MMEs) without these restrictions.
No 'gag' on pharmacists
Pharmacists no longer have any limits on discussing opioid-related issues with customers, including risks, effects and characteristics of the drugs; what to expect when you use it; the proper way to use it; and cost, with insurance or cash.
Some prescriptions exempt
Some prescriptions are exempt from the requirements and limits, though doctors must still write a diagnosis code and “exempt” on them: Prescriptions for people who are getting palliative cancer treatment or hospice care; who have sickle cell disease; who are inpatients at licensed facilities; who are seen by doctors who meet the state requirements to be “pain management specialists”; who were treated with opioids for 90 days or more; who have severe burns or “major physical trauma”; and who are on methadone, buprenorphine or naltrexone, which are drugs used to assist recovery from addiction.
Initially, the legislation was more restrictive — prompting concern from pharmacists that it would prevent “legitimate patients” from being able to get needed prescriptions and put a burden on pharmacists, said the Tennessee Pharmacists Association, which lobbied legislators for some changes.
But the organization said in a statement that decreasing the prescription drug supply must be combined with access to treatment and recovery services, or it may increase both the number of people using illicit street drugs and the number of pharmacy burglaries/robberies.
“While this legislation is well-intended, TPA remains concerned about the unintended consequences of the legislation on patients and the pharmacy profession,” the Tennessee Pharmacists Association said. “Decreasing the overall epidemic of prescription drug abuse and reducing patients’ risk of dependence are commonly shared goals of all pharmacy professionals and Tennesseans. However, the need for patient access to treatment and recovery services has never been greater, and our state must continue to seek solutions which help our patients struggling with dependence and addiction to get the help they desperately need.”