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Running Race Against Pain

MEMPHIS — Leaning heavily on his walker, James Tuggle shuffled out of a Germantown pain clinic for the last time, trying to stay positive. A doctor had prescribed him enough Percocet to last through September, but when those pills run out, Tuggle will need to get his medicine from somewhere else.

Tuggle, 67, from Whitehaven, suffers from arthritis along with a crippled knee and has for the past three years, been a patient of Comprehensive Pain Specialists, one of the largest pain management chains in theSoutheast. But the company is shuttering at least two dozen clinics next week, leaving Tuggle and tens of thousands of other patients searching for new doctors in a state that has become increasingly suspicious of opioid prescriptions. As Tennessee’s deadly opioid epidemic worsens, many chronic pain patients worry they will become a second kind of victim, cut off from medicine they’ve grown to depend upon.

“It’s scary, and it’s gonna hurt a lot of people – a lot of older people. Somebody isn’t gonna get what they need,” Tuggle said after his final doctor’s appointment. “I think I’ll probably find a new doctor, but it’s noguarantee.” Comprehensive Pain Specialists, or CPS, a massive Tennesseebased pain treatment company with about 50,000 patients in 8 states, is closing most if not all its clinics – including clinics in Germantown, Nashville, Chattanooga and Clarksville – by July 31. The closures, first reported by the USA TODAY Network Tennessee earlier this month, have sparked concern among medical experts who say the pain management industry does not have the capacity to absorb the patients left behind by CPS, many of whom are addicted to, or at least dependent upon, prescription opioids.

In a series of interviews about the clinic closures, CPS patients throughout Tennessee said they feel largely forgotten in statewide discussion about opioids, which often focuses on addicts, abuse and overdoses but rarely discusses legitimate prescriptions. And now, just as Tennessee tightens restrictions on opioids, these patients must convince a new doctor to extend their prescriptions or face a life of unmitigated pain.

“It’s absolutely terrifying,” said Deneice Reynolds, 68, who suffers from fibromyalgia and severe back problems. “I just keep praying, every day, that someone says I have an appointment. That’s all I can do.”Reynolds, a retired accountant in Duck River, has been a patient at a CPS clinic in Columbia for about two years. Reynolds said chronic pain once left her unable to stand but she has found some relief in a carefully-monitored prescription of oxycodone and gabapentin. The pain isn’t gone, but it’s manageable, she said.

Fear, withdrawal, a ‘miserable life’

Like many chronic pain patients, Reynolds was originally prescribed opioids by her family doctor, then transferred to CPS after Tennessee first tightened restrictions on prescriptions a few years ago. During the transfer, however, Reynolds temporarily lost access to her medication, then suffered from withdrawal systems that left her feverish and bedridden.

Now, as the Columbia clinic closes, Reynolds has reason to worry her withdrawal will return. CPS issued her one last prescription on Tuesday. It ends in September.

“I’m dependent to the pain medicine, and I’ll be the first to admit it,” Reynolds said. “If I come to the end of my prescription, and I still haven’t found somebody else – I just don’t want to go through that again. I don’t want to go back to that place.” Steve Denney has evenless time. Denney, 65, a patient at the soon-to-close CPS clinic in Hendersonville, was left disabled by a botched back surgery about a decade ago. His last CPS prescription runs out in mid-August.

After weeks of searching, Denney said he has not found a new pain clinic to take him on as a patient. Most pain clinics are full. Some doctors have treated him “like a criminal,” Denney said, and others are unwilling to prescribe opioids altogether because they are afraid of feeding the epidemic.

“It’s a shame when your doctor is scared to help – scared to write a ‘script,” Denney said.

“I mean, my God, this is a miserable life. All I want to do is feel good enough to play with my grandchildren while I’m still alive. I’m certainly not after this for some kind of party.”

Company CEO charged with fraud

Despite multiple requests over the past month, the Comprehensive Pain Specialists has never clarified publicly if it is closing some or all of its clinics. Instead, reporters with the USA TODAY Network independently confirmed that at least 24 of its individual clinics were either closing or already closed.

Two CPS workers said earlier this month the company was closing all clinics but had forbidden employees from talking about it. This appeared to still be the case Tuesday when employees at the Germantown clinic said they had been instructed by company management not to discuss the shutdown. CPS gave the first confirmation of any closures this week in a vague statement saying the company would undergo a “responsible wind down of operations.” The closures were attributed to “significant regulatory and operational uncertainty” in the pain management industry, the statement said, and that CPS is working with patients to help them transition “smoothly” to a new doctor at another clinic.

“CPS is proud of the difference it has made in the lives of thousands of patients and their families, and we remain committed to helping them find the pain management care they need,” the statement said.

CPS has repeatedly ignored questions about if the clinic closures are connected to the recent indictment of a former company CEO.

John Davis, who led CPS from 2011 to 2017, was indicted in April for allegedly accepting $770,000 in bribes in return for referring patients to another company, CCC Medical. Both Davis and CCC Medical CEO Brenda Montgomery have pleaded not guilty.

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