TN Opioid ProgramErica Schlesinger, Pharm.D

Disclosures• Nothing to disclose

TN TogetherGovernor Haslam’s Plan

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

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

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

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.

Public Chapter 1039Important Prescriptions Limits

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)

Requirements for Pharmacists

TN Together Summary

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)

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

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

How can we combat the crisis together?

COMMUNICATION IS KEY!

Questions?Erica.Schlesinger@tn.gov

615-218-7357

Special Thanks• TPA for their infographics