As of July 1, 2018, new laws went into effect in the state of Tennessee regarding the ways doctors are able to prescribe opioids to their patients. The changes were a direct result of a nationwide increase of deaths tied to opioid use, both prescription and illegal. According to the TN Together legislation, opioid related deaths in the US have quadrupled since 1999, and Tennessee remains in the top 15 of all states in drug overdose deaths.
There is no doubt those statistics are staggering, and it is not unreasonable at all to expect our elected officials to pass laws to save as many lives as possible. While it is too early to see a direct decrease in deaths related the new laws, the expectation is that more lives will be saved by reducing the amount of these prescriptions that are written.
There have been many questions surrounding these new laws and determining how patient care will be affected. We hope to provide some education and give patients a better understanding of what to expect for their course of treatment as a patient of Mid-Tennessee Bone and Joint.
What is an opioid?
Opioids are a class of drugs that provide pain relief after a specific event. They are stronger than over the counter pain relievers. Common prescription names for opioids are Vicodin (hydrocodone), Ultram (tramadol), OxyContin or Percocet (oxycodone), Opana (oxymorphone), Kadian or Avinza (morphine), fentanyl and codeine. Heroin is another type of opioid that is not prescribed and is illegal.
When are opioids prescribed?
Opioids are prescribed to relieve moderate to severe pain after a surgery or serious illness. They are generally safe when used for a short time as prescribed, but misuse can be deadly. For most patients, three days or fewer will suffice, and only a small number of patients will require more than seven days’ worth.
What are the risks and side effects from opioid use?
While they’re beneficial for controlling severe pain, opioids can cause significant side effects when taken for prolonged periods. The most concerning has to do with risks of overdose and ensuring the prescription is taken in correct doses. Even when taken as directed, possible side effects include nausea, sleepiness, dizziness, and confusion. The risks for these side effects increase for patients who have existing mental health disorders, a history of drug abuse, or are 65 or older. It’s also incredibly important to avoid alcohol use while taking opioids. Mixing the two can depress the central nervous system, causing decreased breaths, unconsciousness, and death.
What does the new law say?
The law looks at the opioid crisis from three sides – prevention, treatment, and law enforcement. Doctors now have stricter guidelines on prescribing opioids and must routinely check the Controlled Substance Monitoring Database which tracks how often a patient has been prescribed an opioid.
Per the new law, opioid prescriptions are written for specific amounts based on need:
• Initial prescription, written with minimal restrictions – 3 days’ worth.
• Patients who underwent a minimally invasive procedure – 10 days’ worth.
• Patients who underwent an invasive procedure – 20 days’ worth.
• For larger doses, prescriptions are only to be filled for half of the initial amount.
• Doctors must document specific need for increased supply.
• Patient must sign informed consent form agreeing that the physician outlined all of the risks and concerns in taking opioids.
These new requirements were written based on research into the reasons behind opioid abuse. For instance, a 10 day prescription of an opioid may only be filled five days’ worth at a time. The reason for this change goes back to studies that show most people who abuse opioids get the pills from someone else, whether from an active prescription or an old one where all of the pills were not taken. By dispensing only half of the pills at once, the aim is to reduce the amount of leftover medication. If the remaining five days’ worth is legitimately required, the patient just needs to return to the pharmacy for the rest.
Are there exemptions?
There are very few situations in which larger or prolonged doses are allowed. If a patient is undergoing cancer treatment, is in hospice care, has been diagnosed with sickle cell disease, or for those patients who are at an in-patient facility such as a hospital, nursing home, or assisted care facility, then they are not part of the above restrictions. Additionally, patients who have experienced severe burns or major physical trauma and patients who are under the care of a healthcare professional for an opioid use disorder also qualify as an exemption to the new laws. As these exemptions are tied to very rare circumstances, we do not expect our patients will fall into a category in which an opioid prescription will be written.
How does MTBJ handle opioid prescriptions?
Typically, any opioid prescriptions will be reserved as an option for our patients who undergo surgery. Our physicians believe more education is vital when it comes to understanding the role opioids play in pain relief, and that better education about pain will help our community in the long run. Our goal is to manage our patients’ expectations about how much pain they should experience in the first few days after surgery and that it will get better.
As always, Mid-Tennessee Bone and Joint will continue to appropriately utilize a variety of therapies as we always have to address our patients’ pain. We pledge to diligently abide by these new federal opioid laws while continuing our great tradition of specialized, compassionate, and exceptional care.
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