Tennessee’s crackdown on prescription painkiller abuse making progress
Some experts worry measure may create hardship for people who legitimately need pain medication
Tennessee’s effort to control painkiller medication abuse is winning praise nationally, although some local doctors worry the crackdown on so-called pill mills may make it harder for those who legitimately need pain medication to get their drugs.
In a report issued Monday in conjunction with the National RX Drug Abuse and Heroin Summit, meeting this week in Atlanta, the nonprofit group Shatterproof, which has been urging state governments to get tougher on prescription drug abuse, praised Tennessee as one of the states heading in the right direction.
Faced with one of the highest rates of painkiller use in the nation, Tennessee passed the Prescription Safety Act of 2012 to require all doctors who prescribe painkillers to register with the state. As of January, they are required to enter all prescriptions for opioids such as Vicodin, OxyContin or Percocet into the database.
With the database in place, doctors can check its records before writing a painkiller prescription to see if their patient is already getting the drug from another physician, one trick addicts use to obtain the drugs illegally.
According to the Shatterproof report, Tennessee reduced the overall number of painkiller prescriptions by 7 percent between 2013 and 2014. Each percent reduction in prescriptions should result in a corresponding 1 percent decline in overdose deaths, the group reported.
“In my practice it has cut down a lot on doctor shopping,” said Dr. David Castrilli, who practices with CHI Memorial’s Internal Medicine Associates on Gunbarrel Road. “The database is useful because there’s really no other great way to see if somebody lived in Memphis or Knoxville and got a prescription, and then here they are in my clinic and asking me for it.”
The death rate from painkiller abuse has soared in recent years. Drug overdose death rates have increased more than five times since 1980, according to the Shatterproof report. Painkiller overdoses killed 18,893 in 2014, and more people died that year from overdoses than from car crashes.
The Obama administration has been criticized for not doing enough to address the problem, which has gotten worse in the time the president has been in office. The White House last month asked Congress for $1.1 billion to fight the problem, with pill-tracking databases a central part of the plan.
“In Tennessee until 2012, the rate of growth of opioids consumption was greater than 10 percent a year,” said Dr. Mitch Mutter, the Chattanooga physician and state medical director for special projects who oversees the state opioid database. “It flattened in 2013, and now has gone down 14.6 percent.”
“We had a huge problem with doctor shopping in the state,” said Mutter, who is in Atlanta this week at the drug summit. “In the last three years, by providers looking at our database before writing prescriptions, doctor shopping has gone down 50 percent.”
But the database has not eliminated doctor shopping, because it is not nationwide, so smart abusers can seek prescriptions in adjacent states.
“People are getting smarter and hiding in North Georgia,” Mutter said, because Georgia’s law is not as tough as Tennessee’s and doctors who are not licensed to practice in Georgia cannot check that state’s database.
“We’ve wanted [a national database] for a long time,” said Dr. Thomas Miller, an expert in opioid abuse and chairman of the Hamilton County Regional Health Council’s addictions subcommittee. At one point, that seemed possible, but physicians backed out when law enforcement officials insisted on getting access to the database without being required to obtain a warrant, something the doctors would not agree to, Miller said.
While local experts all praised the painkiller database, they also worry the crackdown on painkillers could make it harder for some people who legitimately need the drugs to obtain prescriptions.
A new state law taking effect July 1 will raise the requirements for the medical directors of the state’s pain clinics, and may put some of them out of business, Miller said. In Chattanooga, for example, he predicts as many as 15 of the city’s 20 pain clinics could close their doors.
“Which means there will be a bunch of people truly addicted to drugs that should have never been addicted but who were because they went to a bad place,” Miller said, “and people like me are having to deal with them. There are tens of thousands of people [in that situation] across the state.”
Mutter, who supports the tougher requirements for medical directors, is not as worried.
“We want the bad ones to be out of business,” he said. Pain specialists should be looking at forms of treatment other than painkillers, Mutter said, such as acupuncture, non-opioid drugs, and psychological support.
“Many pain clinics will just offer a prescription treatment for someone’s pain and not do all of the other things a pain specialist would do,” he said.
Mutter said he believes the state will have a sufficient number of pain specialists after July 1.
“We go to bed at night thinking we’ve got the right number and wake up thinking we don’t — we’ll find out after July 1,” he said.
Adding to the concern is that some primary care doctors are opting not to prescribe painkillers to avoid the extra headache of dealing with the database.
“It takes 30 seconds to check the database,” Miller said. “But it does take more monitoring than you need to prescribe someone a blood pressure pill.”
“I have to say it is a little bit of a nuisance,” said CHI Memorial’s Castrilli. “It can take five minutes, and that’s a third of an office visit.”
Added to that is a general cynicism among doctors when patients complain about pain.
“Unfortunately, a lot of people in legitimate pain are also abusing the painkillers,” Castrilli said. “You can take away the pills, but you don’t take away the problem. There is always somewhere else to get the drugs, whether legal or illegal.”
Mutter agreed that while the state has made a lot of progress, the problem of painkiller abuse is nowhere near solved.
“It took us 30 years to get in this mess,” he said, “And it will take us more than three or four years to get out of it.”
Contact staff writer Steve Johnson at sjohnson@timesfreepress.com, 423-757-6673, on Twitter @stevejohnsonTFP and on Facebook, www.facebook.com/noogahealth.
Filed under: General Problems
I understand the need for a data base, but only if it is properly used. The ONLY ones that should be able to use the database is docs & pharms. Since the pill mill crackdown about 5 years ago, the # of opioid rx written has gone down as much as 80% in some areas & the abuse of RX opioids have gone down over 40%, especially in those that are 25 & under.
Yet the death rate has gone from 16,500 to 28,000+ How could this be possible? It is very clear & simple for those that are educated in ACTUAL facts as it is due to the LACK of RX opioids!!
Suicide among CPP”S is skyrocketing because they are being denied their meds. for absolutely no reason!! This cruel, harsh abuse is leaving long term, stable, & compliant CPP’s nowhere to turn, but suicide or illegal street drugs like heroin & now fake fentanyl!!
Even John’s Hopkins has done an extensive study which showed that out of 12,000 long term compliant CPP’s only 4 developed addiction. The patients that are the most at risk, are those w/ a past history of substance abuse, in which the majority of current, compliant CPP’s do not have!!
We need to start following the path that the anti opioid groups travel on as they are the ONLY ones being heard. So maybe if we start doing what they do, maybe we too, could be heard!!
Tennesseans take exception to the misapplication of their statistics. I’ve already taken Mutter to task on this.