Page 2 - Overview of Tennessee Opioid Prescribing Laws Flipbook

Tennessee Guidelines
Prescribing Opioids: Short-Term CME Requirements and Test

for Chronic Pain

Calculations of MME (Morphine Milligram Equivalent) for Commonly All other appropriate and available non-opioid treatments should be tried before prescribing opioids.

Managing In order to obtain 0.25 CME hours for this activity, prescribers must detach, complete, and return this test. Tests
Prescribed Opioids Review prior records. can be given to an SVMIC representative as you leave the live seminar, submitted via email to AskRM@svmic.com,
Chronic or faxed to 615-846-1783. Alternatively, SVMIC policyholders may take the exam online in the SVMIC Education
Morphine milligram equivalents (MME)/day: a measurement used to equate the strength of various Inform the patient the goal is pain reduction, not elimination. Center: education.svmic.com.
drugs to morphine. Opioid Avoid benzodiazepines. Patients on greater than 120 MME per day refer to mental health specialist.

Therapy
Examples: Methadone may not be prescribed to treat pain except by a pain specialist. Methadone may not be Required Information. Please print legibly.
y = y = prescribed for addiction outside of an Opioid Treatment Program, also called a methadone clinic. Name License # Last 4 SSN
1 mg 1 mg MD DO NP PA

Current diagnosis justifying treatment Assessment for misuse, abuse, diversion, and addiction o o o o
1 mg 1 mg 1 mg 1.5 mg Email Address

Clinically significant improvement in function, Use PEG scale (Pain Average, Interference with Address, City, State ZIP A CME Certificate will be mailed to this address.
Hydrocodone Morphine Oxycodone Morphine not only “pain score” Enjoyment of Life, Interference with General Activity) If you have a Vantage™ account, please use your Vantage account email

 Check CSMD per guidelines Screening for mental health disorders

For easy, helpful, and quick dosage conversions, try using the CDC App, CDC Opioid Guideline. Documentation Should Include:

This app, including the calculator, is not intended to replace clinical judgment. Informed consent Alternative treatments attempted Signature: Date:
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Always consider the individual clinical circumstances of each patient. Pain Management Agreement Urine drug screening per guidelines This course is available for continuing education for Physicians, PAs, and NPs only.

*Informed Consent for Opioid Exemptions Opioid Dosage Times/ MME/ Important Notes History & physical, labs, diagnostic testing, etc. Please circle the correct answer.
1. Effective January 1, 2021, Tennessee law will require prescriptions for ALL schedules (II - V) of controlled substances to
Day
Day
Prescriptions Greater than 3 Days a Naloxone Law allows a licensed be electronically prescribed (with few exceptions):
a. True
a The following patients are exempt if the prescription in- Oxycodone 10 mg TID 45 MME healthcare practitioner to prescribe Patient Urine Drug Screening b. False
1. Prescriber must sufficiently explain and disclose adequate cludes the ICD-10 Code and the word “Exempt”: Morphine Conversion naloxone to a person (or their family/ Management
information to allow the patient to make a knowing and Factor = 1 . 5 5 mg TID 22.5 MME friend) at risk of having an opiate-related (times per year) 2. Which of the following is required before issuing a 10-day supply of opioid medication for acute pain for a non-exempt
voluntary decision to give written consent for opioid • Treated with an opioid for 90+ days in the last year overdose. Guidelines patient:
therapy. Must include: • Active cancer treatment QID 40 MME a. Check the Controlled Substance Monitoring Database (CSMD)
• Risks, effects, and characteristics of opioids, including Hydrocodone 10 mg a Buprenorphine Law requires prescribers b. Personally conduct a thorough evaluation of the patient
c. Document consideration of alternative (non-opioid) treatment
risks of physical dependency, addiction, misuse, and • Undergoing palliative care TID 30 MME of buprenorphine products (Tennessee Low d. Obtain informed consent
diversion; • Receiving hospice care Morphine Conversion QID 20 MME law limits to MD/DO) or other controlled < 120 MME Provider encouraged e. Include the ICD-10 on the prescription and in the medical record
to manage
• What to expect when taking an opioid and how opioids Factor = 1 . 0 5 mg substances for addiction treatment to Risk f. All of the above
should be used; and reasonable alternatives, risks, • Diagnosis of sickle cell disease TID 15 MME greater than 25% of their total patient
and benefits, for treating and managing the patient’s population, or greater than 150 patients 3. Which of the following is a “best practice” when informing a patient about expected pain relief:
condition or symptoms. • Opioid issued by a pain management specialist Tramadol Once total, be licensed as a non-residential, Provider consult with a. The goal is to increase function and activities of daily living
• Being treated for substance use disorder Morphine Conversion 100 mg 10 MME office-based opiate treatment facility Moderate b. The patient may expect pain reduction, but not necessarily elimination of pain
2. A reasonable opportunity for questions by the patient; Factor = 0 . 1 Daily (OBOT). ≥ 120 MME PER DAY pain management Risk Confirmation testing is required before treatment begins. c. Consideration of appropriate alternative and non-opioid treatments
• Severe burns or major physical trauma specialist d. All of the above
3. Discussion and consideration by patient and prescriber of
whether the patient should take opioids; and • Patients in a licensed facility 4. When must a prescriber check the Controlled Substance Monitoring Database (CSMD)?
4. If the patient is a woman of childbearing age (15-44) Partial Fill Patient must have annual a. Prior to prescribing an opioid or benzodiazepine for greater than a 3-day supply to a non-exempt patient
b. At the beginning of a new episode of treatment
and ability, information regarding neonatal abstinence a These restrictions do not apply to opioids approved by ≥ 120 MME consultation with a pain High c. Prior to the issuance of each new prescription for the first ninety (90) days of a new episode of treatment
syndrome and methods of birth control, availability of free the FDA to treat upper respiratory symptoms or cough The prescriber may request the pharmacy dispense only half of the prescription by writing “PF” or “partial > 6 months management specialist Risk d. At least every six (6) months when that prescribed controlled substance remains part of the treatment
or reduced cost birth control. as long as the prescription is for 14 days or less. fill” on the prescription. e. All of the above