Page 3 - Overview of Tennessee Opioid Prescribing Laws Flipbook
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Prescribing Opioids:                                                                                                                                                                                                                             Tennessee Guidelines



        Short-Term                                                                                                                                                                                                                                       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
                                                                                                                                 Prescribed Opioids                                                                                                                                 Review prior records.
                                                                                                                                                                                                                                                          Chronic
                                                                                                                                 Morphine milligram equivalents (MME)/day:  a measurement used to equate the strength of various                                                    Inform the patient the goal is pain reduction, not elimination.
                                                                                                                                 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
                                                                                                                                                  y            =                                 y            =                                                                     prescribed for addiction outside of an Opioid Treatment Program, also called a methadone clinic.
                                                                                                                                                       1 mg                                           1 mg
   
                  
                                                                                                                                                                                                                                                       Current diagnosis justifying treatment       Assessment for misuse, abuse, diversion, and addiction
                                                                                                                                                     1 mg              1 mg                          1 mg             1.5 mg
   	       	                      
                                                                                                                                                                                                                                           Clinically significant improvement in function,   Use PEG scale (Pain Average, Interference with
                                                                                                                                                 Hydrocodone        Morphine                     Oxycodone          Morphine                                                  not only “pain score”                        Enjoyment of Life, Interference with General Activity)

             
        
                    
    
                                                                                                                                                                                                                            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
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                                                                                                                                               Always consider the individual clinical circumstances of each patient.                                                         Pain Management Agreement                    Urine drug screening per guidelines



     *Informed Consent for Opioid                                 Exemptions                                                             Opioid          Dosage      Times/        MME/           Important Notes                                                             History & physical, labs, diagnostic testing, etc.
                                                                                                                                                                       Day
                                                                                                                                                                                    Day
     Prescriptions Greater than 3 Days                                                                                                                                                                a Naloxone  Law  allows  a   licensed
                                                                       a The following patients are exempt if the prescription in-     Oxycodone           10 mg        TID       45 MME             healthcare practitioner to prescribe                                                   Patient                                           Urine Drug Screening
     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)
         voluntary decision to give written consent for opioid          •  Treated with an opioid for 90+ days in the last year                                                                      overdose.                                                                           Guidelines
         therapy.  Must include:                                        •  Active cancer treatment                                                                     QID        40 MME
         •  Risks, effects, and characteristics of opioids, including                                                                 Hydrocodone          10 mg                                      a Buprenorphine Law requires prescribers
            risks of physical dependency, addiction, misuse, and        •  Undergoing palliative care                                                                   TID       30 MME             of buprenorphine products (Tennessee                                                                                     Low
            diversion;                                                  •  Receiving hospice care                                   Morphine Conversion                QID        20 MME             law limits to MD/DO) or other controlled                 < 120 MME                 Provider encouraged
                                                                                                                                                                                                                                                                                             to manage
         •  What to expect when taking an opioid and how opioids                                                                        Factor = 1 . 0     5 mg                                      substances for addiction treatment to                                                                                    Risk
            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
            condition or symptoms.                                      •  Opioid issued by a pain management specialist                Tramadol                       Once                          total, be licensed as a non-residential,                                           Provider consult with
                                                                        •  Being treated for substance use disorder                 Morphine Conversion   100 mg                  10 MME             office-based opiate treatment facility                                                                               Moderate
      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.
                                                                        •  Severe burns or major physical trauma                                                                                                                                                                              specialist
      3.  Discussion and consideration by patient and prescriber of
         whether the patient should take opioids; and                   •  Patients in a licensed facility
      4.  If the patient is a woman of childbearing age (15-44)                                                                     Partial Fill                                                                                                                                      Patient must have annual
         and  ability,  information  regarding  neonatal  abstinence     a These restrictions do not apply to opioids approved by                                                                                                                            ≥ 120 MME                consultation with a pain                High
         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
         or reduced cost birth control.                               as long as the prescription is for 14 days or less.           fill” on the prescription.
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