Page 4 - Overview of Tennessee Opioid Prescribing Laws Flipbook

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.