The Tennessee Commission on Pain and Addiction Medicine Education, a group representing medicine, nursing, pharmacy, dentistry and other health professions, recently submitted its initial recommendations on addressing the opiate crisis to Gov. Bill Haslam.
Haslam formed the commission in January as part of TN Together, a statewide initiative to address opioid addiction, and the group was asked to submit a report.
The commission, which includes Bonnie Miller, MD, MMHC, Senior Associate Dean for Health Science Education and Executive Vice President of Educational Affairs, and April Kapu, DNP, RN, Associate Chief Nursing Officer for Advanced Practice, submitted a list of 12 competencies for health professions education. They address pain treatment, safe and effective opioid-prescribing practices, and diagnosis and treatment of individuals abusing or misusing controlled substances.
These competencies will be disseminated in July to all health professions schools in Tennessee, with the goal of widespread adoption.
On July 1, a new state law went into effect, also as part of the TN Together initiative, that addresses the prescribing and dispensing of opioids and other controlled substances, with the goal of preventing drug misuse and addiction. With this legislation, prescribers and dispensers have additional requirements on checking the state’s Controlled Substance Monitoring Database (CSMD) and new limits on opioid prescriptions for specifically defined patients.
“This legislation gives health care providers in Tennessee the power to more effectively limit the potential for abuse, misuse and addiction to controlled substances,” said Miller. “In addition, the governor’s unreserved support to improve how we address this through education — at an early juncture where we can directly impact providers’ knowledge and skills in addiction and pain management — is invaluable.
“It’s an honor to serve on this commission,” said Kapu. “Nurses have traditionally had a central role in assessing, diagnosing and managing patients dealing with drug addiction and abuse. The development of additional focused, educational guidelines to enhance those skills and knowledge for nursing students and for all health care providers is a crucial effort. I believe we can truly improve the early identification and treatment of these patients.”
Miller and Kapu have been working closely with their Vanderbilt colleagues who represent educational programs, pain management and addiction. They examined current curricula and training related to addiction and pain management at Vanderbilt University School of Medicine, Vanderbilt University School of Nursing and Vanderbilt University Medical Center as they developed their recommendations.
While current curricula include evidence-based strategies for managing patients with acute and chronic pain, this is an important opportunity to strengthen training even further and impact prescribing practices for future providers across the state, Miller said.
The related legislation specifies that a practitioner has a professional responsibility to use heightened attention when prescribing opioids to a patient who has recently been prescribed similar medications by other practitioners.
The law restricts treatment of an opioid naïve patient (someone not treated with an opioid in the 30-day period prior to the date of treatment) to no more than a five-day supply of an opioid and no more than a 30-day supply for an acute care patient (someone treated with an opioid for fewer than 90 days during the 12 months before treatment and who is not an opioid naïve patient).
In addition, the dosage of a prescribed opioid cannot exceed a daily 40-morphine milligram equivalent (40 MME).
The following patients are exempted if the prescription includes the ICD-10 Code (the coding system used to report diseases and health conditions) and the word “exempt:”
- Patients treated with an opioid for 90 days or more in the last year or who are subsequently treated for 90 days or more
- Patients being treated with methadone, buprenorphine or naltrexone
- Patients with severe burns or major physical trauma
- Patients receiving active or palliative cancer treatment
- Patients receiving hospice care
- Patients with sickle cell disease
- Patients in a licensed health care facility
- Patients seeing a pain management specialist.
