As a result of the current opioid crisis, many state legislatures are writing regulations concerning opioid medication dispensing. In Tennessee, HB 1831 was introduced Jan. 23, 2018. The bill was comprehensive, but the main impact on dentists would have been:
- Mandatory checks of the controlled substance database for all opioid prescriptions.
- Limiting an initial prescription to three days and a 40 mg morphine equivalent (MME) per day limit.
- ICD-10 codes on all opioid prescriptions.
- A later amendment would have required reproductive counseling for all female patients between 14 and 45 for all opioid prescriptions.
Tennessee AGD’s lobbyist, Mark Greene, stayed in close contact with the legislative chairman throughout the legislative session. He reviewed all legislation and brought to TNAGD’s attention anything that might impact the dental community. He also worked closely with Tennessee Dental Association (TDA) lobbyist Jack Fosbinder. This particular bill was brought to TNAGD’s attention, and the legislative chairman was invited to the TDA governmental affairs committee meeting to discuss this and several other bills of interest. Meeting participants determined a course of action that would lessen the impact of this legislation for all dentists. By having a combined meeting, they were able to present a united lobbying effort.
As a result of TNAGD’s and TDA’s efforts, they were able to secure for all providers the following:
- No database check required unless prescription exceeds three days or 180 MME for the three-day period.
- Three-day prescription has 180 MME total limit instead of the initial 40 MME per day.
- No ICD-10 code requirement for opioid prescriptions of three days or less.
- No counseling requirement for opioid prescriptions of three days or less.
- Counseling and ICD-10 codes will be required for opioid prescriptions over three days, greater than 180 MME, or any refill or new prescription within 90 days (will also require database check and ICD-10 code).
Since most opioid prescriptions written in a dental office are for short-term problems, the changes to the original legislation will allow most dentists to continue to prescribe as they normally would without additional paperwork. The bill, as passed, will also achieve the objective of the Trump Administration in limiting the number of opioids prescribed.
Thanks to Greene, Fosbinder, Richard Dycus (TDA president), Jeannie Beauchamp (TDA governmental affairs chairperson) and the TNAGD Legislative Committee. They were able to help the legislators craft a bill that addresses the opioid problem and limits the impact on all dentists.