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State laws contributed to decrease in total number of pain clinics in Tennessee

David Floyd • Updated Aug 3, 2016 at 8:57 AM

In 2014, there were about 333 pain clinics in Tennessee.

Now there are about 237.

Officials believe that decrease marks a step forward in the state’s fight against prescription opioid abuse.

Several state laws have been passed in recent years to improve the overarching quality of pain treatment in Tennessee and crack down on “pill mills,” a pejorative term used to describe select pain clinics that prescribe medication against proper medical procedure.

Dr. Mitchell Mutter, the medical director of special projects at the Tennessee Department of Health, said these laws have had a strong impact on the number of pain clinics in the state, weening out clinics that don’t follow proper procedure.

Of these laws, the Prescription Safety Act is one of the most notable. The law requires opioid prescribers to register with a statewide database and, when they prescribe medication, to put the recipients’ information in the database, enabling other physicians to determine whether the same patient has already been prescribed opiates.

As a result of this practice, Mutter said the law has caused an almost 50 percent decrease in doctor shopping, the act of visiting multiple physicians to obtain more than one prescription.

The Tennessee General Assembly has also passed laws that have established more rigorous qualifications for the staff at pain clinics.

For example, the medical director of a pain clinic must be a pain medicine specialist, which requires them to have a certificate from the American Board of Medical Specialties or the American Osteopathic Association, the status of a diplomate with the American Board of Preventive Medicine, and a passing grade on an exam administered by the American Board of Interventional Pain Physicians.

In 2014, the Tennessee Department of Health also drafted guidelines to define the way that pain clinics treat chronic pain, suggesting that clinics consider alternatives to medication before they give their patients a prescription.

“You treat heart disease not just by giving pills,” Mutter said. “There are a lot of different things you do. And you treat pain in many different ways. There’s not one good answer.”

Pain clinics are also subject to regular inspections, and the frequency of these inspections will increase from once every three years to once every two years on July 1, 2017.

While many of these problems might seem remote to people in Washington County, Johnson City Police Department Chief Mark Sirois said residents have contacted the station to criticize the management of local pain clinics.

“We have received negative comments from community members regarding the way some pain clinics are operated, that drugs are given ‘like candy,’ and readily available,” Siriois said. “This is especially the case for those families who have lost their loved one to an overdose.”

Like the state at large, however, Washington County is also witnessing a decrease in the number of pain clinics. In 2015, the county had 10 pain clinics; now there are seven.

The Prescription Safety Act has also had an impact on the number of morphine equivalents that have been prescribed over the past two years, which has dropped by about 500 million. But experts believe that there’s still a lot more work to be done.

“(That decrease) is huge, but it’s also a drop in the bucket,” said Dr. Stephen Loyd, the medical director for substance abuse services with the Tennessee Department of Mental Health and Substance Abuse. “(The law) has had some impact, but it has not had an impact on overdose deaths.”

But there is some reason to be hopeful.

Before 2010, the number of morphine equivalents prescribed in Tennessee was increasing on an average of 10 percent a year. Now, there has been a reversal in these figures, and in comparison to the first half of 2013, there has been a 22 percent decrease in the number of morphine equivalents prescribed in the state this year.

Mutter said the introduction of new laws and the creation of pain guidelines carry a simple message from the state: “We don’t oppose treating pain. We’re in favor of it, but we want increased access to quality pain treatment.”

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