Posted Saturday, March 21, 2015
UPPER CUMBERLAND — Over the last 14 years, there have been many repercussions of the Intractable Pain Treatment Act, also known as the Pain Patient’s Bill of Rights — especially in the increase of the number of babies born with Neonatal Abstinence Syndrome across the state.
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Earlier this week, the legislature voted unanimously to repeal that law and is now headed to the governor’s desk for signature.
“I’m personally happy that the legislature saw to fully repeal the law and not to amend it,” District Attorney General Bryant Dunaway said in reaction to the vote in both houses of the state legislature to repeal the IPTA, a bill put forward by state Representative Ryan Williams. “This repeal has been supported by DAs across the state. We’re hopeful that this will help us with the prescription drug epidemic.”
The IPTA, passed in June of 2001, outlines guarantees for patients suffering severe chronic intractable pain. Reasons cited for this legislation included removing fear of physicians in prescribing opiate medication for their patients who suffered severe chronic intractable pain. The safety of opiate medications was noted within the legislation, which gave patients a great amount of responsibility to choose opiate medications as a first line of treatment even though other modalities of pain relief exist. Physicians are required by the law to either provide requested opiate medication or refer to physicians who will.
The repeal states the requirement that, within 180 days of July 1, 2015, the board of medical examiners repeal any rule promulgated by the board under the Intractable Pain Act, to also apply to rules promulgated under the Act by the board of osteopathic examination and the board of nursing.
Shortly after the IPTA passed nearly 14 years ago, 300 pain clinics opened up across the state.
“It made the problem worse, especially in the Upper Cumberland,” Dunaway said.
Monday’s news of the repeal was music to Bill Gibson’s ears.
“This repeal will save lives,” he said.
Gibson, the executive director of the Power of Putnam anti-drug coalition, said the repeal of the IPTA has been a mission of the group’s for a number of years.
“We recognized right off this was a bad law,” he said. “Physicians felt pressured, like they didn’t have a choice in the matter. A few years ago, the problem of prescription drug abuse came to light and we got physicians’ input in it.”
One of those physicians is Dr. Sam Barnes, who published an eight-page study on the physicians narcotic prescribing practice patterns of Putnam County.
He surveyed 76 physicians within the medical community of Putnam County in an attempt to define the usual and customary practice of prescribing opioids and to determine the standard of care.
“Tennessee is at the very epicenter of the overprescribing of opioids earthquake,” he said in his study. “The evidence for this is not just the number of pills prescribed, but also the number of deaths from prescription narcotics which exactly parallels prescribing rates.”
He goes on to say that the overprescribing problem in Tennessee is significant, especially in the 13 counties of the Upper Cumberland region.
“Death from prescription narcotic overdose is twice the state average, as this is similarly reflected in the Upper Cumberland having the fourth highest regional incidence of neonatal absintence syndrome (NAS) in Tennessee.”
Dr. James Gray, president of the Putnam County Medical Society, said in an email sent to legislators in late January that in 2011, residents in the Upper Cumberland were three times more likely to die from an overdose of a prescription drug than to die in an auto accident, according to his analysis of TDOH data.
“Putnam County Medical Society physicians joined with many other groups in the Upper Cumberland to support Ryan Williams’ bill to repeal the Intractable Pain Treatment Act,” Gray said. “Currently, three out of every 100 babies born to mothers residing in the Upper Cumberland spend the first month of their life in the hospital to treat life-threatening withdrawal symptoms caused by narcotic drugs prescribed to their mothers. These babies were denied their birthright to opioid innocence and we won’t know the lifetime implications of their opioid experience for a full generation.
“With the repeal of the 2001 Intractable Pain Treatment Act, preconception health care providers may once again refuse to prescribe opioids when more effective and safer methods are available, period,” he continued. “The IPTA required physicians who determined that a request for opioids should be denied to refer the patient to a physician whose primary practices are the treatment of pain with methods that include the use of opiates.”
Prenatal care providers in collaboration with pain and addiction medicine specialists will still have to manage those women who begin pregnancy already chemically dependent on opioids, Gray said. However, health care providers will be more likely to discuss the risks and alternatives before writing that first legal prescription for chronic opiods to a future mom.
“Hopefully, the patients will be referred to qualified preconception care providers, who are trained to manage common pain complaints in mothers-to-be with methods that do not include the use of chronic opioids,” Gray said.
“Ryan did a great job in getting this law repealed without any opposition.”
“This is a good move,” Gibson said. “We’re grateful for the partnership with Rep. Ryan Williams.”
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