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Message from Our President

Greetings from TnSAM,
I hope everyone is enjoying their summer and taking some time off for family, friends, and personal endeavors.
It is an exciting time for addiction medicine.  More and more light is being shed on the opioid epidemic currently facing our communities.  The tides are turning on the liberal use of opiates for “chronic pain”.  Just recently the President of the AMA, Steven Stack, M.D. addressed the issue regarding the overprescribing of opiates and steps we should all follow to help curb the crisis.  In March of 2016, the CDC released new recommendations for the prescribing of opiates for chronic pain.  Furthermore, discussions have taken place in congress questioning the current practice of the CMS for coupling reimbursements to patient satisfaction scores in regards to pain control.    As this all comes to light, prescribing practices will change and help reduce the excessive use of opiates for pain control, inadvertently leading some down the vicious cycle of addiction.
However, this in itself does not directly impact our current crisis of opiate dependent patients.  Recently, the HHS announced an increase of 275 patients that can be prescribed buprenorphine, for certain qualified physicians, mainly boarded physicians and certified treatment facilities.  This is definitely a step in the right direction yet there are people on both sides of the fences in regards to whom should be qualified to do this.  There are many non boarded physicians whom do an outstanding job that could definitely see more than a 100 patients.  On the other hand, there are some boarded physicians whom do not practice quality addiction medicine and simply write for buprenorphine. They do not spend time with their patients or provide counseling or therapy for them.  Time and time again patients will tell us how another provider did not even take the time to listen to them or show interest.  Poor providers beware, your patients tell on you!!!
Over time, I have changed my view as to the necessity of some regulation and oversight.  If it serves to improve the care of the patient then so be it.  Simply writing medication and taking payment for it without providing insight and solutions to the disease of addiction is simply wrong.  My belief is that over time the “bad apples” will go away and the law of economics will bring about the highest quality care at a reasonable cost for the patient.
Furthermore, TnSAM must support to fight for reimbursement from insurance companies and increase access to care.  It is my hope that one day we all can simply bill insurance and be reimbursed at a “fair and reasonable” level just like any other specialty.  We can not say we want to be regarded as a specialty and not practice billing the way they do.  On this, we have a long way to go…….
Most of us in the field keep up with the regulations and standards in regards to medication assisted therapy.    However, some do not.  Thus I wanted to summarize to anyone who may not be aware of current policies and regulations that will go into effect soon in Tennessee.  Tennessee will be placing all practices under one of two regulatory agencies.  If you are a solo practitioner and see up to 150 patients then you will fall under the Department of Health, Division of Health Related Boards. i.e. the medical board.  If you are seeing 150 or more patients, whether a solo, group practice, or clinic, you will fall under the Department of Mental Health and will be a licensed facility and have to meet certain guidelines.   This will include regulatory fees, meeting certain criteria, and monitoring to ensure the highest quality standards are met.  These regulations are being adopted due to the concerns of many groups including state legislators, law enforcement agencies, health care providers, and certain concerned citizens in Tennessee.  This came out of necessity invariably due to a few providers whom practice out of the standard of care, and may not have their patient’s best interest at hand.
Please continue to do what you do best and that is to provide your patients with the best quality care possible.  I do not know of many other fields where patients thank you on a daily basis for saving their lives.  Addiction medicine is truly a rewarding specialty.
Sincerely,
Alexander Zotos, M.D.
President, Tennessee Society of Addiction Medicine

 

ABMS RECOGNIZES ABAM AS NEWEST MEDICAL SUBSPECIALTY!!!!!

Drs. Sokol and O’Connor said it eloquently in their letter of this announcement to all ABAM diplomates:

As we all celebrate this occasion, we hope that you will take a moment and reflect with pride on your own contributions to our newly recognized field. As ABAM diplomates you have been at the forefront in the care of patients with substance use disorders. Your work has been driven by the will to care for patients and families, and to improve their lives and the health of your community. You have stood up to stigma, ignorance and to outdated policies and practices that accompanied this most challenging of all diseases. You have had many successes with patients and colleagues along the way and have set the stage for medicine’s response to addiction. You have pioneered this new era in American medicine and healthcare. Thank you, and savor the moment.

ABMS RECOGNIZES ABAM AS THE NEWEST MEDICAL SUBSPECIALTY!!!!!

Drs. Sokol and O’Connor said it eloquently in their letter of this announcement to all ABAM diplomates:

As we all celebrate this occasion, we hope that you will take a moment and reflect with pride on your own contributions to our newly recognized field. As ABAM diplomates you have been at the forefront in the care of patients with substance use disorders. Your work has been driven by the will to care for patients and families, and to improve their lives and the health of your community. You have stood up to stigma, ignorance and to outdated policies and practices that accompanied this most challenging of all diseases. You have had many successes with patients and colleagues along the way and have set the stage for medicine’s response to addiction. You have pioneered this new era in American medicine and healthcare. Thank you, and savor the moment.

letter to Commissioner

Dear Commissioner:

It has recently been brought to our attention that changes made in PC 430 this past session could be misinterpreted to require some addiction specialists who also treat pain patients secondarily to be required to register as pain clinics. The unintended consequence was created when the legislature, at our behest, eliminated the exclusion of suboxone from the list of opioids which would be counted toward the threshold for determining if a practice would need to register. For your information, when we brought the original legislation to the General Assembly in 2011 (PC 340), we, like other states that had decided that pain clinics needed tighter regulation, chose not to include suboxone in the calculation, believing that the drug is used to treat addiction and not pain management. Since we have learned that a number of practices have been prescribing suboxone for off-label uses such as pain management.

With the pending October 1, 2013 change in the definition of pain management clinics, we believe it is possible to interpret the revision in a way that far differed from the reason for the change. As such we would urge you to consider adopting the following policy statement that permits addiction specialists to continue to ply their needed trade in the state without the necessity of becoming registered as pain clinics:

Pharmaceutical products containing buprenorphine shall not be considered, and are specifically exempted from consideration, in the determination of whether a facility is designated as a pain clinic requiring registration as such with the state, if and only if the buprenorphine product is used in accordance with its FDA indication for the treatment of opioid dependency and in the context of an opioid dependence treatment program.  Use of buprenorphine products solely to treat pain, whether transdermal (e.g. Butrans) or sublingual (e.g. Suboxone), shall constitute the use of an opiate for purposes of pain management and shall count toward determination of a facility being designated as a pain clinic requiring registration as such with the state.

We greatly appreciate your consideration of this request and are prepared to respond to any questions or concerns you may have.

Sincerely,

Yarnell Beatty, JD
Vice President, Advocacy

cc:          The Honorable Ken Yager

The Honorable Bill Dunn

David Reagan, MD

Mitch Mutter, MD

PC clarification

Andrea,
Here is the tweaked and improved version, and the conversation thread.

“Pharmaceutical products containing buprenorphine shall not be considered, and are specifically exempted from consideration, in the determination of whether a facility is designated as a pain clinic requiring registration as such with the state, if and only if the buprenorphine product is used in accordance with its FDA indication for the treatment of opioid dependency and in the context of an opioid dependence treatment program.  Use of buprenorphine products solely to treat pain, whether transdermal (e.g. Butrans) or sublingual (e.g. Suboxone), shall constitute the use of an opiate for purposes of pain management and shall count toward determination of a facility being designated as a pain clinic requiring registration as such with the state.”

John B. Standridge, M.D., FAAFP, FASAM

President, Tennessee Society of Addiction Medicine
Personal Medicine LLC
2115 Stein Dr  Ste 304
Chattanooga TN  37421-7200

Gary,

Yes, thank you for your courteous and productive response to the issue of clarifying the definition of who must register as a pain clinic. Allow me to suggest wording that the Health Commissioner might issue as a policy statement until it can be added to Senate Bill No 676 in January.
“Pharmaceutical products containing buprenorphine shall not be considered, and are specifically exempted from consideration, in the determination of whether a facility is designated as a pain clinic requiring registration as such with the state, if and only if the buprenorphine product is used in accordance with its FDA indication for the treatment of opioid dependency.”
If you need additional clarification, consider, “Off-label use of buprenorphine products used to treat pain in the absence of an opioid dependence treatment program shall constitute the use of an opiate for purposes of pain management and shall count toward determination of a facility being designated as a pain clinic requiring registration as such with the state.”
Again thank you for your thoughtful deliberation in an effort to avoid the unintended consequences of hindering the efforts of addition specialists in Tennessee. I think these two sentences should satisfy everyone’s concerns.
Thanks again for your productive response.
John

SB reply

Dr. Standridge: thanks for taking the time to speak with me this morning about your concerns on suboxone being included in the threshold for determining if a practice needed to be registered as a pain clinic. As we discussed, I am proposing to draft a letter next week from TMA to the Health Commissioner explaining the concern of addiction specialists and asking if the department would be willing to develop a policy statement to address it, at least in the interim. As you know, we cannot change the statute, if needed, until the legislature returns in January, 2014.

Gary M. Zelizer

Director of Government Affairs

Tennessee Medical Association

2301 21st Avenue South

Nashville, TN 37212

 

Phone: 615-460-1641

Cell: 615-364-7555

Fax: 615-312-1898

Senate Bill No 676 letter

To the responsible TMA representative:
In a page 12 article featured in the September TMA journal, Tennessee Medicine, you stated, “Suboxone will be included in the type of prescriptions considered as part of determining whether a location meets the definition and should be registered with the state as a pain management clinic”.  This statement is precisely the opposite of all previous pronouncements on the topic. Everything I have read until this point in time states, “Suboxone will not be included in the type of prescriptions considered as part of determining whether a location meets the definition and should be registered with the state as a pain management clinic.” [italics offered for emphasis]. I do not believe you understand the dire ramifications of what I hope is shoddy journalism. If your statement is true — and I could find no second source for substantiation — then an entire specialty, that of Addiction Medicine, is crippled beyond repair in the state of Tennessee. Addiction professionals work passionately and hard in a difficult field treating America’s number one disease.  Few outside the field have a good understanding of the brain physiology, psychological forces, social ramifications and spiritual insights of this disease. Understand that Suboxone is not and never has been FDA-approved for the treatment of pain; it is for treatment of opioid dependence and for no other FDA-approved purpose.  If your statement were true, board-certified specialists in addiction medicine all over Tennessee would have to close the doors of their small practices, given the onerous burden of registering as a pain clinic, leaving thousands of patients without care or access to care. The Tennessee Society of Addiction Medicine would have no recourse but to sue to correct restraint of trade issues. If this is true, I need to know immediately what your sources are, in particular I need a copy of the legislative bill that has been passed to create this travesty. If it is not true, we need a vigorous and public retraction correcting the mindset and zeitgeist.
John B. Standridge, M.D.

President, Tennessee Society of Addiction Medicine
Personal Medicine LLC
2115 Stein Dr  Ste 304
Chattanooga TN  37421-7200

The Very Lastest Conference Information — AAFP Preferred CME Credits Have Been Approved

Dear Colleagues:

We have an abundance of new information regarding the 2013 TnSAM Addiction Medicine Conference, now being held in Chattanooga, Tennessee August 29th and 30th. Roughly 123 people have registered.

AAFP accreditation is approved.This Live activity, Tennessee Society of Addiction Medicine Conference (3rd), with a beginning date of 08/29/2013, has been reviewed and is acceptable for up to  12.00 Prescribed credit(s) by the American Academy of Family Physicians. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Family Medicine doctors, we paid the extra monies to get prescribed credit for you. You are very welcome.

NAADAC, the Association for Addiction Professionals, approved the 2013 TnSAM Addiction Medicine Conference for contact hours for attendees. NAADAC is the premier global organization of addiction focused professionals and we are honored that they will provide Continuing Education Credits for their 8,000 members who attend.  Thanks to TAADAS, Tennessee Association of Alcohol, Drug & other Addiction Services, for facilitating this valuable Continuing Education accreditation for counselors.

Specialists in the field of Pain Management will be happy to learn that attendance at the 2013 TnSAM Addiction Medicine Conference will count toward the requirements by the state for physicians working in pain management clinics.

The AMA and the TMA have proclaimed a desire to be on the forefront of the prescription drug abuse crisis issue, promoting access to addiction treatment and physician education. The American Society of Addiction Medicine and the Tennessee Society of Addiction Medicine have created a free three-hour risk evaluation mitigation strategy conference about opiate prescribing.  Titled ER/LA Opioid REMS: Achieving Safe Use While Improving Patient Care, this session is designed in association with the FDA and ASAM at no charge (Free CME!) thanks to a grant.

The 2013 TnSAM Addiction Medicine Conference is co-sponsored by the UT College of Medicine. The Tennessee Society of Addiction Medicine is now offering this conference to those in the field of education for the cost of the lunches. Registration is now open to medical students, nurse practitioner students, and UT faculty and residents for $20! This 2-day conference with full accreditation and internationally recognized speakers is that important.

The conference at a glance:

Thursday morning, 8/29/2013

ER/LA Opioid REMS: Achieving Safe Use While Improving Patient Care – Herbert L. Malinoff , M.D.

Thursday afternoon, 8/29/2013

Hooked But Not Hopeless – Sherry Hoppe, Ed.D and Sylvia Yates

Tennessee Department of Health and TMA Response to Tennessee’s Prescription Drug Abuse Epidemic – Mitch Mutter, M.D.

Dual Diagnoses: Management of co-occurring disorders in Addicted Patients – Terry Holmes, M.D.

Opiate Dependency in Pregnancy – Tom Cable, M.D.

Friday morning, 8/30/2013

Addiction Medicine Talking Points – John Standridge, M.D.

Evidenced-Based Behavioral Treatments for Addiction – James Finch, M.D.

The Neurobiology of Reward and Addiction – John Standridge, M.D.

Friday afternoon, 8/30/2013

Lunch and Learn with Faculty

Counseling Skills Workshop: Motivational Interviewing, Cognitive Behavioral Therapy, and Mindfulness – James Finch, M.D. and Jane Finch, L.C.S.W.

John Standridge, MD, FAAFP, FASAM

President, Tennessee Society of Addiction Medicine

Dr. Herbert Malinoff is scheduled to present the course on ER/LA Opioid REMS: Achieving Safe Use While Improving Patient Care

Dr. Malinoff is the president and founder of Pain Recovery Solutions, PC. He is certified in Internal Medicine, Medical Oncology, Pain Management, and Addiction Medicine. He specializes in treating patients with chronic pain syndromes, addiction as well as addressing their internal medicine needs. His understanding of the relationship between medical problems, pain, and addiction led to the establishment of a practice that provides services to patients that address multiple related problems using an integrated, comprehensive approach.

Dr. Malinoff lectures internationally on Chronic Pain and Addiction and is a member of the board of directors of the American Society of Addiction Medicine (ASAM). He is co-chairman of the ASAM annual course on pain and addiction. Continue reading

Share the word; send your local colleagues this letter. Put your name on it in place of mine.

Dear Colleagues:

The Robert Wood Johnson Foundation calls addiction our nation’s number one disease.  While addiction affects 1 in 6 Americans, many doctors admit knowing little about the subject.  The University of Tennessee College of Medicine, together with the American Society of Addiction Medicine and the Tennessee Society of Addiction Medicine, are pleased to present a 2-day conference on addiction medicine.  The first three-hour conference (8:30 -12 Noon 8/29/13) is an ASAM-sponsored risk evaluation mitigation strategy conference about opiate prescribing.  Titled ER/LA Opioid REMS: Achieving Safe Use While Improving Patient Care, this session is designed in association with the FDA and ASAM at no charge (Free CME!) thanks to a grant.

The remaining day and a half (12 Noon – 4:45 pm 8/29/13 and 8:30 am – 4:45 pm 8/30/13) is sponsored by TnSAM and accredited by the UT College of Medicine (for doctors) and TAADAS (for counselors). The conference provides important information on addiction topics, with an outstanding array of topics and speakers:

12:00-1:00 PM  Hooked But Not Hopeless – Sherry Hoppe, Ed.D and Sylvia Yates

1:15-2:15 PM  Tennessee Department of Health and TMA Response to Tennessee’s Prescription Drug Abuse Epidemic – Mitch Mutter, M.D.

2:30-3:30 PM  Dual Diagnoses: Management of co-occurring disorders in Addicted Patients – Terry Holmes, M.D.

3:30-4:30 PM  Opiate Dependency in Pregnancy – Tom Cable, M.D.

8:30-9:30 AM Addiction Medicine Talking Points – John Standridge, M.D.

9:30-10:30 AM  Evidenced-Based Behavioral Treatments for Addiction – James Finch, M.D.

10:45-11:45 AM  The Neurobiology of Reward and Addiction – John Standridge, M.D.

11:45 AM-12:45 PM  Lunch and Learn with Faculty

1:00-4:15 PM  Counseling Skills Workshop: Motivational Interviewing, Cognitive Behavioral Therapy, and Mindfulness – James Finch, M.D. and Jane Finch, L.C.S.W.

The conference will be held at the University of Tennessee at Chattanooga on August 29 and 30, 2013.  More information is available at www.tnsam.org.  Please make every effort to attend.

TnSAM has negotiated lower rates at 2 great hotels, August 28th and 29th, in Chattanooga, TN.

We have arranged a negotiated rate with Chattanooga Choo-Choo at $99.00 per night. You will need to mention Personal Medicine, through whom we negotiated the rate. The hotel is associated with the historic train station. Just register through the registration desk. http://www.choochoo.com/ 1-800- 872-2529.

We have also arranged a negotiated rate with DoubleTree by Hilton Hotel, Chattanooga Downtown, at $119.00 per night. You will need to mention the UT College of Medicine through whom we negotiated the rate.  The contact person is Sandy Witzel, if there is any question; otherwise, just register through the registration desk. www.chattanooga.doubletree.com. 1-423-756-5150.

For baseball fans the Chattanooga Lookouts have home games, the last series of the season, hosting the Tennessee Smokies at AT&T Field August 29th and 30th at 7:15. For those who enjoy college football, UT-Chattanooga plays UT-Martin in Finley Stadium in their season opener Thursday, August 29th at 7 p.m. Musical entertainment options August 30th  include Corey Smith (one of country music’s hottest new artists) at Track 29; the Channing Wilson Band at Rhythm & Brews; Screaming Orphans (a pop-rock band with four fun, high-spirited, musically-obsessed sisters from Ireland) with Chattanooga’s own Rigoletto, at Nightfall in Miller Plaza (free concerts); and Scenic City Soul Revue at the Foundry.  Something for everybody!

John Standridge, MD, FAAFP, FASAM

President, Tennessee Society of Addiction Medicine

Clinical Professor,  University of Tennessee College of Medicine Chattanooga