In response to current legislative concerns:
We have fended off a number of legislative issues and regulatory challenges in Tennessee over the last few years. Some brief background: Continue reading
Happy 2015, Everyone. I want to thank you for entrusting me with the presidency of TNSAM for my 2-year term which just ended. I want to wish Dr. Alex Zotos all the best as he assumes the leadership of this strong and commendable organization. I also wish to welcome our newest members to TNSAM: Kenneth Trzil, Jonesborough, Tennessee; Joseph Radawi, Jonesborough; Tony Yost, Greeneville; Brandon Coffey, Oneida; Stephen Averett, Linden; Richard Bowie, Johnson City; and Rikki Halavonich, Knoxville, Tennessee. I hope to see each of you at our annual meeting in April in Austin, Texas.
Allow me to review just a few of our 2013-2014 accomplishments. First we formulated the PEACE agenda:
- Parity – equality in access, benefits, coverage, respect, and treatment
- Education – of public, legislators, physicians in training and those in practice
- Advocacy – advancing the stature and recognition of the specialty
- Communication – facilitating the spread of ideas among members and the public
- Evidence-based practice – improve the quality of addiction treatment through research and education
Towards accomplishing these goals, I and others have made many trips to Nashville. We have witnessed remarkable acceptance, respect and inclusion in the legislative processes that affect us. We have worked with the TMA and others to promote legislative proposals that include the Addiction Treatment Act of 2015. This bill seeks to provide Good Samaritan protections for an individual who is having a drug overdose or in good faith seeks medical assistance for a person experiencing or believed to be experiencing a drug overdose. Second, the bill codifies the prescribing of buprenorphine/naloxone to physicians with a DEA “X” number and only in doses and diagnoses which the FDA has approved for the use of the drug. The final piece of the bill repeals a section of the code that allows an insurer to refuse payment to a provider if the patient seeks treatment and it is determined that the patient is under the influence of alcohol or illegal drugs. The Tennessee Society of Addiction Medicine has worked closely with the TMA to promote patient safety and patient access to the best available addiction treatment. This legislation is an important step in the right direction. Treatment decisions on the use of FDA-approved medications for addiction should be made only by skilled physicians, as is true in any of the specialties.
We have witnessed Federal advances in patient care access with the Affordable Care Act and with parity from implementation of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act.
We have held very successful CME activities, including our third TNSAM Addiction Medicine Conference and the ASAM-sponsored CO*RE/ASAM ER/LA Opioid REMS: Achieving Safe Use While Improving Patient Care course. We have held chapter meetings at ASAM’s Med-Sci Annual Conferences. We have created and maintained our website at http://www.tnsam.org. We have revived our charter with the state, and rewritten and approved our by-laws and constitution. We have successfully fought and defeated legislative efforts that would have harmed our efforts to provide proper care to those with substance use disorders. There’s more, but enough is enough.
Mostly I want to share my thanks and appreciation to each of you for all that you do every day for the addiction community. I am your past-president now, but I plan to continue to assist Dr. Zotos where I can, and continue to fight the good fight for addiction medicine and the patients we serve.
John Standridge, MD, FAAFP, FASAM
Past-president. Tennessee Society of Addiction Medicine
ASAM declared its support for The Recovery Enhancement for Addiction Treatment (TREAT) Act. This bill would lift the buprenorphine prescribing limit for addiction physician specialists and non-specialist providers. As it stands, the prescribing limit inhibits treatment for many people suffering from the chronic disease of addiction.
Read the ASAM letter of support from Dr. Gitlow.
For consideration in January, 2014, there is a proposed amendment to TCA Title 53 Chapter 10. The proposed legislation is problematic on several levels. The first of which has to be recognized as a state-sponsored restraint of trade that prohibits qualified specialists in the field of addiction from using an effective medication appropriately. The question of how long a patient “should” be on buprenorphine for addiction management is not an appropriate legislative issue. A banner on the www.TnSAM.org website reads, “Treatment decisions on the use of FDA-approved medications for addiction should be made only by skilled physicians.” A proposed top dose and forced taper is inappropriate. The issue of requiring the naloxone combination is flawed. These issues are fundamental to the proposed bill and therefore there is no acceptable amendment. Continue reading
I spoke by telephone 2 years ago with former senator Pete Domenici who currently serves as a Senior Fellow at the Bipartisan Policy Center. He expressed regret that the bill he and Paul Wellstone drafted, pushed through committees, passed through congress and eventually saw signed into law by president Bush had languished through lack of policy definition by HHS. After years of effort the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) is in effect.
Health and Human Services Secretary Kathleen Sebelius announced today “the largest behavioral health expansion in a generation”, with new requirements that health insurance companies treat mental illness and addiction the same as other illnesses.
Sebelius said the administration will post regulations Friday (11/8/13) requiring mental health parity. The new regulations will apply to both outpatient and residential treatment for mental health and addiction, which means patients would have the same deductible and co-payments applied to physical illnesses. Congress passed and President George W. Bush signed the the Mental Health Parity and Addiction Equity Act of 2008, which “requires group health plans and health insurance issuers to ensure that financial requirements such as co-pays, deductibles and treatment limitations, such as visit limits” are no more restrictive for mental health or addiction than for physical ailments. Continue reading
In the posting at http://health.state.tn.us/Downloads/Pain_Clinic_FAQ.pdf the Department of Health clarified that “if and only if these drugs are used in accordance with their FDA indication solely in the context of a bona fide program for Medication-Assisted Treatment (MAT) for opioid dependence, this would not be considered pain management services and those patients should not be counted as such.”
We continue to have to engage in the political arena to maintain the privilege of practicing addiction medicine in accordance with established standards of care. In a page 12 article featured in the September TMA journal, Tennessee Medicine, it was 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 was precisely the opposite of all previous pronouncements on the topic, but it turns out to be true regarding a fundamental change in the legislation enacted, Senate Bill No 676, unbeknownst to me or anyone else in the addiction community, on the advice of the TMA’s prescription guidelines committee. Please continue to read. Continue reading
It was risky for a tiny 60 person organization to organize and offer a regional conference. What if we spent all that money, time and trouble, and nobody came? We were hoping for 100 registrants: we got 130! ASAM was thrilled with the REMS course turn out. We bested the turn out generated by much larger state chapters. We were hoping for meaningful addiction education. We got outstanding speakers on important topics. The evaluations were glowingly positive. We were hoping to break even. We put several thousand dollars into the TnSAM coffers. Thanks to all who came. Thanks to all who made it happen. Shall we do it again next year?