Tennessee doctors are getting a crash course in the state’s new restrictions on opioids ahead of the law taking effect July 1. Physicians are concerned about new liability since the prescribing rules do away with much of their discretion.

“We just passed the most stringent law in the country, and it’s not simple. It’s very complex,” says Ben Simpson, lobbyist for the Tennessee Medical Association. “Anytime you introduce large, complicated regulation schemes, there are kneejerk reactions by both prescribers and patients.”

Two laws are going into effect. HB1831 creates the state-based restrictions on prescribing which are some of the strictest in the country. SB0777 gets the ball rolling on creating punishments for physicians who overprescribe opioids.

For doctors, it’s no longer a judgment call most of the time. There are very precise rules if a doctor wants to prescribe any more than three days-worth of pain pills.

• Surgery patients have a standard 20-day limit
• Non-opioid therapies have to be tried first
• 10-day prescriptions are allowed for pain, but only if the ICD-10 diagnosis is uploaded
• 30-day prescriptions require justification for “medical necessity”
• If a patient has been on opioids for 90 days in the past year, they’re exempt
• Other exemptions include hospice care, sickle cell diagnosis, patients undergoing addiction treatment and those with severe burns or major trauma
• Starting in January, pharmacists will only do partial fills for prescriptions over three days

The TMA, which represents doctors across the state, has put together flow charts, tutorial videos and customized tips for physicians who range from dermatologists to pediatricians.

“What we have to do is to make sure that when a physician is walking through that normal clinical process, that they’re not running afoul of regulation,” Simpson says.

To avoid any malpractice lawsuits, Simpson figures more physicians will play it safe most of the time and either prescribe just three days of painkillers, or they’ll refer the patient to a pain clinic, which is exempted from the new law but already has much stricter rules to follow.

The cautious approach would still achieve Governor Bill Haslam’s goal of reducing the number of prescription drugs floating around the state, but many doctors contend it might not be best for patients in pain.