States with a high number of pain clinics have more diversion than states with fewer pain clinics. Pain clinics can easily become pill mills containing dispensing doctors. Tennessee has more than their share of Pain Clinics. In fact, along the freeway, you can see a billboard stating “Pain Clinic next exit”. But we can’t just get rid of the Pain Clinics as they have a very legitimate role for people with chronic pain. In addition to medication, services of Pain Clinics include injection, nerve blocks, physical and aquatic therapy, electrical stimulation, acupuncture, relaxation techniques, surgery, and psychological support and counseling.
To address this problem, there have been many meetings by different councils in Tennessee. The conclusion, for the most part, is that we need to crack down on doctors and pharmacists that are prescribing excessive pills. However, it is very difficult to assess medication dispensing in pain clinics due to confidentiality and a number of other issues.
President Obama released a Plan for addressing prescription drug abuse in April of 2011. The plan included: Educate Health Care Providers regarding addiction and prescribing, Prescription Drug Monitoring Programs, Proper Medication Disposal; and Law enforcement to decrease diversion and abuse.
It is always good to educate ourselves about the issue. And the Prescription Monitoring Program in TN is being addressed so that pharmacists enter the prescriptions into a data base in real time rather than within 30 days. Law enforcement is already involved. The real problem may be how to address the Pain Clinics. Unless some type of self-monitoring comes from the doctors that work in the pain clinics, it is going to be a long road through the backhills.
This question prepared by: Donna Seger, MD Medical Toxicologist
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Donna Seger, MD
Tennessee Poison Center
Poison Help Hotline: 1-800-222-1222