On July 1, 2019, our state legislature passed “The Tennessee Together Plan,” which regulates the use and prescription of narcotic pain medications.
The intent of this law is certainly laudable: to curb the overuse of opioids such as hydrocodone, oxycodone, oxycontin, and fentanyl, to name a few. Indeed, as a state, we need to do something because three people die each day in Tennessee from opioid overdoses, and Tennessee is in the top 15 states in our country with this problem.
If you are going to have any surgery, this law will affect you. A physician can prescribe a limited amount of pain pills without jumping through any hoops. This may be enough medication for an operation that is not accompanied by much post-operative pain, such as eyelid surgery or a facelift. But, for patients having a tummy tuck or body procedure, who generally need a higher number of pills, there are going to be changes that will affect you.
To start with…paperwork
There is a required consent everyone gets to read and sign that the state has written regarding opioid use. Also, as a prescriber, I am required to include specific documentation, as well as include a diagnosis code on the written prescriptions.
And maybe another trip to the pharmacy.
Another new thing is that the pharmacist may only fill half the prescription, and you receive the other half at a second visit to the pharmacy (it is unclear to me, but I think this is at the discretion of the pharmacist).
There is a lot of confusion both on the part of prescribers and the pharmacists (we’re getting lots of phone calls). It is hard to object with the intent of the bill though it may take some getting used to for all of us.
How much pain medication is enough?
Narcotic pain medications are necessary for the recovery of surgery for almost all patients. The difficulty in prescribing these is that everyone reacts differently in terms of their pain levels after surgery, which means that everyone needs a different amount of pain medication. Without over-prescribing, my practice is to give people enough so that there is no need for an additional prescription.
Most people will have leftover pills. What do we do about these?
This is not something that has been addressed in the “Tennessee Together” legislation but is vital to us all. When you’re recovered and no longer need any of the leftover pain medication, having it around the house is a liability for many reasons. So, some method of a safe and secure disposal would be ideal. Unfortunately, flushing these pills down the toilet is not a good idea as they then enter the water supply. But what else can we do? Glad you asked.
We found out about DiposeRx from a pharmacist who works at a Walmart pharmacy. This is something they are giving out with every narcotic prescription they fill. DisposeRx is a packet of powder that you mix with warm water in the bottle with your remaining pills. Just shake them together for 30 seconds and then let the mixture sit for 10 minutes. The unused medication turns into a solid gel which cannot be used, is safe for the environment, and can be thrown away in the trash.
This seemed like such a good idea that our office manager (thank you, Lisa!) contacted the company (really lovely folks in North Carolina), and we now have them available for our surgical patients. Every recovery kit going forward will include your very own DisposeRx packet to discard unneeded pain medication responsibly. If you had surgery before we discovered DisposeRx and still have leftover pain medication in your medicine cabinet, just ask for a packet when you come in for your follow-up appointment.
The bottom line:
As a physician, I do feel some responsibility to address the opioid epidemic. One can argue that it has been caused, at least in part, by physicians who inappropriately prescribe or overprescribe opioids. I think I am doing reasonably well on this account. However, getting rid of the medication when it is no longer needed seems to me to be just as important, and I am happy to be able to provide this solution to patients.
Cosmetic plastic surgery is real medicine with real medical concerns. Managing your post-operative narcotic needs is a responsibility that we take seriously because, ultimately, this means that it will be safer for you.
All the best,
David B. Reath, MD