10:25 AM

How Tennessee Dentists Successfully Tackled Opioid Prescribing

The COVID-19 pandemic, rightfully so, has captured intense global attention since it began early in 2020. It has claimed more than 1.5 million lives, devasted families and turned global economies upside down.

Meanwhile, another health crisis — the ongoing opioid epidemic — continues to rage across the country. Studies have shown that nationwide, when compared to last year, drug overdoses jumped by 18% in March, 29% in April and 42% in May. Those increases are on top of the already high number of drug overdoses that were occurring before anyone had ever of COVID-19.

“The time to act is now,” wrote DentaQuest president and CEO Steve Pollock in Commonwealth Magazine in October. “Specifically, more resources are needed to build capacity for identifying and treating [opioid use disorder], particularly among people of color. We must continue to limit opioid prescribing and educate doctors and dentists about alternatives for pain management. And we must reduce the stigma that too often prevents people from seeking help.”

Mercifully, vaccines appear to be on the way to halt COVID-19’s progress. But our already discouraging opioid overdose numbers are getting worse, and we need to bring all available tools to bear to bend the troubling curve. Thankfully, there’s a bright spot in the fight against opioids in Tennessee.

TennCare, the Medicaid program in Tennessee, provides one example that has been effective at reducing the number of opioids dispensed. It showed that by adjusting its own Medicaid program rules around reimbursement, a state can reduce the number of opioid pills that end up on the streets.

In the beginning of 2018, with the aim of attempting to address the crisis of opioid addiction, TennCare implemented new regulations to reduce the dosage, number and duration of opioids prescribed to patients. The new rules included new prior authorization requirements and dosage limits. Specifically, TennCare limited opioid prescriptions to a maximum dosage of 60 morphine milligram equivalents per day with a five-day supply. (It was later reduced to a three-day supply.) After the first opioid prescription fill, another 10 days can be granted only with prior authorization from the state. In addition, Tennessee changed state law to encourage commercial health care plans to adopt similar reductive measures.

And it worked.

A recent report from the DentaQuest Partnership for Oral Health Advancement reveals that far fewer opioid prescriptions were written to TennCare dental patients in 2019 than 2017, indicating the TennCare policy change contributed to the reduction in the number of opioids dispensed to dental patients. The corresponding decrease in the number of overdose deaths in Tennessee from 2017 to 2018 connected to prescription opioids points to how these policy changes can lead to meaningful improvements in health outcomes.

Specifically, the report showed that while the number of TennCare patients ages 0 to 20 who received dental care in 2019 remained substantially similar to the number in 2017, nearly 11,000 fewer opioid prescriptions were issued in 2019, a difference of 45%.

“Reducing overexposure to opioids, especially for individuals who have not previously used opioids, has been a priority for TennCare as part of our broad efforts to address the opioid crisis,” said Dr. Victor Wu, TennCare chief medical officer. “This report is encouraging because it shows focused efforts can meaningfully reduce unneeded opioid prescriptions, and in turn, lower the potential risk for opioid dependency for our members.”

While TennCare’s actions reduced the number of prescription opioids issued and led to a 15% reduction in opioid overdose deaths associated with legal prescriptions, they alone were not enough to reduce the total number of overdose deaths in Tennessee year-over-year. And with the pandemic exacerbating this deadly problem, there is no time to waste in coming up with life-saving policy solutions.

View the full report that explores how TennCare dentists successfully reduced opioid prescriptions, and for additional information on oral health and opioids.