Dear TnSAM Members,

I want to express concern about two pressing issues that threaten the well-being of our patients. Recent work by Pinsley et al and the voiced experience of TNSAM members from across Tennessee highlight the difficulty our patients are having when they seek medically assisted treatment. Pinsley et al found that 53% of the time patients presenting to a pharmacy in Tennessee were refused a first-time prescription for the life-saving medication of buprenorphine/naloxone.

His work also revealed that there was no difference in refusal rates at chains vs locally owned pharmacies. The refusals occurred in 94 of 95 counties. More education from stakeholders to reassure pharmacists about the safety and effectiveness of buprenorphine products seems urgent as fentanyl deaths have risen by more than 30% over the past two years.

Recent legislation intended to increase prescribing of buprenorphine by taking away the DATA2000 X-waiver may have the unintended consequence of stiffening resistance by pharmacists who fear being labeled as problematic dispensers of this unique controlled substance.

Careless prescribing emphasizing medication without requirements for behavioral health interventions seems simplistic and liable to be counterproductive.

The DEA must,  in my opinion, take steps aimed at emphasizing the usefulness of a medication that has shown an NNT of 2 and undoubtedly saves lives, families, and communities.

I offer this editorial comment for the TNSAM website fully welcoming counter viewpoints and discussion.

Last, I am concerned that there is still no FDA-approved, CLIA-waived POC clinical test for fentanyl. As addiction specialists, we see this gap as unacceptable and hampering informed care as we are aware of the prevalence of fentanyl on the streets both as a primary drug and as an adulterant mixed into many other counterfeit ( presses) drugs and sold as “Xanax, Opana, oxycodone, heroin, and even methamphetamine, cocaine, and cannabis”.

Thank you,

Daniel Sumrok MD DFASAM FAAFP ABPM ABAM.
President, Tennessee Society of Addiction Medicine.

Daniel Sumrok MD DFASAM FAAFP ABPM ABAM.
President, Tennessee Society of Addiction Medicine.