The SMART Policy Network periodically publishes research findings, data and best practices in the form of policy briefs. You can join our mailing list to get the latest policy briefs in your inbox.
The United States (U.S.) Centers for Medicare and Medicaid defines a prior authorization as “an approval from a health plan that may be required before you get a service or fill a prescription in order for the service or prescription to be covered by your plan.” The prior authorization process is requested by insurance providers once a healthcare provider has initiated a medical service or prescribed medication. The healthcare provider is then responsible for filling out and submitting paperwork that includes additional justification and patient information. Insurers require this paperwork before they will determine coverage of the prescribed medication or service. Prior authorization exists as a process that allows the insurer to unilaterally determine if the service or medication is medically necessary, saving the insurer money by offloading the cost to the patient or another payer. In most cases, the insurers develop their own standards for review based on information like costs, effectiveness, and medical guidelines. These standards are seldom available to the public.
The DATA Waiver (or X waiver) requirement was removed in the Mainstreaming Addiction Treatment (MAT) Act, meaning providers no longer have to register with the DEA to prescribe buprenorphine as part of treatment for opioid use disorder (OUD). Federally, providers already authorized to prescribe controlled substances can now prescribe buprenorphine for OUD, but providers must still be aware of and follow any practicing state regulations. Whereas state law does not conflict with federal requirements for physicians, Tennessee state law still imposes limitations on buprenorphine prescribing for nurse practitioners (NPs) and physician assistants (PAs). With the X-waiver removal, the United States’ overdose rates could possibly decline, given the results seen in other countries.
An estimated 107,477 overdose deaths occurred in the United States within the last year, with about 4,000 of those deaths being Tennesseans. Over 80 percent of these deaths are attributable to opioids such as fentanyl, for which there does not exist tests approved by the Food and Drug Administration (FDA) for point-of-care testing (POCT). POCT is intended to be used near or at the site of the patient and is performed outside of a physical clinical laboratory, usually at the bedside. A classic example of this is a bedside glucose test in the hospital.
Xylazine is a non-opioid chemical originally approved for veterinary use in 1972 as an animal sedative, but it has never been approved for use in humans because of serious harmful side effects. It is sometimes called “tranq” and might be sought by people who inject drugs to lengthen the duration of short-acting fentanyl injections. However, many people who suffer from acute xylazine toxicity did not know they had ingested or injected it.
Harm reduction is a policy framework that minimizes the negative healthcare outcomes of undesired behaviors by acknowledging that said behaviors are likely to persist. In the context of substance use, this would mean reducing the impact of drug use before reducing the drug use itself.
Opioid overdose deaths (ODD) are best understood as three phases: first due to prescription opioid misuse, followed by a rise in heroin use, and currently due to contamination by synthetic opioids such as fentanyl. Each phase has posed unique policy challenges.
People with mental health and substance use disorders who would benefit from treatment are overrepresented in the criminal justice system. It has been reported that 63% of individuals in jail and 58% of individuals in prison meet the criteria for having a substance use disorder, and 36% of the population serving a state prison sentence were being treated for a mental health disorder, which is 17% higher than the general population in Tennessee. Justice-involved individuals with mental health and substance use disorders have a higher risk of recidivism, especially when they lack access to medications and behavioral health treatments both during and after incarceration. However, despite this heightened prevalence and treatment need, criminal justice entities rarely have the resources needed to ensure at-risk individuals receive continuous evidence-based care. Given Tennessee’s incarceration rate has risen to 10% above the national average, and almost half of all incarcerated individuals are rearrested within three years of release, it is critical for individuals to have access to continuous care both during incarceration and at reentry into the community.
Naloxone is a life-saving opioid antagonist that can reverse an opioid overdose. Tennessee law makes it available to anyone with or without a prescription and protects from civil suit any physician who prescribes it, and any bystander who administers it to those who they believe are experiencing an overdose. Production delays, among other factors, have led to a nationwide shortage of naloxone. This has increased the urgency of improving naloxone distribution policies.
Adolescent substance misuse and its consequences continue to be a challenge in Tennessee communities. To address the problem of substance misuse in Tennessee’s youth and young adults, it is helpful to look at how widespread the issue is; what factors contribute to use; and how it affects communities, families, and individuals. This brief highlights the nature of the youth substance misuse problem in Tennessee and provides recommendations on how the state can move forward with further investments to help address youth substance use prevention.
Broadband access is increasingly seen as a “super-determinant” of health, affecting not only healthcare delivery but educational and employment opportunities. When it comes to the treatment of substance use disorder (SUD), telehealth directly addresses the most common access barriers faced by rural patients. However, telehealth is not being utilized in rural areas as much as it could be, due to a lack of broadband internet access and affordability.
At the end of June, 2021, Knoxville City Council voted in favor of the public broadband plan proposed by Knoxville Utilities Board (KUB). Over the next ten years, KUB will lay fiber optic cable and begin offering public broadband internet as a fifth utility.
Substance Use Disorder (SUD), formerly known as addiction or substance abuse, is a treatable medical condition, but fewer than 1 in 10 Tennesseans with SUD receive treatment. Stigma can lead to a view of those with SUD as weak-willed, unmotivated, and unlikely to recover. However, the reality is that about 60% of people with SUD experience full remission. Treatment is also fiscally sound: every $1 spent on evidence-based treatment for SUD saves $12 in healthcare and criminal justice costs.
Corrections in Tennessee cost over $1 billion annually due to a rising incarceration rate. The state’s increasing incarceration rate is related to the growth in substance misuse which on its own costs Tennessee $2 billion each year and leads to over $1 billion in lost income from a shrinking work force. Prioritizing evidence-based treatment that targets the underlying medical and behavioral issues driving addictive habits for justice-involved individuals could simultaneously address rising recidivism, reincarceration, and growing substance misuse.
About 400,000 Tennesseans have substance use disorder (SUD). Only 1 in 10 Tennesseans who need treatment for SUD obtain it, mainly due to local provider shortages, long distances between a small number of treatment centers, stigma and cost. Telehealth directly addresses barriers and improves access to care.
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