The abrupt closures of several Comprehension Pain Specialist clinics across middle Tennessee have patients and different organizations concerned about future of the opioid epidemic.
The Brentwood-based company has already shuttered the doors of several locations in the region due to a cost reduction effort, according to a statement by Chief Executive Officer Peter Kroll.
According to a letter posted on the front door at the Mt. Juliet location, CPS will no longer be seeing patients there "due to circumstances beyond our control."
CPS reportedly serve thousands of people at more than 45 locations in 10 states.
Former CPS CEO John Davis was indicted for his alleged participation in a $4.6 million Medicare kickback scheme involving durable medical equipment (DME).
Donna Graham is a former nurse diagnosed with Behcet's disease, a rare disorder that causes inflammation to the blood vessels throughout the body. She has been seeking treatment, and receiving morphine and percocet to ease her pain from CPS.
She has not heard from her doctors and is worried about her health as uncertainty of where she will get her medication lingers.
"There will be people going through withdrawal that will have seizures and have a difficult time getting through it," Graham said.
Graham said it is tough enough to find a provider who would treat chronic pain patients. The recent closures will only exacerbate the lack of physicians willing to accept Medicaid.
"It's very difficult to find a doctor who will treat you especially if you have an invisible illness. The government has agreed to pay them but it's such a low level and taking so long, the doctors don't
want to see you," Graham explained.
Smith County Drug Prevention Coalition Executive Director Barbara Kannapel says they are in "crisis mode." Rural areas are feeling the severity of lack of pain management clinics.
"Probably over half of the pain clinics in Tennessee closed in the last few years because requirements
have become stricter," Kannapel said. "Guidelines and the structure have become more controlled by the state because of the opioid epidemic."
Some of the stricter guidelines included requiring doctors to be in the office and oversee charts more, and having pain specialists be on-site, according to Kannapel.
However, her biggest concern is that patients will turn to the streets to find medication they normally would get from the pain clinics.
It could lead to heroin use, which sometimes might be laced with fentanyl, a powerful and potentially deadly synthetic opioid.
"When they get medication on the street, they don't know what they're getting," Kannapel added. "Suicides will increase because people have legitimate pain or are addicted and dependent they have substance abuse disorder at this point."
Kannapel said it will help by providing a list of medical providers in the area that can offer help and publicize the Tennessee REDLINE, a line to receive accurate, up-to-date alcohol, drug, problem gambling, and other addiction information and referrals to all citizens of Tennessee at their request.
In addition, the coalition can create more training for individuals to receive overdose prevention kits including naloxone.
There is a list of registered pain clinics provided by the Tennessee Department of Health.
CPS released a statement about the closures:
“Along with the majority of healthcare organizations in the US, Comprehensive Pain Specialists (CPS) must address the challenges of shrinking reimbursement and escalating costs that are causing extreme financial pressures on the provider side of healthcare,” said Peter Kroll, MD, CPS’s Chief Executive Officer. "As a cost reduction effort across the organization, today CPS has closed several middle Tennessee locations."
On Sunday, Governor Bill Haslam's TN Together took effect. It is a law to help with prevention by limiting the supply of prescription to new patients.
The Tennessee Medical Association released this statement:
“Doctors are concerned about access to pain management in Tennessee. Onerous pain clinic license laws and regulations have helped eliminate ‘pill mills’ and other unscrupulous clinics, but there are still not enough certified pain specialists in the state to care for Tennesseans experiencing legitimate pain. Exploding use of fentanyl, heroin and other illicit drugs are causing more accidental overdose deaths even as opioid prescriptions decline. And now that the nation’s most restrictive opioid prescribing law is in effect, Tennesseans may have even more difficulty accessing effective pain management, especially from primary care and other non-pain specialists in rural areas who have nowhere to refer their patients. It is going to take a multi-faceted and well-funded strategy including addiction treatment and law enforcement to turn back the opioid epidemic and prevent people from turning to street drugs to alleviate their pain.”