Dear Texas Pain Society (TPS) Members,

Happy 2024!  I hope your year is off to a good start so far. It is my pleasure as President to introduce a valuable addition to the TPS communication channels - the Texas Pain Pulse, our exclusive members-only newsletter produced in partnership with ARP. Ensure [email protected] is a trusted email address so you receive it.

Texas Pain Pulse is a curated source of insights, updates, and news designed specifically for TPS members. This monthly newsletter aims to keep you informed about the latest developments in the field of pain management, share best practices, keep you posted on upcoming events and foster a sense of community among our esteemed members.

This year, the Texas Pain Society was honored to present the Schade-Hill Public Policy Award to Stefanie Turner, founder of the nonprofit Texas Against Fentanyl. 

Each year at its annual conference, the Texas Pain Society (TPS) gives out awards to distinguished individuals in the pain industry. One such honor is the Schade-Hill Public Policy Award, which was inspired by the countless hours that Drs. C.M. Schade and Stratton Hill dedicated to TPS, in order to help craft the pain medicine laws that govern Texas today. In its eleventh year, the award recognizes outstanding work that has made a positive change in the world of pain medicine, and this year – during the TPS 15th Annual Scientific Conference – it went to Stefanie Turner.

Turner lost her 19-year-old son, Tucker Roe, after he purchased one illicit fentanyl pill from a peer on social media. After he passed, she began sharing his story and educating others on the deadly effects of this dangerous drug. Texas Against Fentanyl (TXAF), a 501c3 nonprofit, was born.

Her work didn’t stop there, though.

Federal Register Notice

DEA is pleased to announce the July 27, 2023 final rule, Transfer of Electronic Prescriptions for Schedules II-V Controlled Substances between Pharmacies for Initial Filling, which was developed to provide clarity on existing Federal regulatory requirements, as well as to facilitate the proper dispensing of electronic prescriptions for controlled substances. This final rule, effective on August 28, 2023, amends DEA regulations to allow the transfer of electronic prescriptions for schedules II-V controlled substances between registered retail pharmacies for initial filling, upon request from the patient, on a one-time basis. The final rule requires that the transfer must be communicated directly between two licensed pharmacists, the prescription must remain in its electronic form, and the prescription information required by 21 CFR part 1306 must not be altered during the transmission. The final rule also stipulates that the transfer of electronic prescriptions for controlled substances (EPCS) for initial filling is permissible only if allowable under existing State or other applicable law.

In addition, the final rule describes the recordkeeping requirements for pharmacies transferring EPCS for initial filling, as well as pharmacies receiving and filling such prescriptions. The final rule only addresses the transfer of EPCS for initial filling and does not address the transfer of EPCS for refill dispensing, which is outlined in 21 CFR 1306.25.

Further, the final rule does not change the existing requirements for all prescriptions, as outlined in 21 CFR part 1306, nor the requirements for electronic prescription and pharmacy applications, as outlined in 21 CFR part 1311.
We hope this information is helpful.

If you have any questions pertaining to this rule, please contact: 

Scott A Brinks, Regulatory Drafting and Policy Support Section, Diversion Control Division, Drug Enforcement Administration; Telephone: (571) 776-3882; Email: [email protected].

Pain physicians from across the state met at the Capitol in Austin, in order to spread awareness of pain medicine topics to policymakers in Texas.

On March 23, Texas Pain Society members traveled from all over the state to meet with legislators and discuss issues relevant to pain medicine. 

The participants were:

• C.M. Schade, M.D. of Advanced Pain Solutions

• Heidi Seifert, M.D.

It is now easier to prescribe buprenorphine to patients with opioid use disorders.

During the recent State of the Union address, President Joe Biden mentioned a law that simplifies prescribing opioid addiction treatments. He was referring to the X-Waiver, which had been around for over 20 years before it was done away with on December 29, 2022.

“With the signing of the Consolidated Appropriations Act of 2023, Congress eliminated the DATA-Waiver Program,” states the Drug Enforcement Administration (DEA)’s website. “The elimination of the X-Waiver will increase access to buprenorphine for those in need.” 

With the waiver, doctors had to jump through multiple hoops (training, audits, a patient limit) if/when they prescribed the drug. Therefore, as the vice president for research at UT Health San Antonio, Jennifer Potter, told NBC News, health professionals had been waiting for its removal for “years if not a decade or more.”

Dr. Menard of Hill Country Memorial will step into the role of president as the Texas Pain Society (TPS) on October 29, 2022. Recently, he discussed how he started working in the pain medicine industry, as well as his goals for the organization. 

I have always been interested in pain, even during medical school and residency and before pain fellowships were a thing. I did a rotation at Fort Gordon, the US Army hospital in Georgia, with an anesthesiologist who treated pain, which helped me pursue that path. After my residency, I went back on active duty in the US Navy, as they paid for my medical school. I was primarily stationed in Orlando and opened a small pain clinic in the hospital with the help of a couple other physicians, including one of our own Texas Pain Society physicians, Dr. Ashley Classen. 

I moved to Lubbock, Texas, after leaving the Navy, specifically because they had an opportunity open for a combined anesthesia and pain doctor. For most of my time in Lubbock, I was a solo practitioner and was affiliated with Texas Tech University Health Sciences Center (TTUHSC). Fortunately, my association with TTUHSC was during a time when Dr. Prithvi Raj was still there. Both he and Dr. Gabor Racz provided indispensable professional and personal guidance. In fact, I was there when they brought up the idea of the Texas Pain Society and was one of the founding members, donating $1,000 to help get it started. There were probably only 20-30 or so of us attending those early pain conferences at TTU back then, and many of them were residents and fellows.

As to my goals as the new president of TPS, I would like to expand on what my predecessor, Dr. Maxim Eckmann, started by expanding our use of social media (Be sure to follow TPS on Twitter and LinkedIn!). I would like to see an expanded use of the TPS forum to include articles of best practices for members. I would also like to see more use of the TPS educational offerings, such as IPOC and the online modules that offer CME courses. Another thing I want to emphasize to members is how important it is to attend First Tuesdays, in order to get to know your legislators and talk to them on a personal basis. Pain medicine has some big problems looming this next year during the legislative session, and we need to start working on them now. As Dr. CM Schade, our leading expert on legislative affairs, says, "If you aren’t at the table, then you are on the menu.”

This awareness day, focused on opioids, exists to encourage patients to only use opioids as prescribed.

Recently, there has been an influx of news on the topic of opioids, the opioid epidemic, illicit fentanyl overdoses, and National Opioid Awareness Day, which falls on September 21. This awareness date urges people to learn more about these drugs, including the dangers of abusing legitimately prescribed opioids, the potentially fatal results of using or trying illicit opioids, and the proper way to handle opioid prescriptions. 

What are opioids?

Opioids are a class of drugs that are chemicals (either natural or synthetic), which interact with nerve cells and, in turn, treat pain. Also known as narcotics, they include illegal drugs like heroin, synthetics like fentanyl, and prescriptions (both natural and semi-synthetic) like oxycodone, hydrocodone, codeine, and morphine. They can come as oral pills, lozenges, oral solutions, injections, IVs, patches, or suppositories. 

DWC Asks for Input for Return-to-Work Plan-Based Audit DWC seeks input for the Return-to-Work (RTW) Plan-Based Audit, which evaluates the reasonableness of a doctor’s decision and recordkeeping for RTW. The plan-based audit sets the scope, methodology, selection standards, and program area duties as laid out in the Medical Quality Review Process. Comments are due by April 27, 2022. Learn more.

Reminder to Health Care Practitioners About Financial Interest Disclosures

DWC reminds health care practitioners that they must file a financial interest disclosure with DWC when referring an injured employee to another health care practitioner, health care provider, or health care facility that they have a financial interest in.

More details are on the TDI website.

HHSC announces new Drug Utilization Review Board appointments

The Texas Health and Human Services Commission established the Drug Utilization Review Board to develop criteria and standards impacting Texas Medicaid, including:

• Developing and submitting recommendations for the Texas Medicaid preferred drug list;
• Suggesting clinical prior authorizations on outpatient prescription drugs;
• Recommending educational interventions for Medicaid providers; and
• Reviewing drug utilization across the Medicaid program.

The following individuals have been selected for Board appointment:

• Dr. Natalie Vanek, physician representative
• Dr. Carlos O. Viesca, physician representative

Please visit the Board webpage for more information on the Board.  Board meeting agendas are posted approximately seven days prior to the meetings on the Events webpage.  Meetings are also webcast and archived on the Meetings webpage for approximately two years from the date of the meeting.  

Here are some highlights. View the full update here. 

Prescribing Emergency Rule in Effect Through June

The emergency rule related to the issuance of certain prescriptions during the COVID-19 disaster was approved for 60 days at the end of April. The emergency rule (§174.5) continues to allow physicians to utilize telemedicine for issuing previous prescription(s) for scheduled medications to established chronic pain patients if the physician has, within the past 90 days, seen a patient in-person or via a telemedicine visit using two-way audio and video communication. The emergency rule will remain in place for 60 days (until June 30, 2021 at 11:59 p.m.) or for the duration of the time period that the Governor’s disaster declaration of March 13, 2020 in response to the COVID-19 pandemic is in effect, whichever is shorter, pursuant to Section 2001.034 of the Texas Government Code. TMB will continue to provide updates on COVID-19 issues on the TMB website at tmb.state.tx.us/page/ coronavirus. For the latest COVID-19 information for health providers and the public, visit the Department of State Health Services (DSHS) COVID-19 web page at dshs.texas.gov/ coronavirus.

New Acupuncture Board Members Appointed

CONGRATULATIONS! Rey Ximenes, M.D., of Spicewood, is a consultant at Balcones Pain Consultants. He is past president and a member of the American Academy of Medical Acupuncture and the Austin Chapter of the Texas Pain Society. Additionally, he is a member of the American Society of Addiction Medicine, the American Society of Interventional Pain Physicians, and the American Association of Naturopathic Physicians. Ximenes received a Bachelor of Arts in Zoology from The University of Texas at Austin and a Doctor of Medicine from the University of Texas Medical School, Houston.

E-Prescribing Mandatory; Waivers Established

Texas Physicians, House Bill 2174 (86th Legislature) mandated electronic prescribing of controlled substances (Schedules II-V) as of January 1, 2021. The law establishes a waiver from the electronic prescribing requirements in certain situations, including: economic hardship, technological limitations outside of the prescriber’s control and other exceptional circumstances. Once approved, waivers will be valid for one year. A prescriber may reapply no earlier than 30 days before the date the waiver expires. For more information on the requirement, how to apply for a waiver through the My TMB portal, and Frequently Asked Questions, please visit: http:// www.tmb.state.tx.us/page/ renewals-physicianelectronic-prescribingwavier.

 

AAPM Covid Vaccination and Steroids 

Health Advisory: Pan-Resistant Candida auris Identified in Texas

Texas Physicians and Physician Assistants, the emergency rule related to the issuance of certain prescriptions during the COVID-19 disaster has been renewed for 60 days.

The emergency rule continues to allow for telephone refill of certain prescriptions to established chronic pain patients as long as the patient has been seen by the prescribing physician, or health professional defined under Chapter 111.001(1) of the Texas Occupations Code, in the last 90 days either in-person or via telemedicine using audio and video two-way communication.

The emergency rule will remain in place for 60 days (until May 1, 2021 at 11:59 p.m.) or for the duration of the time period that the Governor’s disaster declaration of March 13, 2020 in response to the COVID-19 pandemic is in effect, whichever is shorter, pursuant to Section 2001.034 of the Texas Government Code.

TMB will continue to provide any updates on COVID-19 issues on the TMB website at www.tmb.state.tx.us/page/coronavirus.

Rescheduled: Strengthening Medicine in the 87th Texas Legislature with Dr. Diana Fite

 

The February DCMS Connect event has been rescheduled to Wednesday, February 24 at 6:30pm. DCMS Connect is excited to have TMA President Dr. Diane Fite as the speaker for the February DCMS Connect event. During the 87th Texas legislative session, TMA will work with legislators to navigate budget challenges brought about by the COVID-19 pandemic. They will also work to ensure that nothing interferes with the patient-physician relationship so that physicians can be there when their patients need them. Dr. Fite will speak to how you can help in this effort and how to participate in TMA advocacy events during this session. Learning Objectives:  1. Describe TMA's legislative strategies that ensure an improved health care landscape for physicians and their patients. 2. Identify the unique health care challenges Texas physicians and their patients continue to face. 3. Discuss specific actions TMA is taking to address legislative issue on state and federal levels. 4. Implement steps that physicians and their patients can take to continue improving the health care system. 1 AMA PRA Category 1 Credits™ with the ethics designation. The Texas Medical Association is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. TMA designates this live activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.   The Texas Medical Association designates this activity for up to one hour in the area of ethics and/or professional responsibility education. Registration fee is $25. Questions? Contact Cara Jaggers, DCMS director of events, at [email protected].

Dr. Eduardo Bruera, Chair of Palliative, Rehabilitation, and Integrative Medicine, and Dr. Joseph Arthur, (Conference Chair), Associate Professor in Palliative, Rehabilitation, and Integrative Medicine, invite you and your colleagues to join us for this outstanding educational opportunity. We are happy to announce that registration for the 3rd Annual Interdisciplinary Pain and Opioid Crisis Seminar on April 23-24, 2021, is now open. The 3rd Annual Interdisciplinary Pain and Opioid Crisis Seminar is CME credited for those attending in real-time. Registration is now open and in line with our mission to present accurate data for a global audience.  We hope you will join us for this outstanding educational opportunity. This will be a great opportunity for all APRNs who attend the conference to earn credit towards their regulatory controlled substance CE requirement. - REGISTRATION IS NOW AVAILABLE - Please share the information about this virtual education day with your colleagues.  We look forward to seeing you in April.

SPANISH VERSION NOW AVAILABLE. Take advantage of this free resource for members! 

also available for Non-Members for only $50! 

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