As Tennessee Pain Clinics Close, Some Desperate Patients May Switch to Heroin, Experts Say

One of Tennessee’s largest pain management companies is closing clinics throughout the state this month, sparking concerns that rural patients who abruptly lost their source for opioids will be left with few options and may turn to heroin.

Comprehensive Pain Specialists, known widely as CPS, is closing at least 16 clinics in Tennessee and surrounding states. An additional 11 clinics appear to be closed already.

The company has provided no information or explanation for the closures. Two employees said this week that all of the company’s clinics will be sold or shuttered by the end of the month.

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The abrupt disappearance of these clinics will leave thousands of patients searching for a new source of painkillers. Some of the most addicted patients will transition to heroin, which is cheaper and more available but carries a serious risk of overdose, said Dr. Robert Shearer, an addictionologist in Springfield.

“At a minimum, someone will die from this,” Shearer said. “These patients are going to have a physical dependency, and some of them might be able to wean themselves off, but some are going to buy heroin on the street and some of that is going to be laced with fentanyl.

“The bottom line is, one should assume that there will be an upsurge in illicit opioid usage, and an upsurge in illicit heroin usage, and then an upsurge in heroin deaths.”

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Comprehensive Pain Specialists, which is headquartered in Brentwood, has 21 clinics throughout Tennessee and 19 more in Arkansas, Illinois, Indiana, Kentucky, Mississippi, North Carolina and Ohio. The company employs more than 250 medical professionals, according to federal court records. Kaiser Health News has reported that CPS treats 50,000 patients a month and is one of the largest pain management companies in the Southeast.

“At a minimum, someone will die from this.”

Dr. Robert Shearer, addictionologist

In a series of interviews with The Tennessean, Shearer and three other opioid experts said the most serious ramifications of CPS clinic closures will be in rural areas, where their are fewer options for pain medication. Patients in these areas may have to drive hundreds of miles to find another licensed pain management clinic, many of which are already at capacity, the experts said. The patients' next best option will be to seek prescriptions from their family doctors, but those doctors have become reluctant to prescribe opioids as the state has tightened restrictions amid a growing addiction epidemic.

Faced with all of these dead ends, patients will likely become more desperate than ever, said Dr. David Edwards, chief of pain medicine at Vanderbilt University Medical Center.

“We’ve already seen that when patients become desperate they stop coming to clinics or going to emergency rooms, they stop showing up in our state prescription database and they start turning to heroin," Edwards said. "Those are the patients that end up dying in the street.”

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Edwards said Thursday that the hospital has already seen an influx of consultation requests from CPS patients, a likely fallout from the looming closures. But neither Vanderbilt, nor the state as a whole, has enough pain specialists to keep up with the demand of patients currently on opioids, Edwards said.

Dr. Adele Lewis, Deputy State Chief Medical Examiner, talks about the death rate of opioid overdose in Nashville, Tenn., Thursday, Aug. 24, 2017. Lacy Atkins / USA TODAY NETWORK-Tennessee

Dr. Nancy Hooper, a pharmacist with Axial Healthcare, a Nashville company focused on pain treatment, said she was concerned that some addicted patients may resort to harming themselves in an effort to get new prescriptions out of wary doctors.

"And that is absolutely something we have to avoid," Hooper said.

Although no explanation has been provided for the CPS closures, there have been signs of trouble at the company over the past year. Former CEO John Davis was indicted in April on Medicare fraud charges. He is accused of receiving $770,000 in kickbacks from another company, CCC Medical Inc.

Davis, who has pleaded not guilty, accepted bribes from CCC Medical CEO Brenda Montgomery, according to federal court records. In return for the money, Davis referred patients to Montgomery's company. Prosecutors allege in court records that Davis disguised some of the bribes by buying a sham company, ProMed Solutions, for $150,000.

Kaiser Health News, a nonprofit health-oriented newsroom, also has reported that CPS has been sued by two of its former doctors and several contractors, each alleging the company owes them for unpaid bills.

Comprehensive Pain Specialists has not responded to numerous calls and emails asking for comment on the clinic closures this week.

Brett Kelman is the health care reporter for The Tennessean. He can be reached at 615-259-8287 or at brett.kelman@tennessean.com. Follow him on Twitter at @brettkelman.

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