Policy or Law? Why Tennessee Prescribing Guidelines Are More Than Just Recommendations

Stephen W. Harden
Sep 22
4 min read

Updated: Oct 28

Imagine you're driving down a road with clearly posted speed limit signs. Now imagine a second road where there are no speed limit signs—just a sign that says, “Drive responsibly.” Most drivers would feel safer on the road with clear limits. In Tennessee, when it comes to prescribing controlled substances, the state has posted the equivalent of speed limits—and they’re called “policies.”

But here’s the kicker: even though the Tennessee Board of Medical Examiners (BME) calls them “policies,” these are not mere suggestions. They are enforced with the full power of law. As a prescriber, whether you’re a physician, PA, APRN, or pharmacist, this distinction could make or break your career.

Are BME Policies Really Law?

Technically, a policy is not a law. In general terms, laws are passed by legislatures, rules are issued by regulatory agencies, and policies are internal guidelines meant to shape decisions within an organization.

But here’s the key insight: in Tennessee, BME policies are treated by the board as if they are legally binding rules. That means if you violate a policy, you can face the same disciplinary action as if you violated a law.

“There is no daylight between a BME policy and an enforceable rule when it comes to disciplinary action,” says a legal representative familiar with BME policies. “If a provider thinks policies are suggestions, they’re setting themselves up for a very unpleasant surprise.”

This has been repeatedly emphasized in disciplinary hearings and case law in the state. The Board considers its policies a minimum standard of acceptable professional conduct. Violating them, even if unintentionally, is viewed as professional misconduct.

How the State Monitors Prescribing Practices

Tennessee doesn’t rely on chance to identify improper prescribing. The state has built a sophisticated surveillance and enforcement system to monitor every prescriber. These are just a few of the tools in use:

Top 50 Controlled Substance Providers
Top 20 Buprenorphine Product Prescribers
Annual CSMD Report of Statistical Outliers
Annual CSMD Report of High-Risk Prescribers
Pharmacy Reports and Licensing Board Complaints

Every one of these reports is reviewed by licensing boards. If your name shows up in one or more, expect some scrutiny.

This is not theoretical. According to the Tennessee Department of Health, hundreds of prescribers each year are subject to complaints, audits, or reviews based on CSMD (Controlled Substance Monitoring Database) data. In 2023 alone, over 750 formal complaints related to controlled substance prescribing were investigated across multiple boards.

“The CSMD is not just a database—it’s a diagnostic tool for enforcement,” explains a former Tennessee Board investigator. “It highlights patterns, flags prescribers, and triggers audits.”

Minimum Discipline Requirements—And Their Fallout

Each Tennessee licensing board that oversees prescribers has minimum disciplinary requirements for violations. These aren't guidelines—they’re mandates. That means boards are required to impose disciplinary actions for certain types of misconduct.

Common consequences include:

Mandatory continuing education
License suspension or revocation
Civil monetary penalties
DEA registration restrictions
Mandatory reporting to the National Practitioner Data Bank (NPDB)

And those aren’t the only consequences. Being sanctioned by your licensing board may also lead to:

Loss of hospital admitting or procedural privileges
Exclusion from insurance networks
Termination of collaborative agreements (if you’re an MD working with PAs or APRNs—or vice versa)

The effects can be cascading. One disciplinary action can trigger a cascade of others, like falling dominoes.

The “Indicted Prescriber” Law: Guilty Until Proven Innocent?

Tennessee takes enforcement one step further. Under state law, just being indicted—not convicted—of a controlled substance offense can trigger restrictions on your ability to practice.

This means you can face:

Temporary license suspension
Referral to an evaluation or treatment program
Mandatory supervision
Loss of employment or collaborative roles

This law flips the usual legal presumption on its head. In most areas of life, you're considered innocent until proven guilty. But under this framework, your professional practice can be restricted the moment charges are filed—before you’ve had your day in court.

This legal posture sends a clear message: Tennessee prioritizes public safety and proactive enforcement.

Documentation: Your Best Legal Defense

Given this environment, documentation is your shield. Every prescription you write—especially for opioids, benzodiazepines, stimulants, and buprenorphine—must be justified, clinically appropriate, and clearly documented.

The Tennessee BME has issued guidance on what should be documented:

Diagnosis and treatment rationale
Treatment plan, including non-opioid alternatives
Risk-benefit assessment
Use of tools like urine drug screens and PDMP checks
Informed consent and treatment agreements

“If it’s not documented, it didn’t happen,” says one medical board consultant. “Your chart must speak for you—especially when you can’t.”

And remember: If your name appears in a report, it’s your documentation that will either exonerate you—or bring more scrutiny and questions.

Knowledge Is Power—and Protection

Given the risks, ignorance is not an option. Every prescriber in Tennessee needs to understand:

The policies and rules of their own licensing board
The expectations set forth by the Tennessee Department of Health
How to interpret and apply the CSMD data in their own practice

Yet most providers haven’t read the policies in full and may not know where to find them. This is one of the reasons the BME requires education on the Tennessee Chronic Pain Guidelines every two years.

Take the Next Step: Protect Your License and Your Livelihood

We created a comprehensive online course specifically for Tennessee prescribers like you. It’s designed to help physicians, PAs, APRNs, and pharmacists: