Tennessee – as well as the rest of the United States – is in the midst of an unprecedented drug overdose epidemic. Today, more Americans die from drug overdoses than car crashes or gun fatalities. In 2014 alone, drug overdoses killed 47,000 people in the US, averaging out to 130 deaths per day. The majority of those deaths – 29,000, or 80 per day – involved an opioid painkiller.1
“While our country comprises less than five percent of the world population, we consume 99 percent of the world’s hydrocodone,” notes Mitch Mutter, State Medical Director for Special Projects in Tennessee. (Hydrocodone is just one of several types of opioid medication commonly consumed for pain relief.)2
Tracing the Epidemic’s Appalachian Roots
Between 1999 and 2014, the overdose epidemic spread from central Appalachia (which includes much of West Virginia and eastern Kentucky) to nearly every corner of America. “It wasn’t understood how addicting … prescription pain medications were [early on],” reflects Michelle Lofwall, associate professor at the Center on Drug and Alcohol Research at the University of Kentucky School of Medicine.3
But now, even with renewed efforts by government officials working to ramp up the war on drugs, many experts warn that drug addictions and the overdose epidemic have not yet peaked. This may prove to be true in Tennessee, despite bold efforts put forth by state officials.3
“There’s never a dull day,” says Sharon Duke, an addiction specialist serving patients in eastern Tennessee. “Addiction is a disease that takes a lifetime to combat. Every day [my patients with a substance use disorder] have to decide ‘Today I’m going to stay in recovery again.’”
Charting Tennessee’s Progress
In 2015, Tennessee had the unfavorable distinction of being tied with Alabama for the highest number of filled opioid prescriptions, with 1.2 per capita. However, the National Safety Council’s 2016 report gave Tennessee high marks. They rank the Volunteer State as one of only four states, including Kentucky, they deem to be “making progress.” All other states were given failing marks based on six key indicators.
These encouraging results are largely due to the Tennessee Prescription Safety Act of 2012, a step made by the Volunteer State to centralize patient information. Tennessee is one of the first states to mandate prescriber use of its prescription monitoring program. This requirement has led to a 36 percent reduction in “doctor shopping” — trying to get redundant medications from more than one physician over the same period — according to the National Safety Council, and other sources suggest an even sharper drop.
As a result, the number of pain clinics has decreased significantly – from more than 300 to fewer than 200. However, as these “pill mills” are driven out of business and pain medications become more difficult to get through legitimate channels, addicts are seeking out alternative drugs that are more accessible.
Many addicts are turning to heroin, an illicit opiate. Some find alternative“street” narcotics that are unregulated. They might not be the drug described by the seller. A certain drug to a certain person can easily lead to overdose and death.2
Tennessee Continues to Fight the Opioid Epidemic
As a result of the 2012 legislation, doctors began to be held more accountable. Specifically, physicians must check a patient’s prescription history prior to prescribing painkillers or tranquilizers.
In addition, once they write a prescription, it must be reported promptly to the Controlled Substance Monitoring Database (CSMD), a centralized record of patient information accessible by all doctors and law enforcement personnel. On the flip side, patients risk stiff penalties for doctor shopping.
The 2012 act also took action to limit the production of meth, as well as reduce its exposure to innocent youth and stress the value of educating the public on the dangers of meth.4
Where Does Tennessee Go From Here?
Besides extending the highly successful measures contained in the Prescription Safety Act of 2012 beyond its slated expiration date in 2016, Governor Haslam’s 2016-2018 Public Safety Action Plan includes several important additions. Approved by the General Assembly, these include:
- Enhance sentences for repeat drug trafficking offenders
- Provide “effective alternatives” to incarceration for more nonviolent offenders facing substance abuse and/or mental illness through expanded support for drug treatment (recovery) and other specialty courts
- Increase access to self-run, self-supported recovery houses for citizens seeking to recovery from substance abuse in sober living environments
- Track the growing problem of heroin abuse by county so that intervention and prevention can be targeted to local needs
- Reduce significantly the number of drug-dependent newborns in Tennessee
- Improve the collection of uniform drug overdose reporting by county medical examiners and reduce the number of overdose deaths4
Looking further down the road, heroin will likely continue to rise in popularity short-term. But fentanyl, which is 50 times more potent than heroin, is a growing “next step up” for those who don’t get clean.3
The Need for Accessible Treatment Continues to Grow
The one indicator that Tennessee did not show growth in, according to the National Safety Council’s 2016 state-by-state comparison, was “availability of opioid use disorder treatment.” 2
Such disorders are rarely handled successfully without professional help. “People have views still that being addicted is your own fault, that it’s a spiritual flaw, that you should be able to stop on your own,” Professor Lofwall notes. “But opioid addiction often requires medical help.” Lofwall points to medication-assisted treatment – using drugs like methadone or buprenorphine – as a few of the “life-saving” interventions available today.3
1 Rudd, Rose A., MSPH, et.al., “Increases in Drug and Opioid-involved Overdose Deaths – United States, 2010 – 2015.” Centers for Disease Control and Prevention, December 30, 2016.
2 “No Easy Fix: Tennessee’s Doctors Take on the Opioid Abuse Epidemic.” Tennessee Medicine, Journal of the Tennessee Medical Association, Volume 109, Number 4, Pages 17-20, Quarter 4, 2016.
3 “A Deadly Crisis: Mapping the Spread of America’s Drug Overdose Epidemic.” The Guardian, May 25, 2016.
4 “A Safer Tennessee.” Tennessee State Government, January 2016.