Few states have been hit as hard by the nation’s opioid addiction epidemic as Tennessee. The state has the second highest rate of prescriptions per person, next to West Virginia. Over a million Tennesseans (one in six) abused opioids or suffered from opioid overdose in 2014, according to the Centers for Disease Control and Prevention (CDC). The state’s legislators, treatment providers and residents haven’t stood by in silence. They’ve fought back. In fact, Tennessee’s progress in the battle against opioid addiction has garnered national attention. In 2016, U.S. Surgeon General Dr. Vivek Murthy headed to Tennessee to meet with leaders in the field, including the medical director at The Ranch treatment center, the director of the Food and Drug Administration, state senators and judges, and members of the state department of mental health. Together, they explored how state and federal action has started to reverse the trend. Here are a few of the issues and solutions they discussed. The Problem: Overprescribing by medical providers What’s Being Done About It: Twenty years ago, managing pain — the so-called “fifth vital sign” — became a focus in the medical community. The Tennessee Intractable Pain Treatment Act made long-term opioids a first-line treatment for chronic pain. Unfortunately, the flood of painkiller prescriptions that followed has not improved patients’ self-reported satisfaction with their pain management care and has contributed to an epidemic of opiate addiction. In 2010, physicians prescribed enough pain medication to represent 51 hydrocodone pills, 22 Xanax pills and 21 oxycodone pills for every Tennessee resident over the age of 12. In response to rampant overprescribing, the CDC has issued guidelines to right-size physicians’ prescribing habits and other organizations have worked to better educate medical providers about addiction. In some cases, physicians aren’t permitted to write prescriptions with refills so that patients have to come back and get reassessed before they can get more medication. In addition, the Food and Drug Administration has required black box warnings on pill bottles to flag the addiction danger. Another problem that’s just as significant as overprescribing has surfaced as well: physicians depriving legitimate pain patients of needed medication for fear of punishment. The Problem: Doctor shopping (visiting different doctors to get multiple prescriptions for the same medication) What’s Being Done About It: Tennessee has a controlled substance monitoring database that allows healthcare providers to track opioid prescriptions and check other medications patients are taking. In recent years, a growing number of providers started making use of this system. The number of providers authorized to check patient history has gone from 14,000 in 2010 to over 42,000 in 2015. In that same time frame, the number of database queries has grown from one search for every 14 prescriptions to one search for every three prescriptions, reports the Tennessee Department of Health. But there’s a lot of room for improvement. Since Tennessee is contiguous with eight other states, many people close to a border cross state lines to get additional prescriptions and can’t be tracked by the state database. Many state officials support the creation of a national database or expanded access beyond state lines. The Problem: Skyrocketing opioid overdose rates What’s Being Done About It: From 1999 to 2010, the rate of drug-related overdoses in Tennessee increased faster than the national rate (210% in Tennessee compared to 127% nationwide). To counteract this trend, the state has increased the accessibility of a life-saving opioid overdose reversal drug called naloxone. In 2014, Tennessee became the 18th state to pass a law granting civil immunity to medical providers who prescribe naloxone to patients, friends and family members as well as “Good Samaritans” who administer the medicine to someone they believe is overdosing on opioids. The Problem: Pill mills What’s Being Done About It: Pill mills — clinics, doctors or pharmacies that dispense addictive narcotics illegitimately or for nonmedical reasons — have surfaced all over the country, and Tennessee is no exception. In 2016, Tennessee passed laws that made it tougher for pill mills to do business in the state. Among other provisions, pain clinic medical directors are required to be board certified, and pain clinics have to be licensed with their records regularly inspected by the health department. The state also cracked down on “diploma mills” that granted pain specialist certificates to anyone who paid for one. The Problem: Neonatal abstinence syndrome What’s Being Done About It: When mothers use opioids, alcohol or certain other drugs during pregnancy, their newborns may become dependent on those drugs and face painful withdrawal symptoms when they’re born. In Tennessee, there has been almost a ten-fold increase in the incidence of neonatal abstinence syndrome over the past decade. Although the standard approach has been not to detoxify pregnant women because of the risk of early labor or miscarriage, current research shows they can be successfully detoxified during pregnancy and go on to deliver healthy babies. The key is providing ongoing support and monitoring after birth or the women are at high risk of relapse. All of these steps have helped Tennessee make inroads in the battle against painkiller addiction. It’s progress, but with a problem as massive as the opioid epidemic, it’s not by any means a solution. With reduced stigma and more attention from state and federal officials, there’s hope that the next decade will see much more progress than the last. By Meghan Vivo
