In my last blog, I wrote about information regarding prescription opioids released last fall by the Centers for Disease Control and Prevention. This information gives states’ data for both number of overdose deaths per capita and kilograms of opioids prescribed per capita. Though Tennessee had the 13th highest overdose death rate in the nation, it was the second highest in amount of opioid prescribed per capita, with 11.8 kilograms of opioids prescribed per every 10,000 people.
By the way, North Carolina had a prescription rate of 6.9 kilograms per 10,000. This means that doctors in North Carolina prescribe only around fifty- eight percent of what doctors in Tennessee do, adjusted for population.
We know that areas with more prescribed opioids have higher addiction and overdose death rates than areas with lower rates of prescribed opioids. That’s clear not only from the CDC data, but also with what we know from other studies of addictive drugs. Any time an addictive substance is more available, more people become addicted. This holds true from prescribed medication just as it does for illicit drugs and alcohol. Just from the CDC data alone, it seems apparent that Tennessee has a big problem with pain pill addiction.
Now let’s look at the treatment options for opioid addicts. The best treatment outcomes for opioid addicts are consistently seen with medication assisted treatment with buprenorphine (Suboxone) or methadone.
Other treatment approaches can work, such as medical detoxification followed by at least one month of inpatient residential drug addiction treatment. Better results are seen with longer residential treatments, but inpatient options are often not attainable from the working poor, who are uninsured or underinsured. Therapeutic communities, where the addict lives and works in a community of recovering people, and also receives addiction counseling, can work for those people who can take eighteen months out of their lives for treatment.
And we know what doesn’t work. Putting addicts in jail doesn’t work. If it did, we would have been curing addiction since the 1950’s, when incarceration was first put forward as a solution to the addiction problem.
Inpatient detoxification alone does not work. Relapse rates for opioid addicts, in study after study, are consistently in the 90 to 96% range, and most of these relapses are within the first month. Yet in many communities, the same addicts are cycled in and out of detox, and then blamed because they couldn’t stay clean, even though we know they had less than a 10% chance of being successful.
Medication-assisted treatment with buprenorphine and methadone work well, and work quickly. These approaches are more acceptable to the addicts, and much more affordable, at least in the short-term. We know such treatment saves lives, reduces drug overdose deaths, reduces infectious diseases like HIV, reduces suicides, reduces crime, and improves overall physical and mental health.
But Tennessee has only ten opioid addiction treatment programs in the entire state to serve its present population of 6.3 million. And remember these folks have almost twice the opioids than their North Carolina neighbors. North Carolina, with a population of 9.5 million people, has forty-five opioid addiction treatment programs, ready to treat opioid addicts with the best evidence-based treatment available.
Using present estimates of the numbers of opioid addicts who need treatment, even North Carolina doesn’t have enough space in their opioid treatment programs to treat them all. But then, not all of the addicts want help. Tennessee doesn’t even come close to having adequate, evidence-based treatment available for its citizens who become addicted to pain pills. Thankfully, Tennessee does have buprenorphine (Suboxone) doctors, and the http://buprenorphine.samhsa.gov website lists 292 of them. But each doctor can have only up to either 30 or 100 patients per doctor.
Why has this state, which obviously has one of the worst prescription opioid addiction problems in the entire nation, consistently opposed evidence-based treatment for opioid addiction? Sadly, it’s probably the usual culprit: stigma. Even the officials at Tennessee’s department of health and human services must not be educated and informed about which treatments work the best for opioid addicted people.
If I lived in TN, I’d be fighting mad. Actually, I’m already angry, because I see desperate Tennessee pain pill addicts driving from Tennessee to North Carolina for help. I work at a clinic in the mountains of North Carolina, and see patients driving an hour or more to get the help that should be available to them in their home state. I don’t mind. I’m glad to see them, and glad to help them. Almost without fail, they’re really nice people, the kind you’d enjoy having as a neighbor. But too many times I see these people have to leave a treatment that’s working for them because they can’t practically travel that far every day to get their dose of medication.
If I lived in Tennessee, I’d demand that my state officials get their heads out of the sand, and do something to bring their raging pain pill addiction epidemic under control. I’d write the governor, senators, and state representatives. I’d ask why Tennessee’s Division of Alcohol and Drug Abuse Services appears to be indifferent to perhaps the biggest public health issue of our times. If I didn’t get satisfactory answers, I’d be sure to remember and vote accordingly in the next election. Nothing gets a politician’s attention like threatening not going to vote for them.
I might make some noise at a local level, and ask local officials why their communities have refused to allow treatment centers in a state that desperately needs them. Maybe I’d try to organize a group of concerned citizens at the grassroots level. Perhaps larger national organizations like NAMA (National Alliance for Medication-assisted Recovery) could assist. You can find them at http://www.methadone.org/ And if you go to that website, you’ll find that Tennessee is their number one most important issue, because of the non-evidence-based proposed new regulations on existing opioid treatment programs. NAMA’s website has an address for concerned Tennessee citizens to send mail protesting the proposed regulations. You could also voice your opinion about the need for more treatment centers to help addicts.
But we know treatment centers will never be the whole answer to the problem of addiction. Tennessee, like other states, will need a variety of efforts to solve their problem.
A comprehensive solution will involve things like:
- Better physician education in medical school, residency, and private practice about addiction and its treatment. Doctors need to know how to prescribe opioids more safely, with proper monitoring. State medical boards need to be clear about prevailing standards for prescribing such medications.
- Physicians need to make use of important tools like prescription monitoring programs.
- Drug courts need to be expanded, and need to accept patients on medication-assisted treatments.
- Citizens need to realize they should not share medications with friends and family, both because it could be harmful and because it’s against the law.
- Legal action against pill mills. To determine if a pain practice is legitimate or not, allow other physicians to review charts. Other physicians are better trained to do this than law enforcement.
- Citizens need to make sure all medication is stored securely and out of the reach of children and even adolescents, who often get medications from the adults in their lives.
Consider letting your Tennessee officials know what you think of the job they’ve been doing