Tennessee: Epic Fail?

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

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6 responses to this post.

  1. Posted by dbc3913 on January 30, 2012 at 12:48 am

    Since I live in TN, I can not help but comment. In two different cities I’ve lived in, efforts to establish Methadone clinics were shot down by the community who vehemently opposed them. Most Methadone patients must travel to NC or a long distance to one of the few over-crowded clinics in TN. The community just won’t stand for having these… and its hard for the addicts to demand such a thing. Another HUGE factor is that this state is highly conservative in their political thinking. They voted 80+% in my area for McCain in 2008 election even when Obama had so much momentum. They aren’t interested in treating addicts as if they have a disease, they are interested in leaving them to live or die based on their own personal merits – similar to their approach on health care. Often times I compare the politics of my state, and most conservatives, to that of the Jungle. Survival of the fittest, without interference from any party intended to make things ‘fair’ or ease suffering.

    Reply

    • That’s sad. No matter what their politics or personal feelings, wouldn’t you think people would get tired of hearing about people dying from this treatable disease of addiction?

      Reply

  2. Posted by dbc3913 on February 3, 2012 at 3:00 am

    You might think so, since their own family members are the ones dying from this. BUT, they don’t look at it this way. You would have to live here to really understand their thinking. I mean, the outrage that was expressed in the two times I’ve seen attempts to get Methadone clinics established was .. whew .. I mean, people went nuts in opposition!

    In the first case, it was in Johnson City, a *liberal* city for Tennessee, being host to a major university (ETSU). However, when a businessman proposed opening a Methadone clinic, even this more liberal population was completely and utterly opposed. I was shocked.

    The other attempt was in my ‘home’ town of about 60,000. It got shot down in the blink of an eye.

    In their eyes, they view Methadone clinics as part of the problem. There is no changing this, sadly. I am just thankful they do not yet view Suboxone as part of the problem too.

    They are raiding more and more Pain Clinics as well, shutting them down. It’s in the news all the time. We already have a patient prescription database, something that is about to be further strengthened according to the Governor’s statement a few days ago. So, their policy is: ZERO TOLERANCE. This policy obviously has not been working, yet they continue …. kind of like the ‘war’ on drugs itself.

    They arrest drug users all the time by getting informants to go their friends and get their friend to go buy whatever drug. Then they put their pictures in the paper as if they were big drug dealers, when they were closer to homeless drug addicts. The big dealers never seem to get caught, or very rarely. The police are just concerned about looking good, and probably know they can’t win the battle. It is just a shame they have destroyed so many lives by locking up addicts with long prison sentences. Yes, most the Judges here are also the ‘throw the book at you’ type … no excuses … no extenuating circumstances …

    I can’t describe how it is here without you living here for a while. It’s … Well, its like a different country that is about 50 years behind the rest of the USA in their social and political thinking.

    Reply

  3. Posted by John Q on March 11, 2012 at 4:09 am

    Ahh TN. I remember when I was attending a clinic in WNC it seemed like a 1/3 of the patients drove over an hour each way to attend the clinic. I always asked why they didn’t just have a clinic in TN as it seems there are methadone clinics all over NC and they would talk about the craziness that would go on in TN. I remember hearing about how there would be police who would sit close to the boarders watching cars who crossed state lines every day and then pull them over. If it turned out to be a methadone patient they would confiscate their approved take home doses and pour them out. I even heard of people getting DUIs leaving the clinic for their normal everyday dose that had about as effect on them as benedryl on non-patient.

    I heard that the politicians who decried the clinics said they didn’t want them bringing addicts to their area, not understanding that the addicts were ALREADY THERE. Apparently they didn’t realize that addiction is something that effects all walks of life and a methadone clinic would help reduce crime associated with addiction, not increase it…when will people learn…

    Reply

    • See, I think there should be penalties for a policeman to pour out a properly prescribed, Schedule II medication. It’s no different than police pouring out a bottle of, say, Opana, with the patient’s name and prescribing information. It’s just flat-out wrong. Maybe the ACLU should get involved. I’ve written to the NC and TN chapters a few years ago, describing this problem, but never heard back.

      Reply

      • Posted by John Q on March 25, 2012 at 4:50 pm

        I would be interested to see what it’s like these days as my experiences with WNC clinics was 7-9 years ago. I hope it’s gotten better now that there seems to be a lot more awareness of prescription pill abuse and opiate abuse in general in the media. Does anyone know if TN has gotten any better about it’s attitude toward MMT patients and clinics?

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