Karmic Chickens Coming Home to Roost

Rate of Hep C infection among women giving birth in Tennessee per 1,000 live births – 2014

 

 

 

 

 

A recent report in the CDC’s MMWR (Center for Disease Control and Prevention’s Morbidity and Mortality Weekly Report) described the incidence of Hepatitis C virus infection rates among women giving birth in Tennessee, and the U.S., during the time frame 2009-2014.

In essence, the number of pregnant women delivering babies who were infected with Hep C doubled in the U.S. during this time, but in Tennessee, it tripled. The factors that increased the risk of Hep C included having a history of injection drug use, living in a rural county, smoking during pregnancy, and co-occurring Hepatitis B virus infection. The highest incidence was in the Eastern mountainous part of the state.

Obviously, this increase in Hep C incidence coincides with the rise in incidence of opioid use disorders.

Eastern Tennessee has been uniquely vehement in its rejection of evidence-based treatment of opioid use disorders, while maintaining one of the highest opioid prescribing rates of the nation. You do not have to be psychic to foresee the inevitable: increased burden of disease, death, poverty, disability, and crime.

I’ve been blogging about the sorry state of Tennessee’s approach, or lack of approach, to treating opioid use disorder since I started this blog in 2010 – see entries from 11/13/10, 1/26/12, 1/30/12, 11/14/12, 7/7/13, 10/19/13, 10/23/13, 4/12/14, 4/26/14,  8/25/14, and 12/12/14. Since late 2014, I grew tired of blogging about the same issue and moved on to other topics

I started working at opioid treatment programs in 2001. In 2005, I worked for a non-profit opioid treatment program with eight sites scattered across Western North Carolina. Because their OTP in Boone had so many people driving from Tennessee for treatment, this organization tried to open an opioid treatment program in Eastern Tennessee. These patients drove an hour or more, one-way, to get treatment in NC because it wasn’t available in Tennessee.

The state of Tennessee and the officials of Johnson City would not allow an OTP to open there. I’m not sure what reason they gave, but we all know the real reason: stigma against medication-assisted treatment of opioid use disorder.

If we fast forward to 2013, I was working for CRC Health when they attempted to open an opioid treatment program in Johnson City. Despite the open knowledge of a large population of people with untreated opioid use disorder in that area, state officials in Tennessee’s Health and Human Services maintained there was no need for an opioid treatment program, because there was an insignificant number of people who needed treatment. By that time, there were a number of office-based practices prescribing buprenorphine, but those physicians couldn’t legally prescribe methadone. As we know, one drug will never work for all patients.

A few years ago, the Crossroads group, which has opioid treatment programs in North Carolina, sued to get the right to put an OTP in Johnson City. They were also defeated.

People who know these things tell me there have been at least ten attempts to start an opioid treatment program in Tennessee’s Eastern part of the state over the last fifteen years, and all were refused.

The newspaper of that area, the Johnson City Press, reported earlier this year that an opioid treatment program is set to open in Gray, Tennessee, this summer. However, even though it’s going to be operated by the East Tennessee State University and the Mountain States Health Alliance, both reputable health agencies, local citizens are still picketing in an attempt to thwart the opening of this OTP, too.

I really hope science defeats ideology this time.

Also in Tennessee, as I described in several of my blogs, the state legislature passed a law making it illegal for a person with substance use disorder to become pregnant. Once the woman is pregnant, she is breaking their law, and subject to being jailed. Of course, all of the women jailed under this law so far have been poor and/or minorities, unable to afford lawyers to work on their behalf. Some of these jailed women tried to get help, but no treatment facilities would accept them, because they were pregnant.

Knowing this, pregnant women with substance use disorders may avoid pre-natal care.

I suggest this might contribute to this state’s high Hep C rate in women delivering babies, and also to their high rate of neonatal abstinence syndrome.

So…if an OTP finally opens – about seventeen years into our opioid epidemic – it will be built on the backs of scandalous numbers of people who suffered due to this backwoods misanthropy.

Ten or twenty years from now, we may look back at this disgraceful behavior of state and local officials of Eastern Tennessee with mortification, and vow never again to allow such a travesty crush ordinary people with a bad but treatable disease.

I think Tennessee will continue to give us information we can use – about how NOT to approach substance use disorders. It’s just a shame affected people have paid – and will continue to pay – the ultimate price for this information.

 

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One response to this post.

  1. Posted by Matt McClure on June 2, 2017 at 3:32 am

    Tennessee has a history of denying science. They banned the teaching of evolution in 1925 and gave us the ‘trial of the century’ AKA known as the Scopes trial. Not much has changed in the past 90 years. Of course, nobody died whether they believed in evolution or not, they have taken ignorance to rarified heights. I didn’t look back at your previous posts but it would not surprise me to find this information in one of them. Excellent blog post Dr J.

    Reply

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