State Moves to Curb Rx Addiction
Tennessee, like states across the nation, is facing a pervasive problem when it comes to the abuse of prescription drugs, particularly opioids and benzodiazepines.
It is estimated that of the 4.85 million adults in the state, nearly 5 percent … or about 221,000 … have used prescription opioids for non-medical purposes in the past year. Of that group, officials estimate more than 30 percent, approximately 69,100 adults, are addicted to the prescription drugs and require treatment for opioid abuse.
Although there is an increasing awareness of the issue by both prescribers and the public, Commissioner E. Douglas Varney of the Tennessee Department of Mental Health and Substance Abuse Services (TDMHSAS) said the problem is getting worse. As a result, TDMHSAS, in collaboration with other state agencies impacted by the issue, has created a strategic plan to turn the tide on the epidemic. “Prescription for Success” outlines a number of prevention, education and treatment strategies to meet seven stated goals:
Decrease the number of Tennesseans who abuse controlled substances.
Decrease the number of Tennesseans who overdose on controlled substances.
Decrease the amount of controlled substances dispensed in Tennessee.
Increase access to drug disposal outlets in Tennessee.
Increase access and quality of early intervention, treatment and recovery services.
Expand collaborations and coordination among state agencies.
Expand collaboration and coordination with other states.
Gov. Bill Haslam joined Commissioner Varney to announce the plan on June 3 in Nashville and to launch a statewide tour of events drawing awareness to the issue and the coordinated efforts aimed at prevention and treatment.
In unveiling the plan, Haslam said, “Prescription for Success is a comprehensive, multi-year strategic plan that will involve different agencies across state government to reduce the misuse and abuse of prescription drugs so Tennesseans can live happy, healthy and fulfilling lives.”
Varney said it is often shocking when people learn who makes up this population of addicted Tennesseans. It’s a very different demographic than typically comes to mind with the term ‘drug addict.’ Prescription addiction crosses all ethnic, social and economic lines and includes doctors, lawyers, law enforcement officials and suburban housewives. “It’s really a much broader spectrum of people, which in some ways makes it more difficult to deal with, but conversely, it opens up dialogue about addiction in general and hopefully increases understanding,” he said.
The reasons for the rise in opioid abuse and addiction are multifactorial, but Varney said at least some of the current problem is probably an unintended consequence of the ‘pain as the fifth vital sign’ initiative. Other reasons, he continued, include better access to healthcare in general, not following recommended dosages, the low cost of many of the generic forms of addictive pain medications, and not recognizing the addiction.
“With illicit drugs, you know you are doing something wrong,” Varney added. However, he continued, “Seventy percent of all of these drugs come from legitimate sources.”
Those sources include ‘helpful’ family and friends with leftover pain medications in the cabinet, as well as physicians and other prescribers. In some cases where patients are taking drugs that have been legitimately prescribed, Varney continued, “At the end of the treatment, they weren’t titrated off the medication.” He added, “They’re not placebos. They are serious medications that need close medical supervision. Just because it comes from a doctor doesn’t mean it can’t really hurt you.”
The state has already taken several important steps to curb the issue, Varney noted. He said the Prescription Safety Act, which was signed into law in 2012, is already making a difference. The law requires medical professionals to register with the Controlled Substance Monitoring Database and check a patient’s use of opioids and benzodiazepine before prescribing. Updated weekly by pharmacists and dispensers, the database allows prescribers to see if a patient is doctor shopping. It also allows officials to see if there are prescribing patterns that raise a red flag and to reach out to those medical professionals to better educate them about the dangers of overprescribing.
“I think in our state, we’re going to see a sharp drop in the number of new people becoming addicted to these medications and a sharp drop in the supply of these narcotics because physicians are being more vigilant and the standard of care has changed,” Varney predicted.
“Prescription for Success” has specific targets for each of the goals such as reaching a 20 percent decrease in the number of people using prescription opioids and the number of people who die from prescription overdose by 2018. During that same timeframe, the goal is to decrease the amount of prescriptions dispensed in Tennessee by 15 percent. Although the first benchmarks come in 2018, Varney was quick to point out the program has no endpoint as this will be an ongoing battle.
While prevention is a large part of the overall strategy, Varney said the collaborative plan also focuses on helping those who already are … or will become … addicted have access to resources. He noted detox programs, inpatient and intensive outpatient programming, 12-step programs and medication management to wean individuals off of the drugs have been proven successful.
“Treatment does work if people will engage in therapy,” Varney stated. “We really want communities across our state to become more recovery-oriented.”
He continued, “There are so many misperceptions about addiction. We need to reach out with more than just a stick. We need to also reach out with love and understanding.”
When people cross the line legally, Varney also hopes to see more recognition of alternatives for non-violent drug offenders. “I think we’re beginning to realize in this country that incarcerating people for addiction is not really the answer,” he said. Varney added an increasing number of judges across the state have become more vocal in moving people toward treatment and rehabilitation. “We added 10 new drug courts over the last year,” Varney said, adding there is also one statewide residential program in Morgan County that has diverted some of the most severely addicted from state prison and into the nine-month intensive program. The program, which is unique in the nation, is for men, but Varney hopes to have such a program for women, as well.
While many of the strategies aren’t ‘new,’ Varney said what sets “Prescription for Success” apart is the intensity, focus, and collaboration behind it. Key state agencies that have come together to address this problem include the Tennessee Department of Health, Department of Children’s Services, TennCare, Tennessee Bureau of Investigation, Tennessee Department of Safety and Homeland Security, Department of Correction, Tennessee National Guard, and the Tennessee branch of the U.S. Drug Enforcement Agency.
“We hope this document we’ve published will help keep us all focused and pointed in the same direction and have benchmarks to measure our success,” he concluded.
For additional details, go online to tn.gov/mental/prescriptionforsuccess.
How Big is the Problem in Tennessee?
There were 25 percent more controlled substances dispensed in Tennessee in 2012 than in 2010.
In March 2013, more than 2,000 people received prescriptions for opioids or benzodiazepines from four or more prescribers.
The number of emergency department visits for prescription drug poisoning has increased by approximately 40 percent from 2005 to 2010.
There has been a 220 percent increase in the number of drug overdose deaths from 1999 to 2012.
Young adults in Tennessee ages 18-25 are using prescription opioids at a 30 percent higher rate than the national average.
Drug-related crimes against property, people and society in Tennessee have increased by 33 percent from 2005 to 2012.
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