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VOL. 41 | NO. 37 | Friday, September 15, 2017

Opioid committee on right track, obstacles remain

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Smyrna Police Chief Kevin Arnold can remember the first time his detectives brought a heroin case to him three or four years ago.

“Of course, my reaction immediately was, ‘I thought that went away in the late 70s.’ But we’re seeing it. In fact, we are averaging approximately five heroin overdoses a month just in the town of Smyrna,” adds Arnold, whose city about 10 miles southeast of Nashville has a population of nearly 48,600.

If Smyrna is experiencing that number of drug overdoses as a suburb, the problem clearly is worse in Nashville, Knoxville and Memphis, he adds. But Arnold concedes Tennessee’s rural areas are facing an opioid crisis, as well, with thousands of people dying annually statewide.

“My mother lives in Livingston, and it seems like every time I call home I’m getting a report on someone I went to school with whose kid has either died from an overdose or is in some type of rehab,” Arnold says.

But while the law enforcement community is prepared to work with the Legislature to quell this scourge on the state of Tennessee, Arnold says throwing people in jail isn’t the answer.

Recommendations by an Ad Hoc Task Force on Opioid Abuse approach the problem from several directions, Arnold points out, including treatment, which is a crucial part of any solution because putting people in jail for a few days and then sending them back out into the world is “not going to treat the problem.”

As with most things, though, Arnold acknowledges many of the answers revolve around money.

The proposal

House Speaker Beth Harwell says treatment expansion and funding will be “a priority” for the group of lawmakers who serve on the task force she appointed, and she says she hopes Gov. Bill Haslam will make it a key point in his budget. If not, she says she believes the General Assembly will put money in the budget to provide more treatment statewide.

“This is an ongoing battle, and it does not end here today,” Harwell adds as the task force is wrapping up the crux of its work.

The House speaker, who is running for governor but not stepping away from the Legislature in 2018, even thanked and commended the media for covering the epidemic, somewhat of a rarity.

“Thankfully, this issue is getting the attention necessary for us to take these serious actions. I look forward to continue hearing from those interested in this issue and working with the General Assembly next year,” she says.

In fact, the first item on the task force’s list of recommendations for treatment puts the governor on notice that the House of Representatives wants to see a fiscal 2019 budget bolstering nonprofit, faith-based and local government programs for screening, assessment, detoxification, family intervention, residential rehab, recovery houses, day treatment and outpatient services.

It also calls for setting up pilot recovery schools in each grand division, expanding participation in recovery courts, distributing Naloxone to law enforcement to treat overdoses in “high-risk” areas and expanding Naltrexone grant programs for state prison and county jail inmates addicted to opioids.

In addition, it directs state departments to come up with a model for the distribution of Naltrexone, a medication designed to stop opioid activity.

From a policy standpoint, it calls for adding 25 Tennessee Bureau of Investigation agents to fight the opioid epidemic. That fiscal item alone could cost a few million dollars.

“We have not expanded their resources significantly, and yet this plague, this opioid epidemic, has hit our state and it is critical that we have more agents on the ground,” says state Rep. William Lamberth, chairman of the House Criminal Justice Committee and a former assistant district attorney.

The more resources TBI and local law enforcement agencies have to track down opioid drug dealers and curb illicit Fentanyl distribution, the more deaths will be diverted, says Lamberth, a Sumner County Republican.

Rep. Bryan Terry, a Murfreesboro Republican and anesthesiologist, says Fentanyl is a great anesthetic, one he uses daily in the operating room.

He also uses Sufentanil regularly on patients, but he knows the dangers and points out Fentanyl is a hundred times stronger than morphine while Sufentanil is a thousand times stronger than morphine. In comparison, heroin is only five times stronger than morphine, he explains.

It’s little wonder anyone who’s used heroin and then tries to graduate to Fentanyl or Sufentanil is going to wind up dead.

Toward that end, Terry and state Sen. Steve Dickerson, a Nashville anesthesiologist, are sponsoring legislation in 2018 to cut into the illegal manufacture of Fentanyl and its analogues, substances in which an illicit drug maker adds a chemical or two in an effort to circumvent the law.

Calling the panel’s recommendations a “starting point,” Terry notes all the players will have to acclimate themselves to the plan.

Part of that involves figuring out how much this will cost.

Harwell admits she can’t put a figure on it yet but says task force members will work with the Fiscal Review Committee to target how much will be needed in the budget.

However, according to Rep. Cameron Sexton, the Comptroller’s Office put a number – $1 billion – on the amount of money Tennessee is spending on opioid-related matters, ranging from incarcerating people to taking care of children, dealing with mental health problems or medical treatment through TennCare.

“You add all that together on this problem, and the amount of money it’s costing Tennessee, and we can either fund this on the front end and save money and save lives or we can continue spending a billion dollars on Department of Corrections and everywhere else and just watch the numbers explode,” says Sexton, a Crossville Republican.

Tweaking policy

Just two years after repealing the Intractable Pain Act of 2001, generally considered a boon to the pill industry, the Legislature will consider several new task force policy proposals, such as limiting emergency rooms to prescribing Schedule II pain medication for only 10 days, prohibiting pain clinics from treating walk-in patients by requiring referrals from an independent health-care provider and encouraging electronic prescriptions of Schedule II drugs.

Of course, no list of government proposals would be complete without calling for a creation of a panel, in this case the Tennessee Commission to Combat Drug Abuse, to meet quarterly and review programs and trends and make suggestions to the governor and Legislature.

Nor would things run as normal without someone throwing a bit of a monkey wrench into the proceedings.

State Sen. Jeff Yarbro did just that when he filed a resolution authorizing the governor to expand Medicaid to deal with the opioid crisis.

“We can have task forces and action plans for decades without making the difference we need,” says Yarbro, a Nashville Democrat.

“But it will be next to impossible to solve this problem if people don’t have access to medical care to get treatment, address behavioral health, and treat the underlying health issues that often lead to opiate use in the first place.”

A serious approach to the opioid crisis is “impossible” without expanding Medicaid, he explains.

Yarbro’s resolution cites expansion in Kentucky, Ohio and West Virginia, where Medicaid pays for 35 to 50 percent of medication-assisted addiction treatment. Getting back to the Insure Tennessee argument, Yarbro points out Tennessee has foregone $3.3 billion by refusing to expand Medicaid.

Crux of the problem

While finding money is always a stumbling block, the bigger problem will be stopping people from getting hooked on opiates in the first place.

People have been tapping into poppies since time began to get high, and setting up a state commission to crack down on drug abuse probably won’t stop this age-old urge.

And when physicians prescribe 30 pills for a minor surgical procedure, it’s easy for people to get used to that warm, fuzzy feeling in a matter of days.

Nevertheless, prevention will involve setting up a public awareness campaign to educate people about the dangers of opioids, accompanied by an effort to seek sponsorship from the pharmaceutical industry. If the Legislature and governor can pull money out of those guys, it could be the single biggest accomplishment of this effort.

After all, they’re the ones making the drugs and peddling them to doctors, all at a huge cost to consumers, financially and physically.

The prevention campaign is supposed to include the acknowledgement – finally an effort to “reduce the stigma” – that addiction is a treatable disease.

Information on drug hotlines, disposal sites, the danger of use by pregnant women, how to acquire and administer Naloxone and modern pain management options are among the proposals.

The state Board of Education also will be asked to create lesson plans about opioids and drug use to “promote the benefits of a sober, healthy lifestyle.”

Legislation could come along, too, limiting the number of days an opioid pain pill can be prescribed, possibly to 10 days, and if a second refill is requested, the patient would be required to tell the doctor how well it’s working.

The insurance company would get involved if a third prescription is written, and a long list of requirements would have to be met regarding the cause of pain, alternative treatments, pregnancy status, counseling, etc.

The analysis

Believe it or not, a lot of the recommendations make sense. The question is whether the Legislature can get doctors and drug makers to agree to the problem and the solutions.

Education will only work if the state puts together realistic messages for young people. Most middle-age folks remember those elementary school films showing people ready to jump out of windows after smoking a joint. They never said anything about Cheetos.

Those old films might have been right if they’d been talking about Oxycontin or Oxycodone, heroin or Fentanyl and Sufentanil. Somehow, they’ve got to convince people the plunge will be more like 6 feet to the bottom of a grave. Otherwise, people such as Smyrna Police Chief Arnold will keep counting the victims.

Sam Stockard is a Nashville-based reporter covering the Legislature for the Nashville Ledger, Knoxville Ledger, Hamilton County Herald and Memphis Daily News. He can be reached at sstockard44@gmail.com.