The State of Addiction and Recovery Services in Tennessee September 25, 2018

Our Vision and Mission Vision Mission Goal To be the nation’s most innovative and proactive state behavioral health authority for Tennesseans dealing with mental health and substance abuse problems. Mission Provide, plan for, and promote a comprehensive array of quality prevention, early intervention, treatment, habilitation, and recovery support services for Tennesseans with mental illness and substance abuse issues. Goal To increase recovery pathways for Tennesseans with mental illness and substance use disorders by moving the needle on access to quality, effective and efficient services.

Our Approach To increase recovery pathways for Tennesseans with mental illness and substance use disorders by moving the needle on access to quality, effective and efficient services. Research Partnerships Innovation Practice

Tennessee: From Memphis to Mountain City Tennessee shares borders with many states. Interstates bisect the state. Tennessee’s geographic regions correspond to demographic differences in the three grand divisions of the state.

Tennessee: From Memphis to Mountain City Our statewide network of providers connects people living with addiction to pathways to recovery. Tennessee shares borders with many states. Interstates bisect the state. Tennessee’s geographic regions correspond to demographic differences in the three grand divisions of the state.

Prevalence of Substance Use Disorder (ALL AGES) in Tennessee 2017 Tennesseans, ages 12+: 393,000 were estimated to have a substance use disorder (6.86% of 5,721,780 Tennesseans, rounded to nearest 1,000) Sources: The Annie E. Casey Foundation, KIDS COUNT Data Center (2015-2016); National Survey on Drug Use and Health 2015-2016, 2016; CMHS Uniform Reporting System (URS) Output Tables 2017; U.S. Census population estimates for Tennessee 2016.

Prevalence of Substance Use Disorder in Tennessee Youth 2017 Tennesseans, youth age 12-17: 21,000 were estimated to have a substance abuse issue (4.04% of 513,298 youth, rounded to nearest 1,000) Sources: The Annie E. Casey Foundation, KIDS COUNT Data Center (2015-2016); National Survey on Drug Use and Health 2015-2016, 2016; CMHS Uniform Reporting System (URS) Output Tables 2017; U.S. Census population estimates for Tennessee 2016.

Prevalence of Substance Use Disorder Among Adults in Tennessee 2017 Tennesseans, ages 18 and older: 372,000 were estimated to have Substance Use Disorder (7.14% of 5,208,482 adults, rounded to nearest 1,000) 372,000 Substance Use Disorder Sources: National Survey on Drug Use and Health 2015-2016, 2016; CMHS Uniform Reporting System (URS) Output Tables 2017; U.S. Census population estimates for Tennessee 2016.

Seeing the Beauty of Recovery Video goes here Less than 1 minute

Change in State Appropriations During the Haslam Administration Total 339.2 313.3 307.1 315.6 317.3 328.4 337 375.1 380.2 253.3 260 212.5 222.9 205.9 204.4 190 194.5 194.9 Total Funding Increase: + $41 million or +12% | State funding Increase: + $70 million or +37% Total new federal grants $119,895,564 TDMHSAS Budget in Millions, rounded to nearest tenth Other funding includes revenue from services provided, interdepartmental sources, and other sources

Total Department Budget: $380,236,100 State Fiscal Year 2018-2019 $144.6 Mental Health Institutes 38% $260 State 68% $78.5 Federal 21% $41.7 Other 11% $380.2 Total $106.1 Community Mental Health 28% $106.2 Community Substance Abuse 28% $356.9 Total Services 94% In millions

FY19 State Cost Increases Focusing on Substance Abuse Substance Abuse Prevention and Treatment $9,250,000 Targeted Provider Rate Increase $6,000,000 Tennessee Recovery Navigators $750,000 Medication Assisted Treatment: Recovery Courts $1,000,000 Medication Assisted Treatment: County Jail Pilot $300,000

Federal Grant Funding During FY19 State Targeted Response to the Opioid Crisis Grants (Opioid STR) May 1, 2017 – April 30, 2019 $13.8 million x 2 grant years = $27.6 million State Opioid Response (SOR) $18.5 million x 2 grant years = $37 million Award just announced, working to operationalize

Innovation in Substance Abuse Services

Highlighted Examples of Substance Abuse Services Continuum Community Coalitions Media Campaign Tennessee Prevention Network Naloxone overdose prevention Redline referral Lifeline Peer Project Regional Overdose Prevention Specialists Prevention / Education Outpatient Residential Rehab & Halfway Houses Detox Medication Assisted Treatment Treatment Transitional Housing Oxford Houses Lifeline AA and NA meetings Certified Faith recovery communities TN Recover App Addiction Recovery DUI School Recovery Courts Criminal Justice Liaison Services Criminal Justice Diversion

Current Innovative Substance Abuse Activities at TDMHSAS Continued implementation of State Targeted Response grant Operationalizing State Opioid Response grant MAT Expansion Program Community-based efforts in 40 counties MAT for Recovery Court participants MAT County Jail Pilot Project Faith-based recovery forums Project Lifeline TN Recovery Navigators Public-Private Partnership

TDMHSAS Opioid State Targeted Response: $13.8 million x2 years Treatment services will reach up to 4,380 additional individuals Prevention: $2,480,090 Reduce Overdose deaths & Increase Treatment access Training for 900 professionals and stakeholders Overdose Rapid Response System Distribution of 7,420 naloxone kits to public 3,000 to law enforcement Medication assisted treatment Treatment for pregnant women Treatment and recovery services for individuals -10+ Regional Overdose Prevention Specialists -Naloxone Distribution -Overdose Response System -Pain Management Training -Media Campaign Treatment: $9,872,105 -Continuum of Treatment for Uninsured -Medication Assisted Treatment (MAT) -Tele-Treatment -Treatment for Pregnant Women Recovery: $1,000,000 -Addiction Recovery Program

TDMHSAS Prevention and Education on Opioid Misuse Blue: coalitions Dark blue: enhanced opioid coalitions Funded 44 substance abuse prevention coalitions; of those, 22 coalitions have an enhanced focus on opioid use prevention Funded 10+ regional overdose prevention specialists: Naloxone distribution, signs and symptoms of overdose Pain management Participated in the development of a Rapid Overdose Response System with: Tennessee Department of Health and Tennessee Bureau of Investigation Compiled substance abuse data from 9 state and community agencies through the State Epidemiological Outcomes Workgroup (SEOW) Provided over 39,000 Screening, Brief Intervention, and Referral to Treatment (SBIRT) from 2012 to 2016 in primary care settings

TDMHSAS Increased Screenings and Treatment Services Redline received more than 11,000 calls for treatment referrals in the last year Provided treatment to 23,059 individuals without insurance through TDMHSAS state and federal appropriations. Funded Medication Assisted Treatment (MAT) Expanded tele-treatment Expanded treatment for pregnant women

TDMHSAS Recovery Supports Oxford House: 399 beds Transitional Housing Pastoral/Spiritual Support Faith Communities AA & NA Meetings Lifeline Addiction Recovery Services Case Management Recovery Skills and Activities Employment Skills Relapse Prevention Spiritual Support Health and Wellness Transportation Addiction Recovery Program and Faith Based Initiatives 343 Recovery Congregations Sober Living Beds Certified 343 faith-based “Recovery Congregations / Organizations” Provided 2,466 Lifeline recovery trainings Referred 1,600 people to treatment Started 334 new recovery meetings

Specialized Courts 77 Recovery Courts operating in Tennessee 46 Adult (Including 2 Residential Recovery Court Programs) 6 Juvenile Recovery Courts 2 Family Recovery Courts 9 Veterans Treatment Courts 4 Designated DUI 9 Mental Health Courts 1 Human Trafficking Court

TN Recovery Oriented Compliance Strategy (ROCS) New for this fiscal year Serves the Lower Risk/High Need population Individuals who don’t meet recovery court criteria Release or Sentencing Option for the Court Judge can decide to impose Behavioral Health treatment recommendations as conditions of pre & post disposition release Piloting 5 TN-ROCS program sites in FY 2019 

Prevention Treatment Law Enforcement TN Together is the state’s comprehensive plan to address the ongoing opioid epidemic through three primary levers: Prevention Treatment Law Enforcement

TN Together Bill Signing: June 29, 2018 Video goes here

Department of Correction Re-Purposed 512 Beds at West Tennessee State Prison in Henning Currently, 359 of the 512 beds are filled with inmates receiving substance abuse treatment services An entire compound dedicated to treatment in an intensive, residential therapeutic community One-time 60 day sentence reduction credit TDOC policy revisions were effective July 1 Available to inmates upon successful completion of the 9-12 month intensive, residential therapeutic community Credit not available for 85% and 100% sentences and most sex offenses

Decreasing MMEs Dispensed 43% Decrease Source: Tennessee Department of Health

Prescribing Limits in Effect

Commission on Pain & Addiction Medicine Education 19 members, 5 months, 12 competencies Broad input while in draft form 20 of the 22 healthcare schools in TN have committed to adopt and implement

Tennessee Recovery Navigators Tri-Cities and Memphis already seeing patients 152 patients served between June 1 - August 15 Counties of Residence: Carter, Greene, Hardeman, Hamblen, Hawkins, Knox, Shelby, Sullivan, Unicoi, Washington

Public Private Partnership First of its kind cohort of non-profit and for-profit treatment providers, medication assisted treatment (MAT) providers, hospitals Developed and ranked areas of immediate impact Urgent admissions to addiction treatment providers Workforce strategy to address high-need positions Recovery housing for people in MAT regimens

TN Together Media Campaign Television: More than 27 Million total impressions 23.8M Impressions in Nashville TV Market 2M Impressions in Knoxville TV Market 1.6M Impressions in Tri-Cities TV Market Will add Memphis and Chattanooga markets by year’s end Statewide Digital: more than 14 M impressions Ads running statewide on websites and social media East & Middle TN Newspapers: 3.5 M impressions Statewide Radio: Titans Radio Network During Football Season Numbers through 8/31/18

Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has. - Margaret Mead Questions?