1. Opioid Addiction in Tennessee
State of Tennessee House of Representatives Task Force on Opioid Abuse
February 23, 2017
Rodney Bragg, Assistant Commissioner for Substance Abuse Services
Stephen Loyd, M.D., Medical Director for Substance Abuse Services

2. Addiction is a Disease, Not a Moral Failure
The Science of Addiction

3. Addiction is a Disease, Not a Moral Failure

4. Addiction is a Disease, Not a Moral Failure
Hi-Jacking of the Limbic (Reward) System

5. Addiction is a Disease, Not a Moral Failure
Brain Healing Takes Time

6. Addiction is a Disease, Not a Moral Failure
Source: Surgeon General’s Special Report: Facing Addiction in America Chapter 2

7. How Did We Get Here?
Decade of chronic pain epidemic (1990s); Joint Commission “Pain as the 5th vital sign”
Marketing of opioids as having a low addictive potential when used for the treatment of chronic pain
Result: Opioids prescribed more freely by practitioners
Tennessee Impact:
Increase in doctor shopping
Increase in morphine milligram equivalents (MMEs) prescribed
Increase in prescriptions dispensed
Increase in number of people seeking treatment for opioid use disorder
Increase in improper prescribing (pill mills)
Increase in number of people in the criminal justice system for drug-related offenses
Increase in number of babies born drug dependent
Increase in overdose deaths

8. Tennessee’s Response to the Opioid Epidemic

9. How Many Tennesseans are Affected?
In Tennessee, it is estimated that
69,100 individuals are addicted to
prescription opioids and
require treatment for
prescription opioid abuse.
Another 151,900 Tennesseans
are using prescription opioids
in ways that could be harmful,
and they may benefit from
early intervention strategies.
Source: National Survey on Drug Use and Health

10. Prescription for Success – Summer 2014
Tennessee’s Response
Prescription for Success – Summer 2014
7 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 to and quality of early intervention, treatment, and recovery services
Expand collaborations and coordination among state agencies
Expand collaborations and coordination with other states

11. Tennessee’s Response Successes:
Funded 10 additional anti-drug coalitions for a total of 43.
Increased prevention efforts by reaching 6 million Tennesseans through the Take Only as Directed advertising campaign.
Decreased prescription opioid seizures, crimes, and arrestees.
Source: Tennessee Department of Mental Health and Substance Abuse Services
Tennessee Bureau of Investigation

12. Tennessee’s Response Successes:
Decreased opioid prescriptions by 1.1 billion morphine milligram equivalents (MMEs).
Amount of morphine milligram equivalents (MMEs)1 dispensed to Tennessee patients (in millions) and reported to the Controlled Substance Monitoring Database:
Source: Tennessee Department of Health

13. 221 Tennessee’s Response 106 36 Successes:
Increased the number of permanent drug collection boxes from 36 boxes in 2012 to 221 boxes in 2017 – all 95 counties are covered.
Source: Tennessee Department of Mental Health and Substance Abuse Services and
Tennessee Department of Environment and Conservation 36
Collection boxes January 2012
106
Collection boxes
December 2014
221
Collection boxes June 30, 2016

14. Tennessee’s Response Successes:
Increased funding for a total of 54 recovery drug courts
Increased recovery drug court enrollees from 1,405 in 2013 to 4,884 in 2016 – an increase of 248%
Certified 180 faith-based “Recovery Congregations/Organizations”
Increased funding to expand the number of Oxford Houses – sober living environments – from 6 in 2013 to 50 in 2016 with a capacity of 298 beds
Source: Tennessee Department of Mental Health and Substance Abuse Services

15. Tennessee’s Response Successes:
Conducted 2,466 Lifeline recovery trainings, established 290 new recovery meetings, and referred 1,002 people to treatment
Recovery group meetings established by Lifeline: September 2013-July 2016
Source: Tennessee Department of Mental Health and Substance Abuse Services
290
Sep 2013 to Jun 2016
172
Sep 2013 to Jun 2015 61
Sep 2013 to Jun 2014

16. Tennessee’s Response Successes:
Conducted over 39,000 Screening, Brief, Intervention, and Referral to Treatment (SBIRT) from 2012 to 2016 in primary care settings
In FY 2016, served 12,191 individuals in state-funded clinical treatment services
Source: Tennessee Department of Mental Health and Substance Abuse Services
Substance Abuse Prevention and Treatment Block Grant FY Annual Report

17. Tennessee’s Response The Tennessee General Assembly:
Passed the Prescription Safety Acts of 2012 and 2016 requiring:
Provider education on proper prescribing
Query of the Controlled Substances Monitoring Database (CSMD)
Reporting to the CSMD
Repealed the Intractable Pain Act in 2015
Passed the Addiction Treatment Act of 2015, which includes a Good Samaritan Law assuring people helping others are not charged with a crime.
Passed the Ensuring Patient Access to Pharmacy Drug Disposal Programs Act of 2015, allowing pharmacies to participate in drug collection programs.
Passed legislation establishing regulations for Pain Clinics and Office-Based Opioid Treatment Clinics

18. Tennessee’s Response Other General Assembly Actions:
Funding for Lifeline Program
Funding additional Recovery Drug Courts
Increased funding for naloxone programs

19. Additional Outcomes

20. substance use disorder.
Promising Trends Show a Decrease in Tennessee Adolescent Substance Abuse
Substance use declined among Tennessee youth from to
Illicit drug use dropped from 6% to 3%
Alcohol use declined from 14% to 10%
Misuse of pain relievers dropped from 9% to 5%
Cigarette use declined from 13% to 7%
The later in life a person waits to use substances, the less likely the person is to develop a
substance use disorder.
Source: Tennessee Department of Mental Health and Substance Abuse Services, Strategic
Prevention Framework and Substance Abuse and Mental Health Services Administration
American Society of Addiction Medicine

21. What Tennessee is Doing Works
Includes Tennessee
Tennessee has mandatory prescriber education, opioid prescribing guidelines, pain clinic and office-based opioid treatment regulation, a controlled substance monitoring database, and access to naloxone.
But, we need more funding to meet the need.
Source: National Safety Council Report Card, 2016

22. Disturbing Trend – Increase in Heroin Use
Heroin rates are highest
in urban areas
Source: Tennessee Bureau of Investigation (TBI) CJIS Support Center,

23. Disturbing Trend – Fentanyl Can You Tell the Difference?

24. The Substance Abuse Treatment Gap
Due to a Lack of Funding, Most People in Need of
Substance Abuse Treatment Do Not Receive It
Source: Centers for Disease Control and Prevention and National Survey on Drug Use and Health

25. Potential New Resources

26. Potential New Resources
21st Century Cures Act
Tennessee is likely to receive $13.8 million per year for 2 years for a total of $27.6 million
If received, treatment services that will be funded include:
Continuum of Care Treatment Services
Treatment for Pregnant Women
Tele-treatment in Rural Tennessee Counties
Medication Assisted Treatment
Recovery Support Services
This treatment funding will serve an additional 5,038 – 10,534 Tennesseans based on types of services provided.
Other services funded will include:
Naloxone Training and Distribution
Regional Overdose Prevention Specialists
Media Campaign

27. Potential New Resources
Governor Haslam’s Recommended FY 2018 Budget
$6 million, new recurring state dollars, to expand substance abuse treatment services
This expansion will serve an additional 1,565 – 4,380 Tennesseans yearly based on the type of services provided
“In Tennessee, we know what works.
We have providers standing by ready and able to do what works.
Our gap is in funding.”
Marie Williams
Commissioner
Department of Mental Health and Substance Abuse Services

28. Questions and Comments

29. For More Information
Rodney Bragg Assistant Commissioner Stephen Loyd, MD Medical Director for Substance Abuse Services