Tennessee has an opioid problem, and it’s been a long time in the making.
Numbers from the turn of the millennium show a total of 342 overdose deaths were recorded in Tennessee in 1999. Since then, that number has increased by 477 percent, to the point that 1,631 Tennesseans died from drug overdoses in 2016 — the highest number of such deaths recorded in state history. Paramedics are increasingly spending their time responding to overdoses, and coroners’ offices are running out of space.
Some regions of the state have been hit particularly hard, especially counties in East Tennessee.
In Knox County, from 2012 to 2016, there were 546 deaths that directly involved opioids. In 2015 — a year when there were more prescriptions in Tennessee than actual people — approximately 30 out of every 1,000 babies born in East Tennessee were diagnosed with Neonatal Abstinence Syndrome, a potentially fatal disease that causes drug-dependent newborns to tremble, wail inconsolably, clench their muscles and sometimes gasp for breath as they go through withdrawal.
Opioid withdrawal for adults can be an excruciating process. For newborns, who have no choice in ingesting a drug and have no other way to ask for help than to cry, it is an especially cruel introduction to the world, and bears potentially lasting effects on behavioral and cognitive development.
NAS is now so prevalent in the eastern counties of Tennessee that East Tennessee Children’s Hospital in Knox County has had to develop a new method of treating NAS babies, using small doses of morphine to help infants as they transition through a painful withdrawal process.
Just a couple hours away in the Tri-Cities region of Northeast Tennessee, Niswonger Children’s Hospital opened a new Neonatal Intensive Care Unit to care for the influx of babies suffering from NAS.
These numbers and this ongoing crisis are the result of opioid manufacturers choosing profit over people.
A number of companies have embarked on fraudulent marketing campaigns to convince physicians that these products create minimal risk of addiction, an irresponsible claim that has misled doctors and the public about the need for, and addictive native of, opioid drugs. Their actions have fueled an epidemic and led to the diversion of these substances to the illegal drug market, creating an environment for thousands of individuals in Tennessee to become addicted.
This is a concern that affects all Tennesseans, particularly from a financial perspective. City and county budgets are straining under ever-increasing costs, including the expenses of medical treatment, rehabilitation, and increased law enforcement and incarceration services, among others.
In recent months, various government bodies throughout the U.S. have pursued litigation in an effort to hold opioid manufacturers responsible for their actions. Although this is a necessary, important step in the right direction, it is only one part of a multi-faceted approach that is required to combat the ongoing crisis. It will take work at the national, state and local levels to adequately address the most vulnerable victims of this epidemic — newborns suffering from NAS.
These babies deserve to be protected, regardless of whether the drugs their mothers took were illicit or prescribed. Local and state governments must lead efforts to ensure NAS infants receive high-quality, cost-effective care and are ultimately discharged to a safe home environment.
To address the opioid crisis fully, steps need to be taken on both the supply and demand side of the issue. To reduce the supply of opioids, physicians need to be retrained on how they treat patients with chronic pain. As Dr. Michael Baron of the Tennessee Board of Medical Examiners recently explained, an entire generation of physicians was told that the risk of addiction to opioids was “rare” and that opioid therapy could be easily discontinued.
We now know that neither of those statements is true, which means a change in prescribing practices is needed. States also need stricter enforcement of prescription drug monitoring programs, which aim to prevent opioid abuse and diversion of opioids into the illegal drug market.
To make this happen, legislation should be enacted requiring prescribers and dispensers to report all written and filled opioid prescriptions to their states’ PDMP. Doing so means that physicians will have to consult with their state’s PDMP before prescribing an opioid, and the state will be required to notify a physician when the PDMP reveals a patient demonstrating a pattern of opioid abuse or there is a likelihood of diversion.
Legislators should also support efforts to expand the sharing of prescription drug data between states, which would cut down on “doctor shopping” across state lines.
Reducing the demand for opioids is a complex issue that requires a communitywide effort. States and communities will succeed in addressing the issue only if they have policies and programs that prevent individuals from becoming dependent on opioids in the first place (such as increased behavioral health services), while adequately supporting the recovery of those who are already addicted.
Legislation should focus on establishing a comprehensive program that includes new treatment facilities for opioid addicts who are not receiving care, advice and assistance for accessing treatment, and further data collection to identify patterns of addiction.
And, until the demand for opioids is greatly reduced, federal and state resources are needed to increase the availability of naloxone to first responders and law enforcement, providing a fast-acting treatment for someone who has overdosed on opioids.
The opioid epidemic reaches into every corner of Tennessee, negatively affecting our neighbors, friends, co-workers and children. If we have any hope of reversing its damaging effects, immediate legal, medical, legislative, behavioral and educational changes are needed.
We have already lost one generation to the opioid epidemic. We can’t afford to lose another.
(About the writer and the lawsuit: J. Gerard Stranch IV is managing partner of Branstetter, Stranch & Jennings, PLLC, a Nashville-based law firm that’s filed two separate lawsuits this year against Purdue Pharma and additional pharmaceutical companies on behalf of eight district attorneys general in Tennessee. Together, the suits include three additional plaintiffs, known collectively as Baby Doe by and through their Guardians Ad Litem. The complaints demand judgment against the defendants for damages resulting from breaches of statutory and common law, seek to award restitution to the plaintiffs, and request an injunction to stop the flood of opioids to the region. The first complaint was filed in June in Sullivan County Circuit Court in Kingsport, and the second was filed in Campbell County Circuit Court in Jacksboro. For continuing information on Tennessee’s opioid epidemic and these suits, visit www.tnbabydoe.com.)