Tennessee: A State of Epidemic
Tennessee ranks second per capita in the U.S. for prescription drug abuse. It’s a middle class epidemic. How did it happen in a state known for music and horses?
Editor's Note: This is the first in a Fix series looking at drug addiction issues in states and localities across the country.
Ask yourself what Tennessee is best known for and you will likely come up with Nashville and Graceland and then maybe mention Miley Cyrus, Dolly Parton, Davy Crockett - and horses galore. All happy stuff.
Then there is this: the state’s growing reputation as the home to a virtual epidemic of prescription drug abuse.
According to the Tennessee Medical Association, the Volunteer state (so named for the bravery of its troops in the War of 1812 and memorialized by the fact that a great many of its people sign up to go to war) ranks second per capita in the country for prescription drug abuse (first is West Virginia). It also has the eighth highest drug overdose mortality rate in the U.S. As Tommy Farmer, assistant special agent in charge of the Tennessee Bureau of Investigation, put it: “We’re in jeopardy of losing an entire generation of our youth to addiction if we don’t get a grip on this."
Then there's this disheartening information from David Reagan, chief medical officer of the Tennessee Department of Health: “We unfortunately have a national epidemic of babies being born dependent on legal or illegal drugs their mothers ingested during pregnancy. At birth, the baby is cut off from the drug and goes through a painful process of withdrawal. The condition is known as Neonatal Abstinence Syndrome or NAS, and it is painful for the baby and costly to society.”
“At the current rate this epidemic is progressing, we are projecting more than 800 drug-dependent newborns by the end of this year,” Dr. John Dreyzehner, the commissioner for the Tennessee Department of Health, said late last year. In 2011 there were 629, which startled much of Tennessee. Moreover, 35% of 142 pregnant women that were admitted to state-funded treatment services in Tennessee said prescription pain killers were their primary substance of abuse.
The number of prescription drug-related deaths in Tennessee is alarming. The overdose mortality rate in Tennessee is 16.9 deaths per 100,000 – in 1999 it was 6.1 per 100,000 - according to a 2013 report written by Trust for America's Health (TFAH) called “Prescription Drug Abuse: Strategies to Stop the Epidemic.” The national rate is 12.7. Around Tennessee you frequently hear this bit of state trivia: more people have died from accidental prescription drug overdoses than auto accidents in recent years.
Among the contributing factors is that Tennessee residents simply seem to need or trust meds more than most others - Tennessee currently ranks among the top three states for the number of prescriptions written per capita, with almost 18 a year for every person in the state. In this "I need my painkillers" and addictive climate, sales of two of the most popular prescription painkillers, oxycodone and hydrocodone, both addictive, soared. Oxycodone sales increased more than 500% from 2000 to 2010, while hydrocodone increased nearly 300%, both accounting for a significant portion of the epidemic.
Another driving force behind the epidemic was that before April 1, 2013, doctor and pharmacy reporting to most drug monitoring databases was voluntary, not mandatory. This was the perfect setup for easily obtaining - and cavalierly writing - scripts; perfect, in fact, for cheating.
Common belief is that addicts get their drugs from dealers or steal them. In reality, those who can do so get scripts. Those with less access to doctors, according to the Center for Disease Control, tend to obtain their drugs from friends or relatives; only an estimated 16% are bought from dealers.
In Tennessee, friends and relatives have an easy time becoming enablers because huge amounts pass through the state. A controlled substance database report presented to the Tennessee General Assembly in 2012 stated that in 2011, 275 million hydrocodone pills were dispensed in Tennessee, 117 million Xanax pills and 113 million oxycodone pills. That adds up to 22 Xanax pills, 51 hydrocodone pills and 21 oxycodone pills for every Tennessee resident over 12 years old.
As elsewhere, addictive prescription drugs in Tennessee do not discriminate by gender, race, or social standing - except in a reverse way. In Tennessee, people who are educated, married or successful with their careers are three times more likely to use prescription drugs than others and thus to find themselves addicted, according to the state Division of Alcohol and Drug Abuse Services.
“People don’t feel as if they are abusing drugs that were prescribed by a doctor,” explains Randy Jessee, senior vice president for Specialty Service at Frontier Health, the state’s largest chain of counseling and mental health centers. “It is also a part of a culture that says taking pills for an ailment is the right way to fix your problems."
Creating addiction-extending circumstance is the reality that more women become addicted than men, and then more men tend to seek treatment than women.
According to Jessee, the epidemic began in eastern Kentucky and spread to southwest Virginia before bleeding over to northern Tennessee. “It started in 1998 and by the year 2000, we had serious issues." Hyrocodone (the key ingredient in Lortab, Norco and Vicodin) and OxyContin, he notes, got a boost when they were marketed as non-addictive when first introduced during the 1990s. Then people started crushing the pills and snorting or injecting the drug, giving the user an instant and long-lasting high. In 2010, Tennessee’s per capita spending on prescription addictive drugs grew by 7.2 % to $1,272.94.