Tennessee: A State of Epidemic

Tennessee: A State of Epidemic

By A.J. Dugger III 03/06/14

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?

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CORRUPT DOCTORS AND PILL MILLS

Addiction specialist Dr. Corely Slovis of Nashville cites two major reasons for the dramatic increases. For one, the trust and naivete of some patients. "To them, the drugs are clean. It's pure. It's from the doctor. It's from the pharmacist. It's from the corner store," Slovis said. Second, there were and are physicians hungry for money and who simply don't care if their clients become addicts. Because of this, doctor shopping in which a person visits multiple doctors to get the same (or similar) medications is fairly common in Tennessee. "There are caring and honest physicians and nurse practitioners who are trying to do good by someone in pain,” Slovis said. “But the other group of health care practitioners are helping to abuse the system for their own personal profit.”

To many people, these doctors are professional drug dealers. “My brother overdosed on pain pills two years ago,” said Jessica Johnson, a single mother and accountant. “Thank God he survived. But to me it was amazing that he was able to doctor shop so easily. He knew exactly where to go to get a fix and these doctors were happy to oblige. They would over-prescribe and give him his drug of choice. This kind of stuff happens all the time but is somehow ignored by the public.”

A former Memphis music producer who goes by the stage name “Casper” became addicted to Lortabs in 2010. “It actually helped my creativity in the (recording) studio,” he explained. “I don't know why but it made my creative juices flow a lot better. My imagination would take over. Weed and Lortab...that was my niche. When I was on it, I wrote and produced some of the best music I ever did. Rap, jazz, you name it. When I helped a young lady write a country song I knew this stuff was working good!”

According to Casper, doctor shopping was easy at the time. “I don't think the doctors knew what I was doing,” he said. “I would get something prescribed from one doctor and get it filled. Then I'd go to another doctor and get the prescription filled somewhere else. I kept doing it and when my addiction got worse, I would say the stuff wasn't working and they'd give me more pills.”

Casper says he decided to make a change after waking up one morning in a park with no recollection of how he got there. “I saw where the addiction was heading,” he explained. “I like to be in control of my life and the decisions I make. The Lortab addiction hurt my marriage for a while, too. I went to rehab and with the grace of The Lord and the support of my family I made it through.”

Alix Michel, a Chattanooga lawyer who has made the epidemic a personal cause célèbre and frequently gives public talks about it, notes that he often speaks to doctors and pharmacists who either are somehow not aware of the problem and write scripts heedlessly or are simply indifferent to the epidemic reality. "With the number of deaths now being more than automobile accidents, there should be a similar type of training program in place for prescription drugs," Michel says. "As a doctor, you have to carefully tailor your treatment to the patient standing in front of you. No one really is immune to this epidemic."

Apart from corrupt doctors, serious attention has been focused on the dozen or so pain management clinics that were first shut down in Florida, then in Georgia, and then moved to northeast Tennessee in response to a high demand in the area. As one local newspaper reported: “Pill mills work by a patient walking into the clinic and saying they have pain. The doctors do not take patient history or conduct routine tests like MRIs. Everything is based off of what the patient says. The clinics will only accept cash or money orders and don’t accept insurance. Often there are no limits on how many pills they can get.
 
“‘Around here [in northeast Tennessee], a lot of people are getting the 180 [OxyContin] scripts a month,’ said an undercover officer who is not being identified due to the nature of his/her work. ‘It’s pain management, they are managing pain, they are planning on these people taking these pills for the rest of their lives. They are not trying to bring them down off of it, most of the time they are increasing it.’” 
 
The local paper also reported a high usage of Adderall by high school and college students, with students training each other in what to say to obtain Adderall. 

 

THE GOVERNMENT FINALLY STRIKES BACK

After the reported total of 1,062 overdoes deaths in 2011, the state government finally acted to confront the epidemic. In May 2012, Gov. Bill Haslam signed the Tennessee Prescription Safety Act that required all medical professionals to register with Tennessee's Controlled Substance Monitoring Database and check their patients' history of opiate or benzodiazepine drug use before prescribing pain medications. The law also mandated that dispensers and pharmacists update the database once a week instead of once a month. 

The Act further cracked down heavily on doctor shopping by establishing information sharing across state lines. This limits abusers from using multiple doctors and pharmacies in more than one state . The database also allows clinicians to identify patients who have abused drugs or have the potential to abuse them. Once identified, these patients can receive counseling. “Clinician-patient conversations are especially important among women of childbearing age,” said Reagan. 

Since April 1 of last year, nurse practitioners, physicians, dentists, oral surgeons, pharmacists and physicians' assistants have been required to use the database. Pharmacies began to participate just this past January.

"Less people will have access to drugs and more people will get treatment if we can stop it on the front end," explained Rodney Bragg, assistant commissioner for the Tennessee Department of Mental Health and Division of Alcohol and Drug Abuse Services.  

“Just as we check for allergies before giving a medication intended to help a patient, medical professionals now check the database to help prevent these powerful medications from causing harm,” is how Dreyzehner put it. “We believe this requirement for clinicians to use the database will improve patient safety, provide opportunities for counseling and referral to treatment to prevent misuse and abuse of prescription drugs, and help to prevent the use of drugs for non-intended purposes.” 

"There are many promising signs that we can turn this around - but it requires urgent action," said Jeffrey Levi, executive director of TFAH. 

Numerous other ideas are being floated or are in the works, among them requiring individuals to show a picture ID when picking up someone else's prescription. 

Doctors like Levi became more optimistic when Tennessee last year scored seven out of ten on a New Policy Report Card of promising strategies to help curb prescription drug abuse. In comparison with the other states in the calculations, Washington D.C. and 28 other states scored six or less, while Vermont and New Mexico scored the highest possible with a 10. South Dakota scored a two, the lowest of the participating states.

“I'm glad that they're working on things here in Tennessee,” said Johnson. “I'm glad that they're cracking down. My brother is doing better and I have a friend who is also in recovery. Tennessee was pretty embarrassing for a minute.”

 

 “Dependence or addiction to prescription medicines is a serious behavioral health condition, but it is also treatable,” said E. Douglas Varney, another commissioner of the Tennessee Department of Mental Health and Substance Abuse Services.

There are several places available for drug-addicted Tennesseans to get help. Residents can call the Tennessee REDLINE at 1-800-889-9789, or go online to www.taadas.org/Redline.htm to learn about treatment and recovery services available in your area.

A. J. Dugger lll is a journalist based in Clarksville, Tennessee. He recently published his first book, The Dealers: Then and Now.