TN communities devastated by pill popping search for answers

8:33 PM, Jul 26, 2013   |    comments
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By Tom Wilemon / The Tennessean

COOKEVILLE, TENN. - Tennessee's health commissioner whittled the data on prescription drug abuse down to the daily reality occurring in funeral homes and children's hospitals when he spoke Thursday at a conference on the state's pill problem.

"Today in Tennessee, about three people will die of drug overdoses. About two babies will be born that are drug-dependent," Dr. John Dreyzehner said.

About 90 representatives from communities throughout the state spent the day trying to figure out what to do about the problem. Most were from East Tennessee, once the land of "hillbilly heroin" until consumption spread. With maps of the state's counties, Dreyzehner showed the proliferation of high opioid prescription rates over a five-year span. A few embers lit up red, grew into hot zones and then turned the state scarlet.

By 2011, Tennessee had the second-highest per-capita use of controlled substances of any state in the nation. Dreyzehner attributed the increase to social acceptance of opioid use, saying that while prescription addiction is not communicable, it is in a sense "contagious," as people pick up the habit from others.

The state has enacted laws to better track and regulate distribution of the drugs. This week, the Department of Health sent letters to the 50 doctors who have prescribed the most narcotics, directing them to explain why they wound up at the top of the list.

But state officials cannot do the job alone. Conference attendees heard tips on community initiatives from people in counties where the epidemic began.

"The problem is in the community; the solution is in the community," Dreyzehner said.

Addicted babies

This year, 432 newborns in Tennessee - including 20 in Davidson County - have been diagnosed with neonatal abstinence syndrome, suffering withdrawal from their mothers' drugs.

Department of Children's Services Commissioner Jim Henry has called prescription drug abuse one of the agency's biggest challenges, accounting for an increasing number of reports of abuse and neglect of newborns and older children.

Last year, 41.2 percent of DCS investigations involved drug abuse, up nearly 60 percent from 2008. Over the past five years, there also has been a notable increase in children taken into state custody because of parental substance abuse, reaching a high of 31.9 percent in 2011.

Henry has instituted a new partnership with the Tennessee Bureau of Investigation to train DCS investigators on how to identify drug abuse in families they investigate.

Kristina Clark of the Coffee County Prevention Coalition said her community recognized it had a problem when prescription drugs accounted for 66 percent of school suspensions related to substance use. Parents initially thought their children were ordering drugs from the Internet but then faced up to the fact that the medicine was pilfered from their cabinets - and sometimes their barns. Her community began giving away free lock boxes for pain pills, anxiety drugs and animal tranquilizers.

Karen Pershing of the Metropolitan Drug Commission in Knox County said her organization did that and pitched in free drug testing equipment for hair samples.

Suicide risk

However much teenagers may be tempted to sample their parents' mood enhancers, prescription addiction is primarily an adult problem.

Pill popping is especially dangerous for the middle aged. Of the 1,062 Tennesseans who died of drug overdoses in 2011, the largest group was among people aged 45 to 54, followed by those aged 35 to 44.

Suicide also is a complication of prescription addiction, said Granger Brown, a substance abuse counselor with the Tennessee Suicide Prevention Network. People dependent on painkillers like hydrocodone are nine times more at risk for suicide, he said, while people addicted to anxiety drugs such as Valium or Xanax are 45 times more at risk.

Recent state laws to stem the epidemic include the Pain Clinic Act of 2011, which established tighter regulations for the facilities, and the Addison Sharp Prescription Regulatory Act of 2013, which limited the number of pills that can be prescribed at one time, expanded requirements for patient-specific drug monitoring and enacted tougher restrictions on pain clinics.

Prescribing narcotics

Dr. David Reagan, chief medical officer for the state Health Department, said new data indicate that doctors are becoming more careful about prescribing narcotics.

A survey conducted with 72 primary-care physicians in Putnam County revealed that doctors there really didn't understand the disease of addiction, said Bill Gibson with the Power of Putnam.

Seventy-six percent said they had received no training in addiction, and 34 percent checked off that they would prescribe opioids indefinitely for someone with chronic pain. However, on the bright side, 95 percent said they would refer patients to a chronic pain support group if one existed, Gibson said.

Neonatologists are increasingly becoming addiction experts, but experts still don't fully understand why some drug-exposed babies end up with neonatal abstinence syndrome while others don't. The percentage afflicted is a matter of debate, said Dr. Michael Warren, who heads family health and wellness for the state. Estimates range from 55 percent to 94 percent. Often it may take four to five days after birth for symptoms to appear, he said, and by then the baby has gone home from the hospital.

Another new state law, the Safe Harbor Act of 2013, protects women bearing drug-dependent newborns from criminal prosecution in some circumstances. The law is intended to encourage women to seek help.

This year, the Health Department made neonatal abstinence syndrome a reportable illness - a requirement that is typically limited to communicable diseases. Previously, the state could not track the problem effectively because the Health Department would receive a report nine to 18 months after a diagnosis. Now, doctors and hospital officials must report cases as soon as they are diagnosed.

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