A new report from the National Safety Council lists Tennessee as one in just four states “making progress” in the fight against prescription drug abuse.
Tennessee meets five out of six positive indicators, according to the report, while 46 states were ranked as either failing or lagging behind.
The Tennessee Medical Association and other concerned stakeholders in and outside of the healthcare community have helped create rules requiring pain management education for prescribers, issued state-sanctioned opioid prescribing guidelines, and strengthened laws regulating pain clinics or pain management services.
We have made good progress and can point to some measurable results.
The Controlled Substance Monitoring Act of 2002 allowed the state to implement a database to monitor the dispensing of certain controlled substances. Data collection began in 2006 and subsequent laws in 2012 and 2016 have enhanced its capabilities.
In Tennessee, the Controlled Substance Monitoring Database has reduced the incidence of doctor shopping, the practice of visiting multiple doctors to obtain controlled prescription drugs, by 50 percent since 2011. It’s much harder now for addicted patients to fraudulently obtain prescriptions from a legitimate healthcare provider.
Data also shows a nearly 8 percent drop in the total amount of opioid prescriptions for pain, and a more than 14 percent decrease in Morphine Milligram Equivalents (MME) from 2012 to 2015. Among Tennesseans between the ages of 20 and 30, MME prescriptions have declined nearly 55 percent since 2011.
But we still have a lot of work to do.
As the number of prescriptions goes down, the number of overdose deaths continues to rise. The Department of Health reported that 1,263 Tennesseans died from overdoses in 2014, compared to 1,062 in 2011. That’s a 19 percent increase.
Leading physicians in the TMA have long advocated for increased funding for addiction treatment, which is sorely lacking across the state. Opioid addiction is a disease. Without appropriate medical intervention, our efforts are not enough to reverse and eventually end the epidemic.
The need for treatment is perhaps most vivid in the neonatal units of hospitals around our state, where, in 2014, more than 1,600 babies were born addicted to prescription drugs because their mothers abused drugs during pregnancy. According to the Department of Health, the number of babies born in Tennessee with Neonatal Abstinence Syndrome increased 285 percent in the most recent five-year period for which data is available.
We have to continue identifying, educating and even penalizing healthcare providers who are overprescribing, inadvertently or otherwise, and keep “pill mills,” clinics in operation solely to write prescriptions for controlled drugs, out of operation. The CSMD, along with stronger regulations for pain clinics and pain management services, has helped, but the more we can educate and monitor doctors, nurses and physician assistants on safe and proper prescribing, the better we will control the supply of opioids in our state.
Patients also play a role. According to the state’s “Prescription for Success” report, 71 percent of addicts said they get their drugs from a friend or relative, the practice of conversion. More than half the time they are simply given away for free. Government-run take back programs are a safe, convenient way to dispose of unused or unwanted drugs and avoid contributing to this growing statewide and national problem. Many local law enforcement agencies coordinate take back programs throughout the year.
We are making progress in the fight against prescription drug abuse, but we are far from winning. We must stay the course on the things that are working, fix or replace the methods that aren’t, and continue to look for new strategies to combat this public health plague.
Tennesseans’ lives depend on it.
Memphian Keith G. Anderson, MD, is president of the Tennessee Medical Association.