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Tennessee's Plans to Battle Opioid Abuse: Nurses in Recovery, Naloxone Kits

The state’s new weapons to fight the opioid addiction epidemic might be nurses who have been addicts themselves, and naloxone kits in the hands of those most likely to overdose.

Oh, and $13.8 million from the Sen. Lamar Alexander-led 21st Century Cures Act.

The Tennessee Department of Mental Health and Substance Abuse is counting on its piece of the 21st Century Cures money to come through as early as this month. If the Tennessee legislature also passes Gov.

Bill Haslam’s proposed budget, which includes $6 million for substance abuse services, the department expects to be in an even better position to make a dent in the problem.

The federal government anticipates the $13.8 million from 21st Century Cures, spread out over two years, “moving along pretty quickly, because we are in a crisis,” said Rodney Bragg, assistant commissioner of substance abuse services for the state.

Nearly 20 percent of the money is designated for “prevention,” which could include providing naloxone kits to people at high risk for overdose, said Sarah Cooper, director of prevention and early intervention services for the TDMHSA. If given in time, the drug can reverse opioid overdose.

The department is planning a statewide media campaign, heavily using social media and well-known figures, such as Titans football players, to widen awareness of the epidemic and resources for help.

And it’s in the “development stages” of a plan to put in different regions throughout the state nurses who are themselves in addiction recovery.

“We really feel as though a nurse who has experienced issues with substance use disorders would have an intimate knowledge of recovery and success,” Cooper said.

The nurses would not provide direct patient care or case management, but would train individuals and community organizations on the use of naloxone to reverse drug overdoses; hold educational events on topics like guidelines for prescribing opioids or treatment methods; and dispense “safety kits” and educational materials, including lists of treatment resources.

Cooper said the 10 full-time positions would be spread throughout the state’s regions, though some coalitions could request two part-time positions instead. She also said peer recovery specialists could be used in place of nurses in some regions, if nurses who have gone through recovery aren’t available.

The grant could also be used to expand treatment — both traditional outpatient therapy and medication-assisted treatment with buprenorphine/suboxone and naltrexone, which is marketed as Vivitrol in long-acting shot form. Cooper said there should be more openings for uninsured or underinsured patients, and said the state plans to use telemedicine so providers in one region can treat patients in more rural areas.

“We hope to fund additional recovery support, spiritual support, case management, recovery skills training, things like that,” Cooper said. “What we believe, very strongly, is the longer we keep a person engaged, the better success rate they will have.”

Bragg said his department and the state Department of Health are creating a “rapid response system” for immediately reporting overdoses instead of waiting the typical two years for a report to come out. That would let nurses in a region identify a pattern — such as a spate of overdoses related to a batch of counterfeit drugs coming into an area, or an outbreak of hepatitis C — and respond immediately to head off a larger problem.

“We can actually see it in live time, and they can be boots on the ground,” Cooper said.

While President Donald Trump’s proposed 2018 budget requests $69 billion for the Department of Health and Human Services, a funding cut of nearly 18 percent compared with 2017, it “includes additional funds for program integrity and implementing the 21st Century CURES Act,” funded at $1.1 billion, Trump's budget said. The law is funded in part by the sale of 25 million barrels of crude oil from the Strategic Petroleum Reserve.

Bragg said that with the state working with different coalitions, resources could go to some communities as early as July.

“We feel like we’re prepared enough to begin within two months — or less,” well ahead of the federal mandate to start services within four months of receiving grant money, Cooper said.

“Prevention works, treatment is effective, and recovery happens,” Bragg said. “If that’s a message we can get out to the community, I think a lot of people who are really struggling — that can give them some hope.”

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