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The Opioid Crisis Outgrows Policies on Treatment

The opioid epidemic has had a staggering impact in Tennessee: countless loved ones gone, higher health care costs, more drug-related crime, reduced work productivity, more children in state custody and a 10-fold increase in babies born with symptoms of opioid withdrawal.

To date, Tennessee’s response has largely focused on curbing the abuse of prescription painkillers. In 2012, we had an average of 1.4 opioid prescriptions for every Tennessean — the second highest rate in the country. Among other steps, Tennessee now requires greater use of its controlled substance monitoring database, regulates pain management clinics, and has issued guidelines for prescribers.

These changes have significantly reduced the amount and potency of opioid prescriptions in the state. The number of Tennesseans who report misusing prescription pain relievers has also fallen by nearly a quarter.

But evidence suggests that Tennesseans are increasingly turning to heroin and fentanyl. Fentanyl is a synthetic opioid 50 times stronger than heroin. Opioidrelated hospitalizations, overdose deaths and cases of neonatal abstinence syndrome also continue to rise. An average of 97 Tennesseans died from opioid or heroinrelated overdoses every month in 2015, according to official data.

At least part of reversing these trends lies in understanding and addressing a root cause of the opioid epidemic — addiction. Like asthma and diabetes, addiction is a chronic, relapsing disease that requires long-term care and management. The key difference is that addiction is an illness of the brain.

Research has shown that effectively addressing behavioral health issues like addiction involves four basic elements: promote health and well-being, prevent substance abuse, provide treatment and foster recovery.

Tennessee has programs and policies that fall into each of those four categories. The lion’s share of new funding has gone to treatment and recovery services, which the federal government recently awarded Tennessee $13.8 million to expand.

Even with these additional resources, Tennessee’s capacity for treating opioid addiction is less than demand and out of sync with the geography of the epidemic.

Medication-assisted treatment, or MAT, a combination of therapy and addiction medications, is considered most effective, but some counties with high rates of opioid overdose deaths do not have a single MAT provider. Physicians certified for buprenorphine treatment are more common, but fewer than half of all opioid-dependent Tennesseans had ready access to one in 2015, according to the Pew Charitable Trusts.

Tennessee’s treatment capacity and individuals’ access to treatment are also influenced by the coverage and payment practices of private insurers, Tenn-Care and safety net programs for the uninsured. For example, low payment rates for addiction services could make providers less likely to enter this field.

Gov. Bill Haslam and the General Assembly may want to look at emerging and best practices being pursued by other states, localities, or at the national level.

A comprehensive review of existing and potential steps that involves multiple stakeholders, including the public and private entities that pay for prevention and treatment, could help policymakers determine the best path forward.

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