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Conference Educates Providers on Opioid Options

They'd spent a full day learning about opioids from every angle: how to manage pain without them, how best to treat people who are addicted to them, how to tell when patients might have a problem with their use.

At the end of Friday's East Tennessee Opioid Conference at the Venue in Lenoir City, hosted by Metro Drug Coalition and underwritten by Cigna, more than 250 substance abuse disorder professionals, health providers and community members had a chance to ask questions of a panel of experts who'd presented that day.

One answer that brought resounding applause: Dr. Mark Browne's comment that Covenant Health, of which he's senior vice president and chief medical officer, is soon planning to pilot an "opiate-light" or "opiate-free" emergency room.

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Browne said the health system will likely put the new protocol in place in about 60 to 90 days in two pilot hospitals, possibly one urban and one more rural, though which hospitals will be pilots haven't been decided. Covenant Health has nine acute-care hospitals in the Knoxville area.

"We're just starting to talk to a group of physicians and get good clinical guidance so we can treat our patients' pain appropriately, but do it without opiates," Browne said.

He told the group — which included primary-care physicians, specialists and mid-level providers — that the hospital system is looking at other ways to manage pain in the emergency department, such as using IV analgesics, as well as implementing a "dramatic" 40 percent reduction in the amount of opioid prescriptions given after surgery.

Browne said other Tennessee hospitals have implemented similar measures, with the support of the Tennessee Hospital Association, and that physician and community reaction has been largely positive.

"We're not the first to try all this, so we do have some folks ... to give us some good ideas," Browne said.

Browne was on the conference's physician panel with Dr. James Choo of Pain Consultants of East Tennessee, who did a presentation on pain concepts and options for managing pain; Dr. Mark McGrail of Cherokee Health Systems, who presented on substance abuse disorder and screening, diagnosis and treatment; and psychologist Ted Jones of the Behavioral Medicine Institute, who talked about behavioral health aspects of pain and addiction.

In particular, McGrail, who noted that the number of patients illicitly using opioid drugs is still dwarfed by the number who binge-drink alcohol, said an estimated 10 percent of the more than 20 million people with a substance abuse disorder actually receive specialty addiction treatment.

"If we told people with breast cancer, only about 10 percent of you, we are going to treat, there would be a public uproar," McGrail said. "But we don’t get that same response for opioids."

In discussing how to identify patients at-risk for substance abuse disorder and use different types of screenings, McGrail advocated screening all patients, saying the risk of harm from screening is "minimal to none."

More: Tennessee ranks 43 in women's, children's health

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Former UT Vols quarterback Erik Ainge openly discusses his addiction issues March 23 at the East Tennessee Opioid Conference hosted by Metro Drug Coalition and Cigna at the Venue in Lenoir City. (Photo: News Sentinel staff)

Guest speaker Erik Ainge, a former UT Vols quarterback who was drafted by the New York Jets, talked about his own struggles with alcohol and other drugs and bipolar disorder, which he said began when he was 11 years old. By his senior year at UT, he said, he was addicted to opioid drugs.

Though he had physical pain, "it never made my body feel better; it made my mind feel better," Ainge said. "My drug of choice is anything that I can take in the moments where I don’t want to feel how I feel."

Ainge cautioned providers against buying into a "drug addict" stereotype, saying although personal responsibility plays a part, people who have fallen to addiction "are broken, and they need to be fixed."

Jones said patients can be both in pain and addicted to the medication — a situation drug companies deemed impossible when the newer classes of opioids were first marketed.

He also warned providers that those who have been sober for a period and relapse are more at risk of drug overdose death, since their tolerance is lower than the dose they were used to. They also might be more likely to buy drugs off of the street, which could be counterfeit pills containing the powerful opioid fentanyl, about 100 times stronger than morphine.

Earlier in the conference, on a community panel, Knox County Chief Medical Examiner Dr. Darinka Mileusnic-Polchan said deaths where autopsies showed fentanyl analogues more than doubled between 2016-2017. Preliminary drug-related deaths for Knox County for 2017 are 319, although some cases are still pending, she said, up from 224 in 2016.

Buying, borrowing or stealing someone else's prescription drug "is no longer a legal thing," Jones said. "It’s a life-and-death thing now."

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