Tennessee Faces an Opioids Crisis. Here's How the Candidates for Governor Plan to Tackle It.
Tennessee’s top-tier gubernatorial candidates all agree the ongoing opioid epidemic is among the most critical issues facing the Volunteer State.
But, for the most part, that’s where their commonalities end.
U.S. Rep. Diane Black, who believes in the value of the overdose-reversal drug naloxone, is skeptical about making it widely available in public. Overwhelming evidence indicates it prevents deaths and top health officials recommend it be almost ubiquitous as fire extinguishers.
Williamson County businessman Bill Lee thinks making the penalties for drug trafficking stiffer will stop dangerous drugs like fentanyl from entering Tennessee. He also thinks the government alone can’t solve the opioid crisis.
House Speaker Beth Harwell emphasized education and prevention, citing the efforts of the current Miss Tennessee title-holder in criss-crossing the state to educating children about the dangers of drug addiction.
Knoxville entrepreneur Randy Boyd, who has a multi-faceted plan to address the opioid crisis, thinks Tylenol can often “do the same thing if not better” than prescription pain-killers.
House Minority Leader Craig Fitzhugh says expanding Medicaid will help solve the opioid crisis.
And former Nashville Mayor Karl Dean thinks the legislature and Gov. Bill Haslam should be applauded for their most recent actions on the issue, but more needs to be done.
The top four Republicans and two Democrats, respectively, outlined their individual plans to address the opioid crisiswith the USA TODAY NETWORK - Tennessee.
Tennessee ranks second in the nation for the number of opioid prescriptions per person, and drug overdoses have risen sharply in the past decade. The deadly drug epidemic now claims more lives than car accidents.
Where they stand on lawsuits against drug companies
Five of the six candidates agree that lawsuits against pharmaceutical companies and drug distributorscould play an important role in fighting the epidemic.
The lone exception is Black.
“I think the answer is sitting down with Pharma and saying, 'Hey, you all don’t want this kind of reputation.What can we do to work to address and solve these problems?'" Black said in a May interview with the USA TODAY NETWORK - Tennessee.
In a July interview, Black said she would support a lawsuit against manufacturers if it can be shown that they misled consumers.
“I don’t think that, necessarily, lawsuits always solve problems unless you can show that there has been a misleading,” she said.
The other candidates wholeheartedly endorsed suing manufacturers and distributors. Boyd referred to the drug companies as “perpetrators.”
More access to overdose reversal drugs?
When it comes to naloxone — the life-saving overdose reversal drug that federal health officials recommend be made available to the public — Black also stands out.
Black said she is concerned that making Narcan — a brand name for the nasal spray version of naloxone — readily available in places like college dorms will send the wrong message.
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“In those dorms and places such as that, I think (Narcan) needs to be more controlled with whoever is in the dorm, that’s overseeing the dorm, but I don’t want it to be an excuse where, well, it’s OK if we use the drug because we have a reversal,” she said.
“I think that’s something we have to evaluate.”
According to U.S. Surgeon General Jerome Adams, naloxone is a “safe antidote” that can save lives.
During a May visit to Vanderbilt University, Adams said naloxone should become as commonplace as CPR while foreseeing a day when the drug would be as widespread as fire extinguishers.
Lee said he would turn to nonprofit organizations and “those outside of government” to help make Narcan more available.
“That’s the most cost-effective way to do it, but we’ve got to save citizens’ lives,” he said.
Similarly, Lee said the government needs to engage with others, including nonprofits, health organizations and the private sector, to address the overall opioid crisis.
“Government can’t spend enough money to solve this problem,” he said. “We’re going to have to do it in a partnership across the state.”
Views on the Haslam administration's actions
Tennessee’s opioid crisis dates back to 2012, when officials began recognizing that pill abuse was rampant.
Since then, overdose deaths have steadily increased, peaking in 2016, when at least 1,631 Tennesseans died as a result of a drug overdose. Experts believe that is an undercount.
None of the six candidates offered criticism of Haslam’s work on the issue. This year, Haslam dedicated $30 million — including $25 million toward treatment and recovery programs — toward fighting the epidemic.
“The governor requested more treatment dollars,” Dean said. “I don’t know how much net gain that actually was, but it seems to me that that is a start.”
Praising the governor’s efforts, Harwell said, “It’s really easy for somebody on the outside to be negative, but the bottom line is we balance our budget every year and he did as much as he could given our limited resources.”
Haslam also created a 19-member commission on pain and addiction education.
Harwell, like her competitors, said education about the dangers of opioids plays a key role.
“We have Miss Tennessee, a beautiful young lady going across every part of this state in our high schools saying, 'Don’t get started on this,'” she said, referring to Caty Davis, who lost her brother and father to opioid abuse.
“The bottom line is let’s get people not addicted.”
Likewise, Boyd said educating the public about the dangers of pain medication is imperative.
“Oftentimes you can take Tylenol and do the same thing if not better and yet unfortunately doctors are prescribing them when they don’t need to and patients are taking them when they don’t need to,” he said.
While not offering open criticism of Haslam, some of his potential successors have veered close.
“I think he did all that he was able to do at that time, but we need to do more,” Boyd said.
Boyd has said on his first day in office he would declare the opioid crisis a state of emergency and appoint a cabinet-level “epidemic officer.”
Fitzhugh said the best way to “jump start” the fight against the epidemic is to expand Medicaid.
“In the states that have expanded, they’ve seen on the average, a 16 percent reduction in the opioid problem,” he said.
Several states that expanded Medicaid under the Affordable Care Act, including West Virginia, Ohio, Kentucky and Pennsylvania, had the highest drug overdose death rates in 2016.
How to combat problems from Fentanyl
As prescription opioids have become harder to access, Tennessee has also seen a rise in fentanyl, a potent synthetic opioid that has flooded the illegal drug market.
Last year, in Davidson County, fentanyl killed more people than heroin. It is cheaper to make than heroin and significantly more potent.
Lee said enhanced penalties is how he would work to halt the flow of fentanyl into Tennessee.
“I would make the penalties for drug trafficking in this state so stiff and there’s no penalty off the table for me ... that traffickers want to go to another state besides Tennessee,” he said.
Harwell and Boyd said they'd like to provide more money to the Tennessee Bureau of Investigation to fund additional agents.
Black said keeping drugs out of Tennessee is a challenge given its geography.
"It is a challenge for us because we have a lot of border," she said, vowing to work with law enforcement.
Striking a balance with patient needs
Even as the state has tried to fight the epidemic, some patient advocates have expressed concern about an over-correction in prescribing habits that could prevent people with legitimate needs for opioids from obtaining them.
This year, the Tennessee Medical Association expressed concern that Haslam's plan would interfere with the patient-doctor relationship. Haslam's plan, signed into law this year, limits the amount of opioids doctors can prescribe in certain circumstances.
“We have to make sure if an opioid is the only thing that will take this person out of pain on a short-term basis or whatever it is, we have to make sure that they have the ability to get that,” Fitzhugh said.
Boyd said it is important to have doctors and medical associations at the table when deciding which policies and limitations on access to medicine to adopt.
“We’ve got to be mindful that we are not restricting access to the people that need them,” he said.
"It’s a balance and that’s part of what the legislature struggled with and what the medical association struggled with," Dean said. "Obviously people do need pain relief but then there’s this danger of abuse. You have control the medication."