OPIOID EPIDEMIC

Opiates and opioid drugs

Why an EPIDEMIC? Epidemic: The occurrence of more cases of a disease than would be expected in a community or region during a given time period. A sudden severe outbreak of a disease. From the Greek "epi-", "upon" + "demos", "people or population" = "epidemos" = "upon the population.“ Source: MedicineNet: http://www.medicinenet.com/script/main/

Addiction is a Brain Disease

PAIN OPIOIDS ADDICTION Decade of chronic pain epidemic Joint Commission “Pain as the 5th vital sign” Intractable Pain Act 2001 Pharmaceutical marketing of opioids as having a low addictive potential PAIN Increased prescribing by practitioners Improper prescribing through pill mills Increased number of opioid prescriptions Increased opioid doses: morphine milligram equivalents OPIOIDS Increased doctor shopping Increased drug related offenses Increased drug dependent babies Increased treatment need Increased overdose deaths ADDICTION TDMHSAS Office of Research, 3/22/2017 5

Need Early Intervention In Tennessee, it is estimated that 69,100 individuals are addicted to prescription opioids and require treatment for prescription opioid abuse 69,100 Tennesseans Addicted to Opioids Need Treatment 4.56% of Tennessee population 151,900 Tennesseans with Risky Prescription Opioid Use Need Early Intervention 4,629,000 Tennesseans who Do Not Use Prescription Opioids or Use Them as Prescribed Need Prevention and Promotion Strategies 95.44% of Tennessee Population Source: National Survey on Drug Use and Health, 2008-2010 TDMHSAS Office of Research, 3/22/2017 6

Counties with 200 or more people with opioid misuse disorder (35 counties) 4,259 4,500 4,000 3,500 3,000 2,500 2,000 1,500 1,000 500 3,273 Number of people 2,154 1,582 1,275 769 780 820 860 561 608 614 444 452 455 235 238 247 250 256 266 270 273 284 300 310 335 336 369 391 200 208 218 220 Franklin Bedford Monroe Gibson Dickson McMinn Loudon Coffee Jefferson Tipton Roane Cumberland Hawkins Carter Hamblen Robertson Greene Putnam Anderson Maury Madison Sevier Bradley Wilson Blount Washington Sullivan Sumner Montgomery Williamson Rutherford Hamilton Knox Davidson Shelby Sources: National Survey on Drug Use and Health, 2012-2014, 2014-2015; National Institute on Drug Abuse, Monitoring the Future Survey (2011). 6 TDMHSAS Office of Research, 3/22/2017

Due to a lack of funding, most people in need of substance abuse treatment do not receive it. Percent of individuals with select medical conditions who receive treatment 77% 73% 11% Hypertension Diabetes Addiction (excluding Nicotine) Source: Centers for Disease Control and Prevention and National Survey on Drug Use and Health 7

Number of people arrested1, 2009-2016 Number of people arrested for heroin or other opioid-related crimes (per 10K population), 2015-2016 Opioids2 +28% 7,149 6,896 People arrested per 10k 5,398 Source: Tennessee Bureau of Investigation (TBI) CJIS Support Center, 2009-2016. Notes: Rates are only shown for counties where the combined count during the time period was 5 or greater. Rates based on two year averages. Opioids exclude heroin. Heroin +797% 1,516 360 169 People arrested per 10k 2009 2010 2011 2012 2013 2014 2015 2016 Source: Tennessee Bureau of Investigation (TBI) CJIS Support Center, 2009-2016. Notes: (1) Includes expunged records. (2) Opioid-related arrests include arrests for morphine, opium, and all narcotic-related arrests with the exception of cocaine and crack-cocaine arrests. Arrestees were only counted once if more than one type of narcotic was present. TDMHSAS Office of Research, 3/22/2017 20

71% of drug overdose deaths are opioid-related 2 71% of drug overdose deaths are opioid-related Opioid-related deaths increased 48% (includes heroin & other opioids) All drugs All opioids Opioids with benzodiazepine Heroin 1,451 1,400 1,263 Opioids with benzodiazepine 80% increase 1,168 Overdose deaths 1,200 1,094 1,034 1,000 861 756 800 698 600 Heroin 355% increase 447 342 346 400 249 205 147 200 63 45 2012 2013 Source: Tennessee Department of Health, 2012-2015 2014 2015 Notes: Not all drug overdose deaths specify the drug(s) involved, and a death may involve more than one specific substance. Increases in overdose deaths may be due to increases in reporting by medical examiners. All drug overdose deaths are based on the following ICD-10 underlying cause of death codes: X40-X44, X60-X64, X85, Y10-Y14. “All opioids" overdose deaths were summarized based on an underlying cause of death being a drug overdose and the multiple ca uses of death containing at least one of the following ICD-10 codes: T40.0-T40.4, T40.6. "Opioids with benzodiazepine" overdose deaths were summarized based on an underlying cause of death being a drug overdose and the multiple causes of death containing at least one of the following ICD-10 codes: T40.0-T40.4, T40.6 in addition to T42.4. "Heroin" overdose deaths were summarized based on an underlying cause of death being a drug overdose and the multiple causes of death containing at least one of the following ICD-10 codes: T40.1. TDMHSAS Office of Research, 3/22/2017

Passed the Prescription Safety Acts of 2012 and 2016 requiring: Provider education on proper prescribing Query of the Controlled Substances Monitoring Database (CSMD) Reporting to the CSMD Repealed the Intractable Pain Act in 2015, which removes requirement to treat pain with opioids. Passed the Addiction Treatment Act of 2015, which includes a Good Samaritan Law assuring people helping others are not charged with a crime. Passed the Ensuring Patient Access to Pharmacy Drug Disposal Programs Act of 2015, allowing pharmacies to participate in drug collection programs. Passed legislation establishing regulations for Pain Clinics and Office-Based Opioid Treatment Clinics. Appropriated funds for: Lifeline Program $525,000 Recovery & Veterans Courts $1,270,00 Naloxone programs TDH TDMHSAS Office of Research, 3/22/2017 10

Opioid prescriptions dispensed for pain Decreased prescriptions for opioids dispensed to Tennesseans by 489,516 between 2013 and 2015. Decreased doctor shopping by 50% from 2011 to 2015. Opioid prescriptions dispensed for pain to Tennesseans 8,280,173 8,073,950 7,790,657 2013 2014 Source: Tennessee Department of Health, CSMD Annual Report to the Legislature, February 1, 2016 Note: Excludes prescriptions from methadone opioid treatment programs and prescriptions reported from VA pharmacies. 2015 TDMHSAS Office of Research, 3/22/2017

Heroin and Fentanyl

Carfentanyl (Carfentanil) This is an elephant tranquilizer

Attempts to stop the death by overdose NARCAN (Naloxone) Contents of the Kit

12 Step Abstinence Based Treatment TREATMENT WORKS 12 Step Abstinence Based Treatment Medication Assisted Treatment (Harm Reduction Model)

INTEGRATED TREATMENT WORKS BETTER Addiction Mental Illness Physical Social Spiritual

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