1. OPIOID EPIDEMIC

2. Opiates and opioid drugs

3. 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:

4. Addiction is a Brain Disease

5. 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

6. 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,
TDMHSAS Office of Research, 3/22/2017 6

7. 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, , ; National Institute on Drug Abuse, Monitoring the Future Survey (2011). 6
TDMHSAS Office of Research, 3/22/2017

8. 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

9. Number of people arrested1,
Number of people arrested for heroin or other opioid-related crimes (per 10K population),
Opioids2 +28%
7,149
6,896
People arrested per 10k
5,398
Source: Tennessee Bureau of Investigation (TBI) CJIS Support Center, 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
Source: Tennessee Bureau of Investigation (TBI) CJIS Support Center,
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

10. 71% of drug overdose deaths are opioid-related2
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
Source: Tennessee Department of Health,
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

11. 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

12. 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
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

14. Heroin and Fentanyl

15. Carfentanyl (Carfentanil) This is an elephant tranquilizer

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

17. 12 Step Abstinence Based Treatment
TREATMENT WORKS
12 Step Abstinence Based Treatment
Medication Assisted Treatment
(Harm Reduction Model)

18. INTEGRATED TREATMENT WORKS BETTER
Addiction
Mental Illness
Physical
Social
Spiritual

19. QUESTIONS