The national average for opioid sales per 100,000 people stood at 24.4 kilograms — just over half of what has been witnessed in Tennessee, where nearly 1,300 people died as a result of opioid-related deaths in 2017.
In the midst of the epidemic, local health care providers in Northeast Tennessee — one of the hardest-hit regions — have had their hands full as they’ve worked to combat the crisis.
In 2017, the Tennessee Department of Health reported 24 opioid-related deaths in Washington County. Sullivan County recorded 29, Carter recorded 16 and Unicoi reported seven opioid-related deaths.
“I think we need to be really diligent about what’s going on and continue to prioritize this as a regional problem. We also need to focus our energy on preventing others from moving into this condition of opioid abuse disorder by bolstering prevention programs,” Dr. Robert Pack, executive director of the East Tennessee State University Center for Prescription Drug Abuse Prevention and Treatment, said.
Pack said there has been a sense of urgency among Tennesseans working to combat the epidemic. While Tennessee did rank first in the nation for opioid prescriptions, there has been a decrease in prescriptions filled from 2015 to 2017. During that period in Washington County, the number went down from nearly 161,000 to about 139,500 and the number of overdoses decreased by six since 2016. In Sullivan County, overdoses fell by seven during that time, as opioid prescriptions filled declined from about 214,000 to less than 194,000.
Pack said recent increases for buprenorphine prescriptions that coincide with these numbers may also indicate more people are “engaging in treatment.”
“There are some promising trends that are coming out of this area. I think that we can help people learn more about it nationwide and it can give some people a reason to be optimistic. Maybe not right now, but on down the road,” he said.
But promising trends do not always call for a sigh of relief. Not when numbers still remain high in terms of overdose rates and overprescription rates.
Since 2011, the DEA data indicated a 220.8 percent overall increase in opioid sales.
“The drug overdose and opioid epidemic is complex and dynamic, and it’s changing faster than any statistics can keep up with,” Pack said. “You have to be careful because statistics sometimes go back and forth, and this epidemic is so complicated.”
Since 2010, Tennessee has reduced opioid prescriptions by 35 percent, despite the DEA’s 2017 ranking for sales. However, Pack pointed out that these numbers often “hide the fact that there are a bunch of ‘sub-epidemics’” in the midst of the crisis. A reduction in opioid prescriptions may not indicate a reduction in abuse when considering black markets for fentanyl, fentanyl-laced drugs and for drugs like heroin.
“That’s what's been shown on the national level when we started to reign in on the legal supply, the illegal supply side went up,” Pack said. “The state has put a lot of resources into this from Nashville, and there’s beginning to be traction in a number of areas. The biggest concerns are fentanyl-laced heroin and other laced drugs have taken a hold, and those are the drugs that are most fatal.”
Local, state and grassroots efforts to fight the epidemic by bolstering treatment and prevention programs continue to push on, but Pack said there’s still a lot of work to be done.
“There are some real concerns, not only in terms of physical dependence but also what it does societally and what kind of impacts it can have on our economy,” Pack said. “I think doctors need to do a better job on the front end, and I think we’re starting to get a handle of this in Tennessee.”