Overdose deaths reach 'epidemic proportions'

• Someone who spends about $300 on Oxycontin a day would spend a fraction of that for heroin.
• TBI: A trend toward heroin illustrates "a good and a bad."
• Opioids rewire the brain; stakeholders want more resources for helping people get clean.

At least 1,263 Tennesseans died last year from opioid overdoses, up 97 deaths from 2013 — a staggering statistic that points to growing abuse despite an array of measures to stem addiction.

It’s an epidemic sweeping across the state, affecting people in both small towns and big cities.

More people died in 2014 from opioid overdose in Tennessee than in car accidents or by gunshots.

It’s a public health crisis that worries state health officials, emergency room doctors, clinicians of all stripes and some lawmakers.

“I would like to think the rate of increase has slowed, but quite frankly the 2014 numbers don’t really allow me to say that,” said David Reagan, chief medical officer of the Tennessee Department of Health. “It is at epidemic proportions in our state.”

There were more than 100 deaths in Davidson, Knox and Shelby counties, while 25 other counties had at least 12 deaths. All but four counties had at least one overdose death in 2014.

Opioids are found in prescription painkillers such as Hydrocodone and Oxycodone — sometimes called "hillbilly heroin" — as well as heroin.

It’s a problem that spans all ages, but the highest frequency of overdose deaths are found in men and women ages 45-55, Reagan said.

Reagan said in many cases the abuse of prescription painkillers escalates to heroin usage.

And it’s not hard to get your chosen fix.

Prescription painkillers and heroin are easily attainable illegally on the street. Hydrocodone costs $5-$7 per pill, Percocet is $7-$10 per pill, Oxycodone IR runs $30-$40 per pill, and Oxycontin comes in at about $80 per pill. Heroin is a less-expensive option, costing around $15 per bag, according to data from the Tennessee Bureau of Investigation.

Someone who spends about $300 a day on Oxycontin would spend a fraction of that for heroin hits.

Related: Man found addiction knows no boundaries

Dr. Omar Hamada said he previously worked in an emergency room where people would get prescribed painkillers and then sell them in the parking lot.

Hamada, now the emergency department medical director at Maury Regional Medical Center, estimates two to three people come into the ER each week with an overdose that requires medical intervention.

The hospital, which is in Columbia and serves many people living in surrounding rural areas, is receiving a $100,000 grant from the U.S. Health and Human Services to get more of a temporary antidote to opioid overdose, naloxone, into rural areas. The drug temporarily reverses the deadly effects of opioids, giving overdose victims more time to receive emergency care.

In a move that underscores the pervasiveness of abuse, the health department is recommending people living with an opiate abuser get a naloxone prescription in case the person overdoses.

Although obtaining a prescription for someone else is not often legal, Reagan said naloxone, now available in an EpiPen-like form called Evzio, is an exception to that rule.

Battling an 'epidemic of biblical proportions'

Gov. Bill Haslam signed legislation in 2012 to expand the information tracked by the state's controlled substance database. That same year, the state began new oversight over pain management clinics.

The next tightening measure is set to start in July, when chief medical officers of pain clinics will be required to be pain specialists. There are about 300 pain clinics and roughly 120 pain specialists in the state, according to health department data.

New guidelines and treatment plans were proposed in early summer 2014 by both Haslam and a committee of physicians. Doctors wanted to curb the number of pills that could be prescribed. Haslam sought to put an emphasis on treatment.

“It’s been a step in the right direction, yes. I think there may be some ways to improve the current laws based on our experience,” Reagan said.

The regulations, and increased partnership between agencies, are having an impact on the availability of pills. There's also an unintended consequence: People are turning to heroin because it's cheaper and easy to get.

Frequently prescribed controlled substances

Three of the top 5 most prescribed medications from Tennessee’s controlled substance monitoring database are opioids.

1. Hydrocodone products - opioid
2. Alprazolam – generic name for Xanax; a benzodiazepine.
3. Oxycodone products - opioid
4. Zolpidem – generic name for Ambien
5. Tramadol – opioid; brand names: Ultram, ConZip, Ryzolt

Source: Tennessee Department of Health

The TBI is "very, very" conscious about the move toward heroin, said Thomas Farmer, special agent in charge of Dangerous Drugs Task Force, who calls the trend "a good and a bad."

"It’s a 'good' because it, in some way, validates our efforts in the prescription drug progress,” Farmer said. "We would not want them to go to heroin. We do not want them to go the streets. It’s not safe.”

Yet, the state remains a leader in the number of prescription painkillers per person.

State Sen. Ken Yager, R-Harriman, was a sponsor of the 2012 legislation and wants the state to take further action. Yager would like to see some funding for addiction in the next budget.

“It is an epidemic of biblical proportions that we need to fight on every front,” Yager said.

“This just doesn’t happen to the poor kids in the slums or in the inner cities. This happens at the country club as well,” Yager said. “We have to realize that, as a society, the abuse of drugs doesn’t discriminate, whether you’re rich or poor or black or white.”

‘This wasn’t their idea’

Most people who become addicted to opioids didn’t set out with the intention of being an abuser.

For some a car wreck or a weekend accident that results in a bulging disk or back pain starts the cycle.

"They never intended for that one incident to end up in dependency and addiction," Reagan said. "This wasn't their idea."

Dr. Richard Soper of the Center for Behavioral Wellness in Nashville said he once treated a woman who took her first opioid at age 11 when she fell down stairs and her grandmother gave her a prescription painkiller.

Opioids rewire the brain — specifically the mu, kappa and delta receptors — over time. Some of the changes are reversible or repairable, but others are not. People who take them “don’t have the same biochemistry” as those who are not taking opioids, Reagan said.

Farmer, based out of Chattanooga, said arrests are not the answer to the epidemic, and that law enforcement wants to see people on the path to sobriety.

Addiction should be treated as a chronic illness with education, advocacy and treatment campaigns, Soper said.

“We’re not at a point yet in our society where addiction is treated like end stage renal disease or diabetes,” Soper said. “It’s still stigmatized. It’s still seen as a character defect.”

Reach Holly Fletcher at 615-259-8287 or on Twitter @hollyfletcher.

Overdose deaths by county

• Anderson: 18
• Blount: 21
• Bradley: 24
• Campbell: 19
• Cheatham: 17
• Cocke: 12
• Cumberland: 16
• Davidson: 129
• Dickson: 12
• Greene: 19
• Hamblen: 23
• Hamilton: 58
• Hardin: 12
• Knox: 133
• Loudon: 15
• McMinn: 13
• Maury: 20
• Montgomery: 26
• Putnam: 21
• Roane: 22
• Rutherford: 35
• Sevier: 18
• Shelby: 148
• Sullivan: 44
• Sumner: 28
• Washington: 25
• Williamson: 18
• Wilson: 26

There were no confirmed deaths in Hancock, Lake, Trousdale and Van Buren counties

Counties with fewer than 12 deaths were not released.

Source: Tennessee Department of Health