State overdose data sheds new light on opioid crisis

• Between 2012-2015, several counties more than doubled the number of overdose deaths reported.
• Deaths from fentanyl and heroin are on the rise, as are heroin-related arrests.
• Overdose victims are overwhelmingly white, and likely male.
• Metro areas are seeing a surge in heroin deaths.

A new report from the Tennessee Department of Health on drug overdose deaths sheds new light on the opioid epidemic plaguing the state, darkening the lines of an emerging portrait of the typical abuser killed by the powerful painkillers. 

The drug overdose fatalities are overwhelmingly white, mostly male and increasingly less likely to have prescriptions for the drugs that kill them. And, across Tennessee, those killed are more likely to overdose on opioids — including heroin and fentanyl — than on any other kind of drug.

The report obtained Wednesday details a surge of deaths between 2012 and 2015. In 2015, at least 1,451 Tennesseans died from drug overdoses. 

That's 22 drug overdose deaths for every 100,000 Tennesseans. Over the past five years, the state has recorded 6,036 drug overdose deaths.

The data is a slice of the problem in the state — it’s hard to know how many people are misusing or slipping into addiction.

For every overdose death, the state estimates there are 14 nonfatal overdoses.

Jared Beckett knows about those.

Seven years ago, Beckett woke up in a hospital bed not knowing where he was. It was days since he overdosed on a combination of opioids and Xanax stolen from a neighbor’s house.

His friends had left him unconscious. The neighbor found him and performed CPR that likely kept him alive long enough to be rushed to the hospital, where he was put on life support.

“Here’s the sick part,” said Beckett, now 29 and a lead director of a south Nashville group home for recovering addicts. “When I woke up from the overdose, I didn’t know what was going on. I had a sort of amnesia. But I remember waking up and wondering where my drugs were.”

Overdose deaths more likely to be white males

Like Beckett, more than 86 percent of those who died of drug overdoses in 2015 were white, though that's slightly lower than in either 2014 (nearly 92 percent) or 2013 (more than 90 percent). More than half — 55.89 percent — were male.

In the same year, white Tennesseans made up 89.5 percent of 839 people treated primarily for heroin and 95 percent of 4,071 treated for prescription opioids, according to the Tennessee Department of Mental Health and Substance Abuse Services.

Black Tennesseans made up 62 percent of 1,176 treated for cocaine or crack and 45 percent of 2,065 in treatment for marijuana use.

Judge Seth Norman, who presides over drug court in Davidson County, said he sees the racial divide in the people who come through his courtroom.

“I cannot tell you why, but it’s a funny thing. I’ve heard whites say that cocaine will kill you and I’ve heard blacks tell me that 'I wouldn’t touch opioids because they’d kill you.'”

Between 2012-2015, several counties throughout the state more than doubled the number of overdose deaths reported. Campbell County, in East Tennessee, had 21 OD deaths in 2015 — more than four times the number reported in 2012. In most counties, overdose deaths accounted for between 1 percent and 4 percent of all deaths in 2015.

Some counties had no overdose deaths in particular years -- but no county in Tennessee had zero overdose deaths all three years. 

Opioids, benzos and illicit drugs

Many states are grappling with rising opioid abuse, misuse and overdose death. Appalachia has been hit particularly hard, prompting federal task forces and new tactics to try to get a handle on the problem. 

Initiatives to change how providers write prescriptions are emanating from the state and federal level as lawmakers, public health officials, provider associations and insurance companies try to curb the availability of pain pills.

More than 88 percent of people who abuse or misuse get pain pills that originated from a prescription. Sometimes it’s their own prescription, other times a pill (gifted or stolen) from a script written to a friend or family member.

Overdose deaths have continued to climb even with fewer prescriptions or the morphine milligram equivalent — or MME, a unit that compares the strength of opioids into the potency of morphine — on the streets, Dr. Stephen Loyd, medical director of the Tennessee Department of Mental Health and Substance Abuse Services, said in an interview in February. 

People who find it harder and more expensive to get the prescribed drugs are moving to heroin and fentanyl — a progression that law enforcement and addiction specialists have noted in recent months.

The number of people who died of drug overdose and filled prescriptions for opioids in the past year declined — indicating that more people are overdosing on drugs obtained illicitly.

And metropolitan areas, especially, have seen heroin overdose deaths skyrocket. Davidson County's overall overdose rate increased between 2012-2015 -- but it reported 40 heroin deaths in 2015, compared to 25 in 2014 and 8 in 2012.

Shelby County's heroin deaths jumped to 68 in 2015, from 30 in 2012; Knox County reported 20 in 2015, but acknowledged last year that tests the medical examiner had been using for heroin overdose were less reliable because the drug is metabolized more quickly. That's since been corrected.

"It is always possible that the increases represent a combination of actual increases and increases or changes in testing methodologies," said Shelley Walker, spokeswoman for the Tennessee Department of Health. "Nonetheless, the increase we’re seeing in illicit drug deaths is consistent with what other states and the CDC are also reporting."

The number of heroin-related arrests across the state spiked over the same time, according to data from the Tennessee Bureau of Investigation. There were 491 heroin-related arrests in 2012, which rose to 1,452 in 2015 and grew by 46 percent to 2,119 in 2016. 

Likely more OD deaths than stats show

Several experts, including a circuit court judge in East Tennessee who runs a court program for addicts, think the state data under-reports overdose deaths — particularly in more rural counties that run on shoestring budgets.

Each county has to pay for the toxicology reports and autopsies, so the addition tests can be a financial strain, said Duane Slone. Thus, the local coroner is less likely to order a toxicology for someone who dies at an older age.

In other counties, coroners may track likely overdose deaths even beyond those that meet the state's requirements — so their counties' numbers may be higher than the state's. The state notes the data of local medical examiners may not always match the state's statistics.

 “If anything, (overdose deaths) are under-reported,” Slone said. “You take counties in more rural parts of Tennessee that are typically on very lean budgets. They’re much less likely to do toxicology reports. They’re going to miss the cause of death, especially in older people.”

Beckett has gotten so many calls to tell him about overdose deaths of old friends in recent years from pills or heroin that he’s come to expect them.

Last year, he got a call from his sister about one more death. It was his father. He died last July, in West Virginia, of an overdose. At the funeral, family members were reluctant to speak about how Beckett’s father died. But Beckett, who had not spent time with his father until he was 18 years old, said he is not embarrassed. “It needs to be more talked about.”

“I used to do drugs with him,” Beckett said. “We only had one thing in common, and it was drugs.”