What’s Up in Tennessee? Redux

About a year ago I wrote a blog titled What’s Up in Tennessee? looking at the unenlightened state policies that I thought would make that state’s addiction problem, particularly addiction involving opioids, worse instead of better. It’s been a very popular blog post getting me more comments than almost any other I did last year. Well it’s time to take another look, because Tennessee just stepped in it again.

Here’s a recent press release from the State of Tennessee:


Thursday, February 10, 2016

                CONTACT: Mike Machak

                OFFICE: 615-532-6597


Heroin, Buprenorphine Drug Busts on the Rise in Tennessee

Tennessee Bureau of Investigation data shows prescription drug seizures declining


NASHVILLE – Tennessee’s nearly half-decade long effort, dedicated to limiting easy access to prescription pain medications and similar opioid-based narcotics, has been successful. Since 2012 the state has seen a steady decline in the use and abuse of these substances commonly prescribed by family physicians. 2015 drug seizure data from the Tennessee Bureau of Investigation (TBI) shows a significant drop in law enforcement confiscations of prescription opioids, ie: pain pills.


Steep Decline of Prescription Opioid Drug Seizures: 2012 – 2014

        6,988 Opioid seizures in 2012 4,696 Opioid drug seizures in 2014

*Opioid seizures exclude buprenorphine and heroin; data does not reflect amount of drug seized


This success coincided with Tennessee’s Prescription for Success initiative, launched in 2014. While beneficial in reducing demand for prescription drugs it has resulted in some unintended consequences.

Today, the growing appetite in most Tennessee counties is for heroin and the painkiller replacement medication buprenorphine, known under brand names Subutex and Suboxone. They’re now widely prescribed as therapies to ease opioid withdrawal symptoms and cravings.

“It’s troubling to see these ‘so called’ painkiller replacement therapies dispensed by unlicensed clinics getting patients hooked and dependent on another drug, just as they were to prescription pain pills, “said E. Douglas Varney, Commissioner for the Tennessee Department of Mental Health and Substance Abuse Services. “Our statewide, multi-agency Prescription for Success strategy did an excellent job of reducing demand for prescription pain opioid medications. But once again I’m very concerned about what’s emerging in our state.”

Tennessee Bureau of Investigation data on recent drug seizures for heroin and buprenorphine shows both substances surfacing as new illicit drugs of choice in Tennessee.


Heroin and Buprenorphine Drug Seizures Rising: 2009 – 2014

82 Heroin seizures in 2009 has increased to 341 seizures in 2014

437 Buprenorphine seizures in 2009 has grown to 1,085 in 2014

*Data does not reflect amount of drug seized


“There were very few heroin seizures by law enforcement in 2011 and 2012,” said Commissioner Varney. “By 2015, seizures were occurring routinely in Tennessee’s larger cities and surrounding counties. We’re very concerned about this development as our citizens with an addiction will often resort to obtaining drugs, legally or illegally, any way they can, putting themselves and loved ones at risk of injury or death.”

The widely available opioid-based buprenorphine replacement therapies, Subutex and Suboxone, are commonly dispensed from cash-only clinics. They’re intended to reduce patient cravings. And much like the misuse and abuse of prescription pain medications, these therapies have a street value, too.

“There is no denying heroin’s grip on a troubling number of people in Tennessee,” said TBI Director Mark Gwyn. “But our Agents are also encountering the therapeutic drugs on the street during the course of their investigations. Clearly, there are people out there hoping to profit from substances meant to help, not hurt.”

I’m not sure what it is about the state of knowledge of addiction in Tennessee. I know a lot of good Addiction Medicine specialists in that state. There’s plenty of expertise for the State to rely on for information on addiction. There’s a lot of good information on why addiction is a disease and not a choice. Yet, here it is again. Addiction as a choice.

Rather than understand that an opioid is an opioid and that opioid dependent people don’t just stop using when you close their pill mill, the State of Tennessee seems to be surprised that there’s an increase of heroin use when pill mills close and there’s no increase in treatment. Yes, it was an unintended consequence, but not an unforeseen consequence; well it wasn’t unforeseen by everyone but the State, anyway. They also seem surprised that people on opioids who have little chance of getting treatment from the State will buy buprenorphine on the street rather than suffer through unmedicated withdrawal.

I’m not very political. I’m not Republican or Democrat, but no matter how conservative you are, there’s nothing but the best reasons for treating addiction as a disease. It’s cheaper that way. Whether you like it or not, it is a disease. If you ignore that it’s a disease and continue to treat it as a choice, you’ll continue to have expensive unintended consequences. Now that’s a choice.


Author: AddictionDoctor

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