Drug Abuse is focus of Capitol Hill Week

Senate Health and General Welfare Committee receives update on state’s war on prescription drug abuse and how it affects addicted infants

(NASHVILLE, Tenn.), January 23, 2014 – Senate Committees heard a variety of reports this week, including an update on the state’s war on prescription drug abuse.   Dr. Robert Pack, Professor and Associate Dean of the East Tennessee State University College of Medicine, told members of the Senate Health and General Welfare Committee that the state’s Controlled Substance Monitoring Database shows there were about 51 hydrocodone pills, or 1.4 prescriptions, prescribed each year per person for Tennesseans older than 12 years old.

Pack said this equates to approximately 275 million doses of hydrocodone alone that are in the hands of Tennesseans each year.  This is in addition to prescriptions filled for other opiate pain relievers.  The most common of these are alprazolam, the generic of Xanax, with 116 million doses filled annually, and oxycodone, with 113 million pills prescribed within the state.

Studies show that Tennessee is not alone.  The Center for Disease Control reports prescription drug abuse death rates have increased dramatically by 250 percent nationwide over the last ten years.  The epidemic hits rural and urban areas, with more prevalent use in the West and Appalachia according to the statistics.  Pack said misuse, particularly among youth, occurs most commonly due to family members having unused pills in their cabinets.

“There is a very high volume of prescribed opioid pain relievers that can and do fall into the wrong hands leading to misuse and addiction,” said Pack.  He said that as a result, there is a growing national understanding about the importance of preventing diversion of controlled substances from their intended use.

Pack praised the legislature and Governor Haslam for passing the Prescription Safety Act in 2012 to combat prescription drug diversion and to address bad actors who prescribe opiates carelessly.  He said that as a result of the law, doctor shopping, one of the most prevalent problems in prescription drug abuse, is down by 30 percent.  Five studies in different states have shown that 10 to 15 percent of prescribers are responsible for prescribing 65 to 80 percent of opioid relievers.

Pack said he expects heroin use to escalate in Tennessee to backfill the market for prescription opiate pills as the state clamps down on abuse.  A 2013 study effectively said that those who use opioids are more likely to become addicted to heroin.  There has been an influx of heroin from Mexican cartels which have offered the illegal drug at a cheaper price than the street rate of diverted prescription opiates.

To help prevent prescription drug abuse, Pack recommended better prescription guidelines and education for prescribers, including instruction or referral in the management of acute and chronic pain.  He also recommended greater communication between pharmacists, patients and physicians.

Neonatal Abstinence Syndrome (NAS) escalates in Tennessee  — One of the most significant side effects of the prescription drug epidemic in Tennessee is the ten-fold increase in the number of babies born addicted over the last decade.  Dr. Michael Warren, the Tennessee Department of Health’s Director of Family Health and Wellness, reported to Senate Health and General Welfare Committee members that there have been about 855 cases of babies in Tennessee who were born dependent to opiates in 2013.  The problem is especially prevalent in East Tennessee with Niswonger Children’s Hospital and East Tennessee Children’s Hospital which have a large number of infants in their Neonatal Intensive Care Units due to being exposed to drugs before birth.

Over 42 percent of mothers who give birth to addicted babies have been prescribed the pills, 32.6 percent are from illicit or diverted substances, 21.5 percent are a mix of prescribed and non-prescribed doses, with the remainder from unknown substances.

Addiction to opiates can result in the infant having Neonatal Abstinence Syndrome (NAS), which occurs when the mother’s drugs are cut off at birth.  NAS can cause the infant to have tremors, weight loss, stiff muscles, seizures, inconsolable crying, gastrointestinal disorders and poor nervous system irritability within one to five days after birth in 55 to 94 percent of cases.  NAS babies often require ongoing medical care costing an average of $62,324 during their first year of life.  These infants are 19.7 times more likely to end up in state custody.

Governor Haslam has appointed a working group with representation from the Tennessee Department of Health, Children’s Services, Human Services, Mental Health and Substance Abuse Services, TennCare, Safety and the Children’s Cabinet to address the problem.  The group has already taken action to educate the public and physicians regarding the dangers of prescription drug abuse during pregnancy.  As a result of their work, TennCare has implemented narcotic preauthorization requirements to help deter the prevalence of prescription drug abuse among pregnant mothers.

“NAS is preventable, but requires action by the medical community to help deter the number of babies born addicted,” said Senator Becky Massey (R-Knoxville), member of the Health and Welfare Committee.  “I have personally visited East Tennessee’s Children’s Hospital in Knox County which is at the forefront in the treatment of these infants.  It is heartbreaking to see these babies and watch their struggles.  We need to do whatever we can to help fight this problem.”

“We appreciate both Dr. Pack and Dr. Warren for having taken time from their busy duties to testify before the Health and Welfare Committee,” said Health and Welfare Committee Chairman Rusty Crowe (R-Johnson City).  “Their expertise brought to light not only that Tennessee is making great progress with regard to prescription drug abuse, but that we also have much work ahead of us in fighting this epidemic.  ETSU’s College of Medicine and College of Public Health have been valuable resources for the Senate Health and Welfare Committee.”

Governor proposes legislation to fight meth — In other news on drug abuse, Governor Haslam announced last week that he is proposing legislation to reduce the growing problem of methamphetamine production in Tennessee.  The goal of the Tennessee Anti-Meth Production (TAMP) Act is to limit access to pseudoephedrine or ephedrine products to those who are using it illegally.

Provisions of the governor’s bill include the following:

  • Individuals would be authorized to purchase up to 2.4g (the maximum recommended daily dose of 240mg for 10 days) of products containing pseudoephedrine or ephedrine in a 30-day period by presenting a valid ID to a pharmacist, which is the way state law currently works.
  • If the consumer returns to purchase additional products, a pharmacist, at his or her discretion, may override the National Precursor Log Exchange (NPLEx) system to allow individuals to purchase up to 4.8g (maximum recommended daily dose of 240mg for 20 days) in that same 30-day period.
  • Anything above 4.8g in a 30-day period would require a prescription issued by a licensed physician, certified physician assistant, or authorized nurse.

The proposal would effectively give Tennessee the lowest state limit in the United States. Two states, Oregon and Mississippi, require a prescription for all pseudoephedrine or ephedrine products.

Senate Judiciary Committee acts to place synthetic compound under controlled substances law — Finally, the Senate Judiciary Committee has approved legislation, sponsored by that Committee Chairman, Senator Brian Kelsey (R-Germantown), adding the synthetic cannabinoids, quinolinylindolecarboxester and propylindazolecarboxamide, to the state’s Schedule I controlled substances law.  Senate Bill 1508 now moves to the floor of the Senate for final consideration.

Synthetic drug products, which have become increasingly popular among teens and young adults, are sold at a variety of retail outlets like convenience stores, smoke shops and over the Internet.  They mimic other dangerous illegal drugs.

The General Assembly has passed legislation to ban other chemical compounds used in synthetic drugs; however, unscrupulous chemists manufacturing the drugs continue to modify molecules in the organic compounds to avoid prosecution.

Traffic fatalities are down by 33 percent in Tennessee over the past decade

Tim Wright and Don Lindsey from the American Automobile Association (AAA) and Kendall Poole from the Governor’s Highway Safety Office updated the Senate Transportation Committee this week with good news regarding the safety status of Tennessee’s roads.  Traffic fatalities have gone down by 33 percent from 2003 to 2013.

A major contributing factor in reducing highway deaths is that 84.8 percent of Tennesseans are wearing safety belts.  Over half of those who die due to car crashes in the state do not have on their seat belts.

“These statistics are very telling,” said Senate Transportation Committee Chairman Jim Tracy, R-Shelbyville.  “We need to continue our efforts in encouraging the use of safety belts, which are critical to preventing a tragedy.  It saves lives!”

Traffic deaths last year fell by 2.7 percent, dropping from 1,015 in 2012 to 988 in 2013.  Impaired driving fatalities also fell by 26.7 percent from 2010 to 2013, but still account for 24.1 percent of total road fatalities.  This is five points under the 2012 statistics.

In addition to unbelted drivers, impaired driving and inexperience are key factors that result in highway-related crashes according to the group.  National statistics have revealed that 3 out of 10 Americans will be involved in an alcohol-related crash at some time or another in their life.

On inexperienced or new drivers, AAA Public Affairs Director Don Lindsey said their organization is conducting a study to show how raising the age of licensure could impact safety.   They maintain inexperience and immaturity make for risky driving behavior and increase the likelihood of a crash.  Motor vehicle crashes are the leading cause of death for U.S. teens.

Tennessee has worked to reduce teen motor vehicle fatalities and injuries through graduated driver’s licensing (GDL). This system limits the exposure to high-risk situations by gradually phasing in driving privileges for teens.

Commissioner tells Senate Education Committee Tennessee is fastest improving state in the nation in education

Results from the premier National Assessment of Educational Progress (NAEP) test shows Tennessee is the fastest improving state in the nation, far outpacing its counterparts in success from 2011 to 2013.  NAEP is the gold standard report card given to 4th and 8th grade students across the nation every other year under the federal No Child Left Behind Law.

“We had the largest growth since NAEP has been administered,” said Education Commissioner Kevin Huffman.  “No state has ever grown more than Tennessee. It was extraordinary.”

Huffman said that if you add up all the score points, he would expect Tennessee’s education ranking to improve about nine points, moving the state from 46th or 47th in the nation to 36th or 37th .

The most recent results released in November showed significant progress across the board, especially revealing substantial growth among African American students.  Where Tennessee previously lagged behind its sister states, in 3 out of 4 tests, students are now just one point away from the national average.  The Commissioner says he anticipates students exceeding the national average by 2015.

Tennessee has also seen three years of continuous growth on its state assessments, also known as the Tennessee Comprehensive Assessment Program (TCAP).  Since 2010, 91,000 more students are on grade level in math, and 52,000 more students are on grade level in science.  Likewise, the Explore and Plan tests, which are the ACT pre-test for 8th and 10th graders, have shown widesread student improvement.

Commissioner Huffman told legislators that the state has received a lot of inquiries to find out what was going on to set the groundwork for Tennessee’s student success.  Huffman attributed the gains to raising standards for student achievement and an improved teacher evaluation system which has provided extensive feedback to them on how to improve their students’ outcomes.  He also said the Tennessee Diploma Project has attributed to the success.  The Diploma Project implemented rigorous standards and requirements for students which are more in line with the demands of college and work.

“Without question, the improved teacher evaluation system and the enhanced academic standards were the keys to our students’ success,” said Senate Education Committee Chairman Dolores Gresham (R-Somerville).  “We must stay the course in both areas.”

In Briefetamine production in Tennessee.  The goal of the Tennessee Anti-Meth Production (TAMP) Act is to limit access to pseudoephedrine or ephedrine products to those who are using it illegally while not overburdening law-abiding Tennesseans who need temporary cold and sinus relief.  

 The subcabinet working group has received additional support from the Tennessee Criminal Justice Coordinating Council, the National Governors Association Center for Best Practices, and the Center forPrivate Traffic CheckpointsThe Senate Judiciary Committeehas approved legislation sponsored by Senator Mike Bell (R-Riceville) to ban state and local police from participating in traffic checkpoints conducted by private contractors in Tennessee.  The legislation aims to stop any prospective checkpoints conducted by private research contractors from doing random checkpoint DNA tests on Tennessee drivers.  The practice has been reported in at least 30 U.S. cities where drivers said they were pressured into providing saliva samples or to submit to a blood test.  Affected drivers claim they were forced off the road by employees of the contractor who were accompanied by local law enforcement agencies with flashing lights for a supposedly “voluntary” DNA tests.

Elected Attorney General — The State Senate heard the first two readings of a resolution sponsored by Senator Mae Beavers (R-Mt. Juliet) calling for popular election of the state’s attorney general (AG).  The amendment process requires three readings of the proposed changes before the General Assembly can act.  Tennessee is the only state in the nation in which the people have neither a direct nor indirect voice in the selection of their attorney general, and the only state that gives that power to our Supreme Court.  The resolution would amend the state’s Constitution to allow for popular election of the state’s AG every four years.  The resolution must be approved by the 108th General Assembly currently in session, and the 109th which will take office in 2015, before going to voters in a statewide referendum in the 2018 general election.

Road Debt – The Tennessee Department of Transportation (TDOT) said that its program is 1 out of only 5 states nationwide that do not have debt.  The Commissioner also talked about TDOT’s new Smartway App, being offered to all Tennessee drivers, that provides information on traffic accidents and/or blockages near their area.   To download the mobile App go to:  http://www.tdot.state.tn.us/tdotsmartway/mobile/

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