Health care leaders urge action on opioid abuse

Changing the course of opioid abuse and addiction, and its roots in society, will take a concerted effort by the health care industry, educators, law enforcement, the faith community and policy makers, according to experts.

The rate of misuse, abuse and overdose deaths reflects changes that need to happen in how addiction and pain are treated, as well as how states allocate resources to curb the epidemic, said speakers at a one-day forum on the rampant opioid abuse and addiction that's sweeping the nation. The forum was hosted by Nashville-based startup Axial Healthcare.

The term "war on drugs" is a misnomer for what's facing those trying to crack down on prescriptions and help people who are dependent on the medications because it implies a start and finish, as well as a winner and loser, said Thomas Farmer, special agent in charge of Dangerous Drugs Task Force with the Tennessee Bureau of Investigation. He said it's a "very unique problem" that needs societal change rather than a full-scale effort to criminalize all those involved.

At the core of reducing use and misuse is peeling away the stigma of addiction to treat it as other chronic diseases, such as diabetes or high blood pressure, said Kimberly Johnson, director of the Center for Substance Abuse Treatment at the Substance Abuse and Mental Health Services Administration. It's a brain disease that means people have to relearn how to live their lives without substance, Johnson said. It's not treated by a single visit, or often repeat visits, to treatment programs where people are isolated from real world situations and insulated with support.

"We don’t expect people with chronic disease to be completely adherent," Johnson said. "We don’t expect them to never have ice cream cake or a beer if diabetic."

It's hard to alter behavior if the person's immediate friends and family are also engaging in the behavior, whether it's misusing prescription drugs or eating ice cream every night.

The speakers, from law enforcement to providers, reinforced that pain management needed to be treated on an individual case level — and that patients should be better educated about what to expect after a surgery or with a chronic illness.

"It’s a different culture that we’ve developed here — the expectations of patients to live pain-free," said Dr. Jason Yong, director of The Pain Management Center at Brigham and Women’s Faulkner Hospital. "I ty to reset that."

An entire generation could be lost to the scourge of opioid abuse, U.S. Rep. Diane Black warned Tuesday. Misuse and addiction must be addressed with multipronged education programs in communities, schools and medical schools, she told a crowd of around 350 people.

"It's imperative that every player is informed about the danger of opioids," said Black, R-Tenn, who headlined the morning portion along with  former U.S. Rep. Mary Bono, R-Calif.

It's an epidemic that's impacting families around the country — including hers, Bono said. Her son called to tell her about his addiction when she was in Congress in Washington. Bono said she initially felt guilt for her son's addiction, blaming herself for his descent into abuse. However, she realized more than a decade ago that millions of families struggled with the same problem.

Bono encouraged people to keep the pressure on legislators and agencies to make sure that the "flurry" of "good activity" in proposing guidelines and legislation gains traction.

By Bono's count, there are 73 bills in the U.S. Congress with the word  ''opioid," up from 24 in 2015 and four in 2014.

"Not everyone is an expert, but everyone has good intentions,” she said.

At least 1,263 Tennesseans died from opioid overdose in 2014, the most recent figure available and one that points to rampant abuse, misuse and addiction that impacts hundreds of thousands of Tennesseans, according to the U.S. Centers for Disease Control and Prevention. For every person who dies, there are 851 people in various stages of misuse, abuse and treatment, according to the CDC. That equates to at least 1,074,813 Tennesseans, or 1 in 6.

More than half — 55 percent — of those who abuse painkillers get them from a friend or relative who has a prescription, according to a 2014 report from the Tennessee Department of Mental Health and Substance Abuse Services. Seventeen percent have their own prescription.

"I’m here to tell you that these patients who are in the stages of dependency or abuse don’t just appear out of nowhere. They don’t wake up on a sunny day in Nashville and say, ‘Today would be a good day for a Percocet,’ " Axial CEO John Donahue said.

Opioid abuse has death grip on Tennessee

Providers and pharmacists said the culture of treating pain has changed in recent decades, away from a multidisciplinary approach to a strategy of writing prescriptions. Some who suffer chronic pain would benefit from pain management techniques, including biofeedback and movement, but the fear of pain limits moving — leading to a self-fulfilling fear of pain from movement.

Many people want "a better life through chemicals," said Dr. John Culclasure, an anesthesiologist in Nashville.

The expectation of no pain extends, for some, into the immediate aftermath of surgery when some patients are surprised they have any pain, said Suzanne Nesbit, a clinical pharmacist and pain management expert at The John Hopkins Hospital.

Black, a registered nurse, said she's been impressed by a drug outreach program in Smith County that carries anti-drug messaging into schools with a focus on prescription painkillers. She said it's paramount to teach people that “it’s the way that it's used that makes it safe," and that just because it's in a prescription bottle doesn't mean it's not dangerous.

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

Countries with the highest estimated need for hydrocodone —  2014

• United States: 79,700 kilograms (population: 318.9 million)
• United Kingdom: 200 kilograms (population: 64.1 million)
• Canada: 115.5 kilograms (population: 35.5 million)
• Syrian Republic: 50 kilograms (population: 22 million)
• Colombia: 30 kilograms (population: 46.2 million)
• Denmark: 25.5 kilograms (population: 5.57 million)
• China: 20 kilograms (population: 1.37 billion)
• Vietnam: 20 kilograms (population: 93.4 million)
• India: 10 kilograms (population: 1.24 billion)
• Guatemala: 10 kilograms (population: 15.7 million)

Source: UN International Narcotics Control Board