Rep. Bryan Terry deals with patients from every demographic caught up in the web of opiates.
Patients have an array of tolerance to opioids, as well, from those currently addicted to those who are recovering addicts. As a result, each patient requires an “individualized” anesthetic based on their background and the procedure or surgery they’re to have, says Terry, a Murfreesboro anesthesiologist.
“We see all walks of life with addiction problems,” Terry explains. “Essentially being the person who has a patient’s life in their hands, many patients will confess their drug problems to anesthesiologists just prior to surgery. I have had that happen several times.”
In his profession, Terry knows well the effects pain medication has on people. As he prepares to sponsor legislation in 2018 designed to toughen the laws on illicit opioid activity, the second-term Republican lawmaker takes a clinical approach to this madness sweeping the nation, as well as one targeting dealers.
Drugs such as fentanyl, sufentanil and their analogues, because of their chemical properties and the pain associated with surgery, are “great” opioids before, during and after operations, he says.
“Fentanyl has use outside the hospital setting for chronic pain, as well. However, as with all narcotics, there are risks, including addiction and even death,” says Terry, who chairs the House Health Subcommittee.
With that in mind, Terry and state Sen. Steve Dickerson, a Nashville anesthesiologist, are planning legislation giving the state a new angle for fighting illicit opioid use by increasing the penalties for sales, manufacturing, distribution and intent to traffic.
Rather than a Class C felony charge for Schedule 2 drugs, opioids would join cocaine and methamphetamine, also Schedule 2 controlled drugs, in the Class B felony range with fines of $100,000 or Class A felonies with a $500,000 fine, Terry says. He also notes methamphetamine violations come with a 100 percent minimum sentence of 180 days.
Terry knows better, though, than to think harsher punishment alone will solve this scourge, which is claiming more lives every year, many of them in their early 20s who don’t understand the danger posed by fentanyl and other pain medications.
Comprehensive measures will be needed to combat the national crisis, explains Terry, who is working with the state’s Opioid Task Force, Tennessee Bureau of Investigation, Tennessee Association of Chiefs of Police, medical organizations and the governor’s staff to attack the situation with a multi-pronged effort.
The key to dealing with people’s desire to take opioids has to start with prevention and education about the risks they pose, he adds. For instance, fentanyl is 100 times more potent than morphine, and sufentanil and carfentanil are 1,000 to 10,000 times more potent than morphine.
But getting tough is crucial, as well.
In addition to being available in hospitals across the state, these pain relievers are being manufactured and smuggled into the United States and reportedly used to lace heroin, cocaine and marijuana, which increases the risk of addiction, death and neonatal abstinence syndrome in babies, Dickerson and Terry say.
One recent drug bust in Tennessee led to the seizure of more than 100,000 pills containing fentanyl, they say.
“This is a nonpartisan problem in need of bipartisan solutions. Our legislation addresses just one part of a multifaceted problem,” Terry acknowledges. “The goals should be to ensure that patients have adequate treatment options and adequate access to treatment while decreasing the overuse, abuse and illegal use of opioids.
“From a patient care perspective, I am concerned that some may want to restrict access too much or impose too many regulations such that we lose providers who are willing to treat acute pain and chronic pain. Any solutions must keep the patients in mind.”
Raising awareness
The tragic overdose death this summer of Max Barry, the 22-year-old son of Nashville Mayor Megan Barry and husband Bruce, gave Tennesseans a dose of the harsh reality stemming from opiate abuse. To their credit, they are willing to talk about Max’s life, his struggles with drug use and the exact causes of his death, an apparent mixing of dangerous drugs.
Tennessee congressional candidate Steven Reynolds and wife Shelley also recently spoke publicly for the first time about the December 2015 death of her son, Brandon Fraser, from an accidental overdose at his Florida apartment.
“It’s easy for us to get out of bed in the morning and fight this fight,” Steven Reynolds says. “We think about Brandon, and I don’t want to see another mother go through what my wife has been through. We don’t want to see other families go through this anymore. This is one of the drivers behind our campaign.”
President Donald Trump is weighing in, too, declaring the opioid epidemic a national emergency, which can mean more funding for states to deal with drug problems.
Of course, this is hardly a new thing.
The state Legislature has been trying to quell the increase of opioid abuse for several years with numerous new laws, yet the number of people dying in Tennessee from opioid abuse has increased nearly every year for last two decades, rising to 1,451 in 2015 and some 1,600 in 2016, with more than 6,000 people succumbing to it over the last five years.
With those figures playing prominently, the state’s Opioid Task Force, appointed by House Speaker Beth Harwell, has been taking testimony and gathering information and is set to make recommen-dations within the next few weeks.
“Those affected by this crisis need treatment instead of prison cots, and we should look at increasing penalties for bad actors and gang members trafficking these deadly drugs,” Harwell says.
“Although I do not think another massive federal program is the answer to this epidemic, I look forward to the president’s ideas on how we can tackle this together. I am hopeful the president will return Tennesseans’ tax dollars in block grants that we can use to increase access to treatment.”
Taking stock
The Sycamore Institute gives the state good marks for significant progress in cutting opioid prescribing and dispensing, in addition to making a few “targeted investments” in substance abuse treatment.
In 2012, the Legislature passed the Prescription Safety Act setting up a controlled substance monitoring database at the same time the state started cracking down on pain management clinics. A year later, the enacted the Safe Harbor Act took effect, enabling women whose pregnancy is affected by a prescription drug problem to seek treatment without risking the loss of child custody.
Lawmakers passed another prescription safety act in 2016, making the 2012 changes permanent, while providing $1.3 million for drug recovery courts and this year put $6 million in the budget for safety net treatment services.
It’s not enough, and they’re beginning to see it.
Despite the legislation passed, the number of opioid-related hospitalizations, deaths and neonatal abstinence cases keeps rising. The state averaged 1.4 opioid prescriptions per Tennessean in 2012, the second highest rate in the nation, and prescription opioids surpassed alcohol as the main substance of abuse treated through funding Dept. of Mental Health and Substance Abuse Services funding.
The analysis
Congressional candidate Reynolds points out that opiate and heroin abuse was once considered a big-city problem confined to places such as New York and Los Angeles. People who grew up in the ’70s and ’80s didn’t face the same temptations as today’s 20-year-olds, either, he says.
“Tennessee is ground zero for this issue, and West Virginia is the only state that’s bigger than we are,” Reynolds adds. “What’s happened is all of these big, powerful drugs came to market, and they let it rock on for about 10 years before they cracked down on it, and then when they started cracking down on it, they had this entire class of addicted people, and there was nowhere for them to go.
“And so, they turned to heroin because it was cheaper, and you hear that all the time. It’s cheaper and it’s more powerful.”
Another symptom of the problem, Reynolds says, is that society hasn’t take addiction seriously, treating it as a crime and throwing it in the lap of law enforcement, which isn’t trained to treat addicts or provide mental health care. He adds too often people have to get arrested and thrown in jail before they get treatment.
The Sycamore Institute points out addiction is a chronic brain disease requiring long-term care and management. The best treatment and recovery programs involve early intervention, medically-assisted detox, medications and recovery support. Unfortunately, all of those can be blocked by financial obstacles, social stigma and a shortage of treatment space, the Institute reports.
No doubt, a lot of people have a predisposition to get hooked, possibly through their chemical or mental makeup. It doesn’t help, however, when physicians prescribe pain medication with about 30 pills in the bottle when only a few are needed. If someone took every one of those for a minor surgery they’d be a junky in no time.
The Sycamore Institute adds Americans are the biggest consumers of prescription opioids worldwide, and it’s easy to see why. Too often, doctors and pain clinics are giving people pills they don’t need. People are looking for a cure for every ill, and our young people are trying to ease some kind of pain with prescription and illegal drugs.
People want to get high, failing to realize the risks. Tougher laws are one way to go at it. But it’ll take a massive public relations campaign to make some people understand.
Sam Stockard is a Nashville-based reporter covering the Legislature for the Nashville Ledger, Knoxville Ledger, Hamilton County Herald and Memphis Daily News. He can be reached at sstockard44@gmail.com.