NPR: How Drug Combos Are Making Tennessee’s Opioid Problem Even More Deadly

Original By: AMY ESKIND
Posted On: September 25, 2017

NPR: Combining Dangerous Drugs Pushes Tennessee Overdose Deaths To Record High
NPR: How Drug Combos Are Making Tennessee’s Opioid Problem Even More Deadly

The combining of powerful drugs — both purposeful and unintentional — is making Tennessee’s opioid epidemic even more deadly. The latest figures out this month show 2016 was another record year for overdoses in the state — more than 1,600 people died. And experts say risky drug cocktails are compounding the problem.

Emergency responders have answered hundreds of 9-1-1 calls from friends and family members of people who have overdosed. Last year Davidson County lost 261 people to overdose, almost all of them from opiates. On the street, heroin is a cheaper opiate than pills. Many users are looking for whatever will give them the highest high, says recovering addict Mary Barton Lea.

“When I was buying my heroin I said, ‘who’s got the heroin with the fentanyl?’” she says. “That’s the heroin I want.”

Fentanyl is a very strong opiate that magnifies the experience and lasts longer. Experts expect to see more of it coming into Middle Tennessee.

“It’s a sleep-like state, it’s a state that you feel secure,” Lea says. “I’ve read — and I tend to agree with this — it’s almost like kissing God, because it takes you to a place you’ve never been before.”

But that incredible high comes with a physical and mental addiction, Lea says.

“When you come down from that state, all your body says is I want to get back there…You get up there quick, but then there’s a crash and the crash is horrible. The crash is you will do anything within your power to get more.”

Serious addicts like Lea may be willing to flirt with death. Others are simply unaware, says Sam MacMaster. He’s the chief clinical officer at JourneyPure, an addiction treatment provider. He warns that no one can be sure what they’re buying in the illegal market.

How Drug Combos Are Making Tennessee's Opioid Problem Even More Deadly
Sadly, 2016 was another record year for overdoses in the state — more than 1,600 people died. And experts say risky drug cocktails are compounding the problem.

“You would not be able to tell [by] how it looks at all, and that’s the issue,” MacMaster says. “They believe that they’re purchasing typically heroin or sometimes even a pilled opiate but it’s been cut with fentanyl.”

Indeed, the U.S. Drug Enforcement Agency issued a warning about counterfeit Vicadin and Oxycotin pills. As with heroin, unscrupulous dealers add fentanyl to give themselves a marketing edge — they’ve got the strong stuff.

But some users are buying the laced drugs unknowingly. They may erroneously think it’s stronger because it’s more pure. The next thing they know, they can’t breathe. Then their heart stops.

“If I believe I’m shooting x-amount of heroin, I may in fact be shooting something that is much more potent. And while I may have a sense of what my body can handle, I’ll have no idea what my body can handle in terms of the fentanyl,” MacMaster says.

Some dealers are even lacing their supplies with carfentanil, a veterinary opiate that can knock out a rhino.

But lethal combinations go beyond various opioids. Users have also been adding prescription anxiety medications, such as Xanax, Valium or Klonopin. Not only is that a doubling up on medications that depress the central nervous system, experts worn there can be a multiplier effect. And it’s hitting teens and young adults hard, especially since many of them already have anti-anxiety prescriptions. Others have painkillers, maybe prescribed for an injury.

“There’s actually prescription parties where kids will have a party and everybody raids the medicine cabinets they can get to, brings them to the party, and then you have whatever you have at that party for people to experiment with,” says Cinde Stewart Freeman, chief clinical officer at Cumberland Heights, an addiction treatment center.

Cole Szabo, adolescent specialist at Cumberland Heights, says the days when kids stuck to beer and marijuana are gone.

“The benzos and opioids are the new gateway drug,” he says. And it’s in the schools. “You’re seeing Xanax, you’re seeing benzos, you’re seeing hydrocodones, oxycodones, Vicodin – you’re seeing that more. The problem with that is, you’re going to die quickly. It’s a quick death, you’re going down fast.”

If administered in time a nasal spray called Narcan that reverses the effects of opiates can save a life. Emergency responders in Nashville have used it on more than 500 people already this year.

But Narcan has no effect on other drugs like anti-anxiety pills, cocaine, or alcohol, so combination overdoses can still prove lethal. That was unfortunately the case for Max Barry, the son of Nashville’s mayor, who could not be revived with Narcan, and died over the summer in Colorado with much more than opiates in his system.


By: MELANIE KILGORE-HILL
Published: September 14, 2017

Specialists Address Disturbing Trends, Skyrocketing Death Rates

The Opioid Crisis hits Nashville Tennessee - Cumberland Heights treats Addiction to Opioids and Heroin

More than 2.5 million Americans suffer from opioid use disorder, which contributed to more than 33,000 overdose deaths in 2015, according to figures from the Centers for Disease Control and Prevention. Fortunately, a growing number of treatment options are helping to break the addiction cycle and bring healing to families in Middle Tennessee and beyond.

The New Face of Addiction

“Once upon a time, opioid addiction was limited to healthcare professionals with access,” said Chapman Sledge, MD, FASAM, chief medical officer at Cumberland Heights.

 

An addiction specialist for more than 20 years, Sledge said programs like Cumberland’s primarily treated those suffering from alcoholism a decade ago. Fast-forward to 2017, and the 50-year-old program regularly sees housewives, teenagers and executives – all patients addicted to prescription opioids and, more recently, heroin.

 

“Eight years ago you rarely saw heroin in Nashville,” Sledge said. “When Tennessee became more aggressive with the Controlled Substance Monitoring Database Program, it cut down on multiple prescriptions from multiple prescribers, which tightened up the illegal supply and drove cost up.”

 

To help prevent abuse, pharmaceutical companies also made the drugs less dissolvable. That shift opened doors for mom-and-pop heroin dealers to set up shop, offering an alternative that’s cheaper, easier to get, and more potent than prescription opioids. Today, heroin is often the most popular opioid for first-time users, leading to more overdose-related deaths than ever.

 

Dr. Chapman Sledge, MD of Cumberland Heights Top Opioid Medical Doctor“The thing that’s a game-change is the rate at which people are dying and the desperation among families,” Sledge said. “It’s so incredibly dangerous because the potency has changed. With prescription opioids, we knew what to expect from a single dose … but with heroin, it’s difficult to judge potency.”

Evolving Therapies

Enter medication-assisted therapy (MAT) including fast-acting opioid antagonist drugs, now a standard in pharmacies and emergency departments nationwide. In fact, certain antagonist therapies are available without a prescription in many states, including Tennessee.

 

Also growing is the number of in- and out-patient treatment options now available. At Cumberland Heights, patients undergo an evidence-based, 12-step recovery process that focuses on spiritual healing, as well as physical. In 2016 the program treated more than 2,000 men, women and adolescents through their two main campuses and 10 outpatient offices.

Mental Health & Addiction

Fully addressing an addict’s mental health also is imperative. Kevin Lee, CEO of Nashville-based JourneyPure, said the majority of addicts struggle with mental illness related to anxiety, depression, OCD or bipolar disorder.

 

“Our approach to addiction treatment is to first get an examination done to identify possible mental illness,” said Lee. “That’s one reason we founded JourneyPure, because so many adults with chronic mental illness have spent time in psychiatric hospitals without addiction ever being addressed.”

 

Lee said 70 percent of addicts are between the ages of 20-35, many of whom developed mental illness after using drugs. While the company serves all demographics, JourneyPure also offers programs specifically for professionals struggling with addiction.

 

The company treats more than 3,000 new patients annually at facilities in Kentucky, Florida, Mississippi and Tennessee, including a Knoxville program specifically for expectant mothers. However, Lee said only 10 percent of addicts who would benefit from treatment receive it.

 

“They’re embarrassed because they think they can’t leave work or don’t have the money,” he said. “We want them to know it’s available and that it can be an enjoyable and rewarding process.”

A Lifelong Journey

While inpatient treatment programs traditionally last 30-60 days, those with substance abuse disorders typically face a lifetime struggle with addiction.

 

Maria Russo-Appel, MD, medical director for CleanSlate Addiction Treatment Centers Eastern Division, said patients who stop medications have an 80 percent chance of relapse. “Graduating from treatment is really an old concept in addiction medicine so we don’t frame our programs around that,” she said. “We understand that this is a potentially lifelong disease, and we provide medications for that.”

 

CleanSlate, which is relocating its Massachusetts headquarters to Nashville in 2017, currently treats more than 6,000 patients in eight states (and growing). Working closely with mental health providers, CleanSlate’s care coordinators ensure patients continue to receive medical and behavioral therapies as long as necessary.

Breaking the Cycle

Like Sledge and Lee, Russo-Appel said the stigma around addiction is changing. “Many believe addiction is found in the lower socioeconomic class or the homeless, but it’s startling to see the number of high functioning, well educated people battling this,” she said. That’s because addiction so often starts with a valid prescription for chronic pain. “PCPs and other providers are all coming into an understanding that this has gotten out of control,” she said. “We now have task forces and doctors signing pledges on how to prescribe opioids moving forward.”

 

Russo-Appel said stopping the addiction cycle begins with prevention efforts as early as grammar school. “We need more awareness programs and access to care,” she said. “The heart of our mission is access. How do we get treatment to as many people as we can?”


NASHVILLE, Tenn. (WKRN) – A hard hit can do more than just knock the wind out of a player on the field. It can leave them with an injury requiring medical attention and possibly pain medication.
“Sports are probably the leading cause of injury in kids but I think it is important to understand that sports in general are protective,” Dr. Alex Diamond said. “We know kids who play sports compared to kids who don’t are typically less likely to be involved in risky behaviors.”

 
High school sports injuries can lead to addiction depending on treatmentDr. Diamond is an assistant professor of Orthopedics and Pediatrics at Vanderbilt University Medical Center. He is also the team physician for Vanderbilt University, Nashville Predators and the Nashville sounds. He along with the other physicians at in his department treated 26,000 adult and children athletes in 2016.
“As physicians we need to be mindful when treating children with injuries what situation require pain medication and what situations can be handled without pain medication,” he said. “Most of them can be handled without pain medications.”

 
Pain medications like hydrocodone, oxycodone and other opioids can be very effective in treating chronic pain. But, they can also be addictive and lead to more illicit drugs like heroin.

 
At Cumberland Heights, a non-profit addiction treatment facility, the number of teens entering the facility’s Adolescent and Young Men’s Services department has grown so much in the past couple of months it is expanding to keep up with the need.

 
“We take kids from all over the country,” Director of Adolescent and Young Men’s Services Dean Porterfield said. “The primary diagnosis is substance abuse, but It is not uncommon though that the underlying issues once you take those substances away are anxiety, depression or trauma.”

 
According to Porter for the 18 year old to 25 year old age group that makes up the Young Men’s program a growing number are addicted to heroin.

 
“A notable factor with the young adult population that we serve is that several of them are athletes who have experienced high school or college sports injuries that have required surgery and have become addicted to painkillers.”

 
He continued, “When the painkillers run out or they become more expensive the more accessible affordable drug is the heroin. That replaces what used to be that passion for sports and athletics and now their primary goal is to drug seek.”

 
Porterfield said with heroin it is not uncommon for the treatment center to get a call from family or the patient themselves saying they are in route for immediate admission to the facility.

 
“They are also some of the most vulnerable patients and need a great deal of attention throughout the painful detox and early days of treatment to prevent them from leaving against medical advice,” he said. “One of the things Cumberland Heights clinicians have made a priority is educating these young men on the risks of relapse and the lethal dangers associated with resuming the volume of heroin use they came in handling with the assumption their tolerance level is the same.”

 
He continued, “This scenario increases the likely hood of a lethal overdose.”

 
At Cumberland Heights the process is based on the 12-Steps.

 
After detox the work begins to help the young men understand the underlying reasons they abused drugs. In many cases its tied to the emotion effect their injury had on them and their identities.

 
“Just being an adolescent adult in general is full of ups and downs,” Porterfield said. “When they realize this substance can help alleviate that, they get hooked pretty quick.”
The same progression from painkillers to heroin and stronger opioids is much the same in adult users.

 
According to the CDC Tennessee is one of the most overprescribed states for painkillers.

 
At one point doctor’s wrote more prescriptions for painkillers than there were people in the state.

 
“As physicians we need to be mindful when treating children with injuries about which situations require pain medication and what situations can be handled without pain medication,” he said.

 
“We have a lot of other options that don’t have the same complications and risk involved with addiction.”

 
Dr. Diamond said things like physical therapy, proper braces or casts and anti-inflammatory medications can be very effective.

 
“As a parent you need to be diligent on what pain medication your kids are getting,” he said. “For the most part the narcotic pain medication is not needed for what we are seeing in our children. It is very rare.”

 
Porterfield said parents should be involved in their teens lives take note if you start to notice missing money, missing prescription medication, if your child is hanging out with friends or in places you do not know, and if your child attends unsupervised parties.

 


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