Roy Exum
When a person anywhere in Tennessee fills a prescription for an opioid pain drug, it is mandatory by state law that the person’s name, the size and strength of the prescription, and the physician who wrote the order be entered into a massive database. Opioids, such as Oxycodone (brand names like Percocet or Percodan) and Hydrocodone (brand names like Vicodin or Lortab) are fabulous drugs for fighting pain.
But, as Dr. Mitch Mutter told over 100 young doctors at Erlanger Hospital on Tuesday, Tennessee is among the worst states in the country for prescription drug abuse.
“Three years ago we were one of the worst and today we are still one of the worst but, because of the data bank and other huge steps that are being taken, we are so much better than what we were.”
Dr. Mutter, a hospital favorite when he practiced cardiology for nearly 40 years in Chattanooga, is today the state’s medical director for Special Projects and, when he spoke to the bright-eyed residents and interns at the University of Tennessee’s Medial College, he was hardly preaching to the choir – this newest influx of doctors is well acquainted with the ravages of prescription drugs when they are abused.
Today’s young doctors know that 46 people die of prescription overdose every day. According to the Centers for Disease Control and Prevention, over a half-million Americans go to the emergency room every year with complications and most of those are not abusing the drugs. That stated, the ER is the last place somebody who is abusing prescription drugs wants to go because the state’s highly-effective data base can inform a physician almost instantly if there is abuse.
In Tennessee there are approximately 4.84 million people. It is believed that 221,000 used prescription pain relievers last year for “non-medical purposes.” There are 70,000 who are clearly addicted, sometimes taking 40 to 100 pills a day to fulfill their habit. The other 152,000 are on the brink of disaster.
So the state of Tennessee is today one of three states that require mandatory monitoring of all narcotic prescriptions. Some can no longer be phoned in, requiring a face-to-face visit with the pharmacist, and, as Dr. Mutter told his rapt audience yesterday, the reason is because Tennessee wants to save lives.
“I feel like it is malpractice to do a workup and a history on a patient and not check the narcotic data base. That’s not to go on any witch hunt, but it has been my experience that if a patient is abusing drugs, he’s the last one who is going to tell you about it. The data base will help the primary physician – the doctors who know their patients best – to treat them best,” he told the other physicians.
Obviously, with less than five percent of Tennessee’s citizens abusing prescription drugs, most checks will prove futile, but, with 221,000 abusing prescriptions, the data base will undoubtedly save lives and encourage treatment. “Not long ago in Athens two people were ‘cheeking’ fentanyl patches (putting the skin patches inside their mouth for a faster and greater ‘high.’). What they didn’t know was that after the euphoria wears off, the drug remains in your body. So when they did a second patch, they immediately over-dosed and died.”
The database has had a big effect on the “pill mills” and “doctor shopping” that has plagued the state. People with multiple prescriptions in too short a time immediately leave a trail and the courts are dealing with “doctor shoppers” (those who go to multiple doctors with the same symptoms, collecting a stack of prescriptions in a matter of days.)
“I spoke not long ago in Middle Tennessee and some people were there from Alabama because they want to network with us starting next year. Kentucky is doing that and Virginia is strengthening a program they had in place before ours. Georgia is still ‘behind the curve’ but we believe they’ll move pretty quickly when they notice people from Tennessee and Alabama – states that are clamping down – drive the abusers into Georgia.”
Alabama launched a website and educational platform on Monday to combat prescription abuse in a desperate attempt to thwart the epidemic. George Beck, a U.S. attorney in Montgomery, said they can already see prescription abusers “graduating” to heroin and synthetic forms of marijuana. Alabama leads the nation in opioid prescriptions per 100,000 people and, because they were slow in the opioid wars, now heroin is on the rise. Ain’t that swell?
“When I went to medical school there was no formal training in the treatment of pain. Vanderbilt is the only teaching hospital in the state that now has a “Pain Service,” where interns and residents rotate through the program. My dream is to have one at Erlanger. With prescription pain now an epidemic in Tennessee, this is a piece of the puzzle we must address. A Pain Service would undoubtedly enhance patient care.”
A recent ABC Television special showed that 11 times the number of pain prescriptions are written in Tennessee than in Minnesota. “That’s unacceptable. The ‘pill mills’ along our Interstate highways are wrong, but the legislature has been wonderful. There are some new laws coming because they realize how much drug abuse costs our state.
“We are still one of the worst, but Governor Haslam and his cabinet have made this a huge priority. The young doctors you saw today are part of the solution. We still have a lot to do, but, as I came back to Erlanger today, I’m awfully proud of what we’ve already done for the people who live here.”
royexum@aol.com