Joined by leadership from the House and Senate and Chief Justice Jeff Bivins, Tennessee Governor Bill Haslam on Monday announced an aggressive and comprehensive plan to end the opioid epidemic in Tennessee by focusing on three major components: prevention, treatment and law enforcement. TN Together is a multi-faceted initiative that addresses the issue of opioid addiction through legislation, proposed funding in the governor’s 2018-19 budget and executive actions.
TN Together is a collective effort and has been designed in partnership with the General Assembly through the Ad Hoc Opioid Abuse Task Force established by Speaker Beth Harwell and chaired by Speaker Pro Tem Curtis Johnson and a working group established by Haslam that included Harwell and Lt. Gov. Randy McNally’s appointee, Speaker Pro Tem Ferrell Haile.
“This is a crisis that knows no boundaries and impacts many Tennesseans regardless of race, income, gender or age," said Governor Haslam. "Our approach will be aggressive with provisions to limit the supply of opioids and significant state and federal dollars to provide treatment to those in need. I applaud the collaboration and the considerable work of the House and Senate on the TN Together plan, as well as the judicial branch’s leadership through the Regional Judicial Opioid Initiative and National Opioid Task Force, and I ask all stakeholders around this issue to work together to achieve real reform and action that will save lives.”
The three components of TN Together include prevention, treatment and law enforcement. Specifically, the plan includes:
Legislation to address prevention by limiting the supply and the dosage of opioid prescriptions, with reasonable exception and an emphasis on new patients. Initial prescriptions will be limited to a five-day supply of drugs with daily dosage limits of 40 MME (morphine milligram equivalent).
Limiting coverage for TennCare enrollees to an initial five-day supply with daily dosage limits.
Increasing prevention education in grades K-12 through revisions to the state’s health education academic standards.
An executive order, issued Monday, establishing a special commission to formulate current, evidenced-based pain and addiction medicine competencies for adoption by the state’s medical and health care practitioner schools.
Identifying women of childbearing age who are chronic opioid users and providing targeted outreach about risks and treatment in order to aid in the prevention of Neonatal Abstinence Syndrome births.
Investing more than $25 million for treatment and recovery services for individuals with opioid use disorder. These services will include an increase in peer recovery specialists in targeted, high-need emergency departments to connect patients to treatment immediately.
Improving the state’s data systems to better and more timely identify critical hot spots for targeting resources and increasing information about patient and community risks.
Legislation that expands residential treatment and services for opioid dependence within the criminal justice system and creates incentives for offenders who complete intensive treatment programs while incarcerated – a best practice that is proven to reduce recidivism, improve lives and communities and save taxpayer dollars.
Attacking the illicit sale and trafficking of opioids by providing additional resources to the Tennessee Bureau of Investigation for rapid response teams and, through legislation, penalizing the use and unlawful distribution of dangerous and addictive drugs, including those that mimic the effects of fentanyl, a drug that is up to 100 times more potent than morphine and is linked to an alarming number of overdose deaths.
Providing every Tennessee state trooper with naloxone for the emergency treatment of opioid overdose.
In total, Governor Haslam’s FY 18-19 budget proposal will include a $30 million investment (state and federal funds) to support TN Together.
More details on the TN Together plan, including help for those suffering from addiction and other resources, can be found at tn.gov/opioids.
Democratic leaders Monday said the plan is a step in the right direction, but add the most effective thing Tennessee lawmakers can do to combat the crisis is to pass Medicaid expansion in the state.
House Democratic Caucus Chair Mike Stewart said, “I applaud the governor for his efforts, however, we all know that he’s hamstrung by the Republican super majority in the state legislature and their continued efforts to serve as a roadblock to his Insure Tennessee plan. Tennesseans deserve access to the treatment programs that can only happen with expanded coverage.”
“Tennessee is drowning in opioids, and it’s having a generational impact that’s literally changing the trajectory of communities,” Senate Democratic Caucus Chair Jeff Yarbro said. “This is no time for a standard-issue, incremental plan. We should treat the opioid epidemic like the public health crisis it is. We’re either going to send people to doctors or dealers. And it seems clear that we’re leaving Medicaid expansion dollars on the table and making some easier political choices at the expense of getting more Tennesseans into the treatment everyone knows is desperately needed.”
“I stand with anyone who wants to fight the opioid crisis, but by not expanding Medicaid, we are fighting with our hands tied,” added House Minority Leader Craig Fitzhugh. “Opioid related emergency visits increased nearly 100 percent between 2000 and 2014 (according to the Kaiser Family Foundation, WWW.kff.org). Expanding Medicaid-eligible population coverage to help battle their addictions.”
Senate Minority Leader Lee Harris added, “With overdose deaths on the rise, last year Leader Fitzhugh and I passed legislation requiring those treated for an opioid overdose to be taken to the hospital. We have seen over and over again that people need actual treatment to fight this horrible addiction. In 2016, Shelby County lost 150 lives from drug overdoses involving opioids. Our bill was one small step to combat this very real problem, but one that could save lives.”
Lt. Governor Randy McNally (R-Oak Ridge), said, “I am proud to support the comprehensive Tennessee Together plan to attack the opioid crisis in Tennessee. This scourge is breaking up families, ruining lives and killing our people.
"The approach Governor Haslam outlined today demonstrates the united commitment by all three branches of Tennessee state government to confront this threat. The three-legged stool of enforcement, treatment and prevention will stop the flow of these drugs in our state, help those ravaged by addiction and work to prevent our citizens from starting down the road to addiction.
"We are confronting this crisis from all sides and from all angles. I strongly believe this legislative package will yield results both in the near term and in the long term as we continue to battle this problem in Tennessee.”
Dr. Nita Shumaker, Tennessee Medical Association president, said, "We look forward to getting more details and actively participating in the legislative and regulatory processes surrounding Governor Haslam’s TN Together plan.
"Our priority within the medical community has been and still is prescriber education and prevention of substance abuse disorder. We have made some progress in reducing initial opioid prescriptions but still have a long way to go. We must continue to promote alternative pain management treatments that do not involve opioids while ensuring that treatments are covered by health insurance. We do need to reduce supply and dosage, particularly for new patients and acute episodes like the hospital ER. At the same time, we want to make sure that any law(s) limiting physicians’ ability to prescribe have reasonable exceptions to continue giving relief to patients in legitimate need, such as chronic pain, oncology or hospice patients.
"The most important thing physicians and other healthcare providers can do is follow the CDC chronic pain guidelines, including not co-prescribing medications that, when combined with opioids, increase the risk of accidental overdose deaths.
"We will continue to champion consistent use of Tennessee’s Controlled Substance Monitoring Database, encourage screening prior to therapy, support a reduction in days’ supply when opioids are appropriate, and educate patients about the dangers of opioids, safe storage and proper disposal.
"TMA is also on record calling for more funding for drug treatment programs. Tennesseans need more access to comprehensive, affordable programs that go beyond detox and offer more effective long-term results, especially for low-income people. It is important that funding is available for community support services after treatment as well.
"Tennessee’s physicians have for the past several years led the charge toward safer and more appropriate prescribing patterns among all Tennessee prescribers. We remain committed to fighting this public health crisis through education, prevention and public policies that protect health and welfare of our patients."