(NASHVILLE, Tenn.), January 23, 2014 – Senate Committees heard a variety of reports this week, including an update on the state’s war on prescription drug abuse.   Dr. Robert Pack, Professor and Associate Dean of the East Tennessee State University College of Medicine, told members of the Senate Health and General Welfare Committee that the state’s Controlled Substance Monitoring Database shows there were about 51 hydrocodone pills, or 1.4 prescriptions, prescribed each year per person for Tennesseans older than 12 years old.

Pack said this equates to approximately 275 million doses of hydrocodone alone that are in the hands of Tennesseans each year.  This is in addition to prescriptions filled for other opiate pain relievers.  The most common of these are alprazolam, the generic of Xanax, with 116 million doses filled annually, and oxycodone, with 113 million pills prescribed within the state.

Studies show that Tennessee is not alone.  The Center for Disease Control reports prescription drug abuse death rates have increased dramatically by 250 percent nationwide over the last ten years.  The epidemic hits rural and urban areas, with more prevalent use in the West and Appalachia according to the statistics.  Pack said misuse, particularly among youth, occurs most commonly due to family members having unused pills in their cabinets.

“There is a very high volume of prescribed opioid pain relievers that can and do fall into the wrong hands leading to misuse and addiction,” said Pack.  He said that as a result, there is a growing national understanding about the importance of preventing diversion of controlled substances from their intended use.

Pack praised the legislature and Governor Haslam for passing the Prescription Safety Act in 2012 to combat prescription drug diversion and to address bad actors who prescribe opiates carelessly.  He said that as a result of the law, doctor shopping, one of the most prevalent problems in prescription drug abuse, is down by 30 percent.  Five studies in different states have shown that 10 to 15 percent of prescribers are responsible for prescribing 65 to 80 percent of opioid relievers.

Pack said he expects heroin use to escalate in Tennessee to backfill the market for prescription opiate pills as the state clamps down on abuse.  A 2013 study effectively said that those who use opioids are more likely to become addicted to heroin.  There has been an influx of heroin from Mexican cartels which have offered the illegal drug at a cheaper price than the street rate of diverted prescription opiates.

To help prevent prescription drug abuse, Pack recommended better prescription guidelines and education for prescribers, including instruction or referral in the management of acute and chronic pain.  He also recommended greater communication between pharmacists, patients and physicians.

Neonatal Abstinence Syndrome (NAS) escalates in Tennessee  — One of the most significant side effects of the prescription drug epidemic in Tennessee is the ten-fold increase in the number of babies born addicted over the last decade.  Dr. Michael Warren, the Tennessee Department of Health’s Director of Family Health and Wellness, reported to Senate Health and General Welfare Committee members that there have been about 855 cases of babies in Tennessee who were born dependent to opiates in 2013.  The problem is especially prevalent in East Tennessee with Niswonger Children’s Hospital and East Tennessee Children’s Hospital which have a large number of infants in their Neonatal Intensive Care Units due to being exposed to drugs before birth.

Over 42 percent of mothers who give birth to addicted babies have been prescribed the pills, 32.6 percent are from illicit or diverted substances, 21.5 percent are a mix of prescribed and non-prescribed doses, with the remainder from unknown substances.

Addiction to opiates can result in the infant having Neonatal Abstinence Syndrome (NAS), which occurs when the mother’s drugs are cut off at birth.  NAS can cause the infant to have tremors, weight loss, stiff muscles, seizures, inconsolable crying, gastrointestinal disorders and poor nervous system irritability within one to five days after birth in 55 to 94 percent of cases.  NAS babies often require ongoing medical care costing an average of $62,324 during their first year of life.  These infants are 19.7 times more likely to end up in state custody.

Governor Haslam has appointed a working group with representation from the Tennessee Department of Health, Children’s Services, Human Services, Mental Health and Substance Abuse Services, TennCare, Safety and the Children’s Cabinet to address the problem.  The group has already taken action to educate the public and physicians regarding the dangers of prescription drug abuse during pregnancy.  As a result of their work, TennCare has implemented narcotic preauthorization requirements to help deter the prevalence of prescription drug abuse among pregnant mothers.

Governor proposes legislation to fight meth abuse — In other news on drug abuse, Governor Haslam announced last week that he is proposing legislation to reduce the growing problem of methamphetamine production in Tennessee.  The goal of the Tennessee Anti-Meth Production (TAMP) Act is to limit access to pseudoephedrine or ephedrine products to those who are using it illegally.

Provisions of the governor’s bill include the following:

• Individuals would be authorized to purchase up to 2.4g (the maximum recommended daily dose of 240mg for 10 days) of products containing pseudoephedrine or ephedrine in a 30-day period by presenting a valid ID to a pharmacist, which is the way state law currently works.
• If the consumer returns to purchase additional products, a pharmacist, at his or her discretion, may override the National Precursor Log Exchange (NPLEx) system to allow individuals to purchase up to 4.8g (maximum recommended daily dose of 240mg for 20 days) in that same 30-day period.
• Anything above 4.8g in a 30-day period would require a prescription issued by a licensed physician, certified physician assistant, or authorized nurse.

The proposal would effectively give Tennessee the lowest state limit in the United States. Two states, Oregon and Mississippi, require a prescription for all pseudoephedrine or ephedrine products.

Senate Judiciary Committee acts to place synthetic compound under controlled substances law — Finally, the Senate Judiciary Committee has approved legislation adding the synthetic cannabinoids, quinolinylindolecarboxester and propylindazolecarboxamide, to the state’s Schedule I controlled substances law.  Senate Bill 1508 now moves to the floor of the Senate for final consideration.

Synthetic drug products, which have become increasingly popular among teens and young adults, are sold at a variety of retail outlets like convenience stores, smoke shops and over the Internet.  They mimic other dangerous illegal drugs.

The General Assembly has passed legislation to ban other chemical compounds used in synthetic drugs; however, unscrupulous chemists manufacturing the drugs continue to modify molecules in the organic compounds to avoid prosecution.