NASHVILLE — Gov. Bill Haslam and legislative leaders outlined a $30 million plan Monday to attack Tennessee's opioid epidemic with calls for new limits on painkiller prescriptions, more educational outreach to students, boosting availability of addiction treatment and the use of 512 prison beds to help hundreds of state prisoners with problems.
"This epidemic knows no political boundaries," Haslam said as he was joined by top Republicans to unveil the three-pronged "TN Together" proposal. "It doesn't know political parties or race or income distinctions. It affects families all across our state."
Haslam's proposed approach focuses on prevention, treatment and law enforcement to assist in tackling the longstanding problem that takes the lives of three or more Tennesseans every day from opioid overdoses.
That's in a state where the estimated 7.6 million painkiller prescriptions exceed Tennessee's total population by 1 million.
"Last year, 1,631 Tennesseans died of a drug overdose—12 percent more than the year before—and the highest rate of drug overdose deaths in recorded history in Tennessee. Nearly three out of four of the drug overdoses in our state are related to the opioid crisis," Alexander said. "Earlier this month, I dropped by a meeting at the Tennessee Governor's Residence in Nashville looking at discouraging the over prescription of opioid painkillers. Governor Haslam and Tennessee's state and local leaders have put forward a detailed proposal of steps our state can take to help address this crisis. The antidote to the opioid crisis is strong local communities, and the federal government can be a helping hand to creating an environment in which communities themselves can address the crisis. Congress took important steps in 2016 by passing the Comprehensive Addiction and Recovery Act—which established new programs and encouraged those on the front lines to work together to combat substance abuse, especially opioid abuse—and providing $1 billion in new funding for states to fight the opioid crisis as a part of the 21st Century Cures Act. I expect that Congress will provide a significant amount of new funding for the opioid crisis this year – it's our number one public health issue – that would be used to allow states to provide treatment and implement other strategies to curb opioid abuse. I will be holding more hearings in the spring to address this crisis, and I will continue working closely with the Trump administration and my colleagues in Congress to see what additional steps Congress should take to help states, doctors, and families address and solve this tragic problem."
— U.S. Sen. Lamar Alexander
"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."
— Lt. Gov. Randy McNally
House Speaker Beth Harwell, R-Nashville, Lt. Gov. Randy McNally, the state's Republican Senate speaker, and even state Supreme Court Justice Jeffrey Bivins joined Haslam in announcing the program.
"We will beat this crisis," the chief justice vowed.
One potential trouble spot for the 10-point plan is addressing prevention by limiting the supply and dosage of opioid prescriptions with what the administration calls a "reasonable exception" provision for cancer patients, some other illnesses and for patients in end-of-life hospice care.
But initial prescriptions will be limited to a five-day supply of drugs with daily dosage limits of 40 morphine milligram equivalent. In the past, physicians and other prescribing professionals have pushed back on such limits.
The administration also plans to move forward on long-standing plans to limit coverage for TennCare enrollees to the five-day supply of opioids with dosage limits.
Meanwhile, the plan could expand opioid addiction treatment to between 6,000 to 10,000 more low- income Tennesseans and perhaps even more under a provision aimed at creating public-private partnerships with private drug addiction centers.
While applauding some elements of the proposal, Democratic legislative leaders said the plan ignores what they believe is a major potential source of help: expanding the state's TennCare Medicaid program to some 280,000 low-income adult men and women.
"This is the time for bold action," Senate Minority Leader Jeff Yarbro, D-Nashville, told reporters. "I think there's some things that are included in this proposal that everyone supports. But this is a modest step."
Yarbro called the proposed $25 million for treatment "somewhat troubling," saying there are individual hospitals in the U.S. that spend similar sums annually. "Under this plan, we are not sending enough people into medically assisted treatment."
"I think personally, the governor feels his hands are tied by the [Republican] majority who hasn't let him expand Medicaid," Yarbro added.
The governor, meanwhile, told reporters he believes the plan will "really help us turn the tide in the fight against opioids in everything from overprescription to the prevention of the issue and finally with law enforcement."
He said the state is putting "significant dollars toward treatment with the $25 million in state and federal funds."
"The bulk of that money will go toward treatment and then, obviously, law enforcement [is] a piece of it as well," Haslam said. "Some of it is the education piece. But most of that money is going toward treatment."
Correction Commissioner Tony Parker told reporters the repurposing of the 512 beds at West Tennessee State Prison to deal with systemwide opioid addiction issues will double the department's current capacity.
Mental Health and Substance Abuse Commissioner Marie Williams said prevalence data indicate some 300,000 Tennesseans are "misusing drugs" but aren't addicted. About 80,000 adults "are addicted, based on prevalence data that will be coming out."
As for enlisting for-profit providers, Williams said her department plans to meet with a number of their representatives on Feb. 3 to get their views on how the state "can leverage our resources."
The opioid crisis has been playing out for years in Tennessee. Several years back, state lawmakers ended one of the issues, repealing a law passed over a dozen years ago that resulted in the proliferation of "pill mills" that flooded the state.
A House opioid task force created by Speaker Harwell, who is running to succeed Haslam, called for adding 25 new agents along with other steps.
Haslam said his understanding from TBI Director Mark Gwyn involve the need to have more ability to "target" areas where there is "more illicit activity than other areas in the state. If they can target that with certain resources, they can get ahead of the bad guys, quite frankly."
Haslam said details on that topic as well as other provisions will be fleshed out when his proposed 2018-2019 budget plan is released next week as he delivers his annual state of the state address.
The governor said his administration has not been idle in the fight against opioid addiction.
"Steps we have made in the past have made a difference," he said, pointing to about a one-third drop in annual opioid prescriptions. "And we've added law enforcement. Last year we added about $20 million in treatment. So this isn't brand new."
Contact staff writer Andy Sher at email@example.com or 615-255-0550. Follow on Twitter @AndySher1.
Specific provisions in the 10-point plan include:
› Legislation to address prevention by limiting the supply and dosage of opioid prescriptions with a “reasonable exception” in the case of cancer patients and some other illnesses and situations. Initial prescriptions would be limited to a five-day supply with daily dosage limits of 40 morphine milligram equivalent.
› Limiting coverage for TennCare enrollees to initial five-day supply and daily dosage limits.
› Increasing prevention education in grades K-12 through revisions to state health education academic standards.
› Issuing an executive order to create a commission to formulate new, evidence-based paid and addiction medicine competencies for state medical and health care universities.
› Identifying women of childbearing age who are chronic opioid abusers and providing target outreach about risks and treatment in order to help curb the number of babies born into addiction.
› Improve state data systems to zero in more quickly on “hot spots” for targeting resources and boosting information for communities on risk.
› Legislation expanding residential treatment and services for opioid dependence within the criminal justice system. That includes creating incentive programs for offenders who complete “intensive treatment programs” while incarcerated.
› Attacking illicit sales and trafficking of opioids by providing additional resources to the Tennessee Bureau of Investigation for “rapid response teams” through legislation penalizing use and unlawful distribution of drugs including that mimic fentanyl, a highly dangerous drug up to 100 times more powerful than morphine and linked to a number of overdose deaths.
This story was updated Jan. 22, 2018, at 11:30 p.m. with more information.