Tennessee could receive up to $24 million to fight heroin and painkiller addiction, if Congress approves the Obama administration's proposal to provide $1.1 billion in new funding to help treat what is being called an "opioid epidemic."
The funds would help the state create new clinics, particularly in rural areas that have been particularly hard-hit by addiction to opioids, which include both heroin and painkillers such as Oxycontin.
Federal officials released those figures Tuesday as the Obama administration ramped up its push to win approval for the money.
"Society has to begin to see addiction issues as a disease and not as character flaws," said U.S. Agriculture Secretary Tom Vilsack, who as chairman of the White House Rural Council is heading a task force to address the issue. "This is not people committing crimes, and it should be treated as a disease just as cancer or heart disease."
More than 28,000 Americans died from a heroin or painkiller overdose in 2014, according to the Centers for Disease Control and Prevention.
Emphasizing the seriousness of the issue, a new study of 45,000 Tennessee Medicaid recipients released Tuesday by Vanderbilt University reports that patients using opioid painkillers were much more likely to die of heart problems than those using other pain treatments.
"We found that the opioid patients had a 64 percent increased risk of death for any reason and a 65 percent increased risk of cardiovascular death," said Dr. Wayne Ray, professor of health policy at Vanderbilt University School of Medicine.
"As bad as people think the problem of opioid use is, it's probably worse," said Ray, lead author of the study. "They should be a last resort, and particular care should be exercised for patients who are at cardiovascular risk."
"The doctor and patient need to have a conversation," Ray said. "If the patient hears that there is a chance he or she wouldn't wake up if they took the medicine, they might think really hard about the alternatives."
In an interview Tuesday with the Times-Free Press, Vilsack, a former Iowa governor, said he hopes Congress will recognize the seriousness of the situation.
"Forty-four percent of Americans say they know someone close to them who is dealing with an addiction issue. That is an incredible percentage," he said. On average, 84 people will die of an overdose every day, Vilsack said.
The agriculture secretary has personal experience with the problem. His mother was a prescription drug addict and alcoholic, and she "went through an incredibly difficult time" before finally turning her life around, Vilsack said.
"As a young person, I judged my mom as weak, as not strong enough," he said. "As I got older, I understood there is a disease element of this. We need to understand the totality of what she needed — treatment, constant support from a community that understands what she is dealing with, and not judging her and seeing her as a flawed person, but as someone who needs help."
Vilsack said he believes the economic problems facing many rural areas may lead to increased drug addiction. He noted that rural residents are twice as likely to commit suicide as urban residents.
"In rural areas, you are dealing with a depressed economy, with high unemployment and high poverty," he said. "Many people in that community think their tomorrow is not going to be any better than today, so why not ease the pain?"
Rural communities need to be open to helping people talk about depression and other issues, Vilsack said.
"It starts with the community being educated about the tell-tale signs of depression, of people considering taking their life, bringing that stuff out in the open, and not being persuaded that they have to tough it out, which oftentimes is how we deal with things in rural areas. We're self-reliant, we don't want to admit we have a problem."
Vilsack said the federal government will continue to emphasize providing access to high-speed internet service in rural areas, to give more people access to telemedicine, where doctors use a video connection to talk to patients when they cannot travel to meet with them in person.
The Department of Health and Human Services is also launching a pilot program to allow nurses and physicians assistants to prescribe anti-addiction drugs such as buprenorphine, instead of restricting their use to doctors. Many rural areas are facing a shortage of family doctors, while recent medical school graduates often opt for specialties where they can earn more money, but only if they live in urban areas where they have access to a large population of potential patients.
Vilsack also expressed concern that given the current crackdown on opioids, some patients with chronic pain who depend on painkillers will have difficulty finding a doctor to prescribe them.
"I would say if a physician makes a decision no longer to be prescribing, they do have a responsibility to figure out ways for pain to be reduced to an acceptable level," he said. "You can't just say, 'Sorry, what I've been doing in the past I'm not going to do, you're on your own.'"
Vilsack said Congress only has a few more weeks to respond to the administration's funding request.
"This is not a Republican or Democrat issue. It's not rural or urban. It's not a race issue," he said. "I know the pain of this. I have had friends who have lost children. All of us are affected by this."
Contact staff writer Steve Johnson at 423-757-6673, sjohnson@times freepress.com, on Twitter @stevejohnsonTFP, or on Facebook, www.facebook.com/noogahealth.