As Tennessee officials continue to grapple with the growing abuse of opioids, overdose deaths and babies born addicted, a panel of law enforcement, public health and insurance officials Wednesday described a problem that has remained one step out of reach of efforts to combat it.
"We're going in the right direction, but we're still not going fast enough," said Dr. Mitchell Mutter, medical director of special projects for the Tennessee Department of Health.
Opioid abuse remains the state’s No. 1 public health crisis, and more people in the state died from opioid overdoses than in car accidents or by gunshots in 2014.
On Wednesday a panel of experts on an Opioid Epidemic Forum organized by The Tennessean outlined the challenges, which they acknowledged far outpace the solutions.
In 2012, when Tennessee was No. 2 in the nation for consumption of opioids, lawmakers passed the Prescription Safety Act, which requires health care providers to register in a database patients who receive more than a 15-day prescription in an effort to track patients who go from doctor to doctor to obtain prescriptions.
Tennessee currently has more than 45,000 prescribers registered in the database, twice as many as in California, which has a similar database but more than six times the population, according to Mutter.
"That is the No. 1 tool that we have," he said.
While making a dent in monitoring prescribing habits, law enforcement continues to confront a problem that was once largely confined to eastern Tennessee but has since quickly spread across the state, said Tommy Farmer, Tennessee Bureau of Investigation special agent-in-charge and director of the Tennessee Methamphetamine and Pharmaceutical Task Force.
"The prescription drug arena is a hard one for law enforcement to work in," Farmer said.
Law enforcement also is tasked with the job of combating illicit drugs such as cocaine, marijuana and LSD, he said.
Opioid abusers often turn to heroin when they cannot afford or access enough opioids to keep up with their addiction, but investigating illegal opioid, heroin or other illicit drug abuse is labor intensive and an often long, drawn-out process to go to trial.
"It is very stressful on the resources that are already limited on law enforcement," Farmer said, noting heroin abuse has increased 600 percent since 1999.
"As long as there is a criminal element and as long as there is money to be made, people will continue to do it," he said.
Health insurance companies such as BlueCross BlueShield are now getting involved.
Dr. Andrea Willis, senior vice president and chief medical officer at BlueCross BlueShield of Tennessee, said the insurer is working with a panel of experts to figure out how to get prescribers into better practices.
"We realized we’ve got to be part of the solution here," she said, noting the company covered over 1 million prescriptions for painkillers last year.
But the insurer is now looking at the vast amount of data it gathers in making claims for hospitalizations, emergency room visits and deaths to aid public health efforts to combat opioid abuse.
And beginning as early as July, the insurer will require doctors to obtain authorization before prescribing stronger, long-acting opioids to new patients, she said.
But the continued toll of opioid abuse was clear as the panel concluded with one audience member standing up in tears.
"In my hand are four funeral announcements from my family," said Brandy Mayo, describing relatives who died from drug abuse and what she called a lack of treatment programs in the state. "When I listen to you all talk here, it's like bits and pieces of my life are flashing."