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Gov. Bill Haslam will announce Tuesday a seven-point plan to quash Tennessee's pill-popping problem, but addiction experts worry addicts will turn to heroin as prescription narcotics become harder to get.

Tennessee's prescription drug abuse epidemic has left an estimated 69,100 people with serious addictions to controlled substances. The state ranks second in the nation for per-capita opioid use.

Addiction specialists say some of those users are already turning to heroin.

"Generally, someone will go in with chronic pain and start with a prescription drug," said Dr. Terry Alley with Cumberland Heights. "As tolerance develops, they need more and more. They can't get enough and they will switch over to heroin because it is cheaper and more available. That is a typical pattern that we see."

And it is a pattern that is occurring across the nation, according to an article published online Wednesday in JAMA Psychiatry by professors at Washington University in St. Louis. The researchers determined that 75 percent of heroin users in recent years were first introduced to opioids through prescription drugs. That's a reversal from the 1960s, when 80 percent of users started with heroin.

"We found that heroin use is not simply an inner-city problem among minority populations but now extends to white, middle-class people living outside of large urban areas, and these recent users exhibit the same drug use patterns as those abusing prescription opioids," the Washington University professors concluded in the article.

"In this connection, our data indicate that many heroin users transitioned from prescription opioids."

People addicted to prescription drugs will need access to effective treatment, Alley said, for the state strategy to work.

While state officials will not detail specifics of the seven-point plan until Tuesday, a spokesman for Tennessee Department of Mental Health and Substance Abuse Services said treatment is a key component.

"While we are very cognizant of the heroin problem, the increasing heroin use and abuse issue that we are seeing, this report is really focusing on prescription drugs," said department spokesman Michael Rabkin.

The plan follows a series of efforts in recent years to address the state's prescription abuse problem, including new laws to better track the supply of addictive medications and more disciplinary actions against doctors who overprescribe them.

"We are taking this opportunity to look at everything that we have been doing and put it all under one umbrella, really," Rabkin said.

The announcement is set to occur less than a month after a committee of physicians appointed by the Tennessee commissioner of health agreed on new physician guidelines for prescribing opioids. The guidelines set limits on daily doses doctors can prescribe to patients, spell out protocols for giving the drugs to women of childbearing age and establish new certification requirements for pain medicine specialists.

Joining the governor for the announcement will be Commissioner of Mental Health and Substance Abuse Services E. Douglas Varney, Health Commissioner John Dreyzehner, Commissioner of Safety and Homeland Security Bill Gibbons, Tennessee Bureau of Investigation Director Mark Gwyn and Davidson Criminal Court Judge Seth W. Norman.

"We've come up with seven comprehensive and coordinated goals involving the entire state and a variety of different state departments to really tackle this issue moving forward," Rabkin said.

However, success will also depend on changing how people think about pills.

"If you have a back pain and you talk to your aunt or your uncle and they say, 'Oh, I got back pain too. Why don't you take some of this medicine that I've got left over?' That's not something that we want people to do," Rabkin said.

"But people do it."

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