CDC Report: Local opioid prescriptions dip, overdose deaths still surging

Local health officials appear to be making headway against the flood of opioids prescribed in Northeast Tennessee.

But in a deadly twist, overdose fatalities are rising in area counties, due in part to addicts turning from prescription medication to heroin and fentanyl.

Released in early July, a Centers for Disease Control and Prevention study analyzed 59,000 pharmacies around the country, finding that opioid prescriptions in Washington, Carter, Unicoi and Sullivan have actually remained steady or decreased between 2010 and 2015.

Because opioid prescriptions come in different strengths and doses, the researchers measured the number of opioid prescriptions based on morphine milligram equivalents, or MME, per person.

Sullivan County easily topped the Upper East Tennessee region in the amount of morphine equivalents per capita both in 2010 and 2015, but showed a slight decline during the interval.

Unicoi County showed the most progress in decreasing its opioid prescription rate: declining 449 morphine equivalents per capita between 2010 and 2015.

But despite the progress made, all four Northeast Tennessee counties significantly out-prescribed opioids compared to the nationwide number of 640 milligrams of morphine equivalency per person in 2015. The local counties were also ranked in the fourth quartile of counties nationwide based on the high number of opioid prescriptions per person.

And overdose deaths continue to ascend, both statewide and on a local level.

"There is progress in several areas and then there's a lack of progress in some very important areas, like the number of overdose deaths, including in the East Tennessee and Northeast Tennessee areas," said Dr. David Reagan, the Tennessee Department of Health's chief medical officer.

But why are the numbers going in what seem to be opposite directions?

Reagan attributed the rise in deaths to a surge in illegally distributed fentanyl and a continued increase in heroin use. He also mentioned that fentanyl pressed pills that look like Percocet tablets have led to several overdose deaths in middle Tennessee.

According to data from the Tennessee Department of Health, prescription opioid overdose deaths in Washington County rose from four in 2012 to 17 in 2015.

In Carter County, the toll went from three in 2012 to 10 in 2015, and in Unicoi County, there were no deaths attributed to prescribed opioids in 2012, but three people died from them in 2015.

Sullivan County opioid prescription overdose deaths jumped by 16 during the three-year period to 20 deaths in 2015.

Statewide, the Department of Health reported 596 overdose deaths related to prescription opioids in 2012, compared to 848 of the same attributable deaths in 2015.

A spokesman for the Department of Health did clarify that figures given for specific drugs are not mutually exclusive because most people who die of a drug overdose are found to have more than one substance in their systems.

But on the positive side, Reagan said the prescription decrease showed real improvement.

"In terms of progress, we are pleased that the amount of opioids dispensed in Tennessee continues to decrease, and of course, the CDC only had data through 2015, but we've seen that decrease continue into 2016 and 2017," he said.

The implemenion of the state's Controlled Substantce Monitoring Database has assisted in that decrease, Reagan said.

"I think the No. 1 thing (to assist with the decline in opioid prescriptions) has been the ability for prescribers to have an accurate understanding of what a particular patient had recently dispensed to them," Reagan said.

Before 2012, Reagan said it was optional for physicians to check that database to verify if someone had already been prescribed a particular controlled substance.

Other contributing factors to the decline of opioid prescriptions are stricter prescribing guidelines in Tennessee and doctors choosing other methods of pain management.

"There has been a lot learned in the last few years about the fact that opioids are really not as effective (in treating) chronic pain as we thought," Reagan said. "And secondly, other medicines, for instance the combination of Tylenol and ibuprofen, are actually as effective or more effective than opioids for many types of chronic pain.

"I think prescribers have been re-educated to a degree about this problem in the past few years. And I think it's an ongoing process to continue that education."

Here are the prescription numbers for the four-county area:

Washington County went from 1,470.2 morphine milligram equivalents, or MME, per capita in 2010 to 1129.4 MME per capita in 2015;

Carter County, 1,162.5 MME per capita in 2010, to 1,126 MME per capita in 2015;

Unicoi County, 2010: 1,765.8 MME per capita in 2010, to 1,316 MME per capita in 2015; and

Sullivan County, 1,940.1 MME per capita in 2010, to 1,860.5 MME per capita in 2015.

Email Zach Vance at zvance@johnsoncitypress.com. Follow Zach Vance on Twitter at @ZachVanceJCP. Like him on Facebook at Facebook.com/ZachVanceJCP.