There’s no question that over-prescribing of opioids kick-started the opioid crisis - the data is so overwhelming that nearly two dozen major companies have settled lawsuits to the tune of tens of billions of dollars because of that evidence.We’ve since dramatically cut the supply of prescription opioids, so problem solved, right? My guest this month is Dr. Clay Jackson, a chronic pain specialist and member of the Tennessee Opioid Abatement Council, which is tasked with overseeing the majority of the state’s share of the opioid settlement dollars. In this conversation, we discuss how while tightening regulations and oversight of opioid prescribing have had many positive impacts, they have had unexpected consequences for chronic pain patients as well.For Dr. Jackson, the ongoing demand for fentanyl, methamphetamine, cocaine, and a host of other substances is evidence of the need to reduce demand for all illicit substances altogether, and that clamping down on prescription opioids is not the only policy worth considering. We also discuss successes from the opioid settlement funding, how pharmacies face new challenges, economic realities for modern patients, breaking down treatment silos, and we even dive into a little bit of relevant American history. To say I enjoyed this conversation is a massive understatement. Hosted and produced by Jeremy Kourvelas. Original music by Blind House.Learn more:Tennessee Opioid Abatement Council: https://www.tn.gov/oac Johns Hopkins Principles for the Use of Funds from the Opioid Litigation: https://opioidprinciples.jhsph.edu/ SMART: smart.tennessee.edu Books mentioned in this episode:* Democracy in America, Alexis de Toqueville* Dreamland, Sam Quinones* Deaths of Despair and the Future of Capitalism, Angus Deaton and Anne Case

When staff shortages and tight funding meet a rise in drug crime, you might not expect an overburdened police department to make extra work for themselves. Yet that is exactly what happened in Chattanooga in the mid 2010s, when calls to EMS started backing up so severely the cops had to start shouldering more of the response than ever before. Today I’m speaking with Investigator Terry Topping of the Chattanooga Police Department’s Narcotics Unit, and Jennifer Baggett, senior data analyst for Hamilton County government. As the opioid overdose deaths kept piling up, Terry, Jennifer, and other dedicated individuals on the force used three ingredients to start turning the tide: data, compassion, and leadership.Chattanooga currently does not have a co-response unit, but their Narcotics Unit has used the resources they have to get people that overdose in connection to harm reduction, treatment, and recovery court. And it’s working: not only are their deaths decreasing, so is aggravated assault and burglary. Learn more:Hamilton County drug and crime data: www.hamiltoncounted.orgSMART: www.smart.tennessee.edu Listen on Spotify: https://open.spotify.com/show/5qbzONIr0hlWxiQsPwkXHM

“How can anyone be doing drugs when we all know fentanyl is in everything?” We at UT SMART hear this question a lot from community leaders across the state. How is it that people keep risking their lives when we know for a fact that drugs are more lethal than ever? Sam Quinones, award winning author of Dreamland and the Least of Us, two books that dive deep into the social and cultural realities of the overdose crisis, may have the answer to that question. We talk about the two factors defining this moment: extreme potency and staggering supply. We have never seen this many powerful drugs be so widely available at any time in world history, and we dive deep into the implications of this new reality. We go beyond drugs and overdoses in this conversation. We talk about homelessness, small town economics, and how we really need to be thinking about the overdose crisis as more than just a problem of addiction. By the end of it, we examine how much of our overall culture has been “drugified” - everything from coffee to social media to chicken nuggets - and this drugification is playing out with the same dynamic as fentanyl and methamphetamine: hyper-potency, and overwhelming supply. Finally, we talk about hope, and how even the least of us can make a real, tangible difference. Hosted and produced by Jeremy Kourvelas. Original music by Blind House.Learn more:Sam’s website: https://samquinones.com/Hazard, KY article: https://www.thefp.com/p/rebuilding-hazard-kentucky-sam-quinones?utm_source=tfplinkedin&fbclid=IwAR19l2O2RBS9Lb-YWsH4dCeSsakJpmWlxWQNEC37d6UhTR-w-zvycJDVIho SMART: www.smart.tennessee.edu/LISTEN HERE: https://open.spotify.com/show/5qbzONIr0hlWxiQsPwkXHM

A cop, a guitar company, and a public health analyst walk into a bar…and mount an opioid overdose first aid kit to the wall. We have covered the Training and Empowering Musicians to Prevent Overdose, or TEMPO, project before, specifically the effort to get these high tech naloxone kits called ONEboxes into easily accessible locations, where they may be treated no differently than a defibrillator - an essential first aid device for a modern establishment. The program was so immediately impactful it spread to Knoxville, where a life was saved within a week of the ONEbox installation, and more recently to Chattanooga. However, efforts seemed to have stalled in Nashville…until the right combination of partnerships at the city government level took the program to new heights that surprised everyone involved. My first guest this month is Benton McDonough, director of nightlife through the mayor’s office. It’s a newly created position intended to act as a liaison between business, government, and residents, which in a city like Nashville, seems as essential as the music itself. We’re coming out of the era of COVID, after all, when many businesses had gotten used to seeing local government as an enemy, when a lot of trust between the private and public sector has been lost. But this program shows that with the right policy, and more importantly, the right relationships, you can start to rebuild that trust. My second guest is Erin Evans, chair of the public health and safety committee on the Metro Nashville city council. During the course of my interview with Benton and other stakeholders in this program, it became abundantly clear that I needed to have her on this episode as well. After all, this is a situation where the legislative and executive branches of government are working together, and that teamwork is also a perfect illustration of why it is so critical to not overlook local government.Hosted and produced by Jeremy Kourvelas. Original music by Blind House.Learn more:TEMPO: www.tempomission.orgNashville Banner article on the story: nashvillebanner.com/2024/05/23/naloxone-use-downtown-nashville/SMART: smart.tennessee.edu LISTEN HERE: https://open.spotify.com/show/5qbzONIr0hlWxiQsPwkXHM

According to the most recent report from the Tennessee Department of Health, two-thirds of all overdose fatalities are men, most of whom are aged 25-54. According to independent research, this group is also far more likely to lack health insurance. My guest this month is Bob Merritt, CEO of Myrtle Recovery Centers in rural Scott County. Drawing on a long career in behavioral healthcare, Mr. Merritt has seen first hand how the kind of health insurance you have can significantly impact the quality of care that’s even available to you. And that’s if you have health insurance at all, which about 10% of the Tennessee population does not. In this conversation, we explore why it is that the people most at risk of dying of an overdose have the hardest time getting health insurance, and why that ends up costing the taxpayer. Addiction is certainly a chronic illness, but at the same time it isn’t quite exactly like diabetes or high blood pressure, and this important distinction has significant implications for the healthcare system.Hosted and produced by Jeremy Kourvelas. Original music by Blind House.Learn more:Myrtle Recovery: www.myrtlerecoverycenters.com/ Sycamore Institute analysis on Tennessee health insurance: www.sycamoreinstitutetn.org/2021-health-insurance-coverage-in-tennessee/ SMART: www.smart.tennessee.edu/LISTEN HERE: https://open.spotify.com/show/5qbzONIr0hlWxiQsPwkXHM

Naloxone. Access to treatment. Housing. Employment. Educational opportunities. We’re used to hearing about the need for these aspects of recovery. But what about community? A place to gather with others, especially those with similar experiences? That’s where recovery community centers come in. My first guest this month is Dottie Greene. She’s the executive director of the first recovery community center in the 8 county region of northeast Tennessee. Dr. Greene is a person in long term recovery and has been providing recovery support since the 80s. As you might expect, she has seen the field of recovery change significantly in that time. Our second guest is Bettina Hoeppner, who has joined Dottie to talk about her academic research on recovery community centers, or RCCs. Dr. Hoeppner is an experimental psychologist who focuses on substance use disorder, and she directs the Health Through Flourishing Research Program. Her work on RCCs highlight how their unique natures make studying them as complex as launching them. In this episode, we discuss the ins and outs of recovery community centers and how they fill crucial gaps in the care continuum, as well as how attitudes towards recovery have changed dramatically over the last decade. Learn more:Johnson City Recovery Center: www.jcrecoverycenter.orgHealth Through Flourishing: www.healththroughflourishing.com SMART: www.smart.tennessee.edu LISTEN HERE: https://open.spotify.com/show/5qbzONIr0hlWxiQsPwkXHM

As the drug overdose deaths continue to climb, we have heard more and more Sheriffs and law enforcement officers across the state say “we can’t arrest ourselves out of this problem.” That the criminal justice system plays an important role, but not the only role. That there are many, many factors in the overdose epidemic. My guest this month is Sergeant Mike Hotz of Metro Nashville Police Department. After a long stint of time as an undercover officer, Sgt. Hotz now leads the overdose response unit, which combines law enforcement with mental health care and social work to people who have survived an overdose - instead of simply arresting them. The latest service that they are developing is perhaps their most surprising: when appropriate, the team will start the individual on medication assisted treatment…on scene. Sgt Hotz says the success of his team is due to MNPD’s community partners like the Mental Health Co-Op, but overall, because the team is willing and able to do whatever they can for the individual, beyond what just a solo officer is capable of. Hosted and produced by Jeremy Kourvelas. Original music by Blind House.Learn more:MNPD’s Overdose Response Program (and Spike Alert info): https://www.nashville.gov/departments/health/drug-overdose-informationSMART: smart.tennessee.edu LISTEN HERE: https://open.spotify.com/show/5qbzONIr0hlWxiQsPwkXHM

There have been huge changes at the federal level regarding the prescribing of medications for opioid use disorder, particularly regarding buprenorphine. For two decades since the DATA 2000 law, addiction clinicians had to get a specialized waiver through the DEA to prescribe buprenorphine, and many states passed laws with practice guidelines and limits on the numbers of patients they could see. There were other stipulations and regulations, and while well intentioned, there were quite a few negative consequences. Most of all, access to treatment was significantly limited for most people with an opioid use disorder. Recent legislation, namely the Mainstreaming Addiction Treatment or MAT Act, got rid of the X waiver altogether. This immediately granted every prescribing physician in the country with an active DEA license the ability to prescribe buprenorphine. This bill passed with bipartisan support and was hailed as the right call from just about everyone across the board. But in the year since, we haven’t seen much of an uptake in access. And many states - including Tennessee - still have restrictions in place for nurse practitioners and physician assistants. My guest this month is Dr. Stephen Loyd, chief medical officer of Cedar Recovery and Chair of the Tennessee Opioid Abatement Council. In this conversation, we discuss what policy gaps remain, especially surrounding the issue of dose limits for buprenorphine, and the difficulties of treatment in the age of fentanyl. Hosted and produced by Jeremy Kourvelas. Original music by Blind House.Learn more:Cedar Recovery: https://www.cedarrecovery.com/ SMART: smart.tennessee.edu

When the CDC reports that almost 4,000 Tennesseans died of a drug overdose in 2023, it can be easy to forget that each one of those numbers represents a human being that was found deceased, investigated by law enforcement, and analyzed by a medical examiner. Every death is an individual story, and each story is only known insofar as we have all the facts. Determining the facts comes down to forensics. And when it comes to the overdose crisis, with drug trends that are constantly changing, forensics is no simple game. Especially when it comes to new drugs like xylazine, designer benzodiazepines, and rare fentanyl analogues.My guest this month is Chris Thomas, the Chief Administration Officer of the Knox County Regional Forensic Center, which serves 23 counties in East Tennessee as one of the state’s five regional forensic centers. From his bird’s eye view of the overdose crisis, he can tell us a lot about what’s happening on the ground, as well as where there are gaps in the system.There are many valuable insights into the state of overdose forensics in Tennessee in this conversation, such as how medical examiners rarely get access to mental health records, or the proportion of traffic fatalities involving drugs, but the biggest takeaway for me was what the next wave of the drug crisis might be. Hosted and produced by Jeremy Kourvelas. Original music by Blind House.Learn more:Knox County Regional Forensic Center: https://www.knoxcounty.org/rfc/SMART: https://smart.tennessee.eduLISTEN HERE: https://open.spotify.com/show/5qbzONIr0hlWxiQsPwkXHM

In May, 2023, Governor Lee signed SB 378/HB 403, which imposed significant regulations on the production and sale of hemp-derived cannabinoids, including Delta-8, Delta-10, and all other compounds known as cannabimimetics, which have effects on the same neurological system as marijuana. Due to changes in the 2018 Farm Bill, these compounds abruptly became legal across the country, and many prevention advocates were saying that we had effectively legalized weed but worse, as many of these chemicals were being produced and sold without any oversight or restrictions, and kids could purchase these products just about anywhere. The bill that is the subject of our episode today sought to change that. It goes into effect this July. My guest this month is Stephanie Strutner, CEO of the Prevention Alliance of Tennessee, which represents anti-drug coalitions across the state. We dig into the weeds of what this bill does and doesn’t do, what its expected outcomes will be, and what cannabis-related law in Tennessee might look like in the future. Hosted and produced by Jeremy Kourvelas. Original music by Blind House.Learn more:The bill: https://wapp.capitol.tn.gov/apps/BillInfo/Default.aspx?BillNumber=SB0378&GA=113Prevention Alliance of Tennessee: tncoalitions.orgSMART: smart.tennessee.edu