Jeremy speaks with Dr. Stephen Loyd, Chief Medical Officer of Cedar Recovery, about the recent legislative changes pertaining to telehealth in the state of Tennessee, and how these changes have expanded access to treatment for opioid use disorder, especially in rural areas.

SMART Policy Podcast

Telehealth

If there's one thing Tennesseans can agree on, it's that the criminal justice system needs some improvements.  In the summer of 2021, the Reentry Success Act and Alternatives to Incarceration Act passed; at the same time telehealth permissions expanded.  Jeremy talks with Judge Duane Slone and Dr. Stephen Loyd about how these policy changes will affect justice-involved people with substance use disorder.  In particular, we learn about the novel treatment program in rural Jefferson County, which is the only jail in the entire state to offer in-house medication assisted treatment.

Criminal Justice Reform

Harm reduction does not mean drug use is condoned.  It simply means withholding condemnation of the behavior while the consequences of behavior are first addressed.  For opioids, this basically means keeping people alive so that you can treat them.  Jeremy speaks with Genoa Clark, Director of Harm Reduction at Choice Health Network about harm reduction in Tennessee.  

Featuring new original scoring by Duck Ryan & Ryan Dunaway.

Harm Reduction

Telehealth, broadband internet, criminal justice reform, harm reduction...a lot has been changing lately to expand access to treatment for substance use disorder.  But how well are these changes being implemented in rural areas, where the need is greatest?  And what about prevention?

I spoke with Trent Coffey, Executive Director of STAND, a coalition of Scott County businesses, organizations and community leaders focused on the health and well-being of youth.  

Rural areas have a lot of unique challenges, and my biggest takeaway from this conversation is that in order to make changes that last, we’re going to have to listen to the people who actually live there.

Rural Areas and the Importance of Prevention

At the end of 2022, the CDC released new prescribing guideline for opioids, replacing their last set from 2016.  Excluding patients with cancer and other terminal illnesses, this guideline strongly emphasizes alternatives to opioids and urges extreme caution for physicians considering new opioid prescriptions, while also recommending how to appropriately care for chronic pain patients with long-term opioid treatment.

Notably however, is how the new guideline answers the failures of the past.  According to the CDC, many laws, regulations and policies were “notably inconsistent and have gone well beyond its clinical recommendation.”  This led to rapid tapers, abrupt discontinuation, treating MOUDs like buprenorphine as opioids for pain that needed to be stopped as quickly as possible, setting arbitrary limits on prescriptions by insurers and pharmacies, and even patient dismissal and abandonment.  The fallout from this is “patient harm, including untreated and under-treated pain, serious withdrawal symptoms, worsening pain outcomes, psychological distress, overdose, and suicidal ideation and behavior.”

Dr. Clay Jackson, a board certified pain specialist from West Tennessee who also serves on the Tennessee Opioid Abatement Council, speaks with Jeremy about the new CDC guideline for the prescription of opioids for acute and chronic pain.  Dr. Jackson uses his extensive and first-hand knowledge of the subject to dive deep into the story of how we got here in the first place, and taking us through some of the broader philosophical considerations of the treatment of pain and the future of the field.  This conversation also touches on the FDA, fentanyl, non-opioid treatments and medications, and other topics that are strongly impacted by this still young history of prescription opioid pain treatment.

The New CDC Guidelines: Correcting Past Mistakes

We are now in the fourth wave of the overdose crisis.  Fentanyl is the still the most common drug involved in these deaths, but stimulants, primarily methamphetamine, is increasingly prevalent.  In fact, the vast majority of all overdose deaths now involve multiple drugs.  Meth, cocaine, heroin; worse still, newer contaminants like the animal tranquilizer xylazine are showing up alongside fentanyl and its analogues.  Even more concerning are the novel synthetic opioids that are now being found in toxicology reports.  Some of these are even stronger than fentanyl - nitazine, for example.  

Opioid prescription rates have steadily declined in recent years, which is excellent news considering that overprescribing got us down this path in the first place.  But clearly there is something else going.  In particular, it’s evident that there is an incredibly high demand for stimulants, even stimulants known to be contaminated with extremely powerful sedatives like fentanyl.  

My guest this month is special agent Tommy Farmer of the Tennessee Bureau of Investigation’s Dangerous Drugs Task Force.  He also serves on the state’s Opioid Abatement Council.  In this conversation, we dive into the history of methamphetamine in Tennessee, and how law enforcement has responded over the past thirty years.  Drug trends have changed a lot during that time, and the federal and state legal landscape along with it.  Most importantly, how and where drugs are being produced has changed dramatically, resulting in profound consequences.  

Produced and edited by Jeremy Kourvelas.  Original music by Blind House.

Methamphetamine and the Overdose Crisis

Everyone who’s gone to elementary school in the last fifty years has had some sort of “Just Say No” sessions and activities; we’re all familiar with this type of informational prevention.  But there is much more to the picture. 

My guest this month is Stephanie Strutner, CEO of the Prevention Alliance of Tennessee, an advocacy organization that represents dozens of grassroots coalitions across the state fighting substance use disorders of all kinds.  Over the last few years, she has rapidly become one of the most important voices for primary prevention in all of Tennessee.

Produced and edited by Jeremy Kourvelas.  Original music by Blind House.

What does "primary" prevention for SUD look like?

Purdue Pharma.  Cardinal Health.  CVS.  Walgreens.  I could keep going.  Drug manufacturers and distributors have rightly come under scrutiny in light of the opioid abatement settlements.   As these companies start paying hundreds of millions of dollars out across the country, in an effort to try to make up for the damage they caused by ignoring the warning signs of opioid prescribing trends over the last twenty years, it is easy to sit back and blame the whole thing on corporate greed.  And no doubt, corporate greed played a big role.  But the pharmaceutical industry is a complex web that extends far out from just drug makers and pharmacies.  It involves doctors and providers, pharmacists, governmental agencies, insurance companies, law enforcement, and of course, the patients themselves.  What happened to cause such a huge and complex supply chain with built in checks and balances fail?  Imagine a stack of Swiss cheese slices on top of each other.  As long as the holes don’t line up, nothing can pass through.  But something did happen that lined them up, making a hole big enough for the whole country to fall in.

My guest this month is professor Anne Smith from UT Haslam College of Business.  She specializes in organization failure in the context of disasters and catastrophes.  As professor Smith discusses in this episode, the opioid crisis unfolded not unlike the Challenger explosion, or the Black Hawk helicopter incident in northern Iraq during the Persian Gulf War.  Poor company leadership and values, regulatory failure, and other factors all happened to line up perfectly to create this disaster.  In this episode, we dive into all the different parts of the supply chain, as well as discussing how policymakers and the private sector can learn from this colossal mistake, and hopefully prevent another pharmaceutical catastrophe in the future.  

Produced and hosted by Jeremy Kourvelas.  Original music by Blind House.

Organizational Failure: How Bad Business Created the Opioid Epidemic

Starting with the multiple guilty pleas from Purdue Pharma in 2020, thousands of lawsuits across the country have lead to a series of settlements from numerous pharmaceutical manufacturers and distributors for their role in the opioid crisis.   From just the first and second wave of settlements with Cardinal Health, Janssen, AmerisourceBergen, CVS, Walmart, Walgreens, and several others, Tennessee is expecting to see a little over a billion dollars over the next 18 years.  

My guest this month is Dr. Jennifer Tourville, executive director of the SMART Initiative.  A fairly significant portion of our work lately has revolved around these settlements, and assisting the leadership of Tennessee’s cities and counties in understanding when and where these payments are coming from, what they can be spent on, and what reporting requirements there are.  

Tennessee is actually rather unique in how it has decided to spend these funds.  Unlike most of the other states, who have planned to distribute most of the money directly to counties, Tennessee has elected to open up a large amount of these funds to private entities, who can apply for grants.  This means nonprofits, prevention coalitions, clinics, researchers, and many other groups will have a chance at getting new projects funded, or expanding their existing services without having to appeal to local government.  Though of course, with a decent amount of money still going directly to Tennessee counties, they can try this route as well.  

So it’s a lot to consider, and it can be confusing.  We hope this episode can serve as an introductory guide to local stakeholders in both the private or public sectors, shedding some light on one of the most important public health opportunities in our lifetimes.  

Hosted and produced by Jeremy Kourvelas.  Original music by Blind House.

What's Happening with the Opioid Abatement Settlements?

If you’ve been listening to this podcast for a while, you know that there is strong evidence for the effectiveness of addiction treatment, and that the biggest obstacle we face in combating the overdose crisis is an overall lack of access to that treatment.  Health insurance is of course a major factor, and in Tennessee our statewide average for people lacking insurance is over 12%, which is more than twice the national average.  But even for those with insurance, they face a provider shortage.  And then there’s the problem with appointment availability: even if a patient gets into a clinic, they better keep their appointment or it might be a long time before they can make up for it.  And if the patient lives in a rural county, they might have to drive 50 miles to get there!

So it really goes without saying that this is a difficult, frustrating, and sometimes humiliating experience.  Imagine trying to work a minimum wage job while dealing with all of this, for example.  Do you tell your boss that you can’t work on Monday because you have to drive to the next county for your addiction medication?  Would something like that even get you fired?  It’s not hard to imagine that the stress of all of this makes avoiding the temptation of drugs even harder.  Is there anyone you can turn to? 

Rachel Loveday is exactly the kind of person you could.  

Rachel is a peer recovery specialist at McNabb Center, one of the premier treatment centers in the Knoxville region.  She and her team are contracted with UT Medical Center to help connect people who survive overdoses to treatment.  When patients get stressed or confused or overwhelmed by treatment and its difficulties, Rachel and the other peer recovery specialists are there for reassurance and support.  So far, this program at UT has seen huge success, with a significant increase in connecting ER patients to treatment.  So what makes peer recovery specialists so effective?  It’s simple.  They’re all in recovery themselves.

I really enjoyed this conversation.  Rachel and I get into some good topics here, and address some of the more interesting aspects of addiction and its challenges.  

Hosted and produced by Jeremy Kourvelas.  Original music by Blind House. 

Editor’s note: we reference two bills in this episode.  The first is in relation to the decriminalization of seeking medical treatment for an overdose; this is only guaranteed for the first presentation, and subsequent presentations are at the discretion of law enforcement.  The second is the cannabinoid regulatory bill; it is described as “in the legislature,” but was signed by the Governor on May 11th, making it indeed a law.  Finally, there are some unfortunate audio artifacts at one point in the episode; apologies that I was not able to edit them out without sacrificing the dialogue.

How Peer Recovery Patches Treatment Gaps

In 2020, the TN Together Student Survey found that the average age for first using a substance was 13 to 14 years old.  Identifying and intervening at that age is thus crucial.   Most of the time, however, the problem isn’t caught until later: usually when the person is college aged.  

My guest this month is Nathan Payne, director of collegiate recovery at the Tennessee Department of Mental Health and Substance Abuse Services.  We discuss how the attitudes on college campuses in Tennessee have changed over the last decade, becoming much more proactive about addressing unhealthy drinking habits and preventing substance use disorders.  After all, if we are going to make a dent in this crisis, we have to head the problem off before things spiral out of control.  We have to help the next generation.

Hosted and produced by Jeremy Kourvelas.  Original music by Blind House.

What's Changing on College Campuses in Tennessee?

Earlier this year, three different bills were filed that would all increase the penalty for possessing fentanyl to a Class B felony.  One would accomplish this by reclassifying fentanyl as an agent of chemical warfare, though this bill was returned to the Clerk’s desk as two complementary pieces of legislation advanced.  Those bills, SB0193 and SB1398, the latter of which is known as the One Pill Will Kill Act, make a pretty straightforward change: they simply increase the penalty to a Class B felony without redefining fentanyl.  These bills were signed by Governor Lee on May 11th.  (For some quick drug policy trivia, this was the same day that he signed the cannabinoid regulation bill as well as the legislation adding the second wave of opioid settlements to the OAC trust fund).  

However, when these bills were passing through the legislature, we at SMART heard a lot of concerns about making fentanyl possession a felony.  Specifically, advocates wanted to know if this would lead to more Tennesseans winding up in prison with a lifelong felony charge on their record, just because they had a single pill.  

So my guest this month is Circuit Court Judge Duane Slone.  A strong advocate of drug recovery court and increasing access to medical treatment for addiction, we figured he would be able to give us a good insight into how these bills will impact Tennesseans.

Hosted and produced by Jeremy Kourvelas.  Original music by Blind House.

Fentanyl Is Now A Felony In Tennessee

TEMPO, or Training and Empowering Musicians to Prevent Overdoses, is a multi-partner initiative to distribute naloxone and train musicians and concert venue workers to identify and prevent opioid overdoses.  TEMPO recently made waves in Nashville with a pilot program in partnership with Hikma, who makes Kloxxado, as well as ONEbox, to distribute high-tech overdose reversal first aid kits to music venues, and we at the SMART Initiative were impressed by their immediate results (they saved lives).  Just a week after we extended the program to Knoxville, another life was saved at a music venue.  

In this episode I interview both Dendy Jarrett, Executive Director of Gibson Gives, about TEMPO and this program, as well as the manager of the Knoxville venue where that life was saved.  Being a musician, a fan, or a venue employee in the age of fentanyl is unpredictable, and as a musician myself this project means a lot to me, personally.  You don’t want to miss this one. 

Hosted and produced by Jeremy Kourvelas.  Original music by Blind House.

Learn more: 
tempomission.org

findthepurplebox.com

kloxxado.com

smart.tennessee.edu

Training and Empowering Musicians To Prevent Overdoses

If anyone has gotten a true bird’s eye view of the drug problem in the United States, it’s someone like Special Agent Karl Colder of the U.S. Drug Enforcement Administration.  From starting in Philadelphia when crack cocaine was the top concern to overseeing the region containing West Virginia and D.C. when the opioid crisis progressed from prescription pills to heroin and fentanyl, finally directing the entire department of internal affairs at the DEA, Special Agent Colder has seen the whole drug trade up close and personally.  In this conversation, he reflects on some of the changes and challenges experienced by law enforcement over the past thirty years.   

Now retired from the DEA, he works as a consultant, providing education and training to faith communities and law enforcement organizations on evidence-based practices relating to addiction and mental health intervention.  A big focus of his work centers around improving such resources for law enforcement and first responders.

Agent Colder has a lot of fascinating insights covering everything from the southern border to rural communities, from youth education to telehealth.  His structural and systemic perspectives on what’s happening with law enforcement are particularly interesting. 

Hosted and produced by Jeremy Kourvelas.  Original music by Blind House.

How Law Enforcement Is Rethinking Mental Health And Addiction

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

The Buprenorphine Waiver is Gone...Now What?

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.org
Health Through Flourishing: www.healththroughflourishing.com  
SMART: www.smart.tennessee.edu 

LISTEN HERE: https://open.spotify.com/show/5qbzONIr0hlWxiQsPwkXHM

Recovery Community Centers Are Changing Everything

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.org
Nashville 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

Leveraging The Right Partnerships At The Local Level

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.org
SMART: www.smart.tennessee.edu 

Listen on Spotify: https://open.spotify.com/show/5qbzONIr0hlWxiQsPwkXHM

Data, Compassion, and Leadership: How Police Can Prevent Overdose Deaths

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

If Opioid Prescriptions Are Down, Why Are Overdose Deaths Still So High?

As we’ve discussed many times on this show, the criminal justice system has long since become the primary point of contact for substance use disorder, especially in Tennessee.

My guest this month is Eric Bauder, Deputy Chief of Corrections for the Davidson County Sheriff’s Office. While participating in an overdose fatality review team, he learned key details about how people were overdosing shortly after leaving the county jail - even those that had engaged with the jail’s successful Behavioral Care Center.  

In the last year, Eric lead the charge in implementing two critical evidence-based solutions: naloxone vending machines and initiating medication assisted treatment during incarceration.  These new programs stacked onto the jail’s already robust mental health and education-focused programming, and the impact is tangible.

In this conversation, we dive into the challenges he faced in obtaining the vending machines, the barriers involved with launching MAT in jail and more importantly, continuing it afterwards, and we finish off with an exploration into what makes the Davidson County jail’s Behavioral Care Center so impactful - especially on recidivism rates. 

Hosted and produced by Jeremy Kourvelas. Original music by Blind House.

Learn more:
Davidson County Narcan Vending Services: https://sheriff.nashville.gov/narcan-vending-services/ 
The Behavioral Care Center: https://sheriff.nashville.gov/behavioral-care-center-bcc/ 
SMART: www.smart.tennessee.edu 

Saving Lives in Jail: Naloxone Vending Machines, MAT, and Mental Health at Davidson County

The data is clear: 18-25 is a critical time for substance use and mental health interventions. This is why programs implemented on college campuses have significant impacts.

But that isn’t to say these interventions are easy to launch.

My guests this month are Dr. Jessi Gold, Chief Wellness Officer for UT System and Associate Professor of Psychiatry at UT Health Science Center, and Megan McKnight, Director of the Center for Wellbeing at UT Chattanooga. In this conversation, we talk about some of the successes they have had in launching harm reduction education and prevention programs on college campuses, overcoming concerns over legal liability, debunking myths, addressing stigma, and solving the most important problem of all: logistics, such as who pays for what. Finally, we discuss what next steps look like. After all, getting naloxone on college campuses and saving lives is only step one.

Hosted and produced by Jeremy Kourvelas. Original music by Blind House.

Learn more:
Article on Dr. Jessi Gold plans to “Change the Culture” around mental health: https://news.uthsc.edu/inaugural-chief-wellness-officer-aims-to-change-the-culture-around-mental-health/ 
Megan McKnight honored by the White House for her overdose prevention efforts: https://blog.utc.edu/news/2024/10/utcs-megan-mcknight-honored-by-white-house-for-leadership-in-opioid-overdose-prevention/ 
The ONEbox emergency opioid overdose reversal kit: https://www.wvdii.org/onebox 
SMART: smart.tennessee.edu 

LISTEN ON SPOTIFY: https://open.spotify.com/show/5qbzONIr0hlWxiQsPwkXHM

Getting Naloxone on College Campuses and Other Interventions

From 2001-2011, as the prescription opioid crisis spiraled out of control, Kim Harmon, then with Tennessee Bureau of Investigation, went undercover to bust pill mills, among other investigations into medical fraud.  

Shortly after she progressed up into a new role, however, her daughter Taylor’s own actual struggles with substance use disorder began to spiral out of control, and suddenly this law enforcement officer, once tasked with imitating people with addiction in order to stop the flow of illicit pills, now had to figure out how she could help her own daughter find recovery. And yet despite all her experience and resources, it was not an easy road.

Taylor’s struggles might sound familiar to many Tennesseans. Despite growing up in a peaceful childhood, a personal tragedy caused a tendency to over-drink into a full blown disorder, closely followed by a problem with benzos, opioids and other so-called hard drugs. Fortunately, however, her story of sobriety should be equally recognizable: she found a strong community of peers in recovery and they helped Taylor find her own path. 

This is a fascinating, far-reaching conversation that touches on many topics. If I had to boil it down, though, I might say the big takeaway is that anybody and everybody is susceptible to addiction, and the most important thing we can do from a policy perspective is to make sure people with substance use disorder have real access to resources that make a difference. 

Hosted and produced by Jeremy Kourvelas. Original music by Blind House.

Learn more:
SMART: smart.tennessee.edu 

LISTEN HERE: https://open.spotify.com/show/5qbzONIr0hlWxiQsPwkXHM

From Busting Pill Mills to Battling at Home: An Officer's Daughter Finds Recovery

Late last year, Maury County Commission approved the spending of $920,770 in opioid settlement funding, abating the opioid crisis in their community from multiple angles.

But it’s more than just the broad and comprehensive approach that caught our eye at SMART. The formal and transparent procedures of the Maury County Opioid Abatement Committee have made it so that any local resident can follow along and see exactly how these dollars are being allocated.  

On the show this month is Doug Lukonen, the Maury County Finance Director and Chair of the county’s Opioid Abatement Committee, and Brandon Faun, Financial Administrative Assistant, who was instrumental in creating the documents and procedures of the committee’s abatement community grant process. 

It’s clear that the Finance Office provided some crucial insight, as the guiding principle for the committee has been that though these funds last 18 years, the amounts change significantly over time - and as such, so should the county’s plans. 

This was an excellent conversation with a lot of actionable takeaways for county officials. Most of all, the reminder that the allocation deadline for 2023 funding is only one month away. 

Learn more:
Maury County Opioid Abatement Committee: https://www.maurycounty-tn.gov/645/Maury-County-Opioid-Abatement-Committee 
TN Opioid Abatement Council County Funding: https://www.tn.gov/oac/county.html 
SMART: smart.tennessee.edu 

LISTEN HERE: https://open.spotify.com/show/5qbzONIr0hlWxiQsPwkXHM

Maury County's Fiscally Conservative Approach Pays Off

Overdose Fatality Review, or OFR, is a fairly new and yet already proven strategy for identifying gaps in recovery ecosystems. In other words, you bring together people from healthcare, law enforcement, criminal justice, harm reduction services and more to jointly examine cases of fatal overdoses and find out how these people fell through the cracks.

Lauren Savitskas works for the Institute for Intergovernmental Research on behalf of the Bureau of Justice Assistance to provide technical assistance for the implementation of OFR teams across the country. Trevor Henderson, SMART’s Middle Tennessee Substance Use Response Consultant, joins Lauren as well as Sharena Cathey of the Knox County Health Department and Denise Martin of the Rutherford County Medical Examiner’s Office to provide perspective on how OFR teams have been implemented in Tennessee, showcasing how varied and dynamic this strategy can be.  

In this conversation, we explore why this strategy breaks down data silos, identifies actionable solutions, and leads to long term relationships, including opportunities for further innovation.

Learn more:
OFR Toolkits: www.ofrtools.org
OFR Fact Sheet (LAPPA): https://legislativeanalysis.org/wp-content/uploads/2022/05/OFR-Fact-Sheet-FINAL-1.pdf 
Model OFR Legislation (LAPPA): https://legislativeanalysis.org/wp-content/uploads/2021/03/LAPPA-Model-Overdose-Fatality-Review-Teams-Act.pdf 
SMART: www.smart.tennessee.edu 

LISTEN HERE: https://open.spotify.com/show/5qbzONIr0hlWxiQsPwkXHM

Finding Opportunities to Save Lives With Overdose Fatality Review Teams

Despite significant changes at the federal and state level, the rate of opioid prescriptions remains startlingly high. The most recent data shows that Tennessee is still hovering around 60 prescriptions for every 100 people in the state.  And again, that’s prescriptions, not pills.  As such, many patients are still facing the same on-ramp to opioid medications that got stuck in the opioid crisis in the first place. 

My guests this month are Brand Newland and Michael Doty of Goldfinch Health, Melissa Armstead of Southern Tennessee Health System, and Kathy Federico of Lifepoint Health. In 2024, Goldfinch received a grant to implement a primary prevention program focused on non-opioid pain treatment in surgical settings, and they partnered with a hospital in Lawrenceburg, TN, located in the rural, south central portion of our state.

The early success of the Billion Pill Pledge in Lawrenceburg genuinely surprised me. I worked in rural emergency departments from 2014-2018, during the rise of fentanyl, and so I know first hand how significant it is to so dramatically reduce visits to the ED for pain control. 

In this conversation, we talk about the program, how it works, how it rolled out in Lawrenceburg, and what the future of non-opioid pain treatment may look like, at both the clinical, the scientific, and the policy levels. 

Learn more:
Goldfinch Health - The Billion Pill Pledge: https://www.goldfinchhealth.com/billion-pill-pledge/ 
Southern Tennessee Regional Health System, Lawrenceburg: https://www.southerntnlawrenceburg.com/ 
Lifepoint Health: https://www.lifepointhealth.net/ 
SMART: www.smart.tennessee.edu/

LISTEN HERE: https://open.spotify.com/show/5qbzONIr0hlWxiQsPwkXHM

Changing Healthcare Culture: The Billion Pill Pledge and Non-Opioid Pain Treatment

The group of people that are dying of overdoses at the highest rate, by far, are men in their 30s-50s. This group is also statistically less likely than others to ask for help. This is one of the biggest reasons why it can be difficult to implement effective prevention strategies targeting working age men. 

My guest this month is Dr. Monty Burks, Deputy Director of the Tennessee Governor’s Faith-Based and Community Initiative, which seeks to empower community resources to tackle the biggest challenges of our time, including overdose, addiction, and recidivism. Monty is also a certified peer recovery specialist with years of experience engaging people with substance use disorder and meeting them where they are, so I could think of no better person with which I wanted to discuss one of the main consequences of these deaths: the impact on their families. 

After all, many of these men were fathers, as are many of those men still in the throes of active addiction. What can we do to reach this surprisingly vulnerable population and help them become the best versions of themselves? 

In this conversation, we talk about the ways that we the people of Tennessee can step up to help, from foster care to peer recovery to even just listening to someone who needs to be heard.

Learn more:
Governor’s Faith-Based and Community Initiative: https://governorsinitiative.org/
SMART: http://www.smart.tennessee.edu/

LISTEN HERE: https://open.spotify.com/show/5qbzONIr0hlWxiQsPwkXHM


Fathers Lost in the Overdose Crisis: Prevention, Mentorship, & Rebuilding Families

Small business owners, industry leaders, law enforcement officers, teachers, and even other elected offices like city councilperson - these are some of the most common professions that people have before becoming a county mayor in Tennessee.  But it may surprise you that a fair number of our county executives were EMTs, paramedics, or first responders before seeking public office. 

On the one hand, a path like this makes a lot of sense – if one is drawn to the kind of leadership that responding to literal fires, injuries and disasters requires, surely that mindset could be put to good use in a mayor’s or county executive’s office. On top of that, as far as the opioid crisis is concerned, we at SMART have found that few people are more aware of the complexities of the overdose crisis than EMTs and paramedics, and that degree of expertise goes a long way towards making effective decisions on allocating the opioid settlements. 

My guests this month are Montgomery County Mayor Wes Golden and Jefferson County Mayor Mark Potts, two Tennessee leaders that have dedicated their careers to public safety and now hold elected office. In this conversation, we talk about how their past experiences prepared them for mayoral life, the benefits of a career in public safety, and why a career in public service is life-changing. 


Original music by Blind House. Hosted and produced with additional scoring by Jeremy Kourvelas.

Learn more:
Montgomery County’s Youth Engagement Coalition: https://montgomerytn.gov/juvenile/youth-coalition 
Brighter Tennessee article on Jefferson County’s award winning opioid settlement allocation process: https://indd.adobe.com/view/9bd5aac3-0955-491b-995f-0c5f4101f319 
Portable Spectrometers Brief: https://smart.ips.tennessee.edu/drug-policy-analysis/portable-spectrometers 
SMART: www.smart.tennessee.edu

LISTEN HERE: https://open.spotify.com/show/5qbzONIr0hlWxiQsPwkXHM

First on Scene, Still on Duty: How These EMTs-Turned-Mayors Tackle the Opioid Crisis

Cannabis, cannabinoids, and cannabimimetics like Delta-8 and THC-P and more are increasingly common across America, including in the state of Tennessee, where we have passed numerous regulations on the industry in recent years. And in states where cannabis has been fully legalized, some products containing Delta-9 THC, the psychoactive ingredient of what is defined in Tennessee state law as marijuana, the concentrations have grown to historically unprecedented levels, with some products boasting 90-95% potency. 

Despite the widespread availability of high-THC cannabis products, however, it seems the general conversation around the safety and efficacy of these substances remains grounded in a lot of misunderstandings. Not to mention a lack of awareness about the concerning side effects of these high-potency synthetically manipulated products, which are not at all like the cannabis of the ‘90s or earlier. 

My guest this month is Dr. Kristen Gilliland, Director of Outreach and Advocacy Programs and Assistant Professor of Research at the Warren Center for Neuroscience Drug Discovery at Vanderbilt University. On top of an extensive career in the field, Dr. Gilliland tragically lost her son to a drug overdose in 2019, a couple of years after he had been diagnosed with schizophrenia. Now, Dr. Gilliland works to provide innovative, evidence-based, and compassionate prevention education to teens about the reality of the modern cannabis market, which has been significantly changed since it became a legal, corporatized, and multibillion dollar industry. 

Original music by Blind House. Hosted and produced with additional scoring by Jeremy Kourvelas.

Learn more:
Speaking Through Me: https://speakingthroughme.squarespace.com/home
Dr. Kristen Gilliland: https://speakingthroughme.squarespace.com/kristen 
SMART: www.smart.tennessee.edu

LISTEN HERE: https://open.spotify.com/show/5qbzONIr0hlWxiQsPwkXHM

Speaking Through Me: Using Compassion and Science to Talk to Teens About  Cannabis, Social Media, and Brain Health

If you’ve ever worked in the field of recovery in East Tennessee, there’s a strong chance you’ve met Trent Coffey, executive director of the Schools Together Allowing No Drugs, or STAND, Coalition in Scott County, TN. 

And if are connected to Appalachia and use Instagram, TikTok or YouTube, there’s an equally strong chance you’ve encountered his cousin, Andi Marie Tillman, a comedian, actor and musician who is known for her wide array of relatable characters. 

As it happens, Andi Marie is a person in recovery, and knows first hand what it feels like to need help from the medical system in Tennessee - and how difficult it can be to get that help. 

In this special episode, we talk about Andi Marie’s recovery journey, Trent’s extensive career in drug prevention, the opioid crisis in rural Appalachia, how culture plays a role, opioid settlements, federal funding cuts, and as always, policies that might make this battle against addiction a little easier. We even dive into some Coffey family lore. 

We also filmed this episode, and will soon be releasing the video version on our soon-to-launch YouTube channel, so stay tuned for that release. 

Finally, we decided to include some content that we normally wouldn’t. Consider it behind-the-scenes or bloopers. These two are just too funny to not share that with you - and plus, it shows the real Appalachia you don’t typically see on TV. As always, any views and opinions expressed in this episode do not reflect those of UT. 


Original music by Blind House. Hosted and produced with additional scoring by Jeremy Kourvelas.

Learn more:
STAND Coalition: https://www.standcoalition.com/about
Andi Marie’s Instagram: @andimarietillman
Andi Marie’s YouTube: @andimarie7554
Scott County Opioid Abatement: https://scottcounty.com/opioid-settlement-funding/ 
SMART: www.smart.tennessee.edu

LISTEN HERE: https://open.spotify.com/show/5qbzONIr0hlWxiQsPwkXHM

Family, Recovery, and the Real Appalachia: A Conversation with Andi Marie Tillman & Trent Coffey

When it comes to any large government program targeting health, social, and cultural issues, there are always concerns that the money won’t be spent well. The opioid settlements are no exception.  

So when a program involves multiple community partners, a transparent and collaborative decision-making process, and is based on the local data, the rate of success tends to be high.  

This is what makes Sumner County’s approach so remarkable. After finding out that Highpoint Health hospital alone received over 50% of all overdoses brought in by EMS, they hired a Substance Use & Recovery Navigator to join the emergency department and help connect overdose survivors with local resources and treatment. The program also includes funding to get people help at Volunteer Behavioral Health - located right across the street from the hospital - and a “Box of Hope” containing naloxone, an up-to-date local recovery resource guide, and other tools provided by the Sumner County Prevention Coalition.  And this is just a part of the county’s overall overdose response plan that they are funding with opioid settlement dollars. 

My guests this month are Justin Werlick, Substance Use & Recovery Navigator, Dr. Geoffrey Lifferth, Chief Medical Officer for Highpoint Health with Ascension Saint Thomas, Haylee Mcphearson-Bush, VP of Operations of the Middle/West regions for Volunteer Behavioral Health, Meagan Griffith, Director of the Sumner County Prevention Coalition, Charlotte Hollis of the Sumner County Health Department, and Dr. Dustin Owens, Grant Accountant for the Sumner County Budget Committee.  

In this episode we talk about how all of these vital partners were brought together, how concerns were addressed - including the fear of duplication or supplantation of existing services - and why they are working to make naloxone more available to the community than ever before. We also discuss the larger barriers that people needing recovery face, including not only the lack of connection between existing resources, but the gaps in healthcare coverage that keep people from getting the help they need. 

Original music by Blind House. Hosted and produced with additional scoring by Jeremy Kourvelas.

Learn more:
Highpoint Health Announcement: https://www.highpointhealthsystem.com/news/coalition-receives-grant-to-support-opioid-overdose-crisis-interventions
Sumner County Opioid Abatement Committee: https://sumnercountytn.gov/opioid-abatement/ 
Volunteer Behavioral Health: https://volunteerbehavioralhealth.org/ 
Sumner County Prevention Coalition: https://sumnercoalition.org/ 
SMART: www.smart.tennessee.edu

LISTEN HERE: https://open.spotify.com/show/5qbzONIr0hlWxiQsPwkXHM

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