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.

Rural Areas and the Importance of Prevention

SMART Initiative