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.

SMART Policy Podcast

Organizational Failure: How Bad Business Created the Opioid Epidemic

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

The Rocky Top Recovery Ambassadors are a group of college students, undergrad and grad, that identify as being in recovery and or having a mental health disorder.  Building a community on campus of students wanting a safer, sober college experience, the ambassadors hosted weekly all-recovery meetings and mental health events, as well as sober-friendly social events like group yoga, concerts, bounce house obstacle courses, and more.  They also partnered with TDMHSAS and the Regional Overdose Prevention Specialists to provide trainings on how to be a recovery ally, carry and administer naloxone, and more.  

My guests this month are two of the Ambassadors, Grace Hardin and Morgan Schmitz.  I wish I could have had on all of them, but there is only so much time to an episode.  As such, I strongly encourage you to check out the @rockytoprecovery instagram so you can see the reels the others have made, to get a deeper look into how the on-campus sober community is growing and thriving.  

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

The Kids Are Alright: Meet the Rocky Top Recovery Ambassadors

My guest this month is Karen Pershing, executive director of Metro Drug Coalition.  In the last legislative session, Karen played a significant role in pushing for a bill that reduced the barrier to opening new syringe service programs in rural Tennessee.  

In this episode, we discuss the impact of the bill, how it made it through the legislature, her behind-the-scenes role in the policymaking process, how young people can get more involved in the policy world in Tennessee, and more.

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

Links:
SB 292/HB 275 - https://wapp.capitol.tn.gov/apps/BillInfo/Default.aspx?BillNumber=SB0292

SSPs in Tennessee - https://www.tn.gov/health/health-program-areas/std/std/syringe-services-program.html

Metro Drug Coalition - http://metrodrug.org

The SMART Initiative - http://smart.tennessee.edu

Are More Syringe Service Programs Coming To Rural 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

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=113

Prevention Alliance of Tennessee: 
tncoalitions.org

SMART: 
smart.tennessee.edu

How Does Tennessee Regulate Cannabinoids?

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.edu

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

Decoding Autopsies: What Medical Examiners See That Others Miss

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?

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-information
SMART: smart.tennessee.edu 

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

Nashville’s Overdose Co-Response Unit Brings Harm Reduction to Law Enforcement

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

Organizational Failure: How Bad Business Created the Opioid Epidemic

SMART Initiative

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