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?

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

SMART Policy Podcast

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

What does "primary" prevention for SUD look like?

SMART Initiative

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