Pubdate: Fri, 30 Dec 2016
Source: Knoxville News-Sentinel (TN)
Copyright: 2016 The Knoxville News-Sentinel Co.
Author: Kristi L. Nelson


Tennessee Governor Bill Haslam, left, talks with US Secretary of
Agriculture, Tom Vilsack and audience members during a town hall meeting
on how to deal with the opioid addiction in Appalachia on Thursday, June
30, 2016 at the Southwest Virginia Higher Education Center on in Abingdon,

Tom Vilsack, US Secretary of Agriculture talks about opioid addiction
during a town hall meeting with Tennessee Governor Bill Haslam and
Virginia Governor Terry McAuliffe at the Southwest Virginia Higher
Education Center on Thursday, June 30, 2016 in Abingdon, VA.(SAUL

ABINGDON, Va. - Jaculyn Hanrahan has watched the opioid epidemic devastate
her adopted home county.

"They targeted our region," said Hanrahan, a Catholic sister with the
Congregation of Notre Dame. "It changed the face of Appalachia."

For more than 30 years, Hanrahan has worked in and around Lee County at
the westernmost tip of Virginia - a county where tobacco and coal were
kings, their decline taking jobs and prosperity. More than 20 percent of
Lee County's 25,500 residents live below the federal poverty guideline.

Into this void came opioid drugs, said Hanrahan: first prescription
painkillers, later cheaper heroin.

"The addiction issue that started in our area has now affected three
generations," she said.

On Thursday, she drove more than an hour to Virginia Highlands Community
College in Abingdon to hear U.S. Agriculture Secretary Tom Vilsack talk
about "creative" ways to fight the epidemic. She wanted to see if what he
said matched up with what she sees daily in her own community.

Thursday's public town hall meeting on the opioid epidemic, the first of
several Vilsack plans around the country, drew about 200 attendees. He set
it in a town that nearly straddles the Tennessee-Virginia border, inviting
Tennessee Gov. Bill Haslam and Virginia Gov. Terry McAuliffe to join him
in talking about the "aggressive" approaches both states have taken.

Vilsack's interest is professional as well as personal. President Barack
Obama has asked him to lead an interagency team on opioid abuse,
collecting ideas to combat the nationwide scourge that has its greatest
impact in the rural areas his office has traditionally served.

And the audience fell silent Thursday as Vilsack spoke briefly of dealing
with his own mother's alcohol and drug addiction issues, which started
when he was a child.

Among Vilsack's objectives is promoting Obama's call for Congress to
direct $1.1 billion toward increasing access to substance abuse treatment
- - which could translate into up to $24 million over two years for
Tennessee. A report released earlier this year by the Tennessee
Association of Mental Health Organizations said 4 percent of Tennessee
adults who needed addiction treatment in 2014 received services, with the
wait longest in East Tennessee.

Vilsack asked the governors what they'd do with additional federal funding.

Haslam said he'd put it toward treatment, including counseling, though
"we're not going to treat our way out of this problem, I don't think," he

McAuliffe wants more drug courts in Virginia. It costs the state $18,000
to divert a person through drug court to treatment, he said, compared to
$47,733 to send one to prison, where he said the recidivism rates for
addicts are three times higher than those who go through drug court.

Tennessee has 36 adult drug courts; another six serve juveniles and families.

McAuliffe said he'd also provide more education in schools.

"We have got to get young people, early on, to understand the
ramifications of drug use," he said.

Haslam praised the effectiveness of Tennessee's prescription drug
monitoring system - Virginia has a similar system in place - and the fact
that the state increased opportunities to dispose of unused prescription
drugs. In Tennessee, pharmacies can collect them, and the Highway Patrol
has installed lockboxes for collection.

McAuliffe talked about new Virginia laws putting the drug naloxone, which
can reverse the effects of opioid drug overdose, into the hands of all
first responders, and the law also protects from liability anyone who uses
the drug to help someone overdosing. In Virginia, anyone can obtain
naloxone without a prescription.

Even so, addiction continues to thrive. Between 2013-2014, the number of
drug overdose deaths in Virginia increased 14.7 percent, from 854 to 980.
In the same time period, Tennessee's increased 7.7 percent - but it was
already a higher number: 1,187 Tennesseans died from drug overdoes in
2013, and 1,269 in 2014. Nationwide, just more than 4 percent of the
population - nearly 10 million adults - reported misusing prescription
opioids in 2012-2013. Tennessee's overall rate is slightly higher, but in
some rural counties, it's significantly higher.

Nationwide naloxone access and monitoring of prescriptions are goals of
Vilsack's team, along with increasing supportive housing for people in
recovery. Vilsack said the USDA is looking at designating some of its own
HUD housing for this purpose.

"Why is it so difficult to get Medicaid expanded?" Vilsack asked the
Republican Tennessee and Democratic Virginia governors. Neither state has
passed Medicaid expansion to provide health insurance to people who make
too much money for traditional Medicaid but not enough to qualify for
subsidies to buy insurance policies on the federal marketplace.

"Politics" was the short answer; both governors have advocated for waiver
plans they said protected their states from financial risk, but failed to
get them passed.

Vilsack said later he'd continue to press states on Medicaid expansion, in
part because the law now requires parity, with Medicaid covering
mental-health and substance-abuse treatments at the same rate as medical

"This could really help states deal with this issue," he said.

He also announced nearly $1.4 million in grant money to fund five
telemedicine projects in Tennessee, Kentucky and Virginia to help rural
areas provide mental, behavioral and substance-abuse treatment on a larger

"Because addiction treatment is often out of reach for many in rural
America, expanding access to telemedicine is an important step toward
making sure rural communities have the tools they need to fight the opioid
epidemic," Vilsack said.

The hourlong governors' discussion was followed by panelists from
government and nonprofit agencies discussing resources in Appalachia.
Vilsack closed the forum by reading and discussing a few of the many
comment cards audience members filled out. His staffers will later read
and organize every one, he said, and report back to him.

"I take back with me a number of ideas," Vilsack said. "There are lives to
be saved, and there are futures to be guaranteed."

Hanrahan said what she heard at the forum hit home; she thought addressing
pockets of corruption in law enforcement was the only missing issue.

"This is a great model," she said, "just (Vilsack) coming and listening."
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