Behind the Headlines – January 26, 2018

– (female narrator)
Production funding for Behind the Headlines is made possible in part by: the WKNO Production Fund, the WKNO Endowment Fund, and by viewers like you.
Thank you. – The county’s effort to
deal with the opioid crisis tonight on Behind the Headlines. [dramatic orchestral music] I’m Eric Barnes, Publisher
of the Memphis Daily News. Thanks for joining us. I am joined tonight
by Mayor Mark Luttrell from Shelby County. Thank you for being here again. – Thank you, Eric. – (Eric)
Along with Dr. Alisa Haushalter from the Shelby County
Department of Health. Thank you for being here. – Good evening and
thank you for having us. – So I will start
with you, Doctor. We talked a little bit
before, but let’s just do. And you chime in as
well, Mr. Mayor, where it seems appropriate. Of first defining the
problem from a county, a regional, the regional
scale of the problem. And there’s more and more
attention nationally on this on the (coughing) overdose
deaths, excuse me. There’s more attention. President Trump has
a taskforce on it. The state announced
some things recently which we’ll talk about. But from a Shelby
County point of view, how many people are using
opioids dangerously? How many people are overdosing? How many people are dying? – We don’t know the
exact number of people who are using opioids, ’cause clearly there’s
a large number of people that will be using and
may not suffer an overdose and may not experience a death. What we do know is
that last year alone we had over 900 visits
to the emergency room for overdoses. And those were ones
that actually had to go into the emergency room
and receive treatment. And then over a
four year period, I want to make sure I get
my numbers exactly right, we had over 500 people that died as a result
of opioid overdoses which is a significant number. What a bigger concern
is if we don’t act now, those numbers will
continue to go up. And we anticipate by 2020 that a minimum of 250 people
would die just in one year if we didn’t act now. – And we’ve got a chart
from your office, I believe, that shows the trend
line of where we were and where we are
potentially going without some sort
of intervention. How did this start? For people who aren’t
as familiar with the national crisis, and it is
truly a national crisis. I think it’s an epidemic by the definition
of your profession. – (Alisa)
It is definitely an epidemic. – (Eric)
How did it start? – Well what we know is
in the United States there’s actually been a long
history of opiate addiction that dates really
back to the Civil War. But in more recent years, what’s happened is
pharmaceutical companies have produced synthetic opioids that were primarily used to
treat people with serious pain. And then at the national
level, there was a focus on assuring that people’s
pain was well managed. So what happened is
there was a large influx of synthetic opioids through
the pharmaceutical industry into the healthcare industry. – And this is what we think
of as Oxycontin, or Percocet, or you might get your
wisdom teeth out, or you might have knee surgery. – (Alisa)
Exactly. – Those kinds of drugs, right? – Right. And so that was really
added into the population and it just grew
exponentially from there over a period of
at least a decade, but in some cases,
some communities, it’s been two decades.
And unfortunately, then there become illicit
business associated with that. Either theft of drugs, trading
of drugs, sale of drugs. But then there also became
black market manufacturing of opioids, which has added
to the problem as well. – Yeah. A bunch more questions
we’ll come back to on that. But from your point
of view, Mr. Mayor, the cost associated with
this and the problem. Your perspective on that. – Well, certainly the
cost is significant, but Eric, I’d emphasize that the cost
is not the driving factor in what we’re about. The paradox of this
particular problem is it’s both a health
problem and a safety problem. We need to look at
this, number one, as being a significant public
health challenge for us. But also there’s
very much potential for some illegal activities
that are taking place as Dr. Haushalter
has emphasized. So one of my roles is to ensure that we are indeed looking at
this epidemic from both sides. How can we ensure that our
citizens in Shelby County are well informed
and well treated, and then how can we
hold people accountable that are responsible for really perpetuating
this particular problem? The cost is significant. We know just from the standpoint of what we are undertaking and what the governor is
recommending at the state level is significant money. The Governer’s talking about $30 million at his level. At our level, we’re talking
about the excess of a million to do what needs to be done. So it’s expensive
from the standpoint of the cost of
really addressing it, but certainly the human
cost is significant. – The million would go towards, is that prevention, treatment? Is it law enforcement? Or some combination? – Much of our effort will
be focused on prevention with certainly the side effects
of how we can refer people and get them into
the right treatment. There are partners that
are working with us. University of Tennessee
is working with us and other entities in
the local community that are also approaching this from the standpoint of
treatment in some cases and prevention in others. And then of course, law
enforcement in others. So it’s being approached by
several different organizations and entities across
Shelby County, but we do know that the
cost will be significant in all of those combined. – And this is an area where there’s the Shelby
County Health Department. There is no Memphis
companion department. And the individual
municipalities we were talking a little
bit before the show, don’t have their own health
departments in Bartlett– – The public health
of the community was in responsibility of the purview of Shelby
County government. Dr. Haushalter was
brought in some two years ago because of her record
of community engagement in the Davidson
County health system. She is our point person for really taking our
initiative here in Shelby County from the standpoint
of public health. Certainly from the
standpoint of public safety, that will be a byproduct of
our research and our work. But certainly the public
health informing our citizens is a primarily responsibility
of the health department. – I want to come back to some
of the law enforcement side and so on, especially
given your background. But I’ll switch
back to you, Dr., I remember seeing, I was in some employee
oriented kind of presentation. It must have been five,
six, seven years ago. And the person speaking talked
about drugs in the workplace. And that was the
first time for me that I heard about
this opioid problem. And he talked about. I mean, I was
vaguely aware of it but I didn’t understand
the scale of it and the way in which
it was growing. And he talked about how people were commonly given
a prescription for again, knee surgery
or wisdom teeth, or some kind of routine thing. They would get 30 pills
and two or three refills. And so he did this basic
math of you’ve got 90 pills. Most people when
they take, again, I’m using the brand names, but an Oxycontin, or a
Percocet, or something, Most people might take
five, six, seven of them. A lot of people don’t like them. The side effects,
they don’t like. And so then all those drugs
sit in people’s drawers and are then basically
this oversupply of opioids. That dynamic in
real simple terms, and I’m curious if that
jives with your take on how this happened. But then you know,
kids start taking it ’cause they go through their
parent’s medicine cabinets. Or you know, people coming
in and out of the house. A plumber, or a cleaning
person, or whatever. Is that part of what happened? I mean, just this
incredible availability of unused, untaken,
legally gotten opioids. – That is part of the problem. And particular for young people, what we know is frequently
they took their first opioids out of somebody’s
medicine cabinet. They accessed those
either in their house, grandparent’s house, or a friend’s family
members medicine cabinet. So that actually contributes to particularly
adolescents having access. We also know with the opioids that people can become
addicted very quickly. So some of the initial thinking
around the synthetic opiates was that people could take
them and not become addicted. What we know now is that
you really want people to have a very
limited prescription. That’s part of the state focus, is to really work
with physicians and other healthcare providers to limit the prescriptions
that are given, and also to use alternate
ways to manage pain. An example would be
dental procedures. I’ve had people tell me
that they or their children received Oxycontin
for a dental procedure when in fact Ibuprofen
may have been appropriate or could have been successfully
used to treat the pain. So that’s part of the
statewide campaign and we’ll reinforce those
messages locally as well. – Did we say this already? Opioids versus opiates. I know we talked
about it before. Help me. ‘Cause I
use them interchangeably, I think, and I shouldn’t. – So an opiate is something
that’s naturally occurring. – (Eric)
Morphine. – Or heroin, that really
come from poppies, the plant. Opioids are those things that
are manufactured chemically to be similar to
the natural product. And those would be
things like fentanyl that we hear a lot about. Oxycontin, which we
hear a lot about. But also Percocet and some of
those other pain medications. – And again, you know,
as a parent, you know, this all got on my radar. I’m lucky and fortunate my kids never got
involved with this, but they certainly have friends and friends of friends who have. A number of things about that. One, it’s one of these
epidemics that is broadbased. I mean, race, income,
class, background. And we have some maps, I think, that show the concentration of where opioid overdoses
are happening in the county. The darker colors are more. But they’re really in much, any area where there isn’t, there aren’t quite
a few overdoses. Comment on that,
that widespread. That you are not immune to
it in any sense by class, race, gender, or location– – (Alisa)
Or age. – (Eric)
Or age, thank you. – Or profession. It’s all of those. There’s really not
any part of our county that’s not impacted. Where you see it
darker in the center is actually ’cause we
have more population in that particular area. But if you think about it, all of us go to
healthcare providers, all of us receive prescriptions
and everyone has access. So that this really is
a widespread problem impacting really everyone
within our community. – Going back to the state- Governor Haslam came
forward with proposals, some of which he can
do by executive order; some of which are
part of a package that will go through
the legislature as Mayor Luttrell mentioned,
the $30 million. One part, and I don’t think I have it written
down in front of me. Oh no, I do. Was to limit initial
prescriptions to five days. – (Alisa)
Yes. – So back to what I
talked about, that 30. You know, the standard
prescription of 30 with a couple of refills
is a total of 90. Again, most people
don’t take them all and so you have this
huge supply out there. Potential supply. Five days would be a
hand full of pills? I mean what would that be? From a doctor’s point of
view, what would that mean? – Five days means enough pills to take them as
prescribed for five days. So some pills really are
not taken that frequently, so that may be one or two. Others are taken every
four to six hours. It would really depend on
what the actual medication is. But to limit the number of days so that there are not extras. And then we really
encourage people to count how many they have, to keep them locked away. If you put them in
a medicine cabinet, needs to be a place that’s
locked where there’s not access. But also when you’re done
with the prescription actually to dispose of it, and you can do
that at a drop box. Many of the pharmacies
have a drop box where it can be left off. And now there’s actually, it’s
a bag that has charcoal in it that can be given at the
time of the prescription so that a person can
destroy the drugs when they’re finished
with the prescription. So that way when
you’re done with it, you shouldn’t have any left
over in your medicine cabinet. – From a treatment
point of view, it is no small thing to help people on
treatment on this, right? I mean of all the drugs
people might get addicted to, I don’t know where it ranks,
but it’s bad, I assume. – The treatment is difficult. Addiction is
difficult for anyone. I think the key point is
that treatment is available and people can successfully
complete treatment, go back to work,
live a full life. There are a lot more options than there were many years ago. People can go in-patient, they
can go out-patient treatment, they can have
faith-based treatment, but there are also
medications that can be used to assist a person to
manage their withdrawal. – Last question before
I go back to the Mayor, there’s a drug and I can’t
remember the name of it. Naloxone? – Yes. – That is to help prevent
overdoses, is that correct? – That’s to treat an overdose. So when someone
has been overdosed or experiences an overdose, that actually
counteracts the opioid so that they can survive. – Part of what Haslam’s plan is to provide every Tennessee
State Trooper with this drug in case they’ve
come upon someone or they’ve responded to a call. Is that correct?
– (Alisa) Yes. – Would you look to do
that at the county level with the Sheriff’s Office, or recommend that
to the Memphis? You don’t have control of the
Memphis Police Department, but is that something you’d
recommend on a local level? – Yes. It’s actually being used
at the local level now so it’s just a matter
of expanding it, and certainly we’re
very supportive of that as we have been in the past. – Yeah. Same with law enforcement. I mean, before you
were County Mayor, you were Sheriff
for eight years? Is that correct? Before that, you
ran corrections. Your perspective from a law
enforcement point of view. Can law enforcement solve this? – Not alone, no, by no
stretch of the imagination. It is indeed a health
and a safety issue. It’s what we really call the
intersection of public health and public safety. I would like to
just for a moment outline what the
county’s strategy is because we’re approaching this really from about four
different directions. Number one, Dr. Haushalter is the head
of our health department. We’ve asked Dr. Haushalter
to assume responsibility for how can we inform and how can we point our
citizens in Shelby County in the right direction, and how to deal with this
if it’s a problem with them. And certainly from the
standpoint of prevention, how to avoid it. We’ve asked within
county government we’ve asked our human
resources office to assume some responsibility
of educating our staff in Shelby County government. And we’ve already
started an initiative to train all of our supervisors. We had our first class
just this past week with an excess of 100
of our supervisors that are going through training. And we have about
500 supervisors that will be receiving
this training on how to identify and deal
with it in the workplace. – So that would be supervisors and not just law enforcement, not just health department, any four of our areas– – Anyone in the
supervisory capacity who supervises the
subordinates in their program. And then our third
objective or third attempt is through litigation, if we choose to go
the litigation route. And chances are pretty
good that we will. Litigation will be headed
up by our county attorney and looking at
the options there. That’s a very complicated area in the area of litigation,
because who do we pursue? Do we pursue the
manufacturer, the distributor, the doctors, the
pharmacies, the pill mills? There are so many different
aspects to the litigation front that that’s going to be
legally a very touchy area. Do we pursue it in federal court or do we pursue
it in state court? Do we partner with the state or do we go solo on our own? So there’s a lot that goes in
to the litigation part of it and that’s also part of the law enforcement
side of it as well. – To the litigation,
it was last week we had Chairman of
the County Commission, Heidi Shafer was on. She is very much very adamant about going after
pharmaceutical manufacturers and wants the county to do so. You referenced that
as a possibility. Is your office and the
county commissioner, will you be aligned? Will you be moving in lockstep, or is it possible that the county commissioner
will be moving on one path and the mayor’s office, the
administration, on another? – Well, we’ve invited
the county commission to partner with us as
we’re going forward. County commission has
set up a task force. Dr. Haushalter’s
involved with the task force as well as other people
in the administration. As we make a decision
regarding litigation, we’d love to have the
county commissions engagement with that as well. But I so want to say
that the litigation has to be approached
in a very delicate way to determine what’s the
best way to approach it and who is the best
group to go after. Do we go after the manufacturers or do we go after
the distributors? There’s a very strong
discussion in both areas there. So there’s a lot of questions
that have to be answered, but litigation is a very
real possibility for us. – Roughly 10 minutes left. Staying on the litigation thing. Is it a possibility that
you would, not simply, but you would join other
interested parties? – Yes, very much. We have been in contact with the State Attorney
General’s office to see what they’re doing, the
direction that they’re going. I’ve been personally in touch
with the Attorney General. We’re talking with
various other counties across the United States. Many of the law firms
that we’re talking about are law firms that are dealing
with numerous counties. So yes, this is
something where really the working with others
is force multiplier. So we want to try to find out what’s the best approach to take and that’s in large part
the collaborative effort of those three entities. Our public health,
our public safety, and our litigation fronts to give me the advice that we
need to make that decision. – So many questions. Let me come back to heroin. Again, we sort of
alluded to this, but what I’ve read nationally and seen nationally
on news reports. There’s been this rise
in the use of heroin because, and you will correct me where I get this messed
up, opioids are expensive. So if somebody gets their hands on a pharmaceutical prescription and they sell them one by one, they get very expensive. If somebody gets
addicted to them, they may end up
turning to heroin which on the street is
a whole lot cheaper. – (Alisa)
Yes. – That dynamic is playing
out in Shelby County as well. – Yes. And when we’re really kind
of targeting prescribers to reduce the number
of prescriptions, there actually then
is less prescriptions available on the market as well. So then people will
go to the alternate which is heroin,
which is much cheaper. – But far more dangerous
or just dangerous? – They’re both dangerous. And the combination of
both of those together often times is even
more dangerous. When we look at the
overdose deaths, frequently there’s a mixture
of drugs that people have used, not just one necessarily. – What, is it fentanyl? Am I saying that right? What is fentanyl? – It’s a synthetic
opiate as well. So it’s an opioid that
was historically used for very advanced chronic pain, but now what’s happening is it’s actually being
made in the black market. And so it’s being brought
in from other places and sold on the street. – I mean, back when
you were running the sheriff’s department and
you were worried about heroin. I mean, you were worried about
all kinds of illegal drugs. I mean, who’s bringing
these drugs in? I mean, back in
the day, I guess. I don’t mean to
put you on the spot about law enforcement now. But I’m just so curious about how you try
to target the people selling these illegal drugs and what can really be done
when it gets so widespread. – Well, you’re
focusing on something that is a very interesting
subject in itself is that what we were
dealing with back in the day 5 to 10 years ago was a totally different dynamic from what we’re
dealing with today because in many ways, these pills are being
distributed in legal ways. It’s how they’re being
used and prescribed and handled by the patient. So it’s a different dynamic
that we’re dealing with with opioids than we were
from the street drugs of cocaine, and heroin, and
marijuana, and all those types. – Yeah, crack
cocaine and all that. – Those were the substances
that were transported from the south of the
border in numerous ways, that were brought in
through the mules. That was their profession
to bring it in. Here, it’s much
more sophisticated. That’s why I say that the
solution to this problem is not easy, and it’s very,
very difficult to navigate. That’s why we take our
time, we plot our strategy, we make sure that we have
the right people engaged that can help us
devise that strategy. Because it’s much
different today than it was five years ago or 10 years ago when I was
in the sheriff’s office. – If I could just add to that. I think one of the critical
things that has to happen is really partnership. Public health and law
enforcement working together. Local government working
with state governments. So an example will
be state government monitors prescribing patterns. So it’s not that
we’re ignoring that, we already know the
state is doing that and will share that
information with us. We can– – Legal prescriptions
from doctors, nurses, dentists, and so on. – Yeah, to be able to identify where there might be a pill mill or someone who might be. Go ahead. – Define pill mill ’cause
the Mayor mentioned that too and I think that’s something
that people may not understand. – That’s essentially a practice that’s run by somebody who
has the ability to prescribe. – (Eric)
A legally licensed individual. – Yes, but they are either
selling prescriptions or over-prescribing knowingly. And those individuals are
targeted by the state. There’s data that’s
collected on a regular basis, so that part is monitored. There’s also something that we’re looking at obtaining
locally called OD Map, which is a software system that allows anybody who
responds to an overdose, a police officer, a
sheriff’s deputy, EMS, to put it in an
app on their phone. And at the health department, we can actually monitor daily
where overdoses are happening. If you look at where
the overdoses occur in public health,
you work with law enforcement to see where the
sales are coming from so that you can
intervene for sales. There’s actually technology
that can assist us and the partnership and data
sharing is gonna be critical for us to really
address the sales. – Eric, one of the things that we’re really
trying to focus on is precisely what
you’re doing today, and that’s to educate the
public on what is going on because we’re
finding so few people really comprehend the
magnitude of this problem, and how it came about, and what
is being done to address it. We are already starting to
see some fruits of our work. We’re starting to see doctors
a little bit more cautious about how they are prescribing. We’re watching the pharmacies that are being very careful
about advising when prescribing. So we’re already starting
to see some movement but it’s vitally important through any number of
mechanisms within our community that we educate the public
on the ramifications of this. – You may have mentioned,
I apologize, the schools. What are you doing
within the schools in terms of education
and prevention? – We’ll do outreach
to the schools. That’s not necessarily
the first on our list, but we’ll work with the schools. – And I don’t mean this
as a challenge, why not? What is first on the list? – Really broadly
getting the message out to the community at large, which includes young
people as well. But we also know there
are other organizations that work with the
schools directly, so we want to make sure we
know what all they’re doing and that we provide
support to them rather than everyone
trying to rush in and do duplicate work. So we have a local
prevention council and part of what they do is
work with youth and adolescents. So we’ll be partnering
with them as well. – Just a couple minutes left, so there will be a
lot we won’t get to. I think you’re not saying,
but I just want to make sure. I mean, you’re not saying these
opioids are bad for everyone or should be banned, or are you? Are you saying, look,
these should just go away. The benefit they
may give some people are not worth the overall
public health damage. – No. It’s like any medication. There are legitimate uses for it and there are individuals
who suffer from chronic pain or may have terminal
illness that causes pain, and those individuals
should have access, and should be able to
work with their providers to access that
particular medication. – This is a question and I don’t mean to
put you on a bad spot and so you can punt
it to the Mayor, and we can do a
whole show on this, there is a medical
marijuana bill that’s been proposed
in Tennessee this year. Arkansas has gone to
medical marijuana. Some of the people who
advocate for that talk about medical marijuana being
a really effective substitute for these much more
dangerous opioids. What’s your take on that? – So that’s some of the research is showing that medical
marijuana may be an alternate for individuals who
suffer from chronic pain. In my role, my role is really to look
to the elected officials to make a decision on behalf
of their constituents. – You’re good at your job. I will go to the elected
official. (laughing) – I would say the optimum
term that she uses, may be effective. I think the science
is still imperfect. We’ll watch for the science
and see how it develops, and rely very heavily
on healthcare officials to advise us in that area. – To any degree, are you
glad that the legislature is at least debating
that issue though, which probably means
looking more at science– – Oh yes. I think it’s good and certainly relying
heavily on the science. I think sometimes we lose touch with the fact that we should
rely on the scientific evidence in making those decisions as opposed to making purely
a political decision. – Alright. Again, we could do
a whole show on that but we are out of time. Mr. Mayor, thank
you for being here. – (Mark)
Thank you, Eric. – Dr. Haushalter,
thank you for being here. – (Alisa)
Thank you. – Thank you all for joining us. Join us again next week. Good night. [dramatic orchestral music] [acoustic guitar chords]

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