Davidson County had second-highest rate of overdose deaths in 2022 in cities with a population above 500K
About two years ago, I heard for the first time that 1 kilogram (2.2 pounds) of fentanyl is sufficient to kill 500,000 people. For some reason, this statistic blew my mind, so much so, that I started to follow the issue of the opioid crisis more closely.
I had already been aware of the opioid epidemic at that time, which is why I had tuned into an expert panel presentation to the Metro Council Public Health and Safety Committee, which was chaired at that time by Councilmember Erin Evans.
Evans, who serves again as the chair of the Public Health and Safety Committee, invited the Metro Public Health Department (MHPD) this month to provide an update on Metro’s approach to tackling the opioid epidemic. The issue is also timely because the U.S. Supreme Court in late June overturned a settlement with Purdue Pharma, which manufactures OxyContin.
The overprescription of OxyContin, a legal opioid, and tactics by Purdue Pharma to promote the drug, has largely been credited as causing the first wave of deaths linked to legal prescription opioids in the 1990s. The Supreme Court decided that the latest nationwide settlement would have shielded Sackler family members who own Purdue Pharma from civil lawsuits. A side effect of that recent decision is that a deal that would have funneled billions of dollars toward addressing the opioid crisis is now on hold.
For a more thorough history of the opioid crisis, I recommend you visit the Metro Public Health Department’s website, which created a link about the story of overdose. (https://storymaps.arcgis.com/stories/463b25df77fd4578b80f790911cde00c)
Davidson County was listed as having the second-highest rate of overdose deaths in 2022 among cities with a population above 500,000, according to statistics compiled by the San Francisco Chronicle and published in The Tennessean).
So, what is happening here?
Let’s get back to the MPHD presentation, which Evans organized for her Metro Council committee. Evans, who is not happy that Metro Council was not presented with legislation that would have allowed further discussion about the process to use a recent opioid grant from the state, invited Dr. Anidolee Melville-Chester, the Division Director of Behavioral Health and Wellness with the MPHD, to the July 2 committee meeting.
Melville-Chester reported that between 2018 and 2023, suspected fatalities due to drug overdose increased by 115 percent, from 346 deaths to 745. In 2023, Davidson County saw an average of about two deaths per day due to an overdose. As of now, that rate stands at about 1.5 deaths per day in 2024.
Melville-Chester also said that 78 percent of overdose deaths in 2022 were related to fentanyl, which was 53 percent more fentanyl-related deaths compared to 2018. The age group that is at highest risk of an overdose death are those between 45 and 54 years of age based on data from 2018-2022, followed by those between the ages of 35 and 44.
Besides fentanyl, the Health Department is concerned about the emergence of other substances including Xylazine, also known as Tranq.
According to the U.S. Drug Enforcement Administration (DEA), fentanyl is approved by the Food and Drug Administration (FDA) as a potent synthetic opioid drug used to relieve pain and as an anesthetic. The DEA further notes that fentanyl is about “100 times more potent than morphine and 50 times more potent than heroin.”
Xylazine is an FDA-approved powerful sedative for veterinary use.
The DEA released a warning about Xylazine mixed in with fentanyl, posting on its website that it “is making the deadliest drug threat our country has ever faced…” In 2022, the DEA found that about 23 percent of fentanyl powder and 7 percent of fentanyl pills they had seized contained Xylazine.
The reason Xylazine is of such high concern to health officials is because it is not an opioid. Thus, naloxone, also known as Narcan, does not reverse its effects.
You may also have heard about naloxone, which many providers are distributing to people at risk of opioid overdose. Naloxone is a medication – also approved by the FDA – that is designed to reverse an opioid overdose. It is administered when a patient is showing signs of opioid overdose, but “it is a temporary treatment and its effects do not last long,” according to the Substance Abuse and Mental Health Services Administration (SAMHSA).
Yet it has been shown to be effective enough to prevent deaths. The FDA approved a naloxone nasal spray in March 2023 as an over-the-counter medicine. It is available in pharmacies and through other community-based distribution programs.
In Tennessee, the Department of Mental Health and Substance Abuse Services dispatches about 20 Regional Overdose Prevention Specialists (ROPS) throughout the state. The ROPS distributed more than 678,000 units of naloxone between October 2017 and June 2024, and according to the department, at least 82,000 lives were saved through this approach. They think this is a vast undercount of lives saved.
ROPS provide community trainings. They work with first responders; individuals at high risk of overdose, their families, and friends; and organizations that provide treatment and recovery services.
This spring, the Tennessee Opioid Abatement Council disbursed $81 million in community grants. Nashville’s MPHD received $2.1 million per year for a period of three years. That money will be used to establish an Opioid Care Process System. Effective July 1, Metro is contracting with the Mental Health Cooperative and Samaritan Recovery Community to connect people to that care system.
Melville-Chester explained that the Opioid Care Process System will be comprehensive, data-driven, and evidence-based to address prevention, intervention, treatment, and housing stabilization. A special focus will be given to the unhoused population, African American, Spanish-speaking, Arabic Egyptian, and the youth serving and young adult community.
Samaritan Recovery Community was awarded $1.6 million over the total grant period. Their role is to provide intervention to people in crisis, link them to a navigator, offer respite care, transitional housing and from there work with people to help them move to permanent housing, if they are unhoused/homeless. Samaritan has 32 beds available for in-patient, medication assisted treatment (MAT). MAT is an approach that uses FDA-approved medications in combination with counseling and behavioral therapies.
The Mental Health Cooperative received $2.4 million from Metro to implement a Mobile Response process. “The idea is to increase access to treatment, medication, transportation, peer recovery specialists and resources for individuals that are suffering from a substance use or abuse disorder and focus on increasing access to community services to decrease the utilization of emergency departments,” Melville-Chester explained.
As avid readers of this column will know, I recently interviewed Melville-Chester for this paper, and I immediately was impressed with her thoughtfulness and passion. I walked away thinking that here is a person who truly cares and wants to build a solid system.
She stressed in her presentation to Metro councilmembers and in my conversation with her that current data shows that the unhoused population is at greatest risk from this Opioid epidemic. She pointed out the fact that when people are unhoused, they are in a crisis and coping with a crisis often leads to self-medication. Thus, housing stability is an urgent intervention. “Part of what we want to do is intervene and impact those life circumstances,” Melville-Chester said.
That’s where the partnership with Samaritan Recovery comes in to offer in-patient treatment and temporary housing and help people find permanent housing.
“Yes, 32 beds is not enough,” she said, telling Metro Council that she will come back with an ask after this three-year project is over because there is a need for more respite beds, transitional housing, and permanent housing.
Isn’t it interesting how it all comes back to the fact that people are better able to address any crisis situation if they have a stable place to live in?
I believe in systems building and coordination. We need leaders like Melville-Chester, who fundamentally seem to understand the importance of establishing partnerships and using data to evaluate outcomes in an honest, transparent manner.
But in the end, if the Opioid Care Process will be able to demonstrate success, it will be up to Metro Council to help provide at least partial funding for this effort and expand it to ensure we do not continue to see daily opioid deaths in Davidson County.
That is a statistic that is unacceptable.