USDA chief Tom Vilsack targets rural opioid problem

NASHVILLE — The chief of the U.S. Department of Agriculture will meet with state and local leaders in the Tennessee-Virginia border region this week as federal agencies look for local partners to combat opioid abuse in hard-hit rural areas across the nation.

"There is no silver bullet. I wish there were," Secretary of Agriculture Tom Vilsack said in an interview with The Tennessean. "If there was, we’d obviously be focused on it.”

Federal officials are pushing a multi-pronged strategy that combines treatment, recovery support, economic development and criminal justice reform.

Reducing opioid abuse is challenging to health care, government, law enforcement and community officials because it's a public health crisis that crosses socioeconomic boundaries as well as industry and state lines.

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The Thursday town hall in Abingdon, Va., is one in a series aimed at raising awareness and spurring "creative partnerships" to tackle not only the epidemic of opioid abuse — and overdose deaths — in Appalachia, but some of the underlying problems that help fuel drug abuse, Vilsack said.

As the number of prescriptions has climbed over the last 20 years, so, too, have the deaths. In 2014 overdose deaths hit record numbers across the country, according to the U.S. Centers for Disease Control and Prevention. There were at least 1,263 people who died from overdoses in Tennessee.

Rampant opioid addiction, both from prescription painkillers and heroin, raises concerns about increased rates of hepatitis B as well as increased HIV and hepatitis C infections. Tennessee, West Virginia and Kentucky are highlighted in recent studies from the CDC.

Still, Vilsack said that "there is a time and a place for the appropriate use of opioids."

"It just can't be as extensive as it has been recently," he said.

Vilsack, whose mother struggled with alcohol and prescription painkiller addiction, is leading an initiative, at the request of President Obama, who has rolled out expanded funding for treatment and recovery in the past few months. The effort includes more than a dozen agencies and departments.

Vilsack will hold town halls in other areas hard hit, although locations haven't been announced; the USDA said in March that Vilsack would travel to the Appalachia region as well as Mississippi, Missouri, Nevada and New Hampshire. Tennessee Gov. Bill Haslam and Virginia Gov. Terry McAuliffe are expected to attend Thursday.

The problem in Appalachia is rooted in a variety of factors more far-reaching than access to prescriptions. Alaska and parts of the Southwest and Northeast have rural communities with similar issues.

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Selling painkillers on the street can be lucrative in areas that have seen job losses.

Oxycodone IR can sell for $30 to $40 per pill and Oxycontin about $80 per pill, making it easy for some to net $30,000 a year and, in many cases, more than that, said Tommy Farmer, Tennessee Bureau of Investigation special agent-in-charge and director of the Tennessee Methamphetamine and Pharmaceutical Task Force.

Going to a pain clinic around the first of the month to stock up on pills to take and sell is a "pretty common tactic," Farmer said.

"That's what's so crazy about it," he said. "You don't think about prescription drugs having that much street value."

Vilsack said establishing a "new natural resources economy," such as a local and regional food system, in the Tennessee-Virginia border area will help revitalize an economically depressed area. The area has a natural resource advantage that could support a biomass industry or new approaches to conservation that creates new streams of revenue for landowners.

The appetite for pills has led to an uptick in crime in some areas. A gas station off Interstate 81 in East Tennessee had signs posted last summer warning travelers about the possibility of theft of prescriptions over the border in Virginia.

Vilsack said he wants to see "different ways of approaching folks who get crossed with the law" in addition to more treatment centers — both brick-and-mortar and telemedicine locations — and community resources.

States have an "opportunity and responsibility" to upgrade monitoring databases to work across state lines to help clinicians and law enforcement alike track potential abuse, Vilsack said.

Access to treatment also is a problem. There are about 2.2 million people across the country with a prescription painkiller addiction but only about half have access to treatment, U.S. Surgeon General Dr. Vivek Murthy said at Meharry Medical College in Nashville last week.

In some cases, opioid use may be more about "experiencing a little bit of euphoria and happiness than treating physical pain," Vilsack said, noting the need to raise awareness about the mental health and substance abuse coverage in insurance plans.

"The hope here is that we actually improve health outcomes by enabling physicians to focus on the real genesis of the problem as opposed to treating the symptoms effectively. Let’s really focus on getting to the core problem," Vilsack said. "Opioids don’t always allow us to get to the core problem."

Follow Holly Fletcher on Twitter: @hollyfletcher