Substance Use Disorder and Incarceration

It has been estimated that nearly 2/3 of inmates in US jails and prisons have a substance use disorder. Historically, SUDs have not been addressed by the prison system while a person is incarcerated. This contributes to a cycle of recidivism that’s detrimental, not only to the individual and their loved ones, but also to the community at large. A recent NIH report highlighted a study that compared two rural Massachusetts’ jails, one that provided medications for opioid use disorder (MOUDs) and one that did not. The people who received medication had a 32% lower risk of recidivism. Interestingly, guided by our own Judge Duane Slone, the 4th Judicial District in Tennessee (Jefferson County in East TN) is the first in the state to implement a similar program in their jails. We hope that this bold step will go a long way in stopping the cycle of SUD and incarceration.

Black History Month

February is Black History Month. This presents an opportunity to shine a light on the toll that substance use and mental health disorders can have on Black/African American communities. While occurrence rates are similar in all populations, quality treatment options are less accessible for Black/African Americans. The rate of increase of Black/African American drug overdose deaths between 2015-2016 was 40 percent compared to the overall population increase at 21 percent. Black/African American populations also face double stigma, that of being in a racial minority and the stigma related to substance use and mental health disorders. The National Alliance on Mental Illness (NAMI) offers explanations for why these disparities occur and what may help. The website also includes a comprehensive list of resources available for Black/African Americans in your community that may be struggling with substance use or mental health disorders.

Groundhog Day

February 2nd is Groundhog Day – that momentous day when a furry woodland creature’s shadow (or lack of) supposedly predicts an early or late Spring. You may be wondering, “What does Groundhog Day have to do with substance use disorder?” That takes us to the 1993 movie Groundhog Day with Bill Murray in which the main character repeats the same day over and over. Some recovery programs use this film as a parallel to the addiction-recovery-return to use cycle. An article on The Mighty website poignantly illustrates this.

Free At-Home COVID-19 Tests Available

The U.S. Department for Health and Human Services, in partnership with the U.S. Postal Service, is offering 4 free at-home COVID-19 tests to all U.S. households, including U.S territories and overseas military and diplomatic addresses. The tests are completely free. Orders will usually ship in 7-12 days.

Click here to order your free at-home tests.

The tests available for order:

  • Are rapid antigen at-home tests, not PCR
  • Can be taken anywhere
  • Give results within 30 minutes (no lab drop-off required)
  • Work whether or not you have COVID-19 symptoms
  • Work whether or not you are up to date on your COVID-19 vaccines
  • Are also referred to as self-tests or over-the-counter (OTC) tests

For more information and resources, please click here.

How to Chang Traditional Thinking about Substance Misuse

The New Year brings an opportunity to start fresh with new ways of thinking about addiction and recovery! Dr. Nora Volkow, Director of the National Institute on Drug Abuse (NIDA) wrote an essay with recommendations for how to change traditional thinking about substance misuse and what it means to be in recovery. Characterizing drug addiction as a chronic but treatable disorder rather than a weakness in character is critical to changing old thinking patterns. Abstinence as the primary desired outcome of recovery is often unsuccessful due to the traits of the disease and human nature to avoid perceived failure. Reducing stigma, employing harm reduction strategies, and acknowledging meaningful milestones in long-term recovery are ways to start the New Year with a fresh outlook on what successful recovery looks like!

Public Alert for A New Synthetic Opioid

A new synthetic opioid has been discovered and has warranted a public alert from the Novel Psychoactive Substances (NPS) Discovery, a branch of the Center for Forensic Science Research and Education (CFSRE). Protonitazene has a similar structure to other synthetic opioids but is almost three times more potent than fentanyl. Since May of 2021, nine post-mortem cases had been reported (with two of those in Tennessee). However, there have been six additional cases since December 2021. Considering that there is no medical use for protonitazene, and that the DEA has found this drug-class in 94 recent raids, the deadly potential has prompted an escalation of vigilance in the substance misuse community. Visit NPS Discovery or DEA Diversion for more information and recommendations for your organization.

New Synthetic Opioid Protonitazene Increasing in Prevalence

Protonitazene is a new, potent synthetic opioid bearing structural resemblance to etonitazene, a synthetic opioid that is nationally and internationally controlled. Protonitazene is dissimilar in structure to synthetic opioids typically encountered in forensic casework (e.g., fentanyl, heroin); however, protonitazene is a structural isomer of isotonitazene, requiring increased analytical specificity during toxicological analysis. In vitro pharmacological data suggest that this new opioid exhibits potency similar to other recently emergent “nitazene” opioids, and is approximately three times more potent than fentanyl.

Protonitazene was first reported by NPS Discovery in May 2021 following initial detection in a toxicology case. To date, nine blood specimens associated with postmortem death investigations in the U.S. were confirmed to contain protonitazene; however, at least six additional cases have been discovered through toxicological surveillance by NPS Discovery as of December 2021. Identifications of protonitazene have also been reported from organizations in Europe. The toxicity of protonitazene has not been examined or reported but recent association with death among people who use drugs leads professionals to believe this synthetic opioid retains the potential to cause widespread harm and is of public health concern. Please find more information here.

Increase in Newly Diagnosed HIV with Hepatitis C Co-Infection among Persons Who Inject Drugs

The Tennessee Department of Health, in collaboration with Knox County and East Tennessee Regional Health Departments, is responding to an increase in newly diagnosed HIV with substantial hepatitis C virus (HCV) coinfection among persons who inject drugs (PWID) in your area. Many of these new HIV infections are molecularly similar using whole genome sequencing.

In an effort to find people who may be impacted and connect them with healthcare services, we ask that you do the following:

  1. Test anyone for HIV and HCV who presents for medical care and reports any history of substance use (who are not already known to be HIV or HCV positive).
  2. If a patient tests positive for HIV or HCV, immediately link them to care. Inform newly diagnosed patients that the Knox County or East Tennessee Regional Health Department will be reaching out to them for more information and can help them access low cost or free care/treatment if needed.
  3. If you see a patient who has been previously diagnosed with HIV but is not engaged in regular care, reconnect the patient to HIV care.

Increasing HIV and HCV testing in Tennessee is critical to identifying impacted individuals and getting them promptly into care and treatment. Clinicians should consider frequent screening (e.g., once every 3 or 6 months) for those at increased risk of HIV and HCV, including persons who inject drugs (PWID).

If you have questions, please contact the Knox County Health Department at 865-215-5093 or East Tennessee Regional Health Office at 865-549-5265.

National Impaired Driving Prevention Month

December is also National Impaired Driving Prevention Month. In 2018, more than 10,000 people died as a result of alcohol-impaired driving. According to the National Highway Traffic Safety Administration (NHTSA), 56% of drivers involved in serious injury and fatal crashes test positive for at least one drug. The Governors Highway Safety Association (GHSA) reports that drunk and drug-impaired driving have increased during the pandemic and warn that festive events during the holiday season increases that risk even further. GHSA recommends having a plan in place for ride-sharing, staying over, or assigning designated drivers to keep everyone safe on the road both during and after the holidays!

Universal Human Rights Month

December is Universal Human Rights Month. December 10 is World Human Rights Day. The UN Universal Declaration of Human Rights decrees that all human beings are born free and equal in dignity and rights. As members of Project HOPE and RCORP-ETC, we know that stigma and discrimination are commonplace for the populations we aim to help. We recognize that each of those struggling with substance misuse is a human being deserving of ‘equality in dignity and rights.’ Thank you for your dedication and for making every day a Human Rights Day in your work!

“Where, after all, do universal human rights begin? In small places, close to home […] Unless these rights have meaning there, they have little meaning anywhere.”     – Eleanor Roosevelt