Tennessee Battles Devastating Overdose Crisis: Nitazenes and Opioids on the Rise

John M. Dabbs

The overdose epidemic has hit Tennessee hard recently, with overdose deaths rising consistently since 2017. According to data from the Tennessee Department of Health, there were 3,814 overdose deaths in the state in 2021, a 26% increase from 2020. These deaths involved a variety of drugs, but opioids were involved in 80% of them. The rise in opioid overdose deaths is primarily driven by deaths involving illicit fentanyl.

While the overall trend in overdose deaths in Tennessee is concerning, there is some hope in the latest data released by the Centers for Disease Control and Prevention (CDC). The provisional data indicates that overdose deaths in the US fell for three consecutive months in the first half of 2022. The CDC estimated about 107,600 overdose deaths for the 12 months between July 2021 and June 2022. That's 40 fewer deaths than in the 2021 calendar year.

However, the decline is uneven. Only a few states, including Maryland, Ohio, Pennsylvania, and West Virginia, report sizable overdose death decreases of 100 or more. Tennessee is not one of those states, with East Tennessee having the highest number of overdose deaths, encompassing 42% of the deaths in 2021, followed by Middle and West grand divisions.

One concerning trend in Tennessee is the increasing prevalence of nitazenes, a novel group of potent illicit synthetic opioids derived from 2-benzyl benzimidazole linked to overdose deaths in several states. Nitazenes were created as a potential pain reliever medication nearly 60 years ago but have never been approved in the United States. The potency of certain nitazene analogs dramatically exceeds that of fentanyl, and naloxone has been effective in reversing nitazene-involved overdoses, but multiple doses might be needed.

During 2019-2021, 52 nitazene-involved fatal drug overdoses were identified in Tennessee, with 42 occurring in 2021. These deaths involved multiple substances, with fentanyl being the most common co-occurring drug. Nitazene-involved deaths increased in 2021, with most attributed to metonitazene, which has a lower potency than other nitazenes.

Addressing the overdose epidemic in Tennessee will require a multifaceted approach, including increased testing, surveillance, and linkage to treatment for substance use disorders. The state has already taken steps in this direction, including implementing a Controlled Substance Monitoring Database (CSMD) that provides insight into the degree to which Tennesseans who die of drug overdoses have received prescriptions for controlled substances. The CSMD revealed that many overdose decedents had filled a controlled substance prescription the year before their death.

Additionally, state and federal officials have been working on expanding access to naloxone and increasing public education warning of the dangers of drug use. But much work must be done, particularly regarding nitazenes and other potent synthetic opioids.

The overdose epidemic is not unique to Tennessee, with overdose deaths rising across the United States in recent years. The latest data from the CDC suggests that the overall trend may be improving slightly, but the situation remains dire. Addressing this crisis will require continued vigilance and concerted efforts at the local, state, and federal levels to prevent overdose deaths and support those struggling with addiction.

The rise of nitazenes, potent synthetic opioids, in Tennessee is another concerning factor in the state's overdose crisis. According to a recent report by the Tennessee Department of Health, the prevalence of nitazenes in overdose deaths is on the rise, with 52 nitazene-involved fatal overdoses reported between 2019 and 2021. Most of these deaths occurred in 2021, with metonitazene being the most commonly involved nitazene.

Tennessee officials are taking steps to address the overdose crisis in the state. In 2018, the Tennessee General Assembly passed the "Tennessee Together" plan, which includes efforts to reduce the number of opioid prescriptions, increase access to addiction treatment, and expand the availability of naloxone. In addition, the state has launched a media campaign to raise awareness about the dangers of opioid abuse and addiction.

However, much work must be done to address the overdose crisis in Tennessee and across the United States. A multifaceted approach is necessary, including increasing access to evidence-based addiction treatment, expanding harm reduction services, improving prescription drug monitoring programs, and investing in research to develop new treatments for opioid addiction.

As the overdose crisis continues to devastate communities across the United States, it is clear that urgent action is needed to prevent further loss of life. With a comprehensive approach that addresses the root causes of addiction and overdose, there is hope that the tide of the crisis can be turned and more lives can be saved.

Help Locator in TN

A new substance abuse treatment locator website from the Tennessee Department of Health is available today at FindHelpNowTN.org.

This site directly links individuals to care and help if they struggle with a substance use disorder.

“There is an immediate, critical point where those struggling with substance abuse and misuse are ready to receive help,” said Tennessee Health Commissioner Ralph Alvarado, MD, FACP. ‘’Unfortunately, this point is often at the height of the crisis. The FindHelpNowTN.org website puts addiction and treatment resources within immediate reach, in real-time, when individuals and families don’t know where to turn.”

FindHelpNowTN.org guides individuals to location-based openings and services at substance-use treatment facilities. Site users can search facility listings using up to 60 different features, such as the type of treatment needed, insurance programs, payment methods, and availability of wrap-around services.

Treatment facilities on FindHelpNowTN.org regularly update their availability of residential, in-patient, and outpatient services. Since site users can also access a facility’s contact information, they can immediately contact them for treatment.

Facilities on the site are asked to update the availability of their residential, in-patient, and outpatient services regularly to ensure the most current information is available.

“Individuals and their loved ones facing substance abuse disorder have much to endure in finding a way out of addiction. Our hope is for FindHelpNowTN.org to be a source to find relief in an extremely exhausting and immensely stressful situation.” - Amy Murawski, Director, TDH Overdose Response Coordination Office

Currently, 243 Tennessee facilities have listings on FindHelpNowTN.org, and TDH is working with community partners, providers, and stakeholders to include more facilities on the site.

The launch of FindHelpNowTN.org resulted from a partnership between TDH, the Tennessee Department of Mental Health and Substance Abuse Services, Tennessee Tech University’s iCube program, and TAADAS (TN Association of Alcohol, Drug and Other Addiction Services).

FindHelpNowTN.org works in cooperation with TDMHSAS’s Tennessee Redline at 1-800-889-9789, a 24/7/365 resource for substance treatment referrals via phone call or text message.

“Tennessee is blessed with a wealth of substance use treatment resources, and we continue to look for ways to expand options for people even if they have little or no means to pay for it. We know that treatment works and recovery is real, so we’re excited to have another resource in our state to connect people and families with the help they so desperately need.” - Linda McCorkle, TDMHSAS Director of Treatment and Recovery Services

FindHelpNowTN.org is built upon an online platform based on the Kentucky Injury Prevention and Research Center, a partnership between the KY Department of Health and the University of Kentucky College of Public Health. KIPRC developed the platform in 2018 through a CDC grant to share with states interested in developing locater services for substance abuse treatment.

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An outdoor enthusiast with a passion for travel and adventure. John is a professional consultant and photojournalist.

Bristol, TN

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