Drug Overdose

        Drug Overdose can be either accidental or intentional and occurs when a person takes more than the medically recommended dose of a prescription or over-the-counter drug. In addition to prescription medications, individuals can overdose on illegal substances. For many substances, large amounts can be unsafe for the body and may result in permanent brain damage, organ damage, or even death.

        Substance Use Disorder (SUD) is the primary driver of drug overdose. SUD is a chronic disease that affects the brain and behavior and leads to an inability to control the use of a substance, often drugs or alcohol. There are currently 11 different criteria for SUD, some of which include: taking the substance in larger amounts or for longer than originally intended, wanting to cut down or stop using but not managing to, and continuing to use even when it puts the individual in danger. A person's ability to exert self-control can become impaired when SUD takes over- classifying it as a brain disease and often requires long-term response and treatment.

        In recent years, there has been a rise in drug and misuse. This increase has led to more ER visits because of overdoses and more admissions to treatment programs for drug addictions. In Tennessee, this translated to 7,708 nonfatal overdose inpatient stays and 15,949 nonfatal overdose outpatient visits- ranking it 13th in nation for overdose deaths in 2017. Opioids now account for three fourth of all drug overdoses in the state, with prescription opioids killing more Tennesseans than any other during this year. Within the state in 2017, 12,360 people were admitted for drug treatment, of those only 17 percent had a prescription in the state, including overdose deaths, increasing hospital costs and emegency room visits, children being put in state custody, and incarceration of drug-related crimes.  

        Substance Use Disorder changes normal desires, priorities, and behaviors. SUD interferes with the ability to work, go to school, and maintain positive relationships with friends and family. Drug use and mental illness often co-exist, and primary contributors to Substance Use Disorder include: anxiety or depression, trauma or abuse, family history of SUD, peer pressure, environmental stressors, and emotional distress. But aside from mental health, drug overdose has proven to be multi-faceted by affecting other areas of individual’s overall health status, including increased risk for lung or heart disease, stroke, or cancer.  In addition, these individuals are also at an increased risk of contracting infections. Beyond the harmful consequences for the person with the drug addiction, drug use can cause serious health problems for others including: negative effects of drug use while pregnant of breastfeeding such as neonatal abstinence syndrome (NAS), negative effects of secondhand smoke such as an increased risk of heart disease and lung cancer. 1 in 10 cases of HIV are due to drug injections leading to increased spread of infectious disease and an increased risk of motor vehicle accidents.  

        Health disparities  are prominent in both the impact of substance use disorder and options for treatment for those suffering from SUD.  We see differing trends among use of prescription vs. illicit substances and among drug types used throughout the state. Over time, we have seen a movement toward illicit opioids as prescription opioids became more regulated and most recently have seen the resurgence of stimulants such as methamphetamines and cocaine. 

        In 2017, the rate of fatal overdose was 26.6/100,000 individuals. While white, non-Hispanic persons continue to make up the largest proportion of overdose deaths, the rate of fatal drug overdoses has been increasing much faster for black Tennesseans (244 percent) than white Tennesseans (157 percent) over the last five years. Those aged 35-44 saw fatal overdose rates nearly twice that high, at 49.5/100,000. A majority of fatal overdoses occurred among Tennesseans that were male and white. The number of nonfatal overdoses for all drugs continued to rise through 2016, with dramatic increases in overdose involving heroin.  


Vital Sign Actions Guide

The following are lists of intervention strategies that you, your health council, and other local stakeholders could use to address drug overdose in your community.


1. Community Anti-Drug Coalition

Community coalitions organize a group of stakeholders and organizations with the common goal of reducing substance use disorders and overdoses. The Tennessee Department of Mental Health and Substance Abuse Services offers resources and recommendations on creating an effective coalition in your county or community. Additionally, partnering with existing Anti-Drug Coalitions in programming and educational campaigns is a great way to increase community outreach. 



2.  “Count It! Lock It! Drop It!”

The “Count It! Lock It! Drop It!” campaign seeks to educate patients with prescription drugs about the proper storage and disposal of their medications. Preventing prescription drug thefts helps to reduce the number of accidental drug overdoses. One component of this program is community run drug take-back events. Drug take-backs are events organized by local police departments and the Tennessee Bureau of Investigation in which people can drop off prescription medications, as well as over-the-counter medications, which are no longer needed by the patient. Similarly, drug take-back boxes are permanent receptacles available for people to properly dispose of their medications. The goal of a drug take-back is to prevent unused medications from being diverted into the hands of children or into the waterways when flushed down a drain. “Count It! Lock It! Drop It!” also seeks to educate individuals about making sure to count prescription pills once every two weeks, and to lock up any prescription drugs so friends and relatives aren’t able to reach them.



3. Electronic Screening and Brief Intervention 

 The Community Guide and the CDC’s Alcohol Program recommend implementing a program for Electronic Screening and Brief Interventions (e-SBI). E-SBI involves traditional screening and the delivery of brief intervention techniques through electronic media (computers, telephones, or mobile devices). Patients are assessed for drinking habits and if screened positive for excessive drinking, are offered personalized feedback about the adverse health effects of overconsumption of alcohol, including alcohol poisoning and death. E-SBI should screen for multiple concerning behaviors, including excessive alcohol consumption and high-risk factors for opioid abuse. These programs can be implemented in primary care settings, schools, places of employment, and other community settings. 



4. Generation Rx Educational Program

The mission of Generation Rx is to educate people of all ages about the potential dangers of misusing prescription medications. This program was established by Ohio State University and the Cardinal Health Foundation to provide educational materials and free resources for a community. Educational materials focus on the proper use and storage of prescribed medications. This program is listed as a community activity on the TN Together website. 



5. Good Behavior Game 

The Good Behavior game is an intervention that can be implemented in the classroom to improve behavior and academics. This program is recommended by the Substances Abuse and Mental Health Service Administration (SAMHSA). Evaluation shows that Good Behavior Game participants show decreased tobacco and alcohol use, decreased illicit drug use, and reduced use of services for drug abuse. 



6. Lifeline Peer Project

This project was created to reduce stigma surrounding addiction and to increase access to recovery service, such as Alcoholics Anonymous, Narcotics Anonymous, and Celebrate Recovery. There are currently ten Lifeline Coordinators in Tennessee.  Promotion of this service in high-risk places may increase the number of people receiving help in your community. 


7. LifeSkills Training

LifeSkills Training is a school-based prevention program targeting middle school adolescents. This 3-year program trains students in self-management skills, social skills, and drug awareness and resistance skills. LifeSkills Training is rated by Blueprints Programs as a Model Plus program and rated 3.9-4.0 by SAMHSA. For outcome metrics, visit the site below.



8. Mental Health First Aid 

Mental Health First Aid is an 8-hour course that gives people the skills to help someone who is developing a mental health problem or experiencing a mental health crisis. The evidence behind the program demonstrates that it builds mental health literacy, helping the public identify, understand, and respond to signs of mental illness. This program is intended for any community member who is interested in taking a Mental Health First aid Course, but especially recommended for first responders, primary/secondary school and college staff, faith-based organization members, and friends or family members of those with mental illness or addiction. 


9. Strengthening Families

The Strengthening Families Program (SFP) is a nationally and internationally recognized parenting and family strengthening program for high-risk and general population families. SFP is an evidence-based family skills training program found to significantly improve parenting skills and family relationships, reduce problem behaviors, delinquency and alcohol and drug abuse in children and to improve social competencies and school performance. Child maltreatment also decreases as parents strengthen bonds with their children and learn more effective parenting skills.



10. Syringe Service Program

The Safe Syringe Act passed in 2017 allows any nongovernmental organization to establish and operate a needle and hypodermic syringe exchange program. In Tennessee, a Syringe Services Program must provide a place to dispose of use needles/syringes, offer clean needs or syringes, ensure security at the program site, distribute educational materials, and provide access to naloxone and personal mental health and addiction treatment consultations. Further, these programs must report metrics to the department of health and may not be located within 2000 feet of a school or public park. It should be noted that public support is often higher when these programs are referred to as “overdose prevention sites” over “safe consumption sites” or “safe injection sites.” 



11. Telehealth

The Health Resources and Services Administration supports the expansion of telehealth in improving access to and coordination of care delivery. Telehealth is especially critical in rural and other remote areas that lack sufficient health care services, including specialty care. This type of healthcare can include video conferencing, internet resources, imaging and media streaming, and other communication technology. Telehealth increases access to care in rural communities that often face greater challenges with geography and transportation to clinical services and can be applied to mental health and substance abuse services.



1.  Appalachian Regional Commission

Purpose: Grants and funding are awarded by the Appalachian Regional Commission (ARC) focusing on economic opportunities, ready workforce, critical infrastructure, natural and cultural assets, and leadership and community capacity. Tennessee (Eastern Appalachian region) is among 12 other states that are eligible to receive funding from ARC.

Duration: Varies

Amount: $0 - $4,000,000; varies



2. Federal Grants 

Many large national organizations (i.e. SAMSHA, NIH, HRSA, and CDC) give out additional funding for mental health and substance abuse related programming. For more information on these funds, please contact the Opioids Response Coordination Office at the Tennessee Department of Health.   



3. Rural Health Information Hub

 Purpose: RHI Hub outlines opportunities to address drug overdose and related topics in rural communities at the national, state, and local levels across the country. It identifies initiatives and funding opportunities, rural program examples, tools, and resources focused on prevention, harm reduction, and treatment. 

Duration: Varies

Amount: Varies 



4. Telehealth Network Grant Program 

Purpose: The Health Resources and Services Administration (HRSA) support telehealth initiatives for medically underserved populations. The goals of this grant program are to expand access to, coordinate, and improve the quality of healthcare services, expand training, and improve the quality of health information.  HRSA also supports the Substance Abuse Treatment Telehealth Network Grant Program and the Evidence-Based Tele-Behavioral Health Network Program to increase access to mental health and substance abuse services. 

Duration: Varies

Amount: Varies 



5. Tennessee Commission on Children and Youth, Juvenile Justice Grants

Purpose: The Tennessee Commission on Children and Youth awards funding through the Office of Juvenile Justice and Delinquency Prevention Federal Formula Grant. Organizations may apply for grants that address delinquency prevention, and substance and alcohol abuse services. Any public or nonprofit entity (e.g. governmental, educational, law enforcement) that serves children is eligible to apply. There is no matching requirement for these grants. 

Duration: One year with possibly of two years’ extension 

Amount: Up to $60,000 



6.  Tennessee Department of Children's Services

Purpose: : The Tennessee Department of Children’s Services has announced a funding opportunity for programs, project, and activities related to Tennessee’s Building Strong Brains initiative. This initiative aims to address Adverse Childhood Experiences (ACEs) by promoting safe, stable and nurturing relationships between infants/children and their care takers. ACEs are a strong predictor of adult health and prosperity later in life, affecting many of the socioeconomic drivers of drug overdose.  

Duration: One year, with opportunity to renew

Amount: Up to $200,000


7. Tennessee Department of Mental Health and Substance Abuse Services

The Tennessee Department of Mental Health and Substance Abuse Services offers grant funding periodically to local organizations. Some exampls of funding include Community anti-Drug Coalitions and Juvenile Justice Diverson programming. Check the TDMHSAS website for funding opportunity announcements. 


1. Awareness of TDMHSAS Services

The Tennessee Department of Mental Health and Substance Abuse Services ofers different services to Tennesseans who are struggling with Substance Use Disorder. These services include the crisis phone line and the Tennessee Redline, recovery court programs, crisis detoxification, recovery support centers and peer counselors, Medication Assisted Treatment (MAT), recovery housing, and more. These services are available state-wide.


2. “It Only Takes a Little to Lose a Lot” Campaign

This CDC-backed campaign aims to raise awareness about the addictive nature of prescription opioids and the dangers of abusing them. The overall goal is to reduce the number of patients who overuse opioids. One low-cost way to distribute these educational materials is through a pharmacy bag campaign (partnering with pharmacies to attach flyers to prescription bags). 


3. National Prevention Week 

National Prevention Week is a campaign lead by the Substance Abuse and Mental Health Services Administration that aims to educate the public about mental health and substance use disorders. The 2019 National Prevention Week will take place May 12 through 18. 


4. National Recovery Month

The Substance Abuse and Mental Health Services Administration (SAMHSA) designated September as National Recovery Month to increase awareness and understanding of substance use disorders and celebrate recovery.


5. Overodse Awareness Day/Candlelight Vigil 

Overdose Awareness Day is held each year on August 31st.  A candlelight vigil held for the victims of drug overdose honors those who have struggled with addiction, while raising awareness and educating the public about substance abuse and drug overdose. 


6. Promote Medication Assisted Treatment Programs 

Medication-assisted treatment (MAT) is the use of medications, combined with counseling, to treat substance use disorders. The Robert Wood Johnson Foundation published a guide on how to implement MAT in a community and overcome the barriers associated with this evidence-based treatment program (see the source below). For a list of Tennessee’s treatment agencies and Medication Assisted Treatment locations, see the second source below. Specifically, implementing MAT programs in Emergency Departments, local Health Departments, and prisons and jails would provide access to treatment to a large population of opioid users.


7. Promote Certified Peer Recovery Specialist Program

A Certified Peer Recovery Specialist (CPRS) is a person who has lived experience of a mental illness, substance use disorder or co-occurring disorder, who has made the journey from illness to wellness, and who now wishes to help others. Tennessee’s CPRS program provides State certification for individuals who provide direct peer-to-peer support services to others who have mental illness, substance abuse, or co-occurring disorders. Promoting this service to recovering addicts provides an environment of peer support for addicts who are new to the recovery process. 


8. Promote Certified Recovery Congregations

Certified Recovery Congregations are recognized by the Tennessee Department of Mental Health and Substance Abuse Services as an important part of community-based recovery. These certified congregations must provide spiritual support, view addiction as a treatable disease, embrace and support people in recovery, provide visible outreach in the community, share recovery information, and host recovery support groups for those struggling with addiction in their community. 


9. Promote The Tennessee Redline

The Tennessee REDLINE (1-800-889-9789) is a toll-free information and referral line coordinated by TAADAS and funded by the Tennessee Department of Mental Health Substance Abuse Services. The purpose of the REDLINE is to provide accurate, up-to-date alcohol, drug, problem gambling, and other addiction information and referrals to all citizens of Tennessee at their request. Marketing this resource to the public could save lives and help those struggling with addiction to seek help. 


10. Red Ribbon Week 

Red Ribbon Week occurs each year in October. The campaign raises awareness about the danger of drug abuse and encourages prevention activities.   


11. The Good Samaritan Law/”Don’t Run, Call 911” Campaign

The Addiction Treatment Act states that any individual who in good faith seeks medical assistance to aid a person believed to be experiencing a drug overdose will not be arrested or charged for a drug violation relating to seeking medical assistance. Advertising this law and the “Don’t Run, Call 911” slogan encourages people to call for help and prevent drug overdoses instead of being afraid of legal repercussions. 


1. Recovery Court

The National Drug Court Institute published a set of evidence-based best practices for local recovery courts to adopt. The goal of these recommendations is to improve the outcomes of adults who are involved in the justice system due to serious mental illness and substance use disorder. Adopting these policies in local communities helps adults struggling with substance abuse to get treatment and prevent future overdoses. See the TMHSAS website for a list of recovery court programs in Tennessee. 


2. Trauma-Infomed Policies

Students who are subject to unmitigated childhood trauma may experience poor mental health and substance abuse leading to lower educational attainment, and increased incidences of teen pregnancy, joblessness, and poverty. Schools can be mindful of students struggling with their home lives by implementing trauma-informed policies and training. By training staff how to handle students with traima-informed care, the effects of Adverse Childhood Experiences, metnal dsitress, and substance abuse later in life can be lessened. Examples of trauma-informed policies include screening for ACEs, chronic absenteeism reduction and suspension policies, support groups, and school-based treatment.  


3.  Naloxone Policies for First Responders 

Naloxone, commonly known as Narcan, is a lifesaving drug that reverses the effects of an opioid overdose. Policies requiring all police officers, EMT personnel and other first responders to carry naloxone are recommended by the American Society of Addiction Medicine and would help communities to reduce the number of fatal drug overdoses. 


4.  School-Based Overdose Prevention

The Tennessee Department of Education’s Coordinated School Health published guidelines for schools concerning student drug overdoses. It is recommended that Local Educational Agencies implement a plan for public and nonpublic schools have an opioid antagonist (i.e. Naloxone) on site and train staff in the administration of the overdose-reversing drug.


1. Medication Assisted Treatment (MAT) for Pregnant Women with Opioid Use Disorder

Support System (supported by the Substance Abuse and Mental Health Services Administration) advises against using MAT for pregnant women with alcohol use disorders (naltrexone and acamprosate treatment). For opioid abuse, the PCSS states that it is essential that pregnant women are treated with an opioid agonist therapy through MAT for Opioid Use Disorder (buprenorphine treatment). Standardizing policy in primary care settings for MAT recommendations and referrals to pregnant women will improve the health outcomes from both the mother and the infant.


2.  Prescribing Policies

Implement and update policies regarding when to prescribe opioids for chronic pain and how to decide safe dosages for patients in primary care settings and pain clinics. The Centers for Disease Control recommended guidelines are intended to improve communication between clinicians and patients about the risks and benefits of opioid therapy for chronic pain, improve the safety and effectiveness of pain treatment, and reduce the risks associated with long-term opioid therapy, including opioid use disorder, overdose, and death.


3.  Referral to Medication Assisted Treatment (MAT) in Healthcare Settings

The Centers for Disease Control recommends Medication Assisted Treatment as the primary treatment for Opioid Use disorder. People who have already had a previous drug overdose are more likely to have a subsequent drug overdose. Policy that requires healthcare settings such as Emergency Departments to distribute MAT information to patients with a history of drug abuse or overdose, make program referrals and give out Naloxone kits to patients being seen for an opioid overdose can help to prevent subsequent, potentially fatal, drug overdoses. 


4.  Screening, Brief Intervention, and Referral to Treatment

This early intervention process targets how primary care providers assess a patient's risk for substance abuse and misuse. Low-intensity conversations between physicians and patients allows individuals to be more open about their alcohol and drug use, increasing the likelihood that they seek treatment and avoid further drug abuse. Policies requiring all primary care physicians to take this training would enhance the screening and prevention process for patients at risk for substance abuse. Patients should be screened for use of alcohol, tobacco, marijuana, and illicit drugs. A patient’s medical history should be checked for existing co-prescriptions of opioids and benzodiazepines which create a higher risk of overdose than a single opioid prescription alone. 



5. Screening for Adverse Childhood Experiences 

Adverse Childhood Experiences (ACEs) are stressful or traumatic events, such as neglect or abuse, that occur during the formative stages of adolescence. People who experience one or more ACEs are more likely to use prescription drugs and abuse illicit drugs. Before a physician prescribes opioids, he or she should screen the patient for ACEs due to the increased risk of opioid abuse and overdose. 


*State employees are prohibited from engaging in
political activity not directly a part of that person’s employment during any
period when the person should be conducting business of the state (Tenn. Code
Ann. § 2- 19-207). For further information on State Employee Political
Participation, please visit: https://www.tn.gov/content/dam/tn/hr/documents/12-012_Political_Activity.pdf 

This document is not a Department endorsement of legislative policy.