Timeline: How the Opioids Crisis took Hold

The roots of an epidemic

In 1995, the Food and Drug Administration approved OxyContin for prescription use. Its active ingredient, oxycodone, has been deemed highly addictive since the 1960s.

The drug hit the market at a time of increasing recognition by the U.S. medical community that many patients in pain were being inadequately treated.

In 1996, the American Pain Society argued for medical providers to view pain as a "fifth vital sign." The organization urged medical providers to routinely assess and respond to pain levels in their patients in the same way they monitored blood pressure, heart rate, respiratory rate and temperature.

"We know in the '90s there was a sort of a shift in that pain was the fifth vital sign and that we really need to be paying attention to patients' pain because it wasn't being treated well at that time," said Dr. Jenna Walters, director of medical student and resident education at the Vanderbilt Pain Management Center and assistant professor of anesthesiology and pain medicine.

With the introduction of OxyContin came an aggressive marketing campaign aimed at doctors by drug manufacturer Purdue Pharma. The pharmaceutical company took out ads in medical journals, hosted conferences and deployed pharmaceutical representatives to physician offices and clinics across the country.

In 1999, 5 percent of people who received publicly funded addiction treatment in Tennessee were abusing prescription pain relievers and 342 people died from overdoses.

By 2000, prescription opioids had become the top drug abused by those receiving publicly funded treatment at detox facilities and halfway houses for recovering addicts, according to the Tennessee Department of Mental Health and Substance Abuse Services.

In 2003, the FDA issued a "warning letter" to Purdue Pharma for misleading advertisements that said:

"The combination in these advertisements of suggesting such a broad use of this drug to treat pain without disclosing the potential for abuse with the drug and the serious, potentially fatal risks associated with its use, is especially egregious and alarming in its potential impact on the public health."

As the number of opioid-related emergency room visits and deaths continued to climb around the country, the FDA in 2008 began holding a series of meetings to discuss opioid risks, misuse and abuse.

Opioid deaths spike, state lawmakers take action

In 2011, Lortab (a combination of acetaminophen and the opioid pain medication hydrocodone) was by far the most frequently prescribed controlled substance in Tennessee, according to TennCare data. TennCare approved 707,000 claims for the drug totaling $6.8 million.

That year, the number of opioid overdose deaths in Tennessee rose to 1,062. In 2012, Tennessee became No. 2 in the nation for consumption of opioids, topped only by Alabama.Alarmed by high prescription rates, state lawmakers passed the Prescription Safety Act, which requires health care providers, including some veterinarians, to register patients who receive more than a 15-day prescription in a database.

Doctors are required to check the database before writing a more than seven-day refillable prescription to track patients trying to "doctor shop" — or visit multiple doctors, pain clinics or veterinary hospitals to acquire prescriptions.The epidemic's toll continued to climb. There were 1,094 opioid overdose deaths in 2012.

Focus turns to addicted mothers, dependent babies

The epidemic exacted another toll. Pregnant women who abuse opioids risk giving birth to babies who also are dependent on the drugs.

In 2013, Tennessee required all diagnoses of drug-dependent babies — a condition called neonatal abstinence syndrome — to be reported to the Tennessee Department of Health.

In that year, the state recorded 912 births of drug-dependent babies. Forty-one percent of women who gave birth to drug-dependent babies took painkillers prescribed by doctors.

Lawmakers intervened to pass a controversial law that sent new mothers to jail if their babies tested positive for illegal drugs. The state's opioid death toll in 2013 stood at 1,166. More Tennesseans died from drug overdoses than in motor vehicle accidents, homicides or suicides.

On July 1, 2014, Tennessee began allowing doctors to prescribe an antidote to narcotic overdoses called naloxone.Police departments began training officers on administering naloxone and used grants to acquire their own supply.In 2014, the state reported 1,263 opioid-related deaths. More than half — 55 percent — of those who abuse painkillers get them from a friend or relative who has a prescription, according to a 2014 report from the Tennessee Department of Mental Health and Substance Abuse Services. Seventeen percent have their own prescription.But Tennessee doctors continued to prescribe opioids at high rites.

Tennessee physicians in 2015 wrote more than 7.8 million opioid prescriptions — or 1.18 for every man, woman and child. In 2015, 174 people died in crashes in which a driver either tested positive for drugs or an officer determined drugs contributed to the crash — an 89 percent increase in fatal crashes in which the driver was impaired by drugs in five years. The number of babies born addicted to drugs, particularly opioids, climbed in Tennessee to 1,039 in 2015, while opioid overdose deaths claimed 1,451 lives.The Obama administration's Comprehensive Addiction and Recovery Act of 2016 passed both houses of Congress in the spring.

The wide-ranging new measure included more police access to naloxone; improved treatment for prisoners, pregnant women and others; and the authorization of task forces to fight drug trafficking and develop best practices for the prescribing of painkillers.In March, the Trump administration's efforts to replace the Affordable Care Act stalled. The measure included a roll-back on substance abuse treatment for people who qualified for an expansion of Medicaid in states that opted in for that expansion. Tennessee did not. The president has said he will continue his efforts to overhaul the ACA.

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