Small-Town Struggles: Addiction, Lack of Resources Plague Health Providers at TN-KY Border

A dozen years ago, Dr. Geogy Thomas wasn’t prepared to see pregnant women addicted to pain medication in his little rural primary-care clinic. When they trickled in, he’d refer them to a high-risk obstetrics practice at the University of Tennessee Medical Center in Knoxville, an hour away.

Then he started seeing more and more of them – later and later in pregnancy. He realized many weren’t going to UT Medical Center. Many weren’t getting prenatal care at all.

“We didn’t feel comfortable taking care of the patients here, but they weren’t getting the care anyway,” Thomas said. “And that’s when we had to do a little soul-searching of our own, to say, ‘How do we take care of our own community?’”

Thomas is chief medical officer for Dayspring’s Indian Mountain family health center in Jellico, as well as for Dayspring’s other two clinics in nearby Clairfield, Tenn., and Williamsburg, Ky. The federally qualified health clinics provide primary and obstetrics care to underserved people in the towns along the Tennessee-Kentucky line.

Thomas came to Jellico in 2000 from California, where he’d seen a lot of heroin, cocaine and other street drugs. But the culture of addiction to prescription painkillers and “nerve pills” was new to him, patients coming in with drugs prescribed by “specialists” in the pill mills that dotted the area, Thomas said.

“I came into this community very ill-prepared for the amount of medications that were being prescribed,” Thomas said. “All these things I’d never seen used to treat pain were being utilized for what we would have prescribed ibuprofen and Tylenol for.”

He struggled with patients who came in expecting him to prescribe the painkillers they’d taken for years, and saw other patients struggle to kick the addictive drugs.

And he’d see pregnant women taking high amounts of the opioid replacement drug buprenorphine, used in Suboxone and Subutex. They got them from freestanding clinics and didn't know their babies could still go through withdrawal from these drugs after birth. The majority of mothers in Tennessee and Kentucky whose babies are born drug-dependent are on addiction replacement medications.

In the past two years, Tennessee has shut down nearly half of its 300 pain clinics and imposed regulations that prevent the same clinic from prescribing both pain medications and addiction treatment. Still, Thomas said, pill mills are still prevalent in his area. He’s now seeing a lot of people addicted to the non-opioid gabapentin, or Neurontin, used to treat nerve pain and seizures, which can cause severe withdrawals in newborns.

One-quarter of his pregnant patients now come in addicted to something.

Thomas learned his patients often didn’t have transportation to Knoxville obstetricians. They were frightened the city doctors would take their babies away. They were convinced they could get off the medication on their own – next week, or the next, or the next.

But the weeks ran out, and their babies were born addicted. In 2016, the East region of Tennessee, which includes Campbell and the 14 other counties surrounding Knox, reported 206 resident babies born with “neonatal abstinence syndrome” – more than any other region in the state. More than 26 of every 1,000 pregnant women in the East region last year had NAS babies. By the end of February this year, 118 NAS babies had been born in Tennessee, 24 of them from the East region – second only to the Northeast region around the Tri-Cities, which had 42 NAS babies.

“Every child born with NAS is costing the state $62,000 a year,” Thomas said – and that’s only for infant medical care. “Not the aftercare (and later problems), not the devastation of the family, not court and foster care and social workers” a family with ongoing addiction issues likely will need.

Thomas began telehealth sessions that allowed patients in his clinic to be remotely seen by practitioners at Knoxville’s High Risk Obstetrical Consultants. But he soon realized the women’s partners and even parents were also addicted.

“There’s nothing worse than taking an OB patient, cleaning her up and then sending her back home to her boyfriend, or her mother, who’s still abusing the drugs,” Thomas said. “What would it look like if we took that whole family? Husband, mother, grandmother – we’re talking about whole families that have another chance at life.”

About a year ago, Dayspring received a $325,000 federal grant to start a comprehensive addiction treatment program. Jellico Community Hospital, less than a mile away from Indian Mountain Clinic and the only hospital in Campbell County that delivers babies, has said it will devote six of its 54 beds to a 10-day inpatient detox unit Dayspring wants to start. Thomas and the clinic’s OB/GYN, Dr. Cathy Suto, would like to offer naltrexone, or Vivitrol, a long-acting injectable drug that blocks the effects of opioids.

But Thomas has had difficulty enticing a behavioral health specialist to the community. To get his program under way, he needs a full-time licensed clinical psychologist, social worker or counselor.

Meanwhile, he has four nurse “care managers,” which he describes as “case managers on steroids.” They address social needs, educate patients on chronic illnesses like diabetes and hypertension that often go untreated during addiction, and connect them with resources such as Mothers and Infants Sober Together, a program based at Ridgeview Behavioral Health Services in Oak Ridge.

Starting Wednesday, they can also send pregnant women to Catholic Charities of East Tennessee's Pregnancy Help Center in Newcomb, Tenn., three miles from Indian Mountain Clinic and less than five from the Kentucky border.

In the Crazy Quilt Friendship Center on Highway 297, which already houses a food pantry, director Esther Loudin is organizing racks of baby clothes and shelves of diapers, wipes and other supplies in preparation for Wednesday's grand opening. The center will use a “Earn While You Learn” curriculum that gives parents who complete courses on pregnancy, childbirth, breastfeeding, child development, parenting and life skills "Baby Bucks” they can spend in the “store” of donated items. Diapers and wipes are the biggest need, she said.

Clients enter during pregnancy and can stay until their babies are 2. Newcomb doesn’t have a Catholic church, but Loudin said the center is ecumenical, with local churches of all denominations supporting it.

Volunteers serve as mentors; call 423-784-7322 to volunteer or donate.

A year and a half in the making, it’s modeled after Catholic Charities’ other centers in Chattanooga, Knoxville, Johnson City and LaFollette. Loudin also serves as director of the LaFollette center, which is open three days a week and sees about 50 women. But it’s a 40-minute drive from Newcomb.

“That really poses an issue if there’s limited funds for gas, if transportation is not really reliable, if they’re depending on friends or family members to get them places,” Loudin said.

The area around Newcomb has a median household income of less than $25,000 a year – lower than Campbell County as a whole – and few resources, she said. Poverty and lack of options drive drug addiction. Loudin, who grew up in a small town just over the Kentucky border, said all but five of the 21 people she started school with have had addiction issues.

“It’s alarming to think of the number of people I started kindergarten with who are no longer living,” she said. “Everybody in this community … has been affected by drugs.”

http://www.knoxnews.com/story/news/health/2017/04/18/small-town-struggles-addiction-lack-resources-plague-health-providers-tn-ky-border/100381832/