With the death of Henry Granju, talk is once again focused on the high amount of prescription drug overdoses in Tennessee. Talk the turns to the high amount of prescription pain killers in circulation in Tennessee.
There are horror stories about how easy it is to get these pills and how many of “our children” are becoming addicted to them.
What keeps getting left out of the equation is the key ingredient.
TENNCARE.
Knoxville, where Granju lives and her son died, is the apex of this drug problem. It is also, not coincidentally, the state’s largest city around the Smoky Mountains. It is also where the state’s University is located. These three ingredients: location, customer base and government healthcare are the crucible in which society is brewing this dark scum of addiction.
Pardon me for reaching too far back into history and pointing out that one of the earliest crises our nation faced–in its own infancy–was the Whiskey Rebellion. Mountain farmers resented the fact that their corn was taxed differently simply because it was easier to take to market in jugs. That highlighted the logistical issues facing those who seek to live in the Smokeys. The response of the federal government created a permanent underclass by villifying distillers. then along comes Teddy Roosevelt and some nut job whose name I cant remember (but the dude was truly eccentric). Their love of nature and belief in preserving the country’s unique landscapes led to the creation of our National Park System. Unfortunately there were a lot of the grandchildren of those Whiskey Rebellion farmers actually LIVING on the land that Roosevelt et al. decided to preserve. Through machinations and force the federal government displaced those mountain dwellers, giving us both the lovely Great Smokey Mountains National Park and a bunch of angry homeless people. Homeless people who knew how to make a living transporting and dealing substances the Federal Government vilified.
So the homeless people got new homes and made moonshine. The cars they souled up to avoid the Revenuers were used in racing when they weren’t running whiskey. And that became NASCAR. So clearly these are an industrious, creative and business-minded people. People we turned into enemies and keep slapping down.
Enter Tenncare. The noble idea of insuring “the uninsurable” quickly introduced massive amounts of narcotic pain relievers into the populace. As I’ve written before, it is cheaper for Tenncare to simply prescribe pain pills for people with chronic ailments like arthritis than it is to pay for joint replacements and biological drug therapy. It’s cheaper to prescribe pain pills for cancer patients than to perform tumor resection surgeries and chemotherapy. And since patients who are simply given pain management as opposed to disease modification are more likely to die earlier (and then stop needing insurance) it’s a win-win for Tenncare.
Did I mention that one of the largest concentrations of Tenncare patients is in the East Tennessee area around Knoxville?
So you have people who justifiably dislike the Federal Government and its rules, who are used to the family business of trafficking in illicit substances being introduced to a product that is far easier to distribute than even Marijuana. Pills don’t have to be grown in the mountains. And now pills are much easier to get. Your cousin will sell you some of the ones he gets for his arthritis and your neighbour will sell you the ones they have left after his wife died from the breast cancer that Tenncare wouldn’t pay for a mastectomy for.
Then unscrupulous doctors who have a love for money and a deep hatred of the Student Loan program open a “Pain Clinic” and you can round up a bunch of your neighbours and get drugs for their bad backs. Your buddy Bobby Ray hasn’t worked in three years since the mine shut down. So sure, he’ll go to the Pain Clinic for fifty bucks and the give you his pain pills for a dollar apiece. Tenncare pays for the doctor and the meds so it’s pure profit for him. Profit he needs to keep a roof over his family’s head.
And having a college full of kids nearby means that nobody has to go very far to find customers for all those pills.
So who IS to blame here ?
Most people seem to automatically say “the pills”, as though those inanimate objects snuck themselves out of pharmacies and medicine cabinets to dance around bored little kids on the playground.
A few people will blame the pain clinics or the doctors. A few more will blame the dealers.
But no one seems too eager to blame ourselves.
Just Another Pretty Farce 
You forgot to list the growing source of obtaining illegal pills – the Internet.
It’s harder than it used to be to get pills over the Internet, but you’re right. That doesn’t help the problem. But the Internet buyers tend to be the end addict…kids like Granju or the housewife who got hooked after a back injury. The source buys in our region seem to be centering around pill mills.
Our proximity to Florida–a state with an overwhemingly large pool of chronic and catastrophic patients due to the large number of retiree relocations there–and our pre existing illicit transport network makes it very easy for pill mills to distribute here.
Um, Coble, it’s cheaper for private insurers to pay for pain medication than for all that other stuff, too.* TennCare has nothing to do with it. Our entire model of paying for health care is majorly screwed up; it isn’t making that screwed-up system available to poor folks as well as the middle class that’s the problem.
*Like the third time my nerve/arm issues came back, when I decided it would make more sense to buy the traction machine that I’m clearly going to have to use once a year than rent it over and over for a couple of months each time, and my private insurer decided that they wouldn’t cover it despite my physician’s recommendation. And despite the fact that if I use it I won’t need pain pills, and won’t need as much cortisone, either.
Yes, it is. But in this case I single out Tenncare specifically because by insuring those deemed uninsurable elsewhere, Tenncare has a pool of claimants that is overwhelmingly skewed toward the chronically and catastrophically ill–the two categories of patients most likely to require continuing large doses of pain medication.
In addition, Tenncare is the largest insurer in East Tennessee. And they don’t require copays, all of which make them more attractive to pill mills and mules.