Click here for more information about the 2019 Mayors’ All4Knox Summit, including registration.

Are you or someone you know struggling with addiction? Call the Tennessee Redline today for free, confidential information and referrals: 1-800-889-9789.




 

The Big Picture

Numerous government agencies, nonprofit organizations, health care providers and many others are working to address the substance misuse epidemic in our community. However, it is challenging for any single agency to maintain a comprehensive, big picture view of what all the partners are doing. A shared understanding of this big picture is important if we are to identify gaps and address this problem. That shared understanding is one reason this website was created. This site does not include all the efforts, agencies or complex relationships between the organizations, but it does provide a general representation of the big picture. The interactive diagram below lists many organizations and some of the working relationships. Click on one of the red sectors below to see more details, links and information. Once you click on a sector, you can click on or hover over an organization to learn more.



Click on the red boxes below to learn more about each sector. After clicking on a red sector box, click or hover over the content to learn more.

Providing one place where the community can find comprehensive information about efforts to address this epidemic is just one component of All4Knox. The long-term goal is to develop a communitywide strategic plan to reduce non-fatal overdoses and overdose deaths in our community, which we will launch at the Aug. 2 Summit. Following the guidance set forth by the Substance Abuse and Mental Health Services Administration (SAMHSA), a national substance misuse prevention agency, we will divide the community into sectors to design strategies for each group. These sector strategies will support an overarching, communitywide plan to reverse this epidemic. The sector teams will begin their work at the 2019 Summit. Click here for more information about the 2019 Mayors’ All4Knox Summit, including registration.

 






Background


Knox County Mayor Glenn Jacobs and City of Knoxville Mayor Madeline Rogero, in conjunction with Metro Drug Coalition (MDC), the Knox County District Attorney General’s Office and the Knox County Health Department (KCHD), invited more than 60 people to gather at the East Tennessee History Center in October 2018 for a Community Discussion on Substance Misuse. Karen Pershing, MDC executive director, facilitated the meeting and provided an overview of the existing work in this area by her agency and others. Panel discussions with area experts offered opportunities to share information and gain a more detailed understanding of the issues. Panels included three sectors: criminal justice, education/employment and health. Following panel discussions, attendees were split into groups to discuss and inventory additional community efforts and possible actions. Themes and ideas from the table discussions are summarized below.

 






Themes and ideas from participant table discussions at 2018 summit


Centralization

  • Need for better coordination of not just treatment but all efforts to address substance misuse
  • Consider utilizing hub and spoke model, where a recovery resource center serves as the central source for addiction treatment services in the community, directing those in need to treatment options and helping coordinate other services, such as housing and transportation

Treatment

  • Need for coordinated system to access care (potentially addressed by hub and spoke model discussed above)
  • Transportation options/support
  • Access to treatment
  • Lack of payment for adequate treatment; both insured and uninsured have limitations on days, type, etc.
  • Wrap-around services (case management, mental health services, housing, education, legal and other needs-based services, etc.) happening, but not enough or not well-coordinated

Jobs

  • Employers’ willingness to hire those with history of addiction or incarceration

Housing

  • Availability of/access to affordable housing

Legislation

  • Insurance reform:
    • Increase payment for alternative therapies for pain (physical therapy, acupuncture, etc.)
    • Increase length of treatment for addiction that is covered
    • Change costs for pain medications (i.e., make a five-day supply a lower co-pay than a 30- or 90-day supply)
  • Expand TennCare or make a substance misuse or mental health diagnosis a qualifier for TennCare

Prevention

  • More funding for primary prevention efforts, preventing drug misuse before it starts (examples of programs can be found here and here)
  • Address difficulty in staying ahead of drug and prevention trends; often the response and/or availability of funding occurs well after an epidemic has been identified
  • Need to mitigate adverse childhood events (ACE), negative childhood experiences (abuse, neglect, etc.) that have a tremendous impact on lifelong health and opportunity, including the child’s risk for future drug misuse
  • Support families
  • End generational cycles of addiction

Education

  • Continue community education to reduce stigma by emphasizing addiction is a disease, not a moral failing as people are more likely to seek treatment/help if they aren’t ashamed of their addiction
  • More education to parents, athletic directors and coaches
  • Reduce stigma of medication assisted therapy (MAT)
  • Promote better understanding among agencies/elected officials/community of best practices to address epidemic
  • Work with universities and colleges to educate future health care workers about addiction

Criminal Justice System

  • Criminal justice reform – treat vs. incarcerate low-level offenders
  • Consider implementing model such as Delancey Street Project

Partners

  • Increase engagement and coordination with churches and faith-based organizations

Data Sharing

  • More coordination needed among agencies/organizations

2018 summit outcomes and next steps


The 2018 Mayors’ Summit: A Community Discussion on Substance Misuse was a first step toward developing a communitywide strategic plan to reduce non-fatal overdoses and overdose deaths in our community. That said, many agencies and organizations are taking steps now, in addition to helping with the development of a strategic plan, to help address this epidemic.

Below are just a few of the current efforts by Knox County, the City of Knoxville, Knox County Health Department (KCHD), Metro Drug Coalition (MDC) and the Knox County District Attorney General’s Office. Please note, many other organizations are working to address this issue as well, but that work is not captured here. Next steps include:

  1. Development of this website
  2. Increase opportunities/effort to remove pills from homes and the community
    • Explore distributing medication deactivation packs
    • Increase the number of permanent medication disposal sites throughout the county
  3. Repurpose a KCHD position to oversee the long-term, community strategic plan; this employee, the substance misuse response coordinator, is:
    • Working closely with MDC
    • Serving as a resource for the community on best/evidence-based practices
    • Facilitating the development of a communitywide strategic plan
    • Identifying gaps and working with community partners to address issues/needs
  4. Explore partnership between KCHD and a local hospital, funded by the Centers for Disease Control and Prevention (CDC) and Appalachia HIDTA, to create a standard protocol for treating overdoses in the emergency department
  5. Review KCHD policies and protocols to determine what best practices could be implemented in its clinics to help address the epidemic
  6. Lead by example by comparing current Knox County and City of Knoxville employee policies/benefits to best practices, including:
    • Review benefits to see if/how well alternative treatments for pain are funded and how well addiction treatment is covered
    • Develop a recovery-friendly workplace policy
    • Educate staff about:
      • Opiates and risk of addiction
      • Identifying addiction
    • Determine if staff need:
      • Lock boxes for medications
      • Medication deactivation pouches
    • Explore hosting an employee take-back event
  7. The City of Knoxville will be developing space on knoxvilletn.gov/opioids outlining the work of the Knoxville Police Department and the Knoxville Fire Department, as well as other efforts in the community.
 






Data and Resources


Several government agencies and health care providers are sharing data to help our community better understand this epidemic. Some of their findings include:

Suspected Overdose Deaths Per Year in Knox County
2017

293

2018

290

2019

128

Naloxone Deployment Frequency by Incident ZIP Code
 






About Us


All4Knox is a joint effort of Knox County and the City of Knoxville with facilitation and coordination support from Metro Drug Coalition, the Knox County District Attorney General’s Office and Knox County Health Department. Our hope is to bring together our governments, businesses, nonprofit organizations, faith-based communities and many others in a coordinated fashion to address the substance misuse epidemic.