All that work culminated during this year’s legislative session when lawmakers unanimously repealed the Intractable Pain Act, a law passed in 2001 that some authorities believe protected illegitimate pain management clinics, or pill mills, from prosecution. The repeal went into effect Wednesday.

One part of the law essentially says that if someone complains to a doctor of intractable pain and insists on medication, the doctor must either provide the desired medication or direct the patient to another doctor who will.

“With the repeal of the act, it means the doctors will have the discretion to determine whether or not it’s in a patient’s best interest to get pain medication or not,” said Barry Staubus, district attorney general for Sullivan County. “They’ve gotten their discretion back to make decisions on whether or not someone gets those pain pills. The question is what about the doctors who earn their money doing that?”

Staubus said there will probably still be some pain management clinics that dispense more medication than a patient needs, even after the repeal of the law. Because of this, he thinks there should be laws or regulations that could reduce a person’s potential to abuse prescription pills.

Some of the regulations Staubus would like to see include requiring clinics to accept insurance, keeping detailed medical histories and offering alternative treatments aside from medicine.

Alice McCaffrey, director of the Sullivan County Anti-Drug Coalition, thinks physicians should be held accountable.

“When identified prescribers are not abiding by the treatment guidelines, they should be called before the oversight committee or reported to law enforcement ,” she said. “While I would prefer to see the medical community become highly involved in turning down the spigot, if they are unwilling or unable, they have a responsibility to the community to ask for help.”

She said that not all pain clinics are bad and that she would like to see a better system to recognize those clinics which are doing it the right way. Staubus also said there are good pain clinics which follow the rules and genuinely want to help people suffering from chronic pain. Staubus said those clinics should be models for what regulations to implement and legitimate clinics would not object to some of the rules because they are following them already.

But even though steps have been taken and a law repealed, prescription drug abuse is still at epidemic levels throughout the state, especially in Northeast Tennessee.

Staubus said approximately seven out of 10 autopsies he deals with are related to drug abuse in some way, whether through accidental overdose or rapid aging of the body because of the abuse.

For health care workers, nothing has changed.

“Our numbers are staying consistent,” said Randy Jessee, senior vice president for Specialty Services at Frontier Health. “People seeking treatment are just the tip of the iceberg. The number of people using has been steady. It seems to be a part of our culture.”

Jessee said Gov. Bill Haslam’s plan is having a positive effect. Some of the other newly established guidelines, like the Tennessee Chronic Pain Guidelines and the Controlled Substance Database, should help in the fight against prescription drug abuse.

According to McCaffrey, the Tennessee Chronic Pain Guidelines were finalized last fall, and the anti-drug coalition has been working to ensure local prescribers are familiar with them. With the guidelines, physicians assess both pain and the risk of abuse, diagnosis and goals for pain treatment, including methods other than pharmaceuticals.

The Controlled Substance Database was established in 2012. Prescribers are required to check the database before prescribing narcotics, and law enforcement is allowed access to the information. Because of this, Jessee said people should know who the high prescribers in the state are.

Other programs are being conducted throughout the state to help turn back the tide of prescription drug abuse. The antidrug coalition is launching a Count it, Lock it, Drop it program. The program encourages people to count their medications at least once every two weeks and if any medication is addictive or poisonous to lock it in a personal lock box. And any leftover medications should be taken to a dropbox, located at various places around the region.

Frontier Health has been going into jails to try to identify people who have addiction or mental health issues. Then the organization tries to get them services in jail and help them get reestablished in the community once they are out, according to Jessee.

Recovery courts are also popping up across the state and in the region. Jessee said those courts help give people, including felons, access to treatments and services they never had before.

McCaffrey believes more can be done.

“We would also like to see faith-based communities and businesses get more involved,” she said. “There is currently an active call to recruit faith-based ambassadors to help those in recovery return to productive and sober lives. And businesses could become more committed to drug-free workplace practices that would treat addiction as any other disease and provide shame-free support for their workers to become productive again.”

Jessee said it has been proven that for every dollar a community spends on prevention, it would get $7 in return.

But he said the business of prescription drugs is a big moneymaker on a lot of levels, and while Haslam’s plan sounds good and is working for the most part, he doubts the state has the money or the resources to implement it fully.

And everyone working together is the only way to stop this epidemic.

“You don’t change the whole culture without the community,” Jessee said.