Kristi L. Nelson 

April 19, 2017

As early as 2010, they began to see the signs of the coming epidemic.

Patients came in for primary care with needle tracks on their arms and full-blown cases of undiagnosed hepatitis C.

Pregnant women waited until well into their third trimester to seek prenatal care — afraid to keep taking the drugs they were on, afraid to quit.

People, hurting, no longer able to afford the prescription opioids that dulled the pain, stooped to buying heroin on the street.

They’d come in, see a doctor or nurse practitioner, then disappear for weeks or months. Some would get clean, only to relapse. Some would come back with their parents or their children — multiple generations of families hooked on drugs.

Providers at Cherokee Health Systems spent those years trying to plug the dam, to pull together resources to stem the tide of addiction that threatened to wash over Knox and 13 surrounding rural counties where Cherokee operates primary and behavioral health clinics. But the funding wasn’t there for a full-fledged addiction treatment program. The disease that had already taken root in East Tennessee wasn’t yet on the national radar.

McGrail, a 34-year Army veteran and family physician who last served at Fort Campbell and overseas, worked at Cherokee during a 2013-14 fellowship at the University of Tennessee Medical Center. So he was already familiar with the health center’s patient population — about a third on TennCare/Medicaid, about another third uninsured — and its mission to treat physical and mental health issues at the same time.

McGrail’s primary task was to head up a medication-assisted therapy program, which Cherokee hasn’t had. The center has a state grant to help cover some of the cost of buprenorphine, a replacement drug used to gradually wean addicts from opioids, and naltrexone (Vivitrol), which blocks the nervous system receptors that get pleasure from opioid use. As an MD, McGrail can write those prescriptions, which he began doing a month after his hire.

“Cherokee has long had its intensive outpatient programs, which were run by psychologists and non-prescribing providers,” said McGrail, who said those therapy programs will not only continue but expand. “But we know that medications are a valuable adjunct in the treatment of addiction.”

Under obstetrician Dr. Michael Caudle and psychologist Suzanne Bailey, director of integrated services, Cherokee had been one of the few providers that would treat pregnant women with addiction issues and whose babies might be born drug-dependent. Now those women also will be under McGrail’s care; seven of his patients so far were pregnant when they came in, and five still are.

But even those who aren’t pregnant usually come in with untreated psychological trauma as well as other health issues, such as diabetes, hypertension or serious dental problems. The federal Substance Abuse and Mental Health Services Administration estimates nearly 40 percent of people addicted to drugs also have a mental disorder.

“As you can imagine, many of them have had little to no health care for the last few years,” McGrail said. He envisions his clinic as both directing patients to primary-care and behavioral-health services, and accepting patients whose primary-care doctors or therapists catch their addiction problems during visits for other issues — “an addiction ‘medical home,’ if you will,” he said.

“I think we’re going to be able to address all their needs in one setting — that’s our program,” he said. “We have yet to really open the doors. We’ve written referral guidelines to share with our sister health-care organizations, but we haven’t been brave enough to put them out there yet because I think once that happens, the floodgates are open.”

Read more in the Tennessean.

Kristi L. Nelson is a general assignment news reporter who covers health, social services and other issues.  As a health reporter, she earned a Kaiser Family Foundation Fellowship for reporting on AIDS/HIV in Tennessee, and a National Health Journalism Fellowship from the University of Southern California at Annenberg for a series on the role of foreign-born primary-care physicians in rural East Tennessee. She is a member of East Tennessee Society of Professional Journalists and the Association of Healthcare Journalists.