HIV and AIDS cases are on the rise in Kentucky; officials blame lack of education and increase of heroin use

Despite readily available information and awareness about practicing safe sex, and avoiding sharing needles, HIV and AIDS cases are on the rise in Kentucky. And the reason, say officials, is ignorance and an increase in heroin use, Mary Meehan reports for the Lexington Herald-Leader. Mark Royse, executive director of AVOL, which serves clients with HIV and AIDS in 72 Kentucky counties, said "his nonprofit routinely offers support services, including housing assistance, to about 400 families affected by HIV and AIDS."

Lauren Kirk, HIV and AIDS outreach specialist for the Lexington-Fayette County Health Department, "said a lot of the people they see are young and were born after the AIDS epidemic was at its lethal peak," Meehan writes. Another specialist, John Moses, told hr that the health department is seeing more young people with HIV. Part of that surge, he said, is from the use of shared needles as heroin use in Kentucky is on the rise." Heroin drug deaths in Kentucky increased by 550 percent in 2012, John Cheves reports for the Herald-Leader.

Another problem is that many people refuse to get tested, because discussion of HIV and AIDS includes talk of sexuality, homosexuality and drug abuse, Meehan writes. Royse told her, "It is a perfect storm of things we don't like to talk about." Royse said "a 'silence-is-better' policy is especially prevalent among Latinos and blacks, who account for the majority of new infections in Kentucky. He's concerned that if people stop talking about HIV and AIDS and become complacent, the infection will continue to spread." (Read more)

The state Cabinet for Health and Family Services, in its annual report from June, 2012, said 8,513 Kentuckians are diagnosed with HIV, with 7031 men and 1,482 women. Most of the cases are in urban areas, with 3,849 in Jefferson County and 1,099 in Fayette County. Of those cases, 4544 are classified as from men having sex with men (MSM), 917 as injection drug users (IDU) and 425 as people who reported to having engaged in both MSM and IDU.

The overall total of HIV and AIDS cases includes 21 boys under 13 years old, 107 between ages 13-19, and 1,269 between ages 20-29. For women, it includes 13 girls under 13 years old, 39 between ages 13-19, and 203 between ages 20-29. (Cabinet graphic: Newly diagnosed HIV cases in 2010 for Kentuckians ages 20-29 years old accounted for 32 percent of all new cases, even though that age group only makes up 13 percent of the total population)

Kentucky ranks 25th in HIV infections. In 2010, the state had 85 new HIV cases for people ages 13-24, accounting for 25 percent of all new cases in the state, which is higher than the national average for that age group of 21 percent. The average age of Kentuckians diagnosed with HIV went down from 37.1 years of age in 2006 to 35 years of age in 2010. To read the full report click here.

Night lingers in Appalachia, but there are rays of sunlight

Harry Caudill talked with U.S. Sen. Robert F. Kennedy
during his visit to Eastern Kentucky in February 1968.

In 1963, Harry Caudill of Letcher County published Night Comes to the Cumberlands: A Biography of a Depressed Area, a book that brought national attention to poverty in Appalachia and spurred the War on Poverty. Fifty years later, as part of a year-long series, the Lexington Herald Leader is examining the challenges that Kentucky Appalachians still face on their path to progress, and the story of heartbreak and hope includes the region's contentious battle with drug abuse.

From 2000 to 2010, the number of drug-overdose deaths in Kentucky rose a staggering 296 percent, highlighting the state's drug abuse epidemic that now kills more than 1,000 Kentuckians a year. But communities have started to rise up and fight back against this lethal weapon, and for the first time in 10 years, deaths from prescription-drug abuse in Kentucky declined last year.

Still, the state's highest rates of overdose deaths are consistently found in Eastern Kentucky, where chronic poverty and economic hardships remain and numerous factors make it one of the worst areas in the nation for prescription drug abuse, experts say. Poverty is at the top of the list, reports Estep.

Click here for an interactive version of this map, with individual county data.

Social rank is also a key predictor of drug abuse, which consider how people see their place in the world and their ability to improve their lot, and many people in Eastern Kentucky rank low because of chronic poverty, Robert Walker, a researcher at the Center for Drug and Alcohol Research at the University of Kentucky, told Estep: "It's the belief that I can't do anything to fix this or make my life any better. That is a profound risk condition for drug abuse."

Another factor was the region's chronic health problems, reports Estep. It is well documented that Appalachians suffer from disproportionately poor health and have increased risks of adverse health outcomes, compared to the rest of the nation and the rest of the state; many people addressed these problems with drugs, which unintentionally led to drug addiction.

Public assistance also played a role in the developing drug abuse problem. "Medicaid recipients can get prescription drugs at little cost, and some people then resell them for cash," Estep writes. For example, in Clay County, which has the third highest rate of drug overdoses per 100,000 people, 42 percent of residents were eligible for Medicaid in fiscal 2012, compared with 18.8 percent statewide.

Eastern Kentucky's ongoing battle against pills started well before a decade ago as the area suffered economic devastation of the Great Depression and doctors handed out pills to mask pain for injured coal miners and the sick poor, Caudill wrote, adding that the drudgery of coal-camp life also drove the use of pills.

Fifty years later, Estep writes, "Rising drug abuse added misery to the economic malaise, and corruption among public officials inflamed the drug problem. Drug dealers helped power brokers buy votes, then benefited as some local police and other officials turned a blind eye to their illicit sales."

A story of heartbreak and hope in Manchester

The story of one recovering addict, Melanda Adams, embodies these forces. Her home Clay County was at the center of the prescription-drug explosion, and her father, the county school superintendent, was convicted in a vote-buying scheme that he said he joined to help oust officials who were protecting drug dealers.

Social use of alcohol and drugs led Adams to start abusing drugs, but by the time she was 23, she was snorting as much as $800 worth of OxyContin pills and methamphetamine a day, she told Estep, adding that people start abusing drugs for a variety of reasons, and the shame of their addiction then becomes part of the reason to keep abusing them. "Your soul is tormented, really," she said.

Her craving for drugs led Adams to steal the ingredients that a drug dealer had provided her boyfriend to make a batch of meth, for which she suffered an almost fatal beating that still didn't curb her addiction. After stints in jail and in rehab, police found her agitated and bleeding in her home. She remained in jail for three months, where she suffered from the sharp pain of detoxification and withdrawal. Then she started on the road to recovery, reports Estep.

Fueling problems of addiction faced by thousands, Eastern Kentucky counties used corrupt relationships with local police and political officials in their illegal businesses, which included selling drugs.

Jurors convicted Adams' father, school Supt. Douglas Adams of vote fraud in a number of elections. As part of his defense, Adams said his motivation for getting involved in the most notorious election at issue in the trial, the 2002 primary for county clerk, was that the incumbent, Jennings B. White, had been protecting drug dealers, reports Estep. Adams said he was fighting against White to save his daughter and others who had fallen victim to drugs.

In the late 1990's, Congress designated Eastern Kentucky as a High Intensity Drug Trafficking Area, which led to efforts that helped dry up the county's drug rings. The FBI led investigations, "leveraging charges against drug dealers to pursue investigations of local officials," reports Estep. In the end, more than a dozen public officials or election offers in Clay County had been convicted. This shook up the local political structure, which was necessary for the community to take a stand against drugs, Estep reports.

Now, as a result of greater community awareness, activism against drugs, and targeted law enforcement, drug overdose deaths in Clay County have fallen from 43 in 2011 to 27 in 2012. Coroner Danny Finley also credits this reduction to better practices by many doctors, and new state laws that have cracked down on pain clinics and over-prescribing doctors, reports Estep.

While the fight against drugs is never over, Melanda Adams is proof that there's hope in Manchester and hope for Clay County. "She has clear eyes, a big laugh and a feisty 6-year-old daughter," reports Estep. She runs her own convenience store and says its important for drug addicts who feel trapped to know that they are more than just addicts. "There is a chance," she told Estep. "Give 'em that hope."

FDA wants to limit number of hydrocodone refills available without another doctor visit; approves pure version of drug

"The Food and Drug Administration on Thursday recommended tighter controls on how doctors prescribe the most commonly used narcotic painkillers, changes that are expected to take place as early as next year," Barry Meier reports for The New York Times. "Drugs at issue contain a combination of hydrocodone and an over-the-counter painkiller like acetaminophen or aspirin and are sold either as generics or under brand names like Vicodin or Lortab." (Associated Press photo by Toby Talbot)

"Doctors use the medications to treat pain from injuries, arthritis, dental extractions and other problems," Meier writes. "The change would reduce the number of refills patients could get before going back to see their doctor. Patients would also be required to take a prescription to a pharmacy, rather than have a doctor call it in. The new regulations would reduce by half, to 90 days, the supply of the drug a patient could obtain without a new prescription."

On Friday, the FDA announced it had approved a stronger version of hydrocodone, Zohydro ER, for patients who require 24-hour, long-term pain medication. "The new version is the first pure hydrocodone drug approved in the U.S.," ABC News reports. "Hydrocodone is currently sold in combination pills like Vicodin to treat pain from injuries, surgery, arthritis and migraines." Activists against prescription-drug abuse criticized the decision.

U.S. Rep. Hal Rogers of Kentucky's 5th District "said on Friday that top FDA officials had recently assured him they would only approve new opioids like Zohydro if they were marketed in formulations intended to deter abuse," Meier and Eric Lipton report. "OxyContin is now formulated that way, but Zohydro, which is contains hydrocodone without acetaminophen, is not. Its producer, Zogenix, says it will closely monitor use of the drug." Rogers told the Times, “It is like the original OxyContin, so that is real problematical.”        

More than 6.1 million Americans abuse prescription pills, and last year there were 22,133 prescription drug deaths. The problem is most rampant in Central Appalachia, including Eastern Kentucky.

In 2011, about 131 million prescriptions for 47 million patients, or about five billion pills, were written for medications containing hydrocodone, Meier notes. "Prescription drugs account for about three-quarters of all drug overdose deaths in the United States, with the number of deaths from narcotic painkillers, or opioids, quadrupling since 1999, according to federal data." (Read more)

Kentucky ranks high in prescription drug abuse, but also is a national leader in efforts to fight it, state-by-state analysis says

By Molly Burchett
Kentucky Health News

A new report finds many states do not have effective strategies in place to fight prescription drug abuse, but Kentucky scores high on most prevention measures, indicating that the state is working hard to combat the problem.

The Trust for America's Health report found that Kentucky, along with Massachusetts, New York and Washington, scored 9 out of 10 possible indicators of promising strategies to fight prescription drug abuse. Only two states, New Mexico and Vermont, scored 10 out of 10, while 28 states and Washington, D.C., scored 6 or less.

The only indicator Kentucky lacks is a Good Samaritan law, which would provide a degree of immunity from criminal charges or mitigation of sentencing for individuals who seek to help themselves or others experiencing an overdose, says the report. Such laws are in place in 17 states and D.C.

Prescription drug abuse has become a top national and state public health concern. Since 1999, rates have doubled in 29 states, tripled in 10 and quadrupled in four, including Kentucky. The state has the third highest drug-overdose death rate in the country, with 236 people per million people suffering overdose fatalities in 2010.

"Prescription drugs can be a miracle for many, but misuse can have dire consequences. The rapid rise of abuse requires nothing short of a full-scale response - starting with prevention and education all the way through to expanding and modernizing treatment," said Dr. Jeffrey Levi, executive director of Trust for America's Health, in a news release. "There are many promising signs that we can turn this around - but it requires urgent action."

To develop scores for the report, the organization worked with public-health, clinical, injury-prevention, law-enforcement and community organization experts to review a range of national recommendations and examine the 10 indicators. Kentucky received 9 out of 10 points because it:

• Has an active prescription drug monitoring program
• Requires utilization of monitoring program by prescribers
• Is participating in Medicaid expansion, which helps expand coverage of substance abuse services and treatment
• Has a "doctor shopping" law specifying that patients are prohibited from withholding information about prior prescriptions from their healthcare provider
• Requires or recommends prescriber education
• Has a rescue drug law to expand access to and use of naloxone, a prescription drug that can help counteract an overdose
• Has a law requiring health care providers to physically examine patients (or have a bona-fide physician-patient relationship) before prescribing a controlled substance
• Has a law requiring or permitting a pharmacist to require an ID prior to dispensing a controlled substance
• Has a pharmacy lock-in program under the state's Medicaid plan where individuals suspected of misusing controlled substances must use a single prescriber and pharmacy.

Although a cause-and-effect relationship cannot be determined, there are indications these efforts and strategies may be having a positive impact on reducing prescription drug abuse. A recent survey found fewer Kentucky teenagers said last year that they used prescription drugs without a doctor's direction, and this report indicates steps forward in the fight against abuse. There is still much more work to be done.

"We must use the best lessons we know from other public health and injury prevention success stories to work in partnership with clinical care, law enforcement, the business community, community-based organizations, and other partners to work together to curb this crisis," said Andrea Gielen, director of the Johns Hopkins Center for Injury Research and Policy, in a news release. Click here for a full description of the indicators, state scores and the full report.

Fighting prescription drug abuse? Save your spot for 'The Difference Faces of Substance Abuse' conference Jan. 28-29

Early registration is open for the 2014 Different Faces of Substance Abuse Conference, which seeks to build collaborations and partnerships among Kentucky community members to address the state's prescription-drug abuse problem at the local level.

The conference, to be held Jan. 28-29 at the Griffin Gate Marriott in Lexington, will address all aspects of substance abuse and misuse, and provide opportunities for networking and professional development. Continuing education credits are available for alcohol and drug counselors, social workers, licensed professional counselors and marriage and family therapists.

Topics for Jan. 28 include faces and voices of recovery, children of substance abuse, and drug-use trends and updates. Michael Barry, CEO of People Advocating Recovery, will be the keynote speaker and will talk about combating the stigma of substance abuse.

On Jan. 29, Jennifer Havens, epidemiologist for the University of Kentucky's Center on Drug and Alcohol Research, will discuss her research about the effect of prescription painkiller use in Eastern Kentucky, followed by a session during which stories of recovery will be shared. Participants can also attend three of the following nine breakout sessions:

Registering early guarantees participants one spot among the 250 available. If registration is received by Nov. 1, it costs $100 per person; after Nov. 1, if space remains, the fee increases to $150 per person. Click here to register.

The conference is a partnership of UK's Cooperative Extension Service and state drug abuse prevention gaencies, says its website. Part of its mission is to plan and implement an educational conference for community partners combating drug abuse problems to improve strategies for minimizing and preventing drug abuse in Kentucky counties.

Conway says ruling in his Oxycontin lawsuit means he will seek settlement of $100 million or more

Attorney General Jack Conway says he wants Purdue Pharma to settle for $100 million or more after it missed a deadline to respond to his arguments in his lawsuit over the marketing of Oxycontin, Nick Strom reports for cn|2, a news service of Time Warner Cable. After Purdue Pharma failed to respond to a court motion, "all the admissions the commonwealth sought in the case were deemed admitted" by the circuit judge hearing the case in Pike County.

"Judge Steven Combs ruled Monday that Purdue could not withdraw those admissions which include that the drug maker: misrepresented and/or concealed the addictive nature of OxyContin, knew OxyContin was being abused and wasn’t being used for its stated purpose, continued to market and promote OxyContin despite knowing that, and encouraged physicians to overprescribe the drug," Storm reports. Conway told him, "I expect that a jury would be very very harsh on Purdue Pharma. I’m not going to be really negotiating much less or below nine figures. I want to see something well into nine figures.” (Read more)

Purdue Pharma has been blamed for starting, in Central Appalachia, the national epidemic of prescription-painkiller abuse and deaths. More than 1,000 Kentuckians die each year from prescription overdoses, the sixth highest rate in the country. Forbes ranked the Kentucky as the fourth most medicated state, according to Conway's office. More Kentuckians die from overdoses than in traffic accidents. (Read more) Map by Kentucky Justice and Public Safety Cabinet:

FDA changes painkiller labels to warn expectant mothers, after 2,500% growth in number of Ky. babies born addicted to drugs

The U.S. Food and Drug Administration (FDA) announced Tuesday drug-safety labeling changes and new post-market study requirements for all extended-release and long-acting opioids, and Kentucky political leaders applauded these measures to curb prescription drug abuse.

Long-acting opioids are intended to treat pain but may also lead to drug abuse, dependence or other complications if taken during pregnancy or misused. Now, as part of new FDA safety measures, the boxed warning labels on these drugs will warn expectant mothers that “the use of the products during pregnancy can result in neonatal opioid withdrawal syndrome (NOWS),” says the FDA release.

NOWS is among a group of problems called Neonatal Abstinence Syndrome (NAS) that occur in a newborn exposed to addictive drugs while in the mother’s womb. The baby's addiction can lead to birth defects, low birth weight, sudden infant death syndrome and other health conditions.

Attorney General Jack Conway and his counterparts in other states asked the FDA to act after several states reported an increase in the number of babies born addicted to prescription drugs. In Kentucky, "Instances of NAS have risen 2,500 percent over the past decade – from 29 incidents in 2001 to 730 in 2011," says a Conway release.

“I applaud the FDA for making this change that will better alert physicians and patients about the dangerous consequences of using these powerful prescription painkillers during pregnancy,” Conway said. Also as part of these safety labeling changes, certain educational materials for patients and health care professionals will be modified to reflect the new labeling.

U.S. Senate Republican Leader Mitch McConnell also praised the FDA's decision, saying it is a positive step forward in the fight against the state's prescription drug abuse problem.

Because little is known about the risks of long-term use of long-acting opioids, the FDA is also requiring the drug companies that make these products to conduct further studies and clinical trials to assess the known serious risks of misuse, abuse, increased sensitivity to pain (hyperalgesia), addiction, overdose and death, says the FDA.

"Altogether, the actions we're now announcing are part of FDA's efforts to make opioids as safe as possible for those who need them," said Dr. Douglas Throckmorton, deputy director of regulatory programs in FDA's Center for Drug Evaluation and Research. "This is not the first or last initiative, and we will continue supporting broader efforts to solve the serious public health problems associated with the misuse and abuse of opioids."

UK researcher calls for change in state law to allow syringe exchange program to curb hepatitis C epidemic in Eastern Ky.

Despite the benefits associated with syringe- or needle-exchange programs in preventing the spread of hepatitis C, Kentucky law still prohibits them, and a researcher from the University of Kentucky is calling upon policymakers to help curb this public health threat in Eastern Kentucky.

Syringe exchange programs were first created 30 years ago in response to the AIDS epidemic, and they are an important component of a comprehensive disease prevention strategy, says the Center for Disease Control and Prevention. Yet, Kentucky law prohibits them even though federally funded programs have successfully reduced disease transmission.

A recent study of 500 Appalachian drug users found that nearly two-thirds of them were infected with hepatitis C, reports Stu Johnson of WEKU News. Transmission of the disease in rural Appalachian communities is predominantly due to injection drug use, but community opposition and legal restrictions are barriers to establishing exchange programs.

UK epidemiologist Jennifer Havens would like to see a change in the state law to establish syringe exchange programs in Kentucky. She says these programs don't encourage drug use, which has in the past been an incorrect perception that can inhibit exchange adoption, says the CDC. The programs can instead reduce disease transmission.

“I don’t think anyone walking by the program, the syringe service program, is going to say, `I’m going to start doing drugs today because there’s a syringe service program.’ All it does is allow folks who are already injecting a safer way, a safer source of syringes and potentially program that they wouldn’t otherwise be able to access,” Havens told Johnson.

Haven's previous research, which examined individual and network factors among Appalachian drug users, found an association between injection of prescription opioids and hepatitis C. The study concluded that efforts preventing drug users' transition to injection, especially among prescription opioid users, may curb transmission of the disease. 

One public health tool that has successfully reduced disease transmission in other states is the creation of a syringe exchange program, says the CDC. In addition to asking for a policy change, Havens is calling for federal funding to establish syringe exchange programs in an area of Kentucky particularly impacted by the disease: the eastern region.

“In talking to a lot of the leaders in Eastern Kentucky, I haven’t necessarily approached this issue in particular, but they are at their breaking point with regard to what do we do about this epidemic, so I think, actually at the end of the day, a syringe service program would probably be fairly welcome,” Havens told Johnson.

Beyond reducing the spread of hepatitis C, syringe exchanges can also bring abusers into drug treatment programs, says Havens. The programs are reported to effectively link hard to reach drug users with prevention services, such as screening and drug abuse/ recovery programs, says the CDC. 

As heroin use increases in Kentucky, new report shows its strong connections to abusers of prescription pain medicines

Kentucky's law-enforcement agences, policymakers and public-health advocates have taken serious measures to curb the state's rampant prescription drug abuse problem, and recent state and national news stories suggest that the reduced supply of these painkillers, at least the ones in a non-crushable form, has driven pill abusers to heroin. Now there's research to support this theory.

Non-medical use of prescription pain medication may raise the risk of heroin use, says a new report by the Substance Abuse and Mental Health Services Administration. SAMHSA says people aged 12 to 49 who previously used prescription pain relievers non-medically were 19 times more likely than non-abusers to have started using heroin over the past year.

Proving the connection, the converse was true: Almost 80 percent of those who started to use heroin over the past year had abused prescription pain relievers. These findings are part of a larger effort to identify some risk factors of heroin use, and also to understand the "dependence and initiation that have occurred in the past few years," says a SAMHSA news release.

Heroin use, which had already become a problem in Northern and Central Kentucky, has been spreading to the Southern and Eastern Kentucky. The drug is becoming more popular throughout the state and nation because it is cheaper and easier to get than prescription painkillers, specifically opioid medications.

The number of U.S. heroin users has increased by about 60 percent from 2007 to 2011, says the 2011 National Survey on Drug Use and Health.  And while some can argue for the benefits of prescription medication, that same risk-benefit analysis doesn't apply to heroin, which has only risk.

The SAMHSA report offers another risk of prescription drugs: “Prescription pain relievers when used properly for their intended purpose can be of enormous benefit to patients, but their nonmedical use can lead to addiction, serious physical harm and even death,” said Dr. Peter Delany, director of SAMHSA’s Center for Behavioral Health Statistics and Quality. “This report shows that it can also greatly increase an individual’s risk of turning to heroin use – thus adding a new dimension of potential harm.” 

Kentucky expands list of permanent locations for safe disposal of unneeded or expired prescription medications

Gov. Steve Beshear announced today that Kentucky now has 149 permanent prescription drug disposal locations in 97 counties where Kentuckians can safely dispose of unused or expired medications in order to help curb the state's prescription drug abuse problem.

“The effects of prescription drug abuse are devastating to our families and our communities,” Beshear said in a news release. “Medications, once they are no longer needed for their prescribed purposes, should be disposed of properly to reduce their risk of being diverted and abused . . . "

Counties with permanent disposal boxes are shown on the map below in green. The boxes are monitored to ensure safe drug disposal and are located in law enforcement buildings. There are two pending locations, one in Ohio County and one in Franklin County, as shown in light blue. The 23 counties in white do not have permanent disposal locations.

“One in five of our Kentucky teens has abused prescription medication for an off-label purpose, and that abuse is starting in the home when children have access to their parents’ unused or expired pain medications,” Attorney General Jack Conway said in the news release.

The disposal boxes are funded by Kentucky Agency for Substance Abuse Policy, Operation Unite, Kentucky League of Cities and state and local law enforcement agencies, says the release.  Click here for a complete listing of locations and hours of operation.

National magazine looks at drug companies' efforts to stop anti-methamphetamine bills, especially in Kentucky

In a strong piece of investigative reporting for Mother Jones magazine, largely about Kentucky, freelancer Jonah Engle delves into the history of how making methamphetamine became a simple task via over-the-counter cold medications, and how drug makers have warded off most state laws intended to make the decongestant pseudoephedrine more difficult to purchase. (Photo by Stacy Kranitz: Cleaning up a meth lab found on school property in London.)

Engle's well-rounded story examines the issue from the viewpoints of politics, law enforcement, drug users and the effects of their habits on their children, while looking at how small-town life -- especially in Kentucky, where meth-related cleanup and law enforcement cost the state $30 million in 2009 -- has been hit hard by the drug. When a bill in 2011 to require a prescription for pseudoephedrine, a Washington-based group representing the makers and distributors of over-the-counter medicines and dietary supplements, reportedly spent more than $303,000 in three weeks, with most of the money spent on "robocalls," or automated telephone messages. The bill failed, but in 2012 the legislature passed a law with a tighter limit on the amount of pseudoephedrine anyone can buy in a month, after a strong radio advertising campaign by the Consumer Healthcare Products Association. The drug is kept behind counters so purchases can be tracked but does not require a prescription.

Engle tells a tragic story of meth in many states, ever since 2007, when the process called "shake-and-bake" or "one-pot" method, became commonplace. "The number of clandestine meth sites discovered by police has increased 63 percent nationwide," Engel writes. "As law enforcement agencies scramble to clean up and dispose of toxic labs, prosecute cooks, and find foster homes for their children, they are waging two battles: one against destitute, strung-out addicts, the other against some of the world's wealthiest and most politically connected drug manufacturers. In the past several years, lawmakers in 25 states have sought to make pseudoephedrine—the one irreplaceable ingredient in a shake-and-bake lab—a prescription drug. In all but two—Oregon and Mississippi—they have failed as the industry has deployed all-star lobbying teams and campaign-trail tactics such as robocalls and advertising blitzes."

In Oregon, the number of meth labs found by police dropped 96 percent since the bill was passed, while in Mississippi the number dropped 74 percent, Engle writes. "Children are no longer being pulled from homes with meth labs, and police officers have been freed up to pursue leads instead of cleaning up labs and chasing smurfers. In 2008, Oregon experienced the largest drop in violent-crime rates in the country. By 2009, property crime rates fell to their lowest in 43 years. That year, overall crime in Oregon reached a 40-year low. The state's Criminal Justice Commission credited the pseudoephedrine prescription bill, along with declining meth use, as key factors."

"Everywhere else, industry has prevailed," Engle reports. "Many states have very limited laws on what lobbyists must report, and they don't monitor spending on robocalls or ads. But news reports and my interviews with legislators in Southeastern and Midwestern states where meth labs are most concentrated—and where CHPA had the biggest fight on its hands—show that the pharmaceutical industry deployed a mix of robocalls, print and radio ads, as well as a Facebook page and a website, stopmethnotmeds.com. These states include Alabama, Kansas, Missouri, North Carolina, Oklahoma, and Tennessee." (Read more)

Beshear, Stumbo credit law for reducing prescription-drug deaths, but reduction was far outnumbered by rise in heroin fatalities

Deaths from prescription-drug abuse in Kentucky declined last year for the first time in a decade, and top state officials are crediting a law passed by that year's General Assembly.

However, passage of the law has prompted many drug users to switch to heroin, and the increase in heroin deaths (121) was much larger than the decline in prescription-drug fatalities (19).

"Autopsied overdose deaths attributed to the use of heroin increased 550 percent over the previous year, from 22 in 2011 to 143 cases in 2012," a release from Gov. Steve Beshear's office said. The decline in prescription-drug deaths was 1.9 percent, from 1,023 to 1,004, but the release said nothing else about the new problem and did not link it to the 2012 law that cracked down on abuse of prescription drugs.

“The impact of this bill can’t be measured just in the numbers of pills we’ve kept off the streets,” Beshear said in the release. “This bill, I believe, has literally saved lives in Kentucky.”

House Speaker Greg Stumbo, D-Prestonsburg, said, “I’m proud of the results, and the fact that other states are following our lead. Our goal now is to build on these gains and to improve access to treatment, so that abusers can truly escape this deadly cycle once and for all.”

The first quote in John Cheves' Lexington Herald-Leader story came from Van Ingram, executive director of the state Office of Drug Control Policy, which the new law required to begin publishing annual reports on drug overdose fatalities in the state: "There's no great victories here. I'm glad that we're at least seeing a leveling off and some small decline. I've been in this job for nine years and have watched a steady rise in numbers that whole time."

Top counties: Leslie, Clinton, Clay, Estill, Floyd, Nicholas, Perry, Whitley, Monroe (Herald-Leader)

The law, known as House Bill 1 before Beshear signed it, required pain-management clinics to be owned by a licensed medical provider, required all drug prescribers to register with a state monitoring system, and reduced the number of prescriptions for heavily abused controlled substances, a release from the governor's office said.

"Since the law was passed, 20 non-physician-owned pain management facilities have closed," the release said. The "Cabinet for Health and Family Services has issued cease-and-desist letters to another four pain management facilities operating outside the scope of state regulations."

"Of the 1,004 overdose fatalities in 2012, 888 were found to be unintentional, 59 were suicides and 57 remain undetermined," the release said. "Alprazolam (Xanax) remained the most-detected controlled substance in overdose deaths, present in 41 percent of all autopsied cases. Morphine was found in 32 percent of autopsies, followed by hydrocodone at 26 percent and oxycodone at 24 percent."

"Autopsies often found more than one drug present," Cheves notes. "The youngest overdose fatality was 16; the oldest was 72. Slightly more than half of the victims were men. Leslie County (population 11,170) reported the state's top per-capita rate of an annualized 85 fatal overdoses for every 100,000 people. The county had 11 overdose deaths in 2012, up from eight the previous year. In descending order, the other leading counties were Clinton, Clay, Estill, Floyd, Nicholas, Perry, Whitley, Monroe and Magoffin." (Read more)

Read more here: http://www.kentucky.com/2013/07/26/2734183/kentucky-drug-deaths-decline-slightly.html#storylink=cpy

As prescription painkillers become harder to get and abuse, heroin replaces them in Eastern and Southern Kentucky

Heroin use, which has been a problem in Northern and then Central Kentucky after the state began cracking down on prescription painkillers last year, has been spreading to the Southern and Eastern parts of the state. Heroin is becoming more popular throughout Kentucky because it is cheaper and easier to get than prescription painkillers, specifically opioid medications, reports Valarie Honeycutt Spears of the Lexington Herald-Leader.

While an 80-milligram OxyContin costs between $60 to $100 a pill on the black market, heroin costs $45 to $60 for a multiple-dose supply, reports The Partnership at Drugfree.org.  With national and state efforts to curb prescription drug abuse, including the reformulation of OxyContin that makes the drug more difficult to crush and snort, heroin can also be easier to obtain and abuse.

As drug users turn from prescription drugs to heroin to get their high, Northern Kentucky and major cities like Lexington and Louisville are struggling to address the problem, says an Operation UNITE press release. Operation UNITE is a regional anti-drug coalition fighting substance abuse in Southern and Eastern Kentucky counties (map).

Most Southern and Eastern Kentucky counties are just beginning to see the signs of heroin use, says the release. Dan Smoot, CEO of Operation Unite, told Spears that heroin’s spread throughout Kentucky was inevitable. “We knew it was coming. We just didn’t know when it would hit,” he said.

Rowan County was hit before most Eastern Kentucky counties, said Smoot; the most recent example of increased heroin use occurred July 9, when Operation UNITE agents arrested a known prescription drug trafficker attempting to bring a large quantity of heroin into Beattyville, says the release.

Uncertainty about what heroin users are actually getting makes the drug especially dangerous, says Paul Hays, law-enforcement director for Operation UNITE. “You don’t know the purity of the heroin,” he said in the release. “Dealers will often ‘cut’ the drug with other substances in order to boost their profits. There’s no way the public knows what they’re shooting up.”

This increased risk can be deadly, and although there's no evidence of an increase in heroin overdose deaths in Eastern Kentucky, a task force has been created to address this fatal problem in Lexington. There have been 29 heroin overdose deaths in Fayette County so far this year, seven more than the amount of overdose deaths in all opf 2012, Fayette Coroner Gary Ginn told the newspaper.

Read more here: http://www.kentucky.com/2013/07/22/2726235/heroin-problem-surfaces-in-southern.html#storylink=cpy

Prescription drugs killing more women than ever; Kentucky ties for fifth for its high percentage of deaths

The ongoing national epidemic of addiction to prescription painkillers is spreading more quickly among women, and it is killing more women than ever before. Kentucky ties Utah for the fifth highest percentage of female deaths due to prescription-drug overdose (15.7 percent), says a new government report.

Opioids, or prescription painkillers, are the leading cause of drug-overdose deaths among women, accounting for 70 percent of overdoses. And, although men are more likely than women to die from drug overdose and Kentucky has the highest rate of male deaths in the country (25.9 percent), the percentage increase in the rate of overdose deaths from 1999 to 2010 was greater for women (151 percent) than for men (85 percent). During that period, there was a 415 percent overall increase in opioid painkiller-related deaths among women, compared with a 265 percent increase among men, says a Centers for Disease Control Vital Signs report released last week. (CDC graphics)

Since 2007, more women have died from drug overdoses than from motor-vehicle traffic injuries and about five times as many women died from prescription-painkiller overdoses in 2010 as in 1999. About 6,600 of those deaths occurred in 2010 alone, and prescription painkillers are reported to be involved in one of every 10 suicides among women, says the report.

Across the nation, about 18 women per day die from prescription drug overdose and every three minutes, a women goes to an emergency room for prescription-painkiller misuse or abuse, which is more likely to occur in women between the ages of 25 and 54. The report also says the rise of deaths from prescription drugs relates closely to increased prescribing of these drugs during the past decade.

States can take action against the dangers of prescription drug abuse by increasing access to substance abuse treatment while reducing barriers to getting such treatment, says the report. It is also important to educate health care providers about effective pain treatment options and to educate the public about the risks and benefits of taking prescription painkillers. Click here for a PDF factsheet from the CDC.

Kids Count report shows where children in your county and school district rank, in a huge number of measures

Conditions have improved slightly for Kentucky children, especially in education and health, and the state's overall well-being ranking has gone up one spot, from 35th to 34th in the nation. But economic conditions for young Kentuckians have slipped since last year, says the Kids Count report released Monday by the Annie E. Casey Foundation.

The annual report measures how the country and its 50 states are doing according to four measures of child well-being – education, health, economic well-being, and family and community. How well Kentucky's children score in each domain paints a picture of Kentucky's future.

One of the many data sets available by county and school district

The report includes a wide range of data for every county and school district. The data include current and five-year rates of child poverty; median family income and median household income; infant mortality rate; child death rate; teen death rate; child abuse and neglect cases; foster care cases; births to mothers who are teenagers, who smoke, who are not high-school graduates, and who get early and regular prenatal care; pre-term births; low-weight births; newborns breastfed when they leave the hospital; early childhood obesity, number and percentage of child-support collections; asthma hospitalizations; recreational facilities; number and percentage of children receiving food stamps, Medicaid, child-care subsidies, Supplemental Security Income, and benefits from the Women, Infants and Children nutrition program; the number and percentage eligible for reduced-price meals at school; the number and percentage in publicly funded preschool; the hourly wage needed to pay fair-market rent and the percentage of renters unable to afford such rent; juvenile justice data; percentage of students ready for college and careers; and the six-year college graduation rate.

Statewide, the report shows that Kentucky has made gains in education, and the state ranks 28th on this measure. Since 2005, more children are attending preschool, more fourth-graders are proficient in reading and more eighth-graders are proficient in math, says the report.

Kentucky has also improved in many health measures. There are fewer low birth-weight babies, fewer children without health insurance and fewer teens who abuse alcohol or drugs. Medical coverage should only continue to improve as the state expands Medicaid coverage to households at 138 percent of the poverty line. However, youth advocates say gains in education and health may not be maintained if more children continue to live in poverty.

Unfortunately, Kentucky children continue to struggle economically, weighing in at 32nd in the nation. The report says 37 percent of Kentucky children have parents who lack stable employment, up from 33 percent last year, and 32 percent of children live in households that are burdened by housing costs, up from 27 percent.

The state's lowest ranking is 38th, on the family and community measure. Its constituents: More than 27 percent of children live below the poverty line, compared to the national average of 23 percent, and the number of children in single-parent families has increased from 31 percent in 2006 to 36 percent in 2011. On the bright side, teen births declined during that period.

With the hard work of child advocates, community agencies, educators and policymakers, the report shows progress has been made to improve children's well-being, but there is still much to be done. Click here for Kentucky's profile or here to go to the data center.

Sick of all the bad facts about Kentucky's health? Here's encouraging news about oral health and drug treatment

Despite the plethora of bad news about Kentucky's poor health status, there are many positive initiatives for Kentucky's oral health and substance abuse treatment, which were stories buried under health news headlines about Medicaid expansion and low health rankings.

The Kentucky Board of Dentistry recently established the position of public heath dental hygienist, permitting hygienists to go into Kentucky schools to assess teeth on the front lines, which will provide basic preventive dental care to underserved kids with tooth problems through local health departments, Al Smith, left, reports in an opinion piece for the Lexington-Herald Leader.

"These hygienists will be able to do school fluoride varnish programs, place sealants, refer kids in pain, and promote dental health programs (like brushing and better nutrition) in the schools without being supervised by a dentist," Dr. Rankin Skinner, director of the Clark County Dental Health Initiative, told Smith. "I think this is a major step in developing dental health program like ours across the state and moving our kids towards better health in general."

The initiative, comprising 17 dentists and 127 volunteers, was selected as a national model by a national association of all the health departments. "It isn't often that a private volunteer program in Kentucky sets a national standard," Skinner told Smith.

Meanwhile, in Florence, Kentucky's first lady, Jane Beshear, a Democrat, joined her Republican co-chair of Recovery Kentucky, Lexington homebuilder Don Ball, to celebrate the Brighton Recovery Center's fifth birthday and nearly 800 graduates.

Brighton is one of the 10 new homes for Recovery Kentucky, a program that is also becoming a national model, Smith writes. Since its inception during the Fletcher administration, the program has provided supportive housing and addiction recovery programs to over 10,000 men and women, writes Smith.

Beshear said the next steps are for her and Ball to create more drug-free housing and jobs for graduates of the program, Smith reports. This goal creates hope for other successful initiatives and shines a ray of light at the end of a dark and dreary tunnel.

At least one in eight teens, and perhaps one in five, have a mental-health issue; ADHD tops, substance abuse also high

The most comprehensive report yet on mental disorders in children shows attention deficit hyperactivity disorder (ADHD) is the most commonly diagnosed problem in those aged 3-17, and the most common health issues for teenagers include addiction to drugs, alcohol and tobacco.

An estimated 13 to 20 percent of U.S. children experience a mental disorder in a given year, says a new report by the Centers for Disease Control and Prevention, and children are increasingly suffering from and being hospitalized for mood disorders like depression; that hospitalization rate has increased 80 percent from 1997 to 2010, says the report. And, while 3.5 percent of children under 18 have behavioral problems, almost 7 percent of them are diagnosed with ADHD.

About 4.7 percent of teens, or 1.7 million children aged 12–17, have disorders involving abuse and dependence upon alcohol, drugs or tobacco, says the report. Alarmingly, two-thirds of teenagers had an illicit drug use disorder, one million teenagers abused drugs or alcohol, and more than 695,000 were addicted to tobacco.

“This first report of its kind documents that millions of children are living with depression, substance use disorders, ADHD and other mental health conditions,” CDC Director Dr. Tom Frieden said. “No parent, grandparent, teacher or friend wants to see a child struggle with these issues. It concerns us all. We are working to both increase our understanding of these disorders and help scale up programs and strategies to prevent mental illness so that our children grow to lead productive, healthy lives.”

Could Medicare Part D be an inadvertent enabler of prescription drug abuse?

By Molly Burchett
Kentucky Health News

An examination of the Medicare Part D program that Congress established a decade ago, dedicating billions of dollars to subsidizing prescription drug purchases for 35 million elderly and disabled Americans, uncovers the program's risky lack of oversight -- and suggests that it might be contributing to Kentucky's prescription-drug abuse epidemic.

An analysis of Medicare prescription records by ProPublica, an independent, nonprofit newsroom, found that the program has failed to properly monitor safety, ProPublica's Tracy Weber, Charles Ornstein and Jennifer LaFleur write in The Washington Post. And despite their findings that many providers prescribe antipsychotics, narcotics and other drugs known to be dangerous for older adults, Medicare officials told them it's not their job to monitor for unsafe prescribing or to stop doctors with criminal histories.

The largely unchecked prescribing habits of Medicare providers and the increased availability of prescription drugs suggests that Part D has inadvertently enabled prescription drug abuse, by making drugs available for abuse by Medicare patients, their friends, acquaintances and family members, particularly teenagers. A 2010 national survey by the U.S. Department of Health and Human Services found that 65 percent of teens who report that they have abused prescription medicine got them from friends, family and acquaintances rather than illegal drug dealers.

In Kentucky, drug overdose, mostly from prescription drugs, is the leading cause of death, and the widespread availability of drugs and easy access to drugs are some reasons for this trend, says the 2012 combined report from the Kentucky Justice & Public Safety Cabinet. In addition to taking the lives of loved ones, drug overdose takes a huge financial toll on the state, and a recent study shows that the Medicare program bankrolls the single largest percentage of drug overdose inpatient hospitalizations.

Inpatient hospitalizations for drug overdoses by percentage of total charges,
among Kentucky residents treated in Kentucky acute-care hospitals, 2010

Medicare alone was billed for 30 percent of all inpatient hospitalizations for drug overdoses in Kentucky from 2000 through 2010, totaling over $440.7 million, says a report by the Kentucky Injury Prevention Research Center. During those 11 years, the number of unintentional drug-overdose hospitalizations of Medicare beneficiaries increased 222 percent.

The fact that almost a third of overdose hospitalizations involve Medicare patients is concerning, said Van Ingram, executive director for the Kentucky Office of Drug Control Policy. In addition to these alarming statistics, Medicare and Medicaid incurred nearly $4 million worth of charges for drug-overdose visits to emergency rooms in 2010, which represents 41 percent of the total charges, says the KIPRC report. Also, during the period from 2008 to 2010, the number of unintentional Medicare drug-overdose emergency visits increased almost 44 percent.

Among prescription drugs, opiates and similar narcotics are most likely to be abused and most likely to lead to death. Since Medicare Part D began covering prescription drugs in 2006, drug overdose deaths involving opiates have increased almost 80 percent in Kentucky, says the KIPRC report.

ProPublica's Prescriber Checkup database shows that 30 percent of Medicare Part D patients have filled at least one narcotic prescription. The most common drug provided by Part D in Kentucky is hydrocodone-aceteminophen, which is an opiate painkiller known commercially as Lortab, Lorcet or Vicodin. Part D paid more than $12.6 million on 958,933 claims for hydrocodone-aceteminophen from 2007 to 2010.

Medicare officials told ProPublica that the government isn't responsible for monitoring these types of prescriptions because that is the duty of private health plans administering the program. Yet, health plans aren't given the tools to do so, the reporters write, and no one party has been slated the task of ensuring safe medication-use. This complacent mentality suggests Medicare officials, who also say it's not the providers' duty to "prevent inappropriate prescribing for individual patients," could be passively contributing to the drug-safety issue of prescription medications covered by Part D.

In addition to indicating that providers should not industriously discourage dangerous prescription drug usage, ProPublica’s examination of Part D data showcases numerous examples of Medicare officials failing to act against providers with troubled prescribing backgrounds. Such examination initiates a worthwhile discussion about the program's role in encouraging, or well, at least not actively combating, prescription drug abuse. Click here to visit Kentucky's Medicare Part D Prescriber Checkup. Individual doctors can be looked up.

Bankruptcy filing by mental-health agency is a loser for Kentucky, where such services can be scarce and little used

By Molly Burchett
Kentucky Health News

The decision of Seven Counties Services Inc. to file bankruptcy to avoid paying into the Kentucky Employee Retirement System has created a "no win" situation for the state, and the issue may add yet another obstacle for Kentuckians to get the mental health care they need.

Louisville-based Seven Counties is one of the state's largest mental-health agencies, serving more than 30,000 adults and children with mental-health services, alcohol and drug-abuse treatment, developmental-disabilities services and preventive programs, according to its website.

And while Kentucky's mental-health system has received an F grade for its funding, the state pension system needs agencies like Seven Counties to pay in more because the system is just 27 percent funded. "Employers will have to ante up around 38 percent of annual payroll, compared with the 23 percent now required," Mike Wynn notes in The Courier-Journal.

Kentucky's need for mental health services is much greater than the supply, and an estimated 1.7 million Kentuckians live in areas designated as a "mental health professional shortage area," which means almost 40 percent of Kentucky residents lack proper access to such professionals, says a report by the Kaiser Family Foundation. About 24 percent of residents' mental-health care needs are under-served, and this situation could be worsened by federal health reform, which will expand mental-health and substance-abuse treatment benefits to more Kentuckians without adding to the number of providers.

Bankruptcy for Seven Counties is a lose-lose proposition: It could close its doors in 2014 and stop providing services to 30,000 Kentuckians or, if the bankruptcy goes through, the state's retirement system wouldn't get anticipated agency payments into the system, reports Ryan Alessi of cn|2, a news service of the Time Warner and Insight cable-TV companies.

“The only two paths this can go is we could stay in KERS until we have given them our last nickel, which is a year (or) year-and-a-half from now … (and) we close the doors and go out of business and KERS gets no more money because we’re out of business,” Dr. Tony Zipple, president of Seven Counties, told Alessi.

In addition to funding problems for mental-health services, many people with mental-health issues don't seek treatment because of its stigma, said Sheila Schuster, executive director of the Kentucky Mental Health Coalition, in a recent opinion piece sent to Kentucky newspapers.  Shuster calls on elected leaders to increase funding of mental health services and highlights the prevalence of mental health illness.

"At least one-fourth of us will experience a behavioral health issues (mental illness or substance use disorder) in a given year," Schuster writes. That number, and the number of people needing treatment, will continue to grow, she says.

Schuster also writes about the societal impact of not treating mental illness: "Depression is rated as the #1 cause of disability in this country, and is a leading cause of absenteeism and decreased productivity in the work force." Because some people avoid treatment due to stigma, they may self-medicate with drugs or alcohol, and "the effects of stigma and failure to treat the whole person can have catastrophic results," she writes.

In addition to calling for more mental health funding, Schuster asks all Kentuckians to get educated about mental illness so that its stigma can be erased. Click here to read more from Schuster about mental health and resources for help. For a PDF of her op-ed, click here; for a text version, here.

National Rx Drug Abuse Summit, a Kentucky product, seeks to make the nation face up to its problem

The second annual National Rx Drug Abuse Summit, organized by Eastern Kentucky's Operation UNITE, called for a national commitment to combating the country's drug-abuse problem

U.S. Rep. Hal Rogers, R-5th District

"People of great passion and perspective are here wanting to make an impact in their communities," said U.S. Rep. Hal Rogers, who first funded Operation UNITE. "The first step is we have to admit there is a problem. I don't think the country is there yet. We've got to face up to it. We've got to make this known ... and that we're not going to hide from it." Rogers was quoted in a news release.

UNITE (Unlawful Narcotics Investigations, Treatment and Education) serves 32 counties in Eastern Kentucky. It was created to fight illegal drug use through a comprehensive approach that includes educating youth and the public and coordinating substance abuse treatment while providing support for families affected by abuse.

In Kentucky, drug overdose is the leading cause of death and is more fatal than motor vehicle accidents, and the number of Kentucky drug-overdose deaths nearly quadrupling from 2000 to 2010. The nation has seen a similar trend, with the number of overdose deaths more than tripling over the decade.

“We can stop this epidemic,” Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, said at the summit. “But we need everyone working together in an all-hands-on-deck approach.”

Themes highlighted at the summit included the need to provide better education about drug abuse, the need for greater use and seamless integration of state prescription-monitoring programs, the need to facilitate effective treatment and recovery programs, and the need for abuse-deterrent narcotic formulations.

“We were extremely pleased that so many individuals representing such a broad cross-section of interests shared their knowledge and expertise,” said Karen Kelly, who is leaving Operation UNITE to become district director on the Rogers congressional staff. To read more about the summit, click here.