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.

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.” 

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

Cheaper heroin showing up in Eastern Kentucky as crackdown on pain pills makes that trade less attractive

About 60 grams of heroin, worth about
$8,000. (AP photo)

It was only few months ago that Northern Kentucky law enforcement officers and substance abuse clinics began expressing grave concern that heroin was fast becoming the go-to drug in their region. Today, there are signs that the drug is already moving swiftly east, into the already drug-ravaged mountains of Eastern Kentucky. The reason for the uptick in heroin use? Because pain pills aren't as available anymore.

Federal and state law enforcement have been cracking down on the prescription pain-pill drug trade for years in these parts. They've created electronic prescription-tracking systems, staked out pain management clinics and shut down a drug pipeline that starts in Florida. Some argue that last year's passage of House Bill 1 has discouraged even legitimate doctors from prescribing pain drugs. All these things make heroin usage an unintended consequence of their success, officials fear.

 "There's always some type of drug to step up when another gets taken out," Dan Smoot, law enforcement director of Operation UNITE, which handles drug investigations in 29 Eastern Kentucky counties, told Brett Barrouquere of The Associated Press. "We didn't know it was going to be heroin. We knew something was going to replace pills."

Officials say the heroin is trafficked from Mexico into the U.S., where it first goes to Illinois, Michigan and Ohio. Northern Kentucky counties have been the epicenter of heroin abuse in the state, but law enforcement officials in Louisville, Lexington and Appalachian counties are reporting "a dramatic rise in the number of arrests and seizures related" to heroin. Kentucky State Police seized 11 doses of heroin and other opiates in 2008 in the eastern half of the state; they have seized 395 doses there so far this year.

Users are attracted to heroin's low cost compared to pain pills, Barrouquere reports. A single oxycodone pill can cost from $80 to $100, but heroin can cost as little as $15 to $20 for an amount that will produce the same level of intoxication as one pain pill for 24 hours, Kentucky Office of Drug Control Policy Director Van Ingram said. (Read more)

N. Ky. Chamber to ask state for more funding to fight heroin; London police make first known heroin trafficking arrests there

The Northern Kentucky Chamber of Commerce is planning to lobby the state for more funding for heroin treatment after receiving reports from business and law enforcement about the breadth and depth of the drug problem in the region. Terry DeMio of the Cincinnati Enquirer reports that the chamber's Geraldyn Isler says the area has the “highest volume of people in the state needing substance abuse treatment but is receiving the least amount of funding.”

According to the Northern Kentucky Drug Strike Force, 63 percent of heroin possession and trafficking prosecutions in Kentucky are in Boone, Kenton and Campbell counties, the three urbanized counties in the region. A 2007 University of Kentucky study that shows that the region led the commonwealth in people needing substance abuse treatment, but that it also received the lowest per capita funding from staff coffers for those mental health services for more than a decade.

The chamber told DeMio there are many "hidden costs" to such abuse. Among those costs: increased employee absenteeism, tardiness, job-related injuries and errors. It also notes employee-employer conflict, greater health-insurance costs and crime as likely outcomes of heroin in the region.  (Read more)

There could be other requests for more funding for heroin treatment. This week the London Police Department made the first known arrests for heroin trafficking in Laurel County, The Sentinel-Echo reports.

Northern Kentucky group forms in response to what some consider 'epidemic' of heroin use in their area

Ashel Kruetzkamp with a vial of Naloxone
HCl, used to treat those who overdose
on heroin. (Photo by Patrick Reddy)

Heroin use is reaching such high levels in Northern Kentucky that experts are calling it "a plague." The problem is so dire that local agencies are coming together to form the Northern Kentucky Heroin Impact and Response Workgroup.

Cincinnati Enquirer reporter Terry DeMio reports that the group includes leaders from St. Elizabeth Healthcare, law enforcement, addiction treatment programs, the Northern Kentucky Chamber of Commerce and those who have been impacted by heroin. The goal of the group is “to fight, treat and prevent the destructive force of heroin in our community,” said Dr. Jeremy Engel, a family doctor with St. Elizabeth Physicians, Bellevue. Engel spearheaded the effort based on his belief that heroin use in the area has hit “epidemic” levels.

Engel points to first nine months of 2012 when St. Elizabeth Healthcare treated 311 heroin overdose patients in the emergency rooms of its five hospitals. For the same time period in 2011, the heroin overdoses presented in those emergency rooms numbered 186. With help from the chamber, St. Elizabeth Healthcare and others, Engel is forming the task force under the NKY Vision 2015 umbrella. (Read more)

Covington police chief: New prescription-drug law has unintended consequence of encouraging pain pill addicts to use heroin, commit crimes

Black tar heroin

Kentucky's new prescription drug law may be having its desired effect of taking prescription painkillers off the streets, but could be forcing those very same addicts into using heroin. That's the view of Covington Police Chief Spike Jones, who took his case to the state Senate Judiciary Committee last week to complain about increased crime in his area and to ask for some money for help.

The drug law passed in April 2012, designated House Bill 1, requires Kentucky doctors to complete patients' medical histories, conduct physicals, check photo identifications and run names through the state's KASPER (Kentucky All Schedule Prescription Electronic Reporting) database before prescribing a controlled substance for pain relief. It has required a vast network of oversight of doctors and patients by government and licensing entities. This has reportedly caused some doctors to stop writing those prescriptions completely.

Tiffany Wilson of Cincinnati's WKRC-TV reports that Chief Jones reports more prostitution, theft, car thefts and car break-ins in his northern Kentucky region. He asked the state legislature for money to research how deep the problem is and to discuss the need for more treatment facilities. 

Jones pointed to the recent closure of the pain management clinic of Dr. Gary Shearer in Florence as adding to the problem. Shearer's license was suspended following the death of 15 patients from prescription-drug overdoses. These patients, Jones told Wilson, are exactly the ones at risk for taking the next step and turning to heroin. He added that heroin dealers will often give potential customers the first hit for free, "and from that point, there's no returning to prescription pills." (Read more)

New form of Oxy is harder to inhale and inject, so drug users are turning to heroin, Opana for high

A new formulation of OxyContin makes it harder to
inhale or inject. Drug Enforcement Administration photo.

A change in the formulation of the powerful drug OxyContin has addicts turning to another high to fuel their habit: heroin.

Researchers at the Washington University School of Medicine in St. Louis had more than 2,500 patients from 150 drug rehabilitation treatment centers in 39 states respond to survey questions that had a particular focus on the reformulation of OxyContin, reports research-reporting service Newswise. The new formula makes it harder to crush the pills, making inhaling or injecting them more difficult.

Since the new version of the drug was introduced, "inhalation or intravenous administration has dropped significantly," said lead investigator Theodore J. Cicero. But drug use has not lessened, with addicts turning to heroin instead, which is also inhaled or injected. "We're now seeing reports from across the country of large quantities of heroin appearing in suburbs and rural areas," Cicero said.

OxyContin was originally designed to be released in the body slowly, preventing an immediate high. But by crushing the pills and inhaling them or dissolving them in water and then injecting the solution, addicts were able to get "an immediate rush," Newswise reports.

Moreover, because OxyContin was designed to be slow-release, it contained large amounts of the generic drug oxycodone, which spurred even more in demand. The new version of the drug was introduced in 2010.

Survey results show "users who selected OxyContin as their primary drug of abuse has decreased from 35.6 percent of respondents before the release of the abuse-deterrant formulation to 12.8 percent now," Newswise reports. (Read more)

The Centers for Disease Control and Prevention has called prescription drug abuse an "epidemic." In Kentucky, about a 1,000 people die each year from prescription drug overdoses. More people die in Kentucky from prescription drug overdoses than they do from traffic accidents.

Law enforcement is also seeing that drug seekers are switching from OxyContin to the prescription drug Opana, reports Donna Leinwand Leger for USA Today. "A few years ago, it was OxyContin. Now it's Opana," said Raquel Foster, a police spokeswoman for the Fort Wayne Police Department.

As a new, harder-to-abuse formulation of Opana hits the market, however, "they are going to find a way to satisfy their addiction," said DEA Special Agent Gary Boggs of the Office of Diversion Control. "When they either can't get those particular pharmaceuticals or can't afford them, they now gravitate to heroin."  (Read more)