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MONDAY, JANUARY 16, 2017 -- Small, rural counties are leading the way in establishing syringe exchanges to prevent outbreaks of HIV and hepatitis C among intravenous drug users in Kentucky, according to a top state drug official.
Van Ingram, executive director of the Kentucky Office of Drug Control Policy, spoke with Mary Meehan of Ohio Valley ReSource, a regional journalism collaborative of public broadcasters in Kentucky, Ohio and West Virginia. He cited Powell County, in the Appalachian foothills east of Lexington, as an example of rural counties that are changing the perception of how addiction is perceived in the state, shifting the focus toward treatment and public health initiatives and away from the criminal justice system.
So far, syringe exchanges have been approved in 25 of the state's 120 counties; several others are having debates like the one that went on in Powell County, population 13,000, reports Melissa Patrick of Kentucky Health News.
In nearby and much larger Madison County, the Board of Health supports a syringe exchange, but was met with "mixed feelings" about the program at a county Fiscal Court meeting, with some members concerned that the program condoned IV drug use, Ricki Barker reports for The Richmond Register. The county will host several forums to educate local citizens about the cost and benefits of the program and answer any questions that the public may have about it. Health officials told Barker that the department sees about eight to 10 patients a day with hepatitis C.
In Powell County, physician assistant Troy Brooks initially opposed a syringe exchange. "He said it seemed like a way to let addicts keep using their drug of choice without consequence," Meehan reports. But then local police showed him how bad the problems is by taking him to the playground in Clay City, where they collected 41 dirty needles, and he saw the need to protect children and first responders.
Six of the 25 syringe exchanges approved so far aren't operational yet. Thirteen are in counties deemed most vulnerable counties by the federal Centers for Disease Control, which identified 54 Kentucky counties as among the 220 most vulnerable in the nation to a rapid spread of HIV and hepatitis C infection among IV drug users.
Written by Al Cross Posted at 1/16/2017 10:19:00 AM
By Mary Meehan
Ohio Valley Resource
Sitting on top of the Bible on Pastor Brad Epperson’s desk at the Clay City First Church of God is a list of goals for his small congregation written in a looping cursive hand.
“Our community ought to see the love of God in us, not just by our understanding of a compassionate Gospel, but our public acts of love,” is near the top.
Epperson was born and raised in Powell County in the mountains of eastern Kentucky.
It is one of nearly 100 counties in Kentucky, Ohio, and West Virginia designated at high risk for HIV infection by the Centers for Disease Control and Prevention. The 10 counties the CDC identified as highest risk are all in eastern Kentucky and southern West Virginia. Powell County ranks 15th in the nation. Wolfe County, next door, ranks a sad number one.
That means Epperson and his community are at the epicenter of the heroin-related public health crisis that is ravaging rural America. And addressing that threat would force Epperson and many others in this religious, conservative community to take a hard look at themselves and their deeply held convictions.
Epperson moved away for a more than a decade to tend a church in Tennessee. When he came to Clay City a few years ago he didn’t recognize the place. The impact of drug addiction was everywhere. At the Clay City First Church of God, the first brick building in town after exiting the Mountain Parkway, he conducted too many funerals for people way too young.
Epperson, who is also a school bus driver, saw the pain in the lives of the kids he carries. One boy excitedly told him that both his parents were going to be out of jail at the same time for Christmas. No child, Epperson said, should have that kind of life.
Epperson said he struggles with how to help addicts without appearing to condone drug abuse. He sees addiction as a disease with a moral underpinning. First, there is the collateral damage. Cancer patients don’t steal from Mammaw to pay for chemo. Diabetics don’t infect their spouses.
Second, he said, addicts make the choice to take in that first drug.
Still, he knew something had to change.
Others in his community were having their own struggles.
Six months ago, Mandy Watson, a nurse at the Powell County Board of Health, couldn’t imagine a needle exchange program in her hometown.
“When it first started I actually called several of my friends and told them, ‘Pray that this will not happen here,’” she said.
But then Watson saw the projected devastation if her small community had an HIV outbreak. She listened to the statistics about how infection rates could be lessened. She said she couldn’t cure the addict, but she could help someone to be just a little bit safer. That could help stop the spread to innocents in the community such as a spouse unaware of needle use, or kids at a playground where users stash dirty syringes.
She had to do something.
“We are all very close, we all know each other here,” she said, “and the thought of knowing that Hep C and HIV outbreaks could happen very easily here, it scared me for not only my child but my friends’ children. Almost anybody you ask has some kind family member who does use or some type of trouble with addiction.”
Physician Assistant Troy Brooks is on the Powell County Board of Health. He, like Watson, was against needle exchanges. He said it seemed like a way to let addicts keep using their drug of choice without consequence. (READ MORE)
Based at WEKU, Richmond, KY, Mary Meehan covers health for the ReSource. Reporter Alexandra Kanik contributed to this story.
December 9, 2016
The Lawrence County Health Department is planning a Harm Reduction Syringe Exchange Program to prevent the further spread of Hepatitis C in the county. According to the Centers for Disease Control and Prevention (CDC), Kentucky has the highest rate of Hepatitis C in the nation at 4.0 per every 100,000 people, nearly seven times the national average. Hepatitis C is primarily spread through the sharing of needles and equipment for injection drug use. Health Department Director Debbie Miller said that this became a concern for the health department because as a public health agency the health department is required to detect, prevent and control communicable diseases.
The objectives of the program are to reduce transmission of infections spread by injection drug use by providing new, sterile needles in exchange for contaminated needles; to reduce the amount of contaminated needles improperly discarded in the community by providing sharps containers for proper disposal; and to act as an access point for individuals to obtain connections for treatment for substance abuse, health care, counseling and other services. Lawrence County Health Department Nursing Supervisor Shirley DeLong said, “A harm reduction program is a tool used to prevent the spread of disease that also provides an opportunity to educate participants and link them with other services such as testing, treatment and recovery.”
Lawrence County, along with 54 other Kentucky counties, was recently identified by the CDC as one of 220 U.S. counties vulnerable to the rapid spread of Hepatitis C and HIV among injecting drug users based on factors such as pharmacy sales of prescription painkillers, overdose deaths and rates of unemployment. “This was a call to action for the health department. Our ultimate goal is to prevent drug use and help people get into treatment, but we aren’t there yet. In the meantime, we must try to keep Lawrence County residents as safe as possible,” Miller said.
The Lawrence County Board of Health has adopted a resolution to develop and implement the program. The health department is still seeking approval from the Louisa City Council and the Lawrence County Fiscal Court in accordance with KRS 218A.500. There are currently 14 Harm Reduction Syringe Exchange Programs operating in Kentucky with an additional nine approved to open at a future date.
For more information on Hepatitis C Virus, substance abuse and harm reduction, visit:
Lawrence County Health Department is located at 1080 Meadowbrook Lane, Louisa, KY 41230. Visit our website at www.lawrencecountyhealthdepartment.com or find us on Facebook.
Contact: Debbie Miller
By Melissa Patrick
Kentucky Health News
Kentucky Republicans passed two major anti-abortion bills out of legislative committees Wednesday and through the House and Senate Thursday in hopes of enacting them into law by Saturday.
The bills passed in their respective chambers on Thursday, keeping them on track for weekend passage.
House Speaker Jeff Hoover said it is likely the General Assembly will hold an unusual weekend session to get the bills to Gov. Matt Bevin, who favors them.
One bill would ban abortion after 20 weeks of pregnancy. The other would require doctors to offer women seeking an abortion an ultrasound image of their fetus. Both bills have emergency clauses, which means they would become effective as soon as Bevin signs them.
Similar bills have been introduced in years past, but with Republicans in formal control of the House, Senate and the governorship for the first time in Kentucky history, they are on a fast track for passage. In years past, abortion bills have passed out of the Senate, but died in the Democratic-controlled House.
20-week abortion bill
Senate Bill 5, sponsored by Sen. Brandon Smith, R-Hazard, would not allow women in Kentucky to get an abortion if they are more than 20 weeks pregnant. The bill passed 11-3 out of the Veterans, Military Affairs, and Public Protection committee and now heads to the full Senate.
Tamarri Wieder, director of external affairs for Planned Parenthood Advocates of Indiana and Kentucky, told the committee that nearly 99 percent of abortions occur before 21 weeks, and the ones that are done later are often because of “complex circumstances.”
The bill is based on the premise that 20 week old fetuses can feel pain, though published research generally says this is not true. FactCheck.org, a nonpartisan service of The Annenberg Center at the University of Pennsylvania, published a detailed article on the issue and noted a JAMA article that says, “Evidence regarding the capacity for fetal pain is limited but indicates that fetal perception of pain is unlikely before the third trimester,” which starts at 26 weeks.
“Twenty-week bans are part of an agenda to ban abortion outright,” Wieder said. “There is no evidence, let me repeat, no evidence in the established scientific medical community that a pre-viable fetus feels pain. Senate Bill 5 is misguided.”
Richard Nelson, executive director of the conservative Commonwealth Policy Center, spoke in favor of the bill and disagreed with the research that says 20-week-old fetuses cannot feel pain, saying that medical experts say otherwise.
The committee also heard emotional testimony from Heather Hyden and James Earley of Lexington who are 14 weeks pregnant with a much-wanted baby that has a medical condition that could either resolve itself, or cause it to die. They said they won’t know the outcome until after the 20th week.
“We are concerned that limiting the timeline could cause more terminations, because families are not able to access the appropriate test and doctors visits necessary,” Hyden said.
The bill’s constitutionality is open to question, so the measure establishes for itself a legal defense fund that could receive private contributions to a trust fund overseen by the state.
According to Vox, 20-week abortion bans have been enacted in 18 states, but three of them have been blocked in court because they unconstitutionally limited women’s abortion rights:Arizona, Georgia and Idaho.
Smith, the bill’s sponsor, said the only exception provided for in the bill is if the mother’s life is in danger. This is a change from comments earlier this week when he told reporters there would also be exceptions for rape or incest.
Sen. Perry Clark, D-Louisville, told Smith that he thought there should be some “humane provisions” for cases of rape or incest. Smith said that the bill provided for this because those issues are usually dealt with before the 20th week of a pregnancy.
Smith later said on the Senate floor Thursday that Senate Bill 5 would “protect pain-capable children from the horror of having an abortion performed on them.”
Smith said books for expecting parents describe a 20-week-old fetus as capable of sucking its thumb, yawning, stretching, making faces and responding to pain.
SB 5 passed on a 30-6 vote. It now goes to the House of Representatives for consideration.
Sen. Reginald Thomas, D-Lexington, was among the opponents of the measure, arguing that women should be able to make decisions on their pregnancies without the limitations of SB 5.
“My fear is that by adopting this bill that we’re going to ultimately go back to what we saw in the 50s and 60s when we had back-alley butcher shops to take care of situations rather than having a safe medical procedure,” Thomas said.
House Bill 2 would require doctors to offer women seeking an abortion an ultrasound image of their fetus at least 24 hours before the procedure takes place. An ultrasound can show movement by the fetus, and audio can capture the heartbeat.
The House Judiciary Committee sent the bill to the full House on a 14-5 vote, mostly along party lines. The only Democrat to vote yes was Rep. Kevin Sinnette of Ashland.
The bill’s sponsor, Rep. Addia Wuchner, R-Burlington, opened the meeting with a video of fetus ultrasounds set to music, pointing out what physicians look for when they do an ultrasound. Wuchner said the bill leaves up to the medical provider what kind of ultrasound must be done, depending on the gestational age of the fetus. A transvaginal ultrasound is typically done early in pregnancy and an external one is done in the later weeks.
Wuchner said the purpose of the ultrasound is to assure that a woman considering an abortion is fully informed of what she is about to do, and that an ultrasound is necessary to assure “informed consent.”
“The woman is given the option,” Wuchner said. “She does not have to view the ultrasound, nor does she have to listen to the heartbeat.”
The bill calls for a fine of up to $100,000 the first time a physician does not comply with the law, with further offenses subject to a fine of up to $250,000, Wuchner said.
Asked about cost, Wuchner said that women can go to the state’s only abortion clinic, in Louisville, to get the ultrasound, or one of the 28 crisis pregnancy centers in the state that offer ultrasounds at no charge. That brought a yell of “Biased!” from the crowd, which was vocal throughout the meeting.
After allowing committee members to ask questions, Chairman Joseph Fischer, R-Fort Thomas, immediately called for a vote, but was met with resistance from the crowd when several asked loudly if opponents would be allowed to speak. Fischer allowed them to do so.
Kate Miller, advocacy director of ACLU of Kentucky, said the civil-liberties group is concerned that the aim of this bill goes far beyond providing information about a health-care decision: “We are concerned that this bill will really work to shame and coerce women who have already made the decision to have an abortion.”
Pam Newman and Katie Martin of Louisville talked about their decisions to have abortions and spoke against the bill. Both said they were fully informed before the procedure and that an additional ultrasound was not necessary for their “informed consent” and only created another barrier to access. Both said it was the absolute right decision for them at the time they made it and they had no regrets.
Dr. Christine Cook, an obstetrics professor at the University of Louisville and a practicing obstetrician-gynecologist, said in reply to a question from Rep. Darryl Owens, D-Louisville, that she was concerned that the bill would create additional barriers for women seeking an abortion and that it might cause an increase in women using something other than a medical facility to abort their fetus, as she described was common before the U.S. Supreme Court’s 1973 Roe vs. Wade decision that established woman’s right to an abortion until a fetus is viable outside the womb, usually around 24 weeks.
Rep. Joni Jenkins, D-Shively, in explaining her no vote, said an abortion decision should be made among a “woman, their families and their physicians,” and “We all know what decreases the number of abortions in this country and in this state. . . . It’s getting people out of poverty, getting people hope, getting them access to birth control and getting them access to good education.”
A supporter of the bill, Rep. Stan Lee, R-Lexington, said ” I’m proud to cast a vote in favor of legislation that can help an unborn child . . . because sometimes the most vulnerable of our society need a voice.”
The bill passed the state House of Representatives on an 83-12 vote on Thursday.
No ultrasound would be required in cases of medical emergency where an abortion is considered a “medical necessity,” according to HB 2. Health care providers who do not comply with the requirement would face fines of $100,000 for a first offense and $250,000 for additional offenses.
Several floor amendments were proposed to the measure, including amendments to outlaw all forms of abortion in Kentucky, provide an exception to the proposed ultrasound requirement in cases of rape or incest and ban abortion after 20 weeks gestation. Each floor amendment called stalled on a procedural vote.
One freshman member who voted against HB 2 was Rep. Attica Scott, D-Louisville, who said half of her constituents are female. “I have spent years mentoring women who are older than me, younger than me and in my own age group and have found the importance of trusting women to make their own decisions,” said Scott.
The LRC Public Information Office contributed to this story
Every year as the ball drops and a new year begins, millions of Americans promise themselves they are going to start leading healthier lives. But why not get a head start now, and save on your healthcare spending at the same time?
Now is the time to check to see if you’ve met your health insurance deductible. The deductible is the amount you are responsible for before your insurance company starts paying the bill. Most plans reset to $0 at the beginning of the calendar year.
Most insurance plans begin paying the majority, if not all, of healthcare expenses once you’ve met your deductible. If you have met that amount, or are close to reaching it, now is the time to maximize your health benefits by scheduling appointments, tests or procedures you may not have gotten around to this year. You could save a substantial amount of money, depending on what type of healthcare you need, if you obtain it before the end of the year. A few tests or procedures to consider include a colonoscopy, mammogram, inpatient or outpatient surgery, diagnostic testing and lab work.
It is also important to remember if you have a Flexible Spending Account (FSA) through your employer, those funds do not roll over to the New Year. These types of accounts are based on a “use-it-or-lose-it” principle and if you have funds remaining in the account, the money is forfeited per Internal Revenue Service requirements.
On the contrary, if you have an individual Health Savings Account, those funds roll over and accumulate year to year if not spent.
The key to maximizing year-end cost savings is to schedule any appointments, testing or procedures to occur by December 31. It’s crucial to ensure any check-ups or procedures can be performed before the end of the year to be considered part of your 2016 coverage. When the New Year comes, so does a new deductible and FSA balance.
For more information on your deductible amount, please reach out to your insurance provider. For information on your healthcare options, contact your primary care physician or other specialty healthcare provider.
If you have any questions, please contact Lucrece Carter, Patient Access Director, at 606 638-7426 at Three Rivers Medical Center.