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Date: 09-21-2017

Opioid epidemic in Kentucky is 'a public health catastrophe,' experts tell lawmakers

FRANKFORT, Ky. — It wasn't until his second year of a residency in a prestigious anesthesiology program at Johns Hopkins University that Dr. Michael Sprintz's addiction caught up with him and he was kicked out of the program and into treatment.

"Everyone has a drug of choice," said Sprintz, who became sober and eventually completed his medical training. "For me it was everything."

But he warned Kentucky lawmakers that tackling addiction sweeping the state isn't easy and it will take a sustained effort to reach individuals impaired by drugs or alcohol.

"The thinking isn't logical," said Sprintz, who practices anesthesiology, pain management and addiction medicine in Houston. "It took me literally losing everything to think, 'Huh, maybe I have a problem.'"

Kentucky's opioid addiction crisis was the the subject of an unusual daylong meeting Wednesday in Frankfort, where a legislative committee heard from experts on the wave of heroin and prescription pill abuse engulfing many Kentucky communities.

And the news isn't good, Van Ingram, executive director of the state office of drug control policy told the joint House-Senate Health and Welfare Committee.

"When the clock strikes midnight tonight, four Kentuckians will have died of a drug overdose," he said. "When the clock strikes midnight tonight, 140 Americans will have died from a drug overdose. These deaths are preventable, and they don't have to happen."

Jennifer Hancock, president of the regional Volunteers of America chapter in Louisville, which provides addiction services, called Kentucky's opioid problem "a public health catastrophe."

Drugs including heroin and increasingly, fentanyl — a powerful narcotic often mixed with heroin that can be lethal in low doses — continue to ravage the state to the point where some emergency responders are feeling "opioid fatigue" from reviving overdose victims, some repeatedly, Ingram said.

"It took over 2 1/2 decades to get into this epidemic and sadly, I think it's going to take a lot more time to get out of it," Ingram said.

Abuse of such drugs continues to take a "lethal toll" on Kentucky, driving up overdose deaths to unprecedented levels, according to the 2016 Overdose Fatality Report by the Kentucky Office of Drug Control Policy.

The report, released June 27, found that 1,404 people died from drug overdoses in 2016, a 7.4 percent increase over the previous year. Increased use of fentanyl is contributing to overdose deaths, the report found.

While nearly every community in Kentucky experienced overdose deaths, the toll was highest in Louisville, Lexington and northern Kentucky, the report found.

Ingram said the deadly fentanyl trend appears to be continuing, with that drug involved in more than half of this year's overdose deaths.

Still, Ingram and others who addressed the committee said they hope access to treatment and other efforts will turn things around.

"People do recover," Ingram said.

Hancock, with the VOA, said her agency has had tremendous success with Freedom House, a program it offers pregnant women who suffer from addiction.

By reaching them early in the pregnancy and offering them housing and treatment, the VOA has been able to help women get off drugs and deliver healthy babies not impaired by drugs.

The average cost of an infant born with Neonatal Abstinence Syndrome, impaired by drugs the mother took, is about $100,000, Hancock said. That's because most such babies require lengthy stays in intensive care, with most costs born by the state's Medicaid program.

Just 10 healthy babies represents a savings of $1 million, she said.

So far, the VOA has helped 150 women deliver babies unaffected by drugs, Hancock said, but the demand for their services grows. 

Sen. Julie Raque Adams, a Louisville Republican and chairwoman of the Senate health committee, wondered whether more such programs are needed.

"Do we have enough Freedom Houses to take care of these moms?" she asked.

Hancock said VOA recently broke ground on a second campus to help with the demand for services by pregnant women, funded through private fundraising and $500,000 from Louisville Metro Government. But that may not be enough, she told lawmakers.

"We need to continue to do more and we need your help," she said.

Lawmakers appeared concerned by the testimony but also will be confronted with a tight budget and competing demands for funds, including the state's acutely underfunded public pension system, when they convene in 2018 for the next legislative session. Meanwhile, Gov. Matt Bevin has proposed cuts of 17 percent in most state agencies to deal with a projected shortfall in the current fiscal year.

Still Rep. Addia Wuchner, a Burlington Republican and chair of the House Health and Family Services Committee, said Wednesday's meeting was a chance for lawmakers to get more information about the problem she described as a "ravenous beast."

"Addiction is destroying families and lives, it erodes communities," she said. "People with addiction are suffering from a chemical disease that afflicts the brain and destroys the body."

She also suggested compassion for those experiencing addiction.

"No one chooses this life," Wuchner said.

Sprintz, the Houston physician, said those seeking to help people with addiction must consider the trauma they may have experienced or emotional pain they are suffering, invoking his own experiences as a medical student.

"On paper, I looked freaking awesome," he said. "But I hated myself. I hated my life. In my head I had fooled everyone."

By Deborah Yetter
The Courier-Journal

 

As summer ends and fall approaches, we begin to hear a lot about the seasonal flu and the importance of getting vaccinated. Influenza, also known as “the flu,” is a contagious respiratory disease caused by the influenza virus, which affects the nose, throat and lungs. Every year in the United States more than 200,000 people are hospitalized because of the flu, according to the Centers for Disease Control and Prevention. Several important steps can be taken to help prevent contracting and spreading the virus.

Individuals who are at high risk for developing flu-related complications should exercise particular caution during flu season. Children under age five, adults 65 and older, pregnant women, people with chronic medical conditions and people who live in nursing homes or long-term care facilities are especially susceptible to complications related to flu.

The best way to prevent getting the flu and spreading it to others is to get a vaccine. It’s best to get vaccinated as early as possible in the season as it takes about two weeks for antibodies to develop after vaccination. For the 2017-2018 seasons, the CDC recommends using an injectable influenza vaccine. Two types of injectable vaccines will be available this flu season:

*  Trivalent flu vaccine: A three-component vaccination injected into the muscle of the arm. There are several trivalent shots that are appropriate for people 18 and older. High-dose trivalent shots are recommended for people over 65.

*  Quadrivalent flu vaccine: A four-component vaccination approved for use in different age groups. The intradermal quadrivalent flu shot uses a smaller needle and is injected into the skin instead of the muscle.

Besides vaccination, there are several other things you can do to minimize the risk of catching the virus and spreading it to others. Most viruses spread through direct contact, so it is extremely important to wash your hands regularly in warm, soapy water and avoid contact with face, mouth and eyes. When sneezing, always use a clean tissue and discard used ones, and if a tissue is not available, sneeze away from others.

Using natural methods to help prevent to the flu can also be effective. Staying hydrated and drinking plenty of fluids can help flush out the body. Getting fresh air can also help keep the body hydrated, especially during the cold months when central heat tends to dry out the skin. Exercising regularly and eating a diet high in vegetables and fruits can help increase blood flow and stimulate the body’s natural virus-killing cells.

The seasonal flu virus changes every season, so it is important to stay current with your vaccinations each year. Practicing good cleanliness habits and healthy routines can also help keep you and your loved ones healthy throughout flu season and all year long.

For information about scheduling a vaccine, please call one of our convenient locations listed below:

 

 

Sep 1, 2017 

To fight the opioid epidemic, Kentucky doctors, legislators and health-insurance companies are working to limit the prescription of painkillers.

The 2017 General Assembly imposed a three-day limit on most opioid prescriptions for acute pain. Change told the Herald-Leader that the law is “a game-changer,” and the newspaper said the law “creates opportunities for doctors to educate their patients about non-addictive options.”The 2017 General Assembly imposed a three-day limit on most opioid prescriptions for acute pain. Change told the Herald-Leader that the law is “a game-changer,” and the newspaper said the law “creates opportunities for doctors to educate their patients about non-addictive options.”

At the annual convention of the Kentucky Medical Association, a University of Kentucky trauma surgeon told other physicians how he and his colleagues got a wake-up call about the problem and “how they were able to halve the amount of opiates given to trauma patients without increasing their pain levels,” the Lexington Herald-Leader reports in an editorial.

Dr. Phillip K. Chang, now UK’s chief medical officer, had what he calls an “eye-opening moment” in 2013, when a young man he treated for injuries in a vehicle crash became addicted to the painkiller he had prescribed. He says many physicians have had similar epiphanies, and addiction “could happen to our family, our neighbors, ourselves.”

Dr. Phillip K ChangDr. Phillip K ChangTopics related to the opioid epidemic dominated the KMA’s weekend convention. Journalist Sam Quinones discussed his book, Dreamland, about the 30-year history of the epidemic.

“We believe it is important to know the issue from a historical perspective,” KMA President Nancy Swikert said in a press release. “Knowing how we got to where we are on this issue will help us address it going forward.” She said this was the first time the annual meeting “has had breakout groups to address an important public-health issue.”

The Herald-Leader gives a capsule history: “Two developments of the 1990s spurred this crisis: Pain was added as a vital sign by the hospital accrediting commission. And the pharmaceutical industry targeted physicians with aggressive and misleading marketing of opioids, flooding Kentucky with powerful painkillers, many of which were diverted into the black market.” Meanwhile, the federal Medicare and Medicaid centers began asking patients about pain control, “creating a financial incentive to over-prescribe painkillers.”

Chang told Kentucky Health News and WKYT-TV last year that the UK trauma team adopted a protocol to treat acute pain (as opposed to chronic pain): Use a non-narcotic first, and only prescribe a narcotic if the non-narcotic doesn’t relieve the patient’s pain. “Rather than eliminating pain, Chang aims to keep pain ‘tolerable’ — a standard that Medicare should adopt,” the Herald-leader editorial said.

Chang told the Herald-Leader last week that UK patients are “super receptive” when educated about the risk of opioids. He said the trauma team is integrating art, music and touch therapies into treating acute pain, and has achieved the same level of pain relief with half the amount of painkillers. “Such success among trauma patients certainly could be replicated in other populations,” the editorial said.

The 2017 General Assembly imposed a three-day limit on most opioid prescriptions for acute pain. Change told the Herald-Leader that the law is “a game-changer,” and the newspaper said the law “creates opportunities for doctors to educate their patients about non-addictive options.”

Insurance companies can play a role, too. Anthem Blue Cross and Blue Shield announced last week that prescribed opioids for its members in Kentucky dropped 12 percent in the past year. The insurer said it limits to seven days its coverage of opioids for patients newly starting opioids, requires prior authorization by a health-care provider, and directs patients most at risk for opioid-use disorder to one pharmacy.

All those steps have helped reduced opioid prescriptions, the company said in a press release. “The primary goal of the quantity limits was to prevent inadvertent addiction and opioid-use disorder, and to ensure clinically appropriate use consistent with Centers for Disease Control guidelines,” it said. In March, the CDC recommended that opioid prescriptions last three to seven days, and that prescribers should avoid high doses and warn patients of the risk.

“As a health insurer, we have a responsibility to do what we can to address this health epidemic and we are committed to making a significant difference to our members,” Deb Moessner, president of Anthem Blue Cross and Blue Shield in Kentucky, said in the release. “We believe these changes in pharmacy policy, complemented by a broad set of strategies addressing the opioid epidemic, will help prevent, deter and more effectively treat opioid use disorder among our members.”

The CDC reported in July county-by-county figures for dispensing of opioids in 2015 and 2010. The amount in Kentucky went down, but some counties went up, and the figures are available from Kentucky Health News at www.uky.edu/comminfostudies/irjci/OpioidVitalSigns2017Kytable.xlsx.

Lisa King of The Sentinel-News in Shelbyville used the data as the basis for a story saying that opioid prescriptions declined 20 percent over the five-year period, and also looking at some other counties. But in interviews with pharmacists, she also found a possible reason that the number could now be going up. She wrote:

“Raschelle Cox at Shelbyville Pharmacy said that even though prescription numbers may be down, there are still a lot being written. ‘In the two years that I’ve been here, I haven’t noticed any decrease,’ she said.

Cox added that . . . there are a couple of medications used to treat neuropathy from diabetic nerve pain, that people have been using instead of opiates, that have just recently been declared as narcotics. ‘Now Gabapentin is controlled as of July 1,’ she said. ‘We sell a lot of it.’ Roanya Rice, director of the North District Health Department, said a trend is also underway of using drugs other than narcotics.”

From Kentucky Health News

SEPT. 4, 2017

TALKING ABOUT POOR HEALTH AS AN OBSTACLE TO PROGRESS IN APPALACHIA, AND WHAT TO DO ABOUT IT

By Melissa Patrick
Institute for Rural Journalism and Community Issues

JOHNSON CITY, Tenn. -- Appalachia faces many hurdles when it comes to economic development and creating a healthy workforce, including education barriers, addiction issues, stigma and overall poor health.

Those were the conclusions of a 13-member panel convened to discuss the findings of two new Appalachian Regional Commission reports that found Appalachian health continues to fall behind the rest of the nation, and how that affects economic development.

"Without a healthy workforce, the economic prospects in the region are greatly diminished," declared Julie Marshall, an ARC economist and a principal investigator for the "Health Disparities in Appalachia" report.

The second report, "Diseases of Despair," looked at deaths from overdose, suicide and alcohol-related liver diseases in Appalachian and found them to be 37 percent higher than the rest of the nation: Overdose deaths were 65 percent higher, suicide deaths were 20 percent higher, and alcoholic liver-disease deaths were 8 percent higher.

Michael Meit, lead author of the study, reminded the panel that it's important to look beyond poverty as the only reason for these high rates, pointing out that some Appalachian states, like Mississippi and Georgia, have high poverty levels, but lower death rates for these measures.

Meeting in Johnson City, Tenn., the panel said addiction -- to opioids, alcohol, methamphetamine and cocaine -- is a major workforce issue in the region.

Dan Eldridge, the mayor of surrounding Washington County, said he had recently talked to a company looking to bring more than 600 jobs to his area, and spent most of the time talking about the region's workforce. And when he asked why, they told him that among other things, one of their selection criteria was access to a drug-free workforce and "this region of the country does not have a good reputation."

Eldridge said he thought one contributor to the problem is that high-school students who aren't college-bound don't have any plans for the future, and their drug use seems to increase after they graduate.

Randy Wykoff, dean of the East Tennessee State University College of Public Health, said it's time to bring people together from different sectors -- health-care providers, the criminal-justice system, advocacy groups and people with substance-use disorders -- to "rethink this whole thing." He said it's time to quit putting people in jails who need rehabilitation and treatment.

Successes and strategies

Eldridge said his county has a program that teaches employees how to recognize personal or work-related problems and encourages employers to implement employee-assistance programs to address them.

Mike Caudill, CEO of the Mountain Comprehensive Health Corp., a federally qualified health center in Whitesburg, Ky., pointed to its "Farmacy" program as one of their many successes.

The grant-funded program gives qualifying individuals a "prescription" for fresh fruits and vegetables at their local farmers' market. Caudill noted that one of their participants lowered his A1C, a test for blood sugar, from 14 to 6.2 in just eight months. A normal A1C is between 4 and 5.6.

"In the midst of all this bad news, somebody has to speak life into what is possible," said Jared Arnett, executive director of Shaping Our Appalachian Region, a bipartisan effort to revitalize and diversify Eastern Kentucky's economy.

Arnett said technology can open doors for new economic opportunities, expand entrepreneurship, provide access to health-care specialists through telemedicine, and offer more opportunities for education and workforce training.

Other ideas to improve the workforce included creating multi-sector partnerships, involving community members in decision making, taking advantage of the region's high rate of social associations, including health considerations in all government policies, and better coordinating local educational systems with the region's workforce needs.

Written by Al Cross Posted at 9/02/2017 12:29:00 PM

FRIDAY, AUGUST 25, 2017

Dozens of counties, mostly in rural areas, were at risk of having no individual private insurance options in 2018 after companies like Anthem Blue Cross and Blue Shield pulled out of the markets. But a few insurance companies have filled gaps in coverage, and now there are no areas in the U.S. without coverage.

Paulding County, Ohio, was the very last bare county in the country until CareSource committed to offering coverage in 2018 to the 380 customers who need it, Dylan Scott reports for Vox. CareSource also filled coverage gaps for next year in other bare counties in Ohio and Indiana this summer.

Bloomberg insurance map aug 25 2017 Bloomberg insurance map aug 25 2017


Click here for the interactive county-by-county Bloomberg map; https://www.bloomberg.com/graphics/health-insurance-marketplaces-for-2018/


This summer there were dozens of counties that had no individual insurance options for 2018. President Trump threatened not to pay insurers the federal cost-sharing payments that make it possible for them to offer low-cost plans to the poorest citizens. Because of that and the general uncertainty surrounding Congressional Republicans' fight to repeal and/or replace the Patient Protection and Affordable Care Act, some insurers decided it would be safer to withdraw from markets that depended heavily on federally subsidized plans. That left some areas with no coverage options.

But insurers like CareSource and Centene saw an opportunity in the bare coverage areas and have stepped in to fill the gap. Both are niche insurers that specialize in managing Medicaid programs for the poor. "This isn't a perfect solution, especially for people who don't receive subsidies and therefore aren't protected from premium increases in a monopolized market," Scott writes. "It's also possible that Trump does something in the next few weeks to disrupt the market again — insurers have until the end of September before they are truly locked into selling plans in 2018."

Scott writes that the country should now focus on counties that have only one insurer in 2018. He's not worried so much about insurers with monopolies charging outrageous prices, but more about customers not being able to shop around for plans that fit their needs.

Written by Heather Chapman

Posted at 8/25/2017 11:41:00 AM