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FRIDAY, AUGUST 11, 2017

UPDATE: On Aug. 10 President Trump declared the opioid crisis a national emergency. A White House statement said he "has instructed his administration to use all appropriate emergency and other authorities to respond to the crisis caused by the opioid epidemic," the New York Times reports.

President Trump is giving "incredible attention" to the issue after first refusing to call it an emergency.President Trump is giving "incredible attention" to the issue after first refusing to call it an emergency.Among other benefits, "the emergency declaration may allow the government to deploy the equivalent of its medical cavalry, the U.S. Public Health Service, a uniformed service of physicians and other staffers that can target places with little medical care or drug treatment, said Andrew Kolodny, co-director of opioid policy research at the Heller School for Social Policy and Management at Brandeis University. He said the DEA might be able to use the emergency to require prescriber education for doctors and others who dispense opioids," the Times reports.

Original post:

In a July 31 interim report, the bipartisan White House Commission on Combating Drug Addiction and the Opioid Crisis asked President Trump to declare the opioid crisis that's killing more than 142 Americans every day a national emergency.

But after an Aug. 8 meeting with members of his administration and health officials, the president declined to do so — yet. "Health and Human Services Secretary Tom Price later told reporters that declaring a national emergency is a step usually reserved for 'a time-limited problem,' like the Zika outbreak or problems caused by Hurricane Sandy in 2012. Declaring a state of emergency allows the government to quickly lift restrictions or waive rules so that states and local governments don’t have to wait to take action. Price said that the administration can do the same sorts of things without declaring an emergency, although he said Trump is keeping the option on the table," Jenna Johnson and John Wagner report for The Washington Post.

Price said the president is giving "incredible attention" to the issue. In a brief address to reporters, President Trump focused on preventative measures, saying that the best way to prevent opioid addiction is to prevent people from using drugs in the first place. "If they don’t start, they won’t have a problem. If they do start, it’s awfully tough to get off," Trump told reporters at the clubhouse at his private golf club, where he is on a 17-day working vacation. "So if we can keep them from going on — and maybe by talking to youth and telling them: 'No good, really bad for you in every way.' But if they don’t start, it will never be a problem."

President Trump won over rural voters in opioid-ravaged areas with promises to end the opioid crisis by increasing funds for treatment programs and building a border wall with Mexico to stop the flow of drugs into the country. But detractors say little of that has materialized. The border wall is years from completion, and funds for drug treatment may be effectively cut. "Republicans in Congress have proposed cutting Medicaid in ways that health-care advocates say would reduce access to drug treatment for many, and the president’s budget proposal calls for reducing funding for addiction treatment, research and prevention efforts. Several Republican lawmakers who did not vote for their party’s plan to repeal and replace the Affordable Care Act this summer said that the legislation would make it more difficult for their states to combat the heroin epidemic," the Post reports.

According to the bipartisan commission's preliminary report, declaring a national emergency could allow lawmakers to waive a federal rule that restricts where Medicaid recipients can receive treatment. The Department of Health and Human Services would also gain the power to negotiate lower prices with the pharmaceutical companies that manufacture overdose prevention drugs. The price on many such drugs has skyrocketed in recent years, hampering the ability of first responders in small towns with small city budgets to respond to overdoses.

Written by Heather Chapman Posted at 8/11/2017

 

MARKEY CANCER CENTER STUDY SHOWS ‘KILLER PEPTIDE’ HELPS ELIMINATE SOME CANCER CELLS

UK’s Vivek Rangnekar, left, and Ravshan Burikhanov. (UK Now Photo)UK’s Vivek Rangnekar, left, and Ravshan Burikhanov. (UK Now Photo)


By Allison Perry
Special to KyForward

A new study by University of Kentucky Markey Cancer Center researchers shows that when therapy-sensitive cancer cells die, they release a “killer peptide” that can eliminate therapy-resistant cells.

Tumor relapse is a common problem following cancer treatment, because primary tumor cells often contain therapy-resistance cancer cells that continue to proliferate after the therapy-sensitive cells have been eliminated.

In the new study, published in Cancer Research, Markey scientists identified a Par-4 amino-terminal fragment (PAF) that is released by diverse therapy-sensitive cancer cells following therapy-induced cleavage of the tumor suppressor Par-4 protein. PAF caused death in cancer cells resistant to therapy and inhibited metastatic tumor growth in mice.

Additionally, the PAF entered only cancer cells, not normal cells, keeping healthy tissue intact.

The findings indicate that this naturally generated PAF could potentially be harnessed to target neighboring or distant cancer cells to overcome metastasis and therapy resistance in tumors.

“This new information could positively impact how physicians plan their treatments, so as to use the sensitive cells in the tumor to release this peptide to help eliminate the resistant cells,” said Vivek Rangnekar, principal investigator and Alfred Cohen Chair in Oncology Research with the UK College of Medicine’s Department of Radiation Medicine. “We are developing PAF against therapy-resistant tumor metastasis for which no other treatment options are available.”

Markey researchers Nikhil Hebbar and Ravshan Burikhanov from Rangnekar’s team were the first two authors on the study, which also involved a partnership with Dr. Kojo Elenitoba-Johnson at the University of Pennsylvania.

Rangnekar’s team first announced the generation of the cancer-resistant Par-4 mouse back in 2007. Since then, his team’s work has spawned numerous research projects focusing on preventing and treating many types of cancer, including Markey oncologist Dr. Peng Wang’s clinical trial using the anti-malarial drug hydroxychloroquine to induce Par-4 secretion.

Allison Perry writes for UK Now

 

Date: 08-02-2017

An event held last week to decrease overdose deaths in Floyd County brought dozens of people to the Floyd County Health Department.

Health department Director Thursa Sloan reports that 61 people received free Narcan (Naloxone) training and kits that contained two nasal doses of the drug, which can temporarily reverse the effects of an opioid overdose.

Reporting that most of those in attendance were first responders, emergency management officials and fire and police officials, Sloan said in a statement, “It is important that our emergency responders are trained in Narcan administration not only to be able to give in the event of an first response for opioid overdose, but to rescue a first responder who has been exposed to opioids during operational situations.”

That is why Floyd County Sheriff Sgt. Roger Shepherd came to the training while he was off duty.

He said that police officials worry about being exposed to deadly drugs while they’re out on a call, especially after a Boyd County sheriff deputy had to be treated with Narcan after being exposed to an opioid while working last month. With Narcan, police officials can also help save lives, Shepherd said.

“She (the trainer) told us we would have to look for indicators (of overdoses), but most of the time, when we show up, we’re already told that they’re overdosing,” he said. “It just gives us the advantage of being able to maybe bring them back until a first responders can get on the scene and take it from there.”

In his 11 years of his service with the Floyd County Sheriff Department, he has seen “countless” overdoses.

“I can’t even recall, to be quite honest,” he said. “At least 40 to 50, and that’s just me giving a rough estimate. And it’s went from, you know, just regular pain pills to, now, stronger medications….It’s pretty scary.”

Prestonsburg resident Jennifer Howard, who works as a therapist with the Behavioral Health Group, also took the training and got a free Narcan kit.

“I’ve been in this field for five years,” she said. “I do therapy. I do counseling, so I don’t know much about this. I’ve seen it administered before in the hospital, but I just want to learn more.”

Jennifer Little, public information officer and training sergeant at the Floyd County Emergency and Rescue Squad and employee at Big Sandy Community and Technical College, took the training and received a free Narcan kit so she can be prepared to use it if the need arises.

“Anytime you’re involved in any sort of rescue, fire department rescue, anything like that where you come in contact with the community, any training that you can do to help you be ready to help your community is definitely something you need to do,” she said.

Dr. Jody Jaggers, PharmD, director of Pharmacy Emergency Preparedness for the Kentucky Pharmacists Association, said the Narcan community outreach and communication program, which is sponsored by the Kentucky Department for Public Health, is geared to save lives.

“In Kentucky, I think everybody has been touched by overdose or the opioid epidemic in some way, shape or form, and, you know, the eastern part of the state seems to be disproportionally hit with that, and Naloxone, right now, short of not being an addict and, of course, not having the overdose, is the only way to save somebody is getting Naloxone in their system,” he said.

Over the past several years, opioid treatment has soared in Floyd County, which was recently ranked as seventh among the top 10 counties nationwide that have a high density of physicians treating a high volume of patients for opioid use disorder. Eight of the other nine counties in that top 10 ranking were also located in Eastern Kentucky.

The Kentucky Office of Drug Control Policy reports that 86 Floyd County residents have died of drug overdoses since 2012, and 14 of those deaths occurred last year.

When asked if there were any dangerous side effects to giving a person Naloxone/Narcan, Jaggers said it has “no pharmaceutical effect” in the body unless a person is allergic to it or the person given the drug has opioids in his/her system.

His wife, who trained participants on the use of nasal Naloxone (Narcan), urged any person who administers the drug to call 911 immediately, saying that it forces an overdose victim to go into withdrawals and medical assistance is required.

The event in Prestonsburg marked the Kentucky Pharmacists Association’s 20th in the state and officials had more than 100 Narcan kits to distribute to Floyd County residents.

Jaggers said officials welcomed first responders and police officials to the event, but they hoped to see more community members also attend.

“We’d really like to see moms, dads, grandmas, grandpas, brothers, sisters, people like that because, odds are, they’re going to be the ones that will truly be the first responder if something like that happens and they stumble on their loved ones,” he said. “So, it could be in their hands and they can buy time, you know, after you call 911, to get someone there.”

Kentucky was the first state to authorize the sale of Naloxone/Narcan without a prescription. In Floyd County, local residents who know someone at risk for an opioid overdose can buy Naloxone/Narcan without a prescription at both Rite Aid locations in Prestonsburg. Pharmacists on staff will show customers how to appropriately use the drug, a spokesperson said.

For more information on Narcan availability and substance abuse treatment, visit, www.dontletthemdie.com.

By Mary Meadows
Floyd County Chronicle & Times

Date: 08-08-2017

Poll: One in 12 Kentucky 10th-graders have attempted suicide

A 2016 survey found that 8.2 percent of Kentucky’s high-school sophomores — about one in 12 — said they had attempted suicide at least once in the previous 12 months. That may seem high, but the national rate is even higher: 9.4 percent.

“We need to take that seriously,” Dr. Julie Cerel, a psychologist and professor at the University of Kentucky College of Social Work and president of the American Association of Suicidology, told Kentucky Health News.

The state is stepping up its efforts to prevent suicide among teenagers, said Patti Clark, the state’s suicide-prevention coordinator.

“Any number of students that attempt suicide is too many,” Clark said. “For us, that indicates that we have kids who have unidentified issues and they are not receiving appropriate care. They are not being connected to resources that can help them through the rough parts of their life.”

The biennial “Kentucky Incentives for Prevention” survey is given to students across the state in even-numbered grades starting in the sixth grade, but the official report says it only offers statistics from 10th graders, since these are the most likely indicators for high-school students. The survey primarily assesses alcohol, tobacco and other drug use, but also looks at suicide and other high risk behaviors.

The 2016 poll includes information from about 28,000 students in 149 of the state’s 173 public school districts, but did not include the state’s two largest districts. In addition to the Jefferson and Fayette county schools, Warren, Meade, Morgan, Laurel and Martin counties did not participate.

The survey found that 15.4 percent of Kentucky’s sophomores reported having suicidal thoughts within the previous year. The rate was higher in eight of the state’s 14 regions than it was in 2014, the first year the survey asked questions about suicide.

Beyond thinking about suicide, how many 10th graders made a plan about how they might kill themselves? 12.5 percent. The rate in seven of the 14 regions was higher than in 2014.

The statewide suicide-attempt rate of 8.2 percent was about the same as in 2014, but was higher in eight of the 14 regions. The highest rates were in three Western Kentucky regions: Four Rivers (9.3 percent), Pennyroyal (10.4 percent) and River Valley (9.2 percent) and a Northern Kentucky region comprising Bracken, Fleming, Mason and Lewis counties (9.6 percent).

Why do teens consider or try suicide?

Cerel said increased media information about suicide, both fictional and real, could be a reasons for the number of reported suicide attempts among the state’s 10th graders because this exposure “might make teens more likely to admit they’ve had these thoughts and experiences.”

She added that the state’s shortage of mental-health-care providers may also contribute to the number of teen suicide attempts in the state. The federal government estimates that as of December 2016, Kentucky had only 56 percent of the providers it needed.

That means many Kentuckians have to wait three to six months to see a mental-health-care provider, Cerel said, adding such a wait is a long time in the life of a teen who is sad or depressed — about one quarter of the school year.

“What does it mean for say a ninth-grade girl to be out of her peer group for three to six months because she is so depressed she can’t function? Everything moves on past her,” Cerel said. “So kids just aren’t — all Kentuckians, actually — aren’t getting access to appropriate mental-health services that could really lead to decreased suicide.”

Cerel said the provider shortage is even worse for teens because many providers and pediatricians are reluctant to use medications to treat young people who are depressed. The American Association of Suicidology, which Cerel heads, says depression is present in at least half of all suicides.

Cerel also suggested that the state’s opioid epidemic has likely played a role in the number of Kentucky’s teens who have attempted suicide: “I would assume that that would be highly correlated.”

What is Kentucky doing about it?

Clark said the state requires all middle- and high-school students receive some type of suicide-prevention information by Sept. 1, and every teacher or otherwise certified employee is supposed to participate in at least two hours of suicide prevention training every school year. But the implementation of these programs vary from school to school, she said.

Clark’s office is rolling out a new suicide-prevention program called “Sources of Strength” in 100 schools across the state in the fall. She said 60 schools have already signed up to participate.

The Sources of Strength website says it is an evidence-based program that builds resiliency to suicidal thoughts, and touches on related issues such as substance abuse and violence through peer-led messaging campaigns that focus on “hope, help and strength.”

“The thing about Sources is that it is peer-led, so it becomes the student’s process,” Clark said. “They get to make the change. Evidence does show that peer-led programming done correctly — meaning that the kids are not just a seat at the table, but they are truly given the power to do what they need to do and are equipped to do it in the right manner — really can make a difference … We are excited about where this can go.”

The state suicide-prevention program already provides technical training and assistance to schools with evidence-based programs, Clark said, as well as “gatekeeper training,” which teaches people in the community how to recognize the warning signs of suicide and how to get help for someone in crisis.

Clark’s office also runs the “Kentucky Initiative for Zero Suicide” program, which trains mental-health-care providers — both practicing and those who are still in school — how to assess, treat and prevent suicide.

Clark said she and her staff don’t know why so many Kentucky students contemplate, plan or attempt suicide. In a search for answers, they have scheduled meetings with in-patient psychiatric nurses and conducted a series of focus groups with directors of local schools’ Family Resource & Youth Services Centers to find out what students are telling them about it.

“We are looking at ways to increase our data, to increase our surveillance opportunities, to find that information so that we can target our prevention efforts,” Clark said.

What can parents do?

Cerel said parents should not hesitate to tell a child they are concerned about them if they think their child is contemplating suicide, and offer to get them help. She said family resource center staffs, school counselors and pediatricians are great resources for both kids and parents.

“I think they cannot be afraid to ask directly about it,” she said. “Say, ‘I’m really worried about you; are you thinking about killing yourself?’ It’s not like that is going to put any ideas in anyone’s head.” She said there is “absolutely no evidence” to support that mistaken belief.

Cerel said it’s important for parents to take any threat of suicide seriously, regardless of the circumstances, and not think it is “merely a cry for attention. It’s a cry for attention because they are feeling so awful that suicide might be the only way they think they can change their circumstance.”

Clark said that it’s important for parents to store firearms separately from ammunition.

“Especially for youth, the time from the decision to die to actually attempting death may be as short as five minutes,” she said. “If there is enough of a barrier between that child and that weapon, you may have the opportunity to save that child’s life. So simply storing your gun and your ammunition separately could make a big difference in those numbers.”

SO YOU KNOW

Suicide is the second leading cause of death among Kentucky’s teens and young adults, according to the American Foundation for Suicide Prevention.

Experts say these are warning signs of suicide:

• talking about suicide;

• making statements about feeling hopeless, helpless or worthless;

• deepening depression;

• preoccupation with death;

• taking unnecessary risks or exhibiting self-destructive behaviors;

• out-of-character behaviors, including changes in sleep habits or appetite;

• increasing the use of alcohol or drugs;

• a loss of interest in the things one cares about;

• visiting or calling people one cares about;

• setting one’s affairs in order; and

• giving prized possessions away.

If you have any of these warning signs, or someone you know is exhibiting any of them, help is available at the National Suicide Prevention Lifeline at (800) 273-TALK (8255). Another resource is the Crisis Text Line: Text HOME to 741-741.

By MELISSA PATRICK
Kentucky Health News

 

Syringe exchanges coupled with therapy, treatment could virtually eliminate hepatitis C, conference told

By Melissa Patrick
Kentucky Health News

Kentucky leads the nation in new infections of hepatitis C, a liver disease now driven mainly by intravenous drug use. It could be virtually eliminated, but that would require a committed strategy to increase syringe exchanges, medication-assisted therapies, and cutting treatment restrictions such as a ban on treating active intravenous drug users.

That was the overarching message to almost 300 people who attended the fourth annual Viral Hepatitis Conference in Lexington July 27. They also heard that Kentucky is working on all three fronts, but not going as far as some experts want when it comes to treating drug users.

“Hepatitis can be eliminated,” Homie Razavi, director of the Center for Disease Analysis, an independent research group based in Lafayette, Colo. “The key is to increase harm-reduction programs and basically remove all restrictions, and the final catch is we have to expand it to treat everyone, whether they are 15 or 74.”

Razavi said studies show if you only have a syringe-exchange program, it reduces new hepatitis C infections by 15 percent; if you only offer medication-assisted therapies, they reduce the rate by 50 percent; but if you have both, that cuts it 75 percent.

“These programs are very, very effective. They are very cost-effective,” Razavi said. But he added, “At the end of the day harm-reduction programs can only go so far.”

More than 38,000 Kentuckians are estimated to be chronically infected with the disease, and many don’t know they are, because it can take decades for symptoms to appear. If left untreated, hepatitis C can cause liver damage from cirrhosis or fibrosis, liver cancer, and even death.

Kentucky has the potential to get a lot more hep-C cases, quickly. The federal Centers for Disease Control and Prevention has identified 54 Kentucky counties among the 220 most vulnerable in the nation to a rapid spread of HIV and hepatitis C infection among persons who inject drugs. Sixteen of the state’s counties ranked in the nation’s top 25.

In 2015, the Kentucky legislature authorized syringe-exchange programs that let drug users swap dirty needles for clean ones to thwart the spread of HIV and hepatitis. But if they want special state funding, the administration of Gov. Matt Bevin requires them to have a one-for-one exchange policy, which experts discourage.

“I cannot underscore enough, one-for-one exchange is not an effective public health intervention,” Wayne Crabtree, who oversees the syringe exchange in Louisville, told the group.

“Exchange is not about syringes, it’s about the relationship”

As of July 25, Kentucky had 26 operating syringe exchanges and eight that have been approved but not operational, according to the state Cabinet for Health and Family Services.

Crabtree called the Louisville program a “sad success,” since it has had more than 11,000 participants since it opened in 2015, with 4,790 returning. He said that in addition to reducing infection rates and offering other important harm reduction services, syringe exchanges can lead people who inject drugs to testing, counseling and treatment.

“Studies show that program participants were five times more likely to enter drug treatment than IV drug users who did not participate in syringe exchange programs. That’s amazing!” he said. “Syringe exchange is not about syringes, it’s about the relationship. And if you are in relationship with someone and they know you care, you have the makings of change.”

State infectious-disease specialist Dr. Ardis Hoven, one of the moderators, said she appreciated Wayne’s efforts as “we continue to push and pull and shove and make our voices heard in public health around this very, very important issue.”

Eliminating barriers to treatment has its own barriers

Razavi said a successful strategy to eliminate hepatitis C must also allow IV drug users and people who are in the early stages of the disease to be treated. Those restrictions have been reduced in some commercial and veterans’ insurance policies, but remain in Kentucky’s Medicaid program – which provides care to about one-third of the state’s people, generally those with incomes up to 138 percent of the federal poverty line.

Dr. Gil Liu, the state medical director for Medicaid, said 10,500 Kentuckians on the program had been diagnosed with hepatitis C, costing the federal and state governments an average of $83,735 for each case. “In the last full fiscal year, Kentucky’s Medicaid program spent $69.7 million on pharmacy claims to treat 833 beneficiaries,” according the cabinet, the Lexington Herald-Leader reported in May.

State Medicaid rules allow hepatitis C treatment only during advanced stages of the disease, which Liu called “very restricted.” He said, “We want everybody to have access. We are moving toward relaxing those requirements.”

But one restriction, which requires a person being treated to not inject an illicit drug for six months prior to treatment, doesn’t seem as likely to be relaxed. Liu said the rule was “under discussion” but there is concern that if it is relaxed, people who use IV drugs won’t seek “the full continuum of care” needed to overcome their addictions.

However, Jon Zibbell, senior public-health analyst for the Behavioral and Urban Health Program at RTI International, an independent nonprofit research institute, said that if active injectors can be treated, fewer people would be infected, and therefore fewer to transmit the disease.

“Let me make it clear, we will never control the epidemic unless we treat people who are actively using,” Zibbell said. “Scientific fact.”

Liu eventually got to the crux of the matter: money.

He said it will soon be “financially unsustainable” to support the state’s “heroic expansion of eligibility of Medicaid,” and he wasn’t sure how the state would or could pay to treat everyone for hepatitis C if all restrictions on treatment were removed.

“It very quickly becomes a question of what are you going to ration; that is a zero-sum-game at some point in time,” Liu said.

Razavi said research has proven that “the cost of inaction is actually more costly than elimination” of hepatitis C. He said the cost of new, life-saving pills that have a 100 percent cure rate have dropped from $80,000 to $35,000 and lower.

“From a health-care perspective, the state of Kentucky is going to pay for these people. So whether you treat them or don’t treat them, they are going to cost you – in fact more if you don’t treat them.”

The World Health Organization defines the elimination of hepatitis C as reducing the number of new infections by 90 percent and reducing the number of liver-related deaths associated with it by 65 percent before 2030.