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Tanya L. Horn, R.S.

Health Environmentalist II

Lawrence County Health Department

1080 Meadowbrook Lane

Louisa, KY 41230

Phone: 606-638-4389

Date: 02-22-2016

Kentucky tightens warnings on fish consumption

 FPM Fish Kill

Be careful with any fish you eat that come from Kentucky waterways.

State officials have found more fish in more waterways with higher levels of mercury, so they’ve tightened up their consumption warnings. They now rec­ommended restrictions for everyone, not just the special population of women of childbearing age or children 6 years or younger.

“We want Kentuckians to be informed about any potential danger or ill effects that could result from the food they con­sume, and that includes fish caught lo­cally in our rivers, streams and lakes,” said Kathy Fowler, director of the Divi­sion of Public Health Safety, in a news re­lease.

“Contaminants, like mercury, can be harmful to the brain and nervous system if a person is exposed to too much of them,” she said. “We ask that Kentuck­ians be mindful of the kinds and amounts of fish they consume, particularly more sensitive populations such as infants, young children and pregnant women.”

Kentucky Waterways Alliance water policy director Tim Joice said the group appreciates a new approach that puts different advisory levels on different species and pollutants. “It also appears to heighten the warnings for citizens re­garding certain species and pollutants, namely, mercury.

“Toxic contaminants in our water­ways are clearly still an issue, even with the Clean Water Act being 44 years old in 2016.”

Kentucky League of Sportsmen President Ed Morris said he fishes and follows the recommendations, adding that he really doesn’t eat much of what he catches.

“Like a lot of fishermen, I’m now mostly fishing catch-and-release, espe­cially on the Ohio River,” he said.

But he said “we go out once or twice a year and get some catfish and have a fish fry,” he said.

Lanny Brannock, the spokesman for the Kentucky Department for Environ­mental Protection, said that in the past “we have sampled targeted waterbodies that have had known contaminant issues to monitor specific changes.” But in fish tissue sampling in 2009 and 2013, “we sampled lakes statewide and were able to gain a better understanding about statewide mercury levels in fish.”

He said they did not find mercury lev­els in fish tissue increasing from 2009 to 2013. The press release emphasizes natu­ral causes — saying mercury is a natu­rally occurring in the environment and widespread across the country.

A more detailed flier from the Ken­tucky Division of Water acknowledged primary sources of mercury include emissions from coal-burning power plants, hazardous waste incineration, chlorine production, and mercury prod­uct breakage and spillage. In Kentucky, the flier said, mercury reaches surface water primarily from what falls out of the sky.

The new warnings divide fish into two groups — panfish and bottom feeders such sunfish and catfish, and top predators, including smallmouth bass, largemouth Bass, and walleye. Nobody should eat more than one meal per month of the predatory fish, and those in the special population should limit themselves to only six meals a year, according to the recommendations. For panfish and bottomfeeders, the recommended limits are one meal per week for general population, and one meal per month for women of childbearing age and the young children. 

There is also a long list of even tighter recommendations for specific rivers or lakes, including some where officials recommend not eating any fish, and sometimes because of the long-banned but persistant chemical PCB. One meal is considered to be an eight ounce serving for a 150-pound person.

By James Bruggers
The Courier-Journal

 

Mandy CurryCHARLESTON — A Putnam County entrepreneur is the winner of the 2016 Vanguard Agriculture Competition sponsored by the Robert C. Byrd Institute for Advanced Flexible Manufacturing (RCBI).

Mandy Curry created Healthy Kids — an easy-to-use, customizable online meal planner that includes recipes, instructional videosand shopping lists of ingredients.

With the help of her husband, a master gardener, Curry is developing a new component that integrates farming technology into the meal planner, offering guidance on what to grow in particular areas, how to grow and care for the plants, when to harvest and how to incorporate homegrown produce into meal plans.

As winner of the West Virginia Vanguard Agriculture Competition, Curry will receive a business assistance package valued in excess of $10,000, including product design and development, funding opportunities, business incubator space and other services. She received the award during a ceremony Feb. 26 at the West Virginia Small Farm Conference at the Charleston Civic Center.

The West Virginia Vanguard Agriculture Competition honors innovation and ingenuity in agriculture, recognizing an entrepreneur whose idea has potential to solve logistical challenges in the local food supply chain. 

The contest is part of RCBI’s Agricultural Innovations initiative, a focused effort to improve opportunities for West Virginia’s farming and agricultural economy. Funded by a grant from the Claude Worthington Benedum Foundation, the initiative supports and enhances a vibrant local foods system by promoting entrepreneurship and innovation.

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The Robert C. Byrd Institute for Advanced Flexible Manufacturing (RCBI) provides leading-edge equipment, specialized training and staff expertise so entrepreneurs and manufacturers of all sizes can innovate, create jobs and thrive.

Cure or curse?

Opiate addiction has been called an epidemic in rural Appalachia.

With the release of drugs such as Oxycodone and Roxicodone, addiction to the drug that has been named “hillbilly heroin” has been blamed for crime, the breakdown of families and deaths.

So, when an addict learns there is a drug that can help them end their addiction to opioids, they are more than willing to try treatment that will soften the symptoms of withdrawal while they fight the physical, mental and emotional pain of addiction.

Suboxone, manufactured by the pharmaceutical company Indivior, is prescribed by doctors and clinics to help ease the symptoms of opioid withdrawal. But questions have been raised over the drug’s effectiveness and safety.

“It’s a bandaid over a big gaping wound,” according to recovering addict John Blevins. “It’s doing nothing but causing a lot more problems.”

Indivior, the pharmaceutical company that manufactures Suboxone and local doctors and clinicc that prescribe the drug did not return calls seeking comment.

Information from the website Suboxone.com says: 
“Suboxone film contains buprenorphine, a opioid that can cause physical dependence. Buprenorphine is the primary active ingredient in Suboxone film. By attaching to the same receptors as other opioids, it can help to suppress withdrawal symptoms and reduce cravings. Naloxone is included to help prevent misuse. If you are dependent on a full opioid agonist and attempt to inject Suboxone film, the naloxone is likely to cause withdrawal signs and symptoms.”

A quick fix for addiction?

John Blevins starting using opiates after he was injured at work. He said hee became addicted to the drug, and went to a Suboxone clinic in order to stop taking opiates. He says the concept was to start taking Suboxone as a substitute for opiates, and then gradually stop taking the Suboxone. But, there was no plan set out to end his addiction. So, Blevins did what addicts do — he found a way to use the situation to his advantage.

“I could take a half of a dose and go two or three days, so I thought that I didn’t have to take but a little bit of my medicine and get rid of (sell) the rest,” he said. “(Before I started taking Suboxone) I was spending from $400 to $1,000 a day on opiates. This (Suboxone) is $25 a day, and would last three or four days. I was looking to try to make money.”
But, when Blevins stopped taking Suboxone, he said the symptoms from the withdrawal were like nothing he had encountered when he stopped taking opiates.

“Opiates is the reason you take it,” he said. “But, they don’t tell you this: (Suboxone) is 10 times worse to come off of. I have never been as sick as I was coming off Suboxone. That is the worst thing. I have come off Oxycontin, I’ve done heroin. That’s a five, six, seven day sickness. But, to come off Suboxone, on my 23rd or 24th day, it was just getting wound up. It didn’t get our of my system for over 30 days.”

The way the drug stays in the system, addicts say, makes withdrawal from Suboxone harder than withdrawal from other drugs.

“You go in to the clinic, and doctors tell you all these good things about it, like it’s long lasting, and you can go up to 72 hours and not be dope sick,” said Ryan Sellards, a 30-year-old man who used the drug. “For people like us (addicts), it makes us want that, makes us feel like we have a chance, that we might be able to live a normal life.”

The plan with Suboxone is to taper off the drug, but, addicts say that doesn’t happen. Psychological counseling is part of the treatment plan, theoretically, but addicts say that rarely happens. 
“They made me do counseling, once a month,” Sellards said. “But they didn’t really counsel you, you just go in there and talk.”

“They don’t set a date (to stop taking Suboxone),” Blevins said. “They wrote (a prescription for) three (doses) a day, along with Kolonopin for anxiety and Neurotin for nerve pain. They will wean you off, a quarter (of a dose) here and there, but if you tell them you need it, they will add it right back because they are pushing a product.”

Tyler Kidd, 25, said he struggled with opioid addiction for years before he went to a Suboxone clinic. 

“Their plan was to wean me down, but I was prescribed two per day the whole time I was going to the clinic, for about a year,” Kidd said. 

Pike County Jailer Freddie Lewis, who says he estimates Suboxone makes up 85 percent of the drugs that are intercepted while being smuggled into the Pike County Detention Center, said he believes the clinics look more at their profit margin than their patients’ recovery.

“They don’t want to bring you off if,” Lewis said. “If a person walks in and tells a doctor that they want to start coming off this, the doctor will drop that person from 30 milligram (dose) to a 15 milligram (dose). He knows that person will be scratching at his door, trying to bust his windows out, within a week’s time to get back in there because you can’t drop them like that. You have to do these people gradually, a milligram or a milligram and a half a week. But, they (doctors) are smart, so they will drop you 15 or 20 (milligrams). So, you come back, and you are already going through withdrawals, and so they will take you from 30, and say, okay, if you are in that bad shape, they will give you 60. Once they give you 60 … it’s a money racket.”

Lewis said he believes drug companies are taking advantage of people who are in a vulnerable state when they provide a drug to treat drug dependence that is itself addictive.

“With Suboxone, we find it is a harder, worse drug to come off of than cocaine,” Lewis said. “There is nothing worse than looking, in our jail, at a 19 or 20 year old girl or boy laying on a concrete floor going through withdrawals from Suboxone. It makes you want to cry for them.”

A criminal cost?

Recent crimes have also drawn a heightened attention to the drug.

Included in that was the Feb. 2 robbery of the Commonwealth Pharmacy in Coal Run, which has resulted in charges against Christopher R. Daniels, 33, of Billy Compton Branch, Pikeville.
The pharmacist at the store told the News-Express after the incident that the suspect entered the store, armed with a handgun and demanded Suboxone and Subutex, both brand names for the generic drug buprenorphine.

Court documents revealed that, a brief time prior to the robbery of the Commonwealth Pharmacy, Daniels was charged with attempting to bring Suboxone into the Pike County Detention Center while being booked in on charges related to a separate alleged crime.

On the same day Daniels was indicted, a Pike grand jury indicted Adam S. Lester, 30, of Ky. 610, Jenkins, on a charge related to the Jan. 18 armed robbery of the Dollar General store at Robinson Creek. While Lester’s alleged crime was not linked directly to the drug Suboxone, a grand jury also indicted Lester on a charge alleging that he possessed the drug in the Pike County Detention Center while being held on the robbery charge.

Lewis said the addictive nature of Suboxone, along with the film form, makes it difficult to prevent the drug from being smuggled into the jail.

“It has been a total nightmare at our jail, and it still is,” he said. “People say the strips are great — no, they aren’t great. They will melt those strips down and inject them. They’re very hard to find. One tenth of a strip, which is the size of an eyelash, is strong enough to keep someone from going through withdrawal for four days. That is hard to deal with inside the jail.”

“I can get just as much in jail as I could on the street,” Blevins said. “It’s no problem getting Suboxone in jail. It’s the accessibility of it. It’s easy to hide, and easy to get in.” 
The marketing of addiction

The legality of the drug — and the fact that it is often, as a prescription drug, paid for by insurance plans — makes it easy for addicts to manipulate, both the drug and the insurance system.

“They have made different spinoffs, and the reason they did is so insurance will cover it,” Blevins said. “It’s just pharmaceutical companies coming up with these to make it convenient. They say, ‘This is better because they can’t shoot (inject) it.’ But, they’ll find a way. You can if you freeze that solid, and melt it back down. There’s nothing made they can’t do. Addicts are smart people and they will find a way. They have a lot of ingenuity.”

In fact, Lewis said the jail had to purchase a copy machine strictly for inmate mail. He explained that inmates’ friends and family would wet Suboxone strips, and allow the drug to melt into letters. 

“They would read their letters, then eat them,” Lewis said. “So, now we just make copies of their letters, and shred the originals, in case they have Suboxone in them.”

Asked if they would recommend Suboxone as an option for fighting opioid addiction, all three of the addicts the News-Express interviewed gave a definitive ‘no.’

“If someone came to me today, considering going to a Suboxone clinic, I would say, no,” Kidd said. “I would say first they need to go to rehab and give that a chance. I would try meetings, I would try anything. I would not go to a dependence on something else, especially something as addictive as Suboxone is. It did not help my opiate problem. I went from one thing to another.”

“If someone is thinking of going to a Suboxone clinic, I would suggest they check themselves into rehab and tough out the pain, because you will have a lot worse pain coming off Suboxone,” Sellards said.

The people who spoke to the News-Express all said shared the same opinion: That the manufacturers of Suboxone are contributing to the addiction problem in Appalachia.

“Last year, my cousin killed himself when he was coming off Suboxone and nerve pills,” Blevins said. “He tried to come off of it, and it hurt so bad, it broke him down so bad, that he thought he was dependent on it and couldn’t have any other life but to be a drug addict. Pharmaceutical companies are preying on the people … not just the addicts but their families. Addicts will do anything they can to get that because they don’t want that sickness (withdrawal).”

“It’s causing a lot of crime, not just getting people addicted,” Kidd said. “It’s damaging communities and causing as many problems as the opiates. In my eyes, it’s just as bad if not worse (than opiates). Detox centers are pushing you to go in that direction.”

Lewis said to substitute one drug for another is simply taking advantage of a vulnerable person.

“People have a drug problem, they have no money, they’ve lost everything they’ve got,” Lewis said. “Then they go to a doctor and they are begging for help, and in two years later they are in worse shape than they were before they went to the doctor. That’s sad. If somebody comes to you crying for help, let’s help them. Let’s not milk them.”

By Julia Roberts
Appalachian News-Express