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A judge on Wednesday ordered records unsealed in a case in which Kentucky alleged that improper marketing of the powerful painkiller OxyContin fueled a tide of addiction and death.

The maker of OxyContin, Purdue Pharma, agreed in December to pay the state $24 million to settle the lawsuit.

The settlement included a provision for many records from the legal fight to be destroyed, but some remain sealed in Pike County, where the state filed suit.

Those records include a sworn statement from Dr. Richard Sackler, a former Purdue Pharma president whose family controls the privately held company, according to a digital publication called STAT.

STAT, which is based in Boston and reports on life sciences and medicine, said in a news release that Sackler is believed to be the only member of the family questioned under oath about OxyContin marketing.

STAT sought a court order opening access to the records.

It said the documents are believed to contain new information on what Purdue Pharma executives knew about the addictive properties of OxyContin, a type of painkiller known as an opioid.

The state lawsuit accused Purdue Pharma of misrepresenting how easy it is to get hooked on OxyContin.

The company did not admit wrongdoing as part of the $24 million settlement.

Pike Circuit Judge Steven D. Combs on Wednesday granted STAT’s request to unseal documents in the case, saying the public’s right to the information outweighed Purdue Pharma’s objections.

The court “sees no higher value than the public (via the media) having access to these discovery materials so that the public can see the facts for themselves,” Combs wrote.

Combs said the documents would be made public in 32 days. However, he said his decision will be put on hold if it is appealed.

An attorney for Purdue Pharma said the company would appeal Comb’s order, STAT reported.

STAT issued a statement applauding Combs’ ruling.

“The national opioid epidemic is killing 30,000 people a year, and we are pleased that the court moved so swiftly to bring to light records that can inform the public’s understanding of Purdue’s role in this crisis,” said Rick Berke, executive editor of the publication.

By Bill Estep
Lexington Herald-Leader

Federal study finds counties at high risk of HIV/hep C spread; 8 out of top 10 are in Eastern Kentucky, study says

Letcher County is one of the nation’s 50 most vulnerable to an outbreak of HIV or hepatitis C from intravenous drug abuse.

Yes, it’s that bad, according to a preliminary report from the federal Centers for Disease Control and Prevention (CDC). Of the nation’s 25 most vulnerable counties, 16 are in Kentucky. Wolfe County is No. 1, but there’s probably not much difference in the risk there and in Breathitt, Perry, Clay, Bell, Leslie, Knox, Floyd, Clinton and Owsley counties, which are in the nation’s top 12.

The preliminary report by the CDC has identified 220 counties in the United States as being most vulnerable to outbreaks of HIV and hepatitis C among those who inject drugs in those communities, and 54 of those counties are in Kentucky. There are 3,144 counties in the United States. Most are in Appalachia, but the list includes the non-Appalachian counties of Hickman, Breckinridge, Grayson, Allen, Taylor, Boyle, Mercer, Carroll, Gallatin, Grant and Campbell.

Kentucky leads the nation in the rate of acute hepatitis C, with 4.1 cases for every 100,000 residents, more than six times the national average, according to the CDC.

“Both HIV and hepatitis C can be transmitted when people who inject drugs share their needles,” Doug Hogan, actingcommunications director for the Cabinet for Health and Family Services, said. “Many of Kentucky’s HCV cases are among rural youth, ages 12- 29, who have been sharing needles.”

Clark County Health Director Scott Lockard called the CDC report a “wake-up call.”

“We are potentially on the leading edge of one of the biggest public-health crises to hit our state,” Lockard told Kentucky Health News. “It will take a combined effort across sectors to prevent an HIV outbreak in the SOAR region such as the one that occurred in Scott County, Indiana,” north of Louisville.

Lockard made these comments in April after attending a Shaping Our Appalachian Region (SOAR) roundtable that focused on substance abuse and intravenous drug use in the region. More than half (56 percent) of the 220 counties identified as most vulnerable for HIV or hepatitis C were located in the Appalachian regions of Kentucky, Tennessee and West Virginia.

“About 25 percent of our state’s population lives in these 54 counties,” Hogan said.

The CDC began this study after an unprecedented outbreak of HIV infections occurred in Scott County, Indiana, in 2014 among its intravenous drug users to see what other counties might be vulnerable to such an outbreak.

Researchers looked at all 3,143 U.S. counties and based their rankings on six variables, including: the number of overdose deaths, per-capita-income data, unemployment data, population studies, prescription opioid sales, and prescription sales for opioid treatments such as buprenorphine.

The report points out that this does not mean that HIV or hepatitis C outbreaks are inevitable in these counties, or that there is a current problem with intravenous drug users in these counties, but says that intravenous drug users in these counties are at a higher risk.

One way to slow down the spread of HIV and hepatitis C is through needle exchanges, where intravenous drug users trade dirty needles for clean ones. Needle exchanges were authorized in Kentucky under a 2015 anti-heroin law but also require local approval.

So far, only Louisville and Lexington and the counties of Boyd, Carter, Clark, Elliott, Franklin, Grant, Harrison, Jessamine, Kenton, Knox, Pendleton and Pike are either operating or have approved such programs. Of the 54 high-risk counties, only Boyd, Carter, Clark, Knox and Pike counties have operating needle exchanges.

Hogan said, “The Kentucky Department for Public Health is working closely with (the) CDC and at-risk communities to increase HIV and hepatitis C testing, and is assisting counties in their processes of establishing syringe exchange programs.”

Here’s a list of Kentucky counties and their national rankings for vulnerability to the rapid spread of HIV and hepatitis C among people who inject drugs: Wolfe, 1st; Breathitt, 3rd; Perry, 4th; Clay, 5th; Bell, 6th; Leslie, 8th; Knox, 9th; Floyd, 10th: Clinton, 11th; Owsley, 12th; Whitley, 14th; Powell, 15th; Knott, 17th; Pike, 21st; Magoffin, 23rd; Estill, 25th; Lee, 30th; Menifee, 31st; Martin, 34th; Boyle, 35th; Lawrence, 39th; Rockcastle, 40th; Harlan, 45th; McCreary, 48th; Letcher, 50th; Johnson, 53rd; Russell, 54th; Elliott, 56th; Laurel, 65th; Carroll, 67th; Taylor, 75th; Grant, 77th; Adair, 93rd; Lincoln, 97th; Wayne, 99th; and Cumberland, 101st.

The Mountain Eagle


In a long-anticipated announceemnt, the Food and Drug Administration said today it is assuming regulatory authority over electronic cigarettes, which have become a growing concern among youths, especially in rural areas, 

e cigs banned for anyone under 18Tripp Mickle reports for The Wall Street Journal. FDA's new tobacco regulations will prohibit sales of e-cigarettes and all tobacco products to anyone under 18. Health warnings will also be placed on packages, saying, “WARNING: This product contains nicotine. Nicotine is an addictive chemical.” Rules also will "require manufacturers to submit products for approval." 

FDA "rules have the potential to upend the $3.5 billion e-cig industry," Mickle writes. "Many of the small vape shops, device manufacturers and liquid nicotine producers won’t be able to afford the FDA’s approval process, which could cost anywhere from $2 million to $10 million per item, according to the regulatory consulting company SciLucent LLC."

Greg Conley, president of the American Vaping Association, an industry-funded advocacy group, told Mickle, “This is going to be a grim day in the history of tobacco-harm reduction. It will be a day where thousands of small businesses will be contemplating whether they will continue to stay in business and employ people.”

By Tim Mandell
Institute for Rural Journalism blog



Respiratory Therapy Graduates Second-year Respiratory Therapy students passed their exit examinations on Monday, April 18.  Shown are: Stephanie Burkett, Amanda Crisp, Rebecca Justice, Tyra McKinney and Ashley Mullins.

PAINTSVILLE, Ky. – Big Sandy Community and Technical College’s (BSCTC) respiratory therapy program second-year students completed their exit examinations with a 100% pass rate.

The five students earned their degrees during a commencement and pinning ceremony on Saturday, May 7 at the Mountain Arts Center.

“I am extremely proud of our students,” said Melissa Skeens, coordinator of the respiratory therapy program at BSCTC. “The exit exam is comprehensive and part of the National Board for Respiratory Care.”

For more information on the respiratory therapy program, contact Skeens at (606) 788-2822 or email This email address is being protected from spambots. You need JavaScript enabled to view it.This email address is being protected from spambots. You need JavaScript enabled to view it..">.



Providing support and comfort in various ways to mothers giving birth is what the Fort Logan Hospital’s Birthing Spa aims to do, according to the unit’s medical director Dr. James Miller.

Ephraim McDowell Fort Logan Hospital is the first in the state to offer an alternative option for pain relief to women in labor in the form of nitrous oxide – more commonly known as “laughing gas.” 

Providing support and comfort in various ways to mothers giving birth is what the Fort Logan Hospital’s Birthing Spa aims to do, according to the unit’s medical director Dr. James Miller.

Miller said the use of nitrous oxide during labor was fairly common in the 1950’s but when epidural anesthesia came into play, laughing gas seemed to fall by the wayside. 

Now, Fort Logan Hospital’s Birthing Spa is bringing it back as a safe, new option for pain relief and in turn allowing mothers more control over the entire birthing experience. 

“We in our unit found, when we started hearing again about the nitrous oxide, that it just fit really well with our philosophy of trying to offer choices to moms,” Miller said. 

Miller said while epidural anesthesia still seems to be the most prominent pain management option offered to women in labor, the positive benefits have yet to be made evident. 

“Epidurals cost a lot and haven’t shown the benefits. And they changed labor from a low-risk setting to a high-risk setting,” Miller said. “With an epidural, we know that it drops the mom’s blood pressure, so they have to have an IV ahead of time and load up on fluids to try to prevent the drop in blood pressure, and then it can still happen. Then you have to monitor the baby’s heart tones.”

Miller said water births on the other hand have proven to show benefits such as lower cost and shortening the length of labor by naturally relaxing the mother

“When we remodeled and built the new hopsital eight years ago I wanted to change the name to ‘birthing spa’ and we’re really the only unit in the nation that uses that term,” he said. 

It’s that variety of resources and ongoing support from the entire unit’s medical staff that brings expectant mothers from all over to Fort Logan Hospital, Miller said. 

“That was the idea, we try to pamper women and offer a variety of support services that will help them through labor and we’re really good at it,” he said. “That’s kind of how we’re built and designed. The nurses have developed skills to almost function as a ‘doula.’”

Miller said there are several pain management options to choose from, for example if a mother doesn’t want an epidural there is IV medication and if a mother doesn’t want IV medication she can choose to use nitrous oxide. 

“The nitrous oxide just seemed like it was one more thing we could offer,” he said. “We can try the tub, the walking, the garden, the massage chair and position changes, all of those kinds of things.”

As he prepares mothers for child birth, Miller said he tells them there is going to be about a three-hour period where they are going to wish they could quit and go home and the nitrous oxide could help during that time period. 

“The nitrous oxide seems like it would come in handy during that time to help lessen anxiety and relax them and make them experience less pain,” he said. 

Nitrous oxide isn’t incredibly potent and it won’t take away all of the pain but it relaxes mothers enough to where they are less bothered by the pain, he added. 

“It’s very fast acting so when the pain is starting to contract, they start breathing the medicine and within seconds it takes effect and then as the pain resolves, they take the mask away and the medicine wears off that quickly too. So they don’t need any relief in between pain.”

In a statement released by the hospital Shannon Goff, director of the Birthing Spa, said the unit is excited to offer new pain management for mothers-to-be. 

“The patient controls it herself, so she can use it as much or as little as she feels necessary,” Goff said. 

According to the release, women can also use the nitrous oxide earlier in their labor than they would typically get an epidural. 

Miller said he expects other hospitals to adopt the use of nitrous oxide again at some point but he’s not sure that all will since it requires a more hands-on presence from medical staff. 

“There’s a lot of hands on help and it’s just a really different experience altogether,” he said. “Birth is very challenging but it’s an engineering marvel. We’ve found that the simple things that support mom seem to work the best and don’t delay the process.”

By Abigail Whitehouse
Interior Journal