Friday, November 29, 2019

Bullitt County schools to sue Juul, alleging it created e-cigarette epidemic that has cost schools money and instructional time

Bullitt Central High School Principal Joe Pat Lee watches students arrive on opening day. (BCPS photo)
The Bullitt County school board voted Nov. 25 to sue Juul Labs and other manufacturers of electronic cigarettes, as well as distributors and retailers.

"Bullitt County Public Schools, like every other school district in the country, has witnessed a dramatic increase in the use of vaping products by its students," the board's resolution said. "The targeting of school children by these companies in their marketing campaigns has resulted in an epidemic of nicotine addiction in children."

Juul Labs is the leading maker of e-cigarettes and has used research by traditional cigarette companies to make its devices the most popular and, critics say, the most addictive.

School Supt. Jesse Bacon said in a news release, “In recent years, we have seen a dramatic increase in the number of infractions that involve vaping in our middle and high schools. The amount of resources being used and the instructional time that is lost as a result of this issue is alarming, to say the least.”

Ron Johnson, the attorney hired to file the lawsuit, said it would be the first such suit by a Kentucky school district. "This year in Kentucky, there have been four lawsuits filed against Juul and more than 100 around the country," Sarah Ladd reports for the Louisville Courier Journal.

Juul Labs used research that tobacco-cigarette manufacturers wanted to use to get young people to become addicted to nicotine

In this screenshot of an April 2016 video, recently removed from YouTube, a co-founder of Juul Labs, James Monsees, presents an R.J. Reynolds research memo (YouTube image via Los Angeles Times)
In developing the world's most popular electronic cigarette, the founders of Juul Labs used the decades-old research of tobacco companies that was aimed at getting young people to smoke.

"A review by the Los Angeles Times of more than 3,000 pages of internal Juul records, obtained by the Food and Drug Administration and released to a researcher through the Freedom of Information Act, found that the concept behind the formula that makes Juul so palatable and addictive dates back more than four decades" to the laboratories of R.J. Reynolds Tobacco Co., the nation's No. 2 cigarette maker, Emily Baumgaertner reports for the Times.

"The key ingredient: nicotine salts," Baumgaertner writes. "Juul’s salts contain up to three times the amount of nicotine found in previous e-cigarettes. They use softening chemicals to allow people to take deeper drags without vomiting or burning their throats. And they were developed based on research conducted by the tobacco companies Juul claimed to be leaving behind. . . . The evidence depicts a Silicon Valley start-up that purported to 'deconstruct' Big Tobacco even as it emulated it, harvesting the industry’s technical savvy to launch a 21st century nicotine arms race."

Juul "acknowledged that the product intentionally 'mimicked' the nicotine experience of a traditional cigarette," but said that was to satisfy cravings of adult smokers, not children, Baumgaertner reports. "But a new generation of nicotine addicts has already been established, and health experts warn that millions of teenagers who currently vape could ultimately turn to other products like cigarettes for their fix."

A now-dead R.J. Reynolds researcher wrote in a confidential internal memo in 1973 that teenagers found the physical effects of smoking “quite unpleasant.” Later that year, another researcher proposed a cigarette design to get “a larger segment of the youth market” by packing “more ‘enjoyment’ or ‘kicks’ (nicotine)” while making it easier on the throat. An RJR chemist did that by using an acid to neutralize the high alkalinity of nicotine, creating a nicotine salt.

An RJR spokesperson told Baumgaertner that the research was intended to “reduce the risks” of smoking while “maintaining nicotine delivery,” and while the salts were patented, they were never used in a traditional RJR cigarette. In the late 1980s, RJR and three other cigarette makers "agreed to begin paying billions of dollars to compensate states for having knowingly propelled a smoking epidemic," Baumgaertner writes. "Within this climate, the company was unable to combine its two technical triumphs — palatable salts and early vaping equipment."

But RJR's research was used by Juul's developers, Baumgaertner reports: "Juul records show the start-up collected research done by tobacco experts about nicotine — work on using salts to control harshness, written by a former top scientist at Reynolds, as well as methods to maximize nicotine delivery, and piles of literature on nicotine’s impact on adolescent brains."

Juul cofounder James Monsees said at a 2018 conference, “Certainly, the nicotine salt chemistry was one of the big breakthroughs.”

The patent for Juul's nicotine-salt formula refers to RJR's patent, saying Juul's founders “unexpectedly discovered” the “efficient transfer of nicotine to the lungs of an individual and a rapid rise of nicotine absorption in the [blood] plasma.”

David Kessler, a pediatrician who headed the Food and Drug Administration in 1990-97, during its tobacco investigation, told Baumgaertner, “Addiction is central to the business model. With their nicotine salts, Juul has found the Holy Grail.”

Before Juul was introduced, "Most vaping fluids contained 1% to 3% nicotine, the latter described as 'super high' and intended for two-packs-a-day smokers,: Baumgaertner reports. "Juul offers pods that contain 5% nicotine, according to the company’s website. . . . From 2016 to 2017, Juul’s sales skyrocketed by more than 640%. Its cartridges were so palatable that teenagers sometimes raced one another to finish inhaling them. Many said they didn’t know the pods contained nicotine. Each 5% cartridge contained the nicotine equivalent of about 20 cigarettes."

Matthew Myers, the president of the Campaign for Tobacco-Free Kids, told Baumgaertner, “Juul mimics the evil genius of the cigarette — but does it even better. They also pulled it off without any of the historical baggage, giving the deceptive illusion that it was safe.”

Doctors think nicotine salts allow the chemical to “cross the blood-brain barrier and lead to potentially more effect on the developing brain in adolescents,” Anne Schuchat, chief deputy director of the federal Centers for Disease Control and Prevention said at a congressional hearing in September. She told the Times that the salts “allow particularly high levels of nicotine to be inhaled more easily and with less irritation” than earlier e-cigarettes, "and could enable nicotine dependence among youth," Baumgaertner writes.

She concludes, "Today, Juul comprises about two-thirds of the vaping market. In 2018, the largest tobacco company in the U.S.," Altria Group, "purchased a 35% stake in Juul. After the purchase, several of the tobacco company’s employees also started working at Juul . . .In September, Altria’s former chief growth officer, K.C. Crosthwaite, became Juul’s CEO."

Kentucky state senator taken aback by 'shoutfest' in White House between electronic-cigarette interests and their foes

State Sen. Julie Raque Adams speaks in the White House Nov. 22 as President Trump and Health and Human Services Secretary Alex Azar listen. (Image from White House video, via WDRB-TV)
A Kentucky state senator witnessed what one report called a "shoutfest" in a White House meeting hosted by President Trump between lobbyists for health interests and those for electronic cigarettes.

Sen. Julie Raque Adams, a Republican from Louisville, "says she was taken aback by the lack of decorum shown by vaping industry executives," reports Joe Sonka of the Courier Journal.

"There was a lot of passion in that room," Adams told Sonka. "Frankfort is tamer than that meeting was."

Trump said in September that he would ban all e-cigarette flavors except tobacco and menthol, then backed off in the face of protests from users, retailers and manufacturers.

Adams got a surprise invitation to the Nov. 22 meeting only two days in advance. The White House described it as a roundtable discussion that would likely be private so the two sides could speak frankly, she said.

But soon after she voiced concern that "We have a whole new generation addicted to nicotine," and said many teenagers don't know e-cigarettes contain the drug, Trump "suddenly asked if it was OK to allow news media into the room, she said."

That is not mentioned in the White House's incomplete transcript of the meeting, which indicates that Adams was the first guest Trump asked to speak.

Adams recounted, "I said beyond anything, we have to look at keeping nicotine out of the hands of teens, because research shows that the sooner they're introduced to nicotine, they're more susceptible to become addicted to other substances. It messes with their brain chemistry. So the longer that we can keep nicotine out of the hands of teens, the better it would be for my state."

Not long after she spoke, "People started getting really loud and talking over each other," she told Sonka. "And I was really surprised in that setting that there wasn't a higher level of respect between people."

Sonka writes, "Adams added that Trump appeared to enjoy the 'free for all' to see what was driving the arguments of the different groups but cut in several times to 'rein them back in.'

"It was interesting to watch [Trump] because he was clearly not disturbed by the back and forth in the banter and the kind of aggressiveness," Adams told Sonka. "Everybody in the room was super-passionate about the issue. And then he would bring everybody back to a more respectful level, and then the passion would get wild again and then he tried to bring it back."

She said Ryan Nivakoff, CEO of e-cigarette manufacturer NJOY, and American Vaping Association President Greg Conley were "by far the loudest voices in the room," dispuiting arguments of Sen. Mitt Romney, R-Utah, who wants to ban flavored e-cigarettes.

"Nivakoff and Conley said such a ban would put companies and independent vaping shops across the country out of business while taking away an option that many adults have used to quit smoking cigarettes," Sonka reports. "However, Adams says those vaping-industry officials provided four areas in which they were ready to compromise, including raising the age limit for purchasing tobacco and vaping products to 21, a self-imposed marketing ban, increasing punishment for retailers selling to anyone under 21, and increasing oversight of vape shops by local health officials."

Adams "said she supports addressing the issue of marketing products to teens and thinks it is worth having a continued conversation about flavored products," Sonka reports. She plans to sponsor a bill in the legislative session that starts Jan. 7 that would raise the age to buy tobacco products to 21.

"Adams said she was glad to attend the meeting and to get her perspective in front of the president," Sonka writes, quoting her: "You know me, I'll work with conservatives, liberals, moderates. This issue, I'm just very passionate about it, because we save a lot of tax dollars by having a healthy Kentucky."

Thursday, November 28, 2019

Substance abuse drives decrease in life expectancy in U.S., Ky.

Charts from report show impact of drug overdoses; ages 45-54 showed an increase almost as steep.
By Al Cross
Kentucky Health News

Americans are dying younger, and Kentucky is a big part of that.

The most basic measurement of a population's health, life expectancy at birth, has decreased in the United States for three straight years, and in Kentucky for four. The leading cause is drug overdoses, but there are many other factors.

In 2000, Kentucky had a mortality rate of 425 deaths per 100,000 people; in 2017, the rate was 512 per 100,000, an increase of 20 percent. Most of that increase, 14.7 percentage points, occurred from 2010 to 2017, according to a study published in the Journal of the American Medical Association.

Eight states had greater increases: New Hampshire, 23.3%; West Virginia, 23%; Ohio, 21.6% Maine, 20.7%; Vermont, 19.9%; New Mexico, 17.5%; South Dakota, 15.5%; and Indiana, 14.8%.

For a larger version of any image, click on it.
The study calculated the "excess deaths" caused in 2010-17 by the increase in midlife mortality, defined as deaths of people aged 25 to 64. It said there were 1,524 excess deaths in Kentucky, 1,839 in Indiana, 3,179 in Pennsylvania (where the mortality rate rose 14.4%) and 4,730 in Ohio. The study report said higher midlife mortality in 2010-17 "was associated with an estimated 33,307 excess U.S. deaths, 32.8% of which occurred in four Ohio Valley states."

The report said, "The increase in opioid-related deaths is only part of a more complicated phenomenon and does not fully explain the increase in midlife mortality rates from other causes, such as alcoholic liver disease or suicides (85.2% of which involve firearms or other non-poisoning methods.) . . . Two recent studies estimated that drug overdoses accounted for 15% or less of the gap in life expectancy between the United States and other high-income countries in 2013 and 2014, respectively."

Other possible causes include high rates of tobacco use (including effects that linger despite lower smoking rates), obesity and socioeconomic factors: "substantial job losses in manufacturing and other sectors, contraction of the middle class, wage stagnation, and reduced inter-generational mobility. Income inequality widened, surpassing levels in other countries, concurrent with the deepening U.S. health disadvantage. . . . Increases in death rates were concentrated in areas with a history of economic challenges, such as rural U.S. areas and the industrial Midwest."

Dr. Steven H. Woolf
The study was done by Dr. Steven Woolf of Virginia Commonwealth University in Richmond and Dr. Heidi Schoomaker of Eastern Virginia Medical School in Norfolk.

"We found increases in 35 causes of death," Woolf told "An increase in mortality spanning 35 causes of death is difficult to blame on a single cause, such as the opioid epidemic or obesity. The pervasive trend suggests a systemic cause, something distinct that is causing this to occur in the United States and not other wealthy nations. . . . Job losses in manufacturing and other sectors, stagnant incomes, and widening income inequality could contribute to poor health in multiple ways and would explain the disproportionate impact we observed in the Rust Belt and other areas hit hard by the economy. This suggests that, while it is important to treat the 'symptoms' of this trend (addressing drug abuse, the obesity epidemic, etc.), social and economic policies to improve education, create good jobs, and invest in communities may be even more important in reversing this trend. If we fail to act, the trend is likely to continue, and that will mean that our children will live shorter lives than ours."

Wednesday, November 27, 2019

New state Medicaid contracts drop Passport and Anthem, which say they will appeal; top Beshear aide voices concern

On its way out, the administration of Republican Gov. Matt Bevin has given five health-insurance companies new, five-year deals to manage the care of Kentuckians on Medicaid -- and dropped Anthem Inc. and the nonprofit Passport Health Plan, which now have contracts with the state.

The three returning firms are subsidiaries of Aetna, Humana and WellCare. The two newcomers are UnitedHealthcare Community Plan of Kentucky and Molina Healthcare of Kentucky. The new contracts would replace the old ones on July 1, unless Passport and Anthem win protests they say they will file.

On Dec. 10, Bevin will be replaced by Democrat Andy Beshear, who defeated him this month. Beshear's top aide, J. Michael Brown, issued a statement saying, “Awarding $8 billion in contracts with just 11 days left in this administration is concerning. As we move through the transition and ultimately the change of the administration, we will be taking a close look at this action.”

The insurance-company subsidiaries are known as "managed care organizations." MCOs manage the care of about 1.2 million Kentucky Medicaid beneficiaries, which costs $8 billion a year, with about 80 percent of the money coming from the federal government.

"The Bevin administration solicited bids for the contracts over the summer, but the announcement of the successful bidders has been delayed," reports Chris Otts of Louisville's WDRB-TV. The Cabinet for Health and Family Services, which oversees Medicaid, referred questions to the Finance and Administration Cabinet, where spokeswoman Pamela Trautner said in an email that contracts were awarded competitively.

Trautner wrote: "Proposals were submitted by prospective MCOs, which were evaluated and scored by a technical evaluation team comprised of subject matter experts against the evaluation criteria stated in the RFP. The RFP stated that between three and five awardees would be selected. The five highest scored vendors were selected. Because Passport and Anthem were not among the five most highly scored proposals, they were not awarded a contract."

Passport is a nonprofit formed in 1997 to get the state into the business of managed care, with the goal of saving taxpayers' money. The company said in a news release that it was "deeply disappointed" by the decision and that it plans to challenge the outcome. Anthem also plans to challenge the decision, Deborah Yetter reports for the Louisville Courier Journal.

Passport serves more than 300,000 Kentuckians on Medicaid, mostly in the Louisville region. Anthem serves 130,000 enrollees in Kentucky, mostly outside Louisville, Yetter reports.

Bevin and Passport have a conflict that predates his governorship. In May 2015, Passport gave $25,000 to the Democratic Governors Association, which supported Bevin's Democratic foe, Jack Conway. Passport said the money funded a one-day health-policy conference in Louisville. In 2018, the state cut some MCOs' payment rates, and Passport said it was hit hardest and almost went out of business. "Bevin had been critical of Passport, calling it 'poorly run'," Yetter notes.

In May, Evolent Health, a health-management firm, agreed to buy 70 percent of Passport, but told investors "that the company would likely liquidate Passport, selling it for parts, if Passport failed to win the next round of Medicaid business from Kentucky," Otts reports.

Evolent spokeswoman Kim Conquest told Yetter that the company supports Passport's decision to protest the loss of the contract and that Evolent "will continue to support efforts to keep the plan on solid financial footing. Per our agreement, we intend to proceed with the pending acquisition as planned and anticipate it will close by the end of this year.”

"Should the deal fall through, the University of Louisville, as a founding partner of Passport, could lose about $45 million from the sale," Yetter notes. U of L spokesman John Karman told her that the university is disappointed in the decision: "U of L is proud of its longstanding relationship with Passport and supports its decision to challenge the outcome of the evaluation and award process for this contract."

Yetter notes that most of the company's main revenue comes from managing care for Kentucky Medicaid. Anthem, by contrast, is one of the nation's largest health-benefit companies.

Passport spokesman Ben Adkins told Yetter that the company has about 600 employees in Louisville.

"This decision, if upheld, would have a profound impact on our 300,000-plus members whose access to care will be disrupted as a result," he told Yetter. "We strongly encourage state leaders to reconsider this decision and its devastating impact on our proud Kentucky company and the communities we serve."

The Cabinet for Health and Family Services said in its news release announcing the contracts thay they include a number of improvements, including a a separate contract with WellCare to cover all children in the state's foster-care system.

The contracts also include, among other things, provisions for tighter management of the prescription drug program, including abolishing "spread pricing," a system in which middlemen known as pharmacy benefit managers can profit by paying pharmacists less than they make from state Medicaid programs.

Louisville newspaper tracks huge, powerful and violent drug cartel's invasion of small towns in Kentucky and other states

Courier Journal illustration shows farm worker who oversaw flow of $30 million in drugs into Kentucky.
The tentacles of a huge, powerful and violent drug cartel reach from Mexico into unlikely places in Kentucky and other states, Beth Warren reports for the Louisville Courier Journal.

The "New Generation Jalisco Cartel," is known by its Spanish name, C├írtel Jalisco Nueva Generaci├│n and its acronym. "CJNG’s increased distribution of fentanyl across the country has helped the synthetic opioid unseat heroin as the nation’s No. 1 killer," Warren writes. "The billion-dollar criminal organization has a large and disciplined army, control of extensive drug routes throughout the U.S., sophisticated money-laundering techniques and an elaborate digital terror campaign, federal drug agents say."

CJNG’s network reaches into "the mountains of Virginia, small farming towns in Iowa and Nebraska, and across the Bluegrass State" of Kentucky, Warren reports. "A cartel member even worked at Kentucky's famed Calumet Farm, home to eight Kentucky Derby and three Triple Crown winners. . . . CJNG members have followed relatives or friends who left Mexico for the U.S. to find jobs. The cartel exploits its connections with otherwise hard-working immigrants, said Dan Dodds, who leads DEA operations in Kentucky, Tennessee and West Virginia.

Ciro Macias Martinez, now serving a 31-year prison term, "led a double life, working as a horse groomer by day and overseeing the flow of $30 million worth of drugs into Kentucky by night before being imprisoned in 2018 for meth trafficking and money laundering, federal records show," Warren writes. "No sooner had authorities busted Kentucky's CJNG ring than the cartel replaced Macias, sending in another team. It hauled in more than 3 kilos of fentanyl, the synthetic opioid so potent that an amount as small as Abraham Lincoln's cheek on a penny can be fatal."

In Paducah, sheriff's investigators said the cartel warned a business owner who fell behind on a drug debt, "If we don’t get our money, we’re gonna kill you and your family." Russell Coleman, U.S. attorney for the Western District of Kentucky, said, “We’re fighting a war for our families, and (the cartels) are winning.”

CJ Editor Rick Green explained to readers that the paper made the effort because "It's a local story."

Tuesday, November 26, 2019

Report says Kentucky Medicaid could save nearly $240 million by cutting middlemen between drug makers and pharmacists

Kentucky's Medicaid program could save nearly $240 million a year by eliminating pharmacy benefit managers and returning to its old "fee for service" system of reimbursing pharmacists for each prescription, a state report says.

Pharmacy benefit managers are the middlemen between insurance and drug companies. The PBMs have much power; they determine what drugs are offered, how much someone pays for the drug, and the payments to pharmacists.

The report was done by the independent accounting firm Myers and Stauffer, which is a national expert on prescription drug pricing, Deborah Yetter reports for the Louisville Courier Journal.

Kentucky lawmakers have been working on PBM issues for years. Most recently, they called for increased scrutiny of PBMs' pricing practices. The bill's sponsor, Republican Sen. Max Wise of Campbellsville, told Yetter that this report sheds some light into what's in the "black box" as lawmakers look into "unfair practices that are harmful."

Wise was referring to a separate report issued earlier this year, "Medicaid Pharmacy Pricing: Opening the Black Box," which found two PBMs kept $123.5 million last year from the state's Medicaid program by paying pharmacies a lower rate to fill prescriptions, while charging the state more for the same drug, a process that is called "spread pricing."

Wise told the Courier Journal that he didn't know what would result from the report, but said he plans to "take it up with legislative leadership to discuss possible changes in state law," Yetter writes.

Independent pharmacies in Kentucky and around the nation have said for years that the payment practices of PBMs are so bad that they threaten their survival.

Greg Lopes, a spokesman for the Pharmaceutical Care Management Association, a trade group for the PBMs, told Yetter, “Pharmacy benefit managers are hired to reduce prescription drug costs and improve the quality of benefits for consumers, employers, and public programs, including Medicaid."

The report makes no recommendations on what Kentucky should do, and a spokeswoman for the Cabinet for Health and Family Services, which oversees Medicaid, told Yetter that its Department of Medicaid Services, which sought the study, had no recommendation either.

But Kentucky pharmacists were quick to call for reform, Yetter reports.

"The savings estimated in this report demonstrate that overpaying PBMs to administer pharmacy benefits is an untenable situation that must be remedied," Don Kupper, president of the Kentucky Pharmacists Association, said in a statement.

And Rosemary Smith, co-founder of the Kentucky Independent Pharmacists Association, told Yetter that the report provides a much-needed framework to reform the system. Smith and her husband, Luther, own six Eastern Kentucky pharmacies.

"We need to act immediately," Yetter heard from Shannon Stiglitz, vice president of government affairs for the Kentucky Retail Federation. "For many years, the pharmacy benefit managers have told us they save dollars," she said. "Now we know and this report is evidence that those savings go to their bottom line at the expense of patients, taxpayers and providers."

Kentucky Medicaid, which gets about 80% of its money from the federal government, spends about $1.5 billion a year on drugs. The report estimates that eliminating PBMs, it could save about $237.5 million a year — keeping about $45 million for itself, with the rest of the savings being the federal share of the money, Yetter reports.

"That conflicts with the findings of state Medicaid officials in 2018 that a carve-out of prescription drugs could cost the Medicaid program an additional $200 million a year, $36 million of that in state funds," Yetter writes.

Both Smith and Kupper recommend returning to the fee-for-service system, which is already used for patients outside Medicaid managed care, such as nursing home residents and those in special Medicaid programs for people with disabilities, Yetter reports.

"We already have the system in place to take this back," Smith said. "We have the resources. We have the staff and we can save the state all of this money."

The state Medicaid program contracts with five managed care companies that in turn subcontract with PBMs. The PBMs then contract with pharmacies. CVS Caremark, an affiliate of the drugstore chain, has most of the PBM business in Kentucky, handling prescription drug claims for four of the five managed-care companies.

How to enjoy holiday-season foods, without the weight gain

Seasonal, calorie-rich holiday foods that show up on Thanksgiving Day and stick around until New Year's Day can be detrimental to the waistline. But the good news is that there are strategies which will allow you to enjoy all of your favorite foods without the unwanted weight gain.

Beth Ackerman of the University of Louisville Physicians Diabetes and Obesity Center offers several tips to keep your weight in check on the U of L Physicians blog.

Eat regular meals: Don’t skip breakfast and hold out for the big meal. Instead, eat regular meals and don’t stuff yourself.

Cut down on leftovers: Because holiday foods are often high in calories, consider cutting recipes in half, and if you do end up with leftovers, freeze them for another meal on a different week.

Portion size is the key: Keep portions to a couple of tablespoons instead of a full serving. This way you can have a little bit of all your favorite dishes.

Hide tempting food: Place tempting foods, like pies and cookies, in containers in the pantry.

Healthy choices: Make sure to also offer lower-calorie foods such as vegetable trays or fruit trays so guests can enjoy healthy alternatives.

Start a new tradition: Take a walk, play a game of basketball or go shopping after the big meal to burn off some calories.

Make some swaps: Choose sweet potatoes instead of sweet potato casserole; a wheat roll instead of a biscuit; or fruit instead of a slice of pie.

Fill up on veggies: Veggies will keep you full, and maybe help you avoid a second dessert.

Saturday, November 23, 2019

Employer-sponsored insurance health plans in Ky. more costly in 2018; high premiums and deductibles leave many underinsured

By Melissa Patrick
Kentucky Health News

A recent analysis by The Commonwealth Fund, a foundation interested in the health-care system, shows that the overall cost of employer-sponsored insurance plans keeps going up, and families are spending more of their income on health care.

“The majority of people under age 65 in the U.S., 164 million, get their health insurance through an employer, and that insurance is less and less affordable for many of them,” Dr. David Blumenthal, president of The Commonwealth Fund, said in a news release. “Ensuring that everyone can afford health insurance and health care will require policy fixes and systemwide efforts to get to the heart of the health care cost problem: the exorbitant prices we often pay for health care in the United States.”

The analysis found that Kentucky families covered through employer plans spent on average, 13 percent of their yearly income for health coverage in 2018 -- or $7,471 in out-of-pocket spending. That was slightly above the national average of 11.5%.

That was a 3.1% increase from 2016, compared to a 4.4% jump in the national rate. But when you compare the state's average potential out-of-pocket spending in 2018 to what Kentuckians were paying a decade ago ($3,886), it's up 92%.

And because Kentuckians make less money on average than people in other states, they spend a larger share of their incomes on their premiums and deductibles. For example, in Kentucky, the median household income in 2018 was $50,247, compared to $61,937 nationally.

“Over the last decade, employer health-insurance premiums and deductibles have grown faster than workers’ wages. This is concerning, because it may put both coverage and health care out of reach for millions of people," Sara Collins, lead author of the study, said in the release.

The analysis of Kentucky empoloyer-based insurance shows that the premium cost for single-coverage plans saw the biggest jump between 2016 and 2018, from $1,290 to $1,633, or 12.5%. The rest of the nation saw a 3.8% increase for this measure.

Deductible costs for single coverage dropped 1.9%, to $1,833; deductibles for the combined average of single and family coverage dropped 3.2%, to $2,930; and premiums for family coverage increased 6.6%, to $5,382. Changes nationally were higher for the deductible costs, but lower for the premium cost.

Offering a bit of perspective, the Commonwealth Fund points out that high-deductible plans leave many people at risk of being underinsured, which is defined as having a deductible equivalent to 5% or more of their income. That said, a $2,930 deductible would leave many middle-class families in Kentucky underinsured, making it difficult for them to pay their medical bills and more likely resulting in skipping care because of the cost.

In general, the report says, employees pay about one-fourth of U.S. employers’ portion of the premium costs -- and that holds true in Kentucky. Employer-sponsored insurance premiums, which includes contributions from both the employer and employee, for single coverage in Kentucky in 2018 was $6,690 (up 7.8% from 2016) and $19,277 for family coverage (up 7.5% from 2016).

The researchers note that recent proposals to address the rising cost of health insurance include enhancing the affordability and cost protection of Affordable Care Act marketplace plans, allowing people with employer plans to buy coverage on the marketplace, or replacing private insurance with a public plan like Medicare.

The study used data from the federal Medical Expenditure Panel Survey. Researchers surveyed more than 40,000 business establishments in 2018, with an overall response rate of 67.8%. It looked at both premiums, the amount a person has to pay each month for their plan, and deductibles, the amount a person has to pay before an insurance company's payments kick in; and the size of the costs relative to the median income in each state.

Friday, November 22, 2019

Words matter when writing about addiction, and wrong words increase stigma that impedes recovery; speakers offer advice

By Melissa Patrick
Kentucky Health News

ASHLAND, Ky. -- The words used to describe drug addiction and those suffering from it can either perpetuate the stigma that is attached to the disease or can help people move beyond it, and journalists have a responsibility to stop using stigmatizing language.

Bishop Nash and Lyn O'Connell speaking  in Ashland Nov. 15 at
"Covering Substance Abuse and Recovery: A Workshop for Journalists"
That was the main message of the last two speakers at the Nov. 15 workshop in Ashland, Ky., "Covering Substance Abuse and Recovery: A Workshop for Journalists," sponsored by the University of Kentucky's Institute for Rural Journalism and Community Issues and Oak Ridge Associated Universities.

"Nobody has the power to change language like us," said Bishop Nash, most recently the health reporter at the Herald-Dispatch in nearby Huntington, W.Va., a city that has been called the epicenter of the opioid epidemic. “That's just how it is and I feel it in my heart to do it for my people."

Nash said he, like many other reporters, has had to learn to write differently about addiction, but once he understood the science of the disease and why it was important to not use stigmatizing language, it has been an easy switch.

"It really requires a change of heart," he said. "When you get your heart wrapped around this issue, you really don't have to think about it."

Nash gave credit to Lyn O'Connell, the associate director of community services in the division of addiction sciences in family medicine at Marshall Health in Huntington, for helping him and others in the area understand why the words journalists use to cover addiction matters.

O'Connell, who spoke first, explained that after making regular phone calls to the Herald-Dispatch, including ones to Nash, and asking them to print less stigmatizing headlines, she realized the journalists and their editors just didn't know any better, so she compiled a set of guidelines on how to cover addiction and set out to teach them. O"Connell shared some of those guidelines at the day-long workshop.

Like other speakers at the conference, O’Connell said stigma is what keeps many people with substance use disorders from seeking treatment. She added that it also keeps lawmakers from providing adequate funding for programs to support them.

"So if they see these damaging headlines, it's only going to perpetuate these diseases in our communities," she said.

She encouraged journalist to use non-stigmatizing language, and offered four suggestions.

First, she said it's important to use "people-first language." For example, write "an individual with a substance-use disorder" instead of the more stigmatizing term "addict." "Remember that we are talking about a human and we should put the human first in a sentence," she said.

O'Connell also noted the importance of focusing on the medical nature of a substance use disorder. She pointed out that we don't call people with cancer "those cancer people" and asked why would we de-humanize a person with a substance-use disorder, which is a chronic disease, and call them an addict.

She also encouraged using language that promotes recovery. For example, instead of saying "an individual with a substance-use disorder," when appropriate say "an individual in recovery."

It's also important to avoid perpetuating negative stereotypes and biases through the use of slang and idioms, she said. In other words, don't use words like junkie, addict, user, abuser, crack-head.

She also encouraged journalists to move away from writing or saying "substance abuse," which she said has criminal under-tones. Instead, she said be medically accurate and use the term substance use disorder, which is what it is. "I think this is one of the hardest adjustments," she said.

She offered several more suggestions, including making sure you only mention the details of a person's addiction if it is relevant; to never say an infant is born addicted, but to instead say it was born experiencing exposure or withdrawal; and to not ever use the words "clean or dirty" to describe a drug screening, but to instead say it was positive or negative for the substance. She also said to make sure the images and photographs used in a story are accurate and are images that promote treatment and recovery.

She concluded by noting that addiction is a complex, chronic-relapsing disease that is the result of many different factors, and that most individuals in treatment have a history of trauma.

She said, "When we don't consider the entire person in that story, we're missing out on a lot of who that person is, and the back history."

Nash said he initially thought all of these changes would "clog” his writing and that readers would roll their eyes and say, "Oh, the PC police are out." But since, he said he has evolved to writing substance use disorder on first reference because that establishes it as a disease, and then refers to it as an addiction because that is the word his readers understand.

"This isn't about being politically correct," he said. "This is about being right in the science with it."

A person in the audience noted the struggles editors face in trying to fit so many words into a headline and said alternative, smaller words are needed that are also appropriate to use.

"That just speaks to the importance that you should not just be teaching this to reporters," Nash said. "You've got to teach this to editors, you've got to teach this to copy desk people, and the hardest thing is that you've got to teach this to a lot of people who are set in their ways."

Nash recognized that a reporters job is to report, and to not sugarcoat the news, but said there is no reason that the words they use should add to the stigma.

He said, "I believe that state and local journalists in particular have a moral imperative for the greater public good in the communities they serve."

State health department offers food safety tips to keep your family and guests safe during the holiday season

A properly prepared turkey and safe food handling practices go a long way in keeping friends and families safe from foodborne illness during the holiday season, and the state health department is offering tips on how to do just that.

Centers for Disease Control and Prevention photo
Defrosting the turkey:There are three safe ways to thaw a turkey: in the refrigerator, in cold water and in the microwave. Never thaw a turkey or other meats on the kitchen counter.

The safest way is to thaw it in the refrigerator. Leave the turkey in its original wrapping and place it on a tray in the bottom section of the refrigerator. Every five pounds needs at least one day to thaw in the fridge, so a 10-pound turkey will take two full days and a 20-pound bird will need at least four.

Turkeys can also be thawed in a cold-water bath. This requires submerging the bird in its original wrapper in cold tap water and adding new cold water about every 30 minutes. Every pound needs about 30 minutes to thaw, so a 10-pound bird would need five hours. Using this method, the turkey must be cooked immediately.

For thawing in a microwave, the health department recommends following the guidelines for thawing that came with the appliance. Turkeys thawed in the microwave also must be cooked immediately.

Be wary of cross-contamination: "Wash your hands, but not your turkey!" That's the advice of the U.S. Department of Agriculture. USDA warns that it's nearly impossible to wash bacteria off the bird, and juices that splash during washing can transfer bacteria onto kitchen surfaces, other foods and utensils. The best way to avoid the spread of harmful bacteria is to wash your hands with warm water and soap for 20 seconds before and after handling the turkey and its packaging.

The only way to destroy bacteria on a turkey is to cook it to a minimum internal temperature of 165 degrees Fahrenheit as measured by a food thermometer. Be sure to check the turkey's temperature in the innermost part of the thigh and wing, and the thickest part of the breast.

Safe cooking temperatures for other foods: Seafood, 145 degrees Fahrenheit; ground beef, veal, lamb and pork, 160 degrees; ground turkey, chicken and other poultry products, 165 degrees.

Keep it clean: Keep utensils and surfaces clean with hot, soapy water. And wash your hands before and after handling all food. It's also important to wash fresh fruits and vegetables before preparation.

Separate foods: Use two cutting boards, one for meat and the other for everything else. And never put cooked food back on plates or platters where raw meat or poultry was previously stored.

Safe Food Storage:Keep hot foods at 135 degrees or warmer. Keep cold foods at 41 degrees or below. And foods that sit out for longer than two hours should be discarded. Remember, when in doubt, throw it out!

Eggs: Use pasteurized eggs for dishes containing raw eggs because Salmonella and other harmful germs can live on both the outside and inside of them. Pasteurized shell eggs can be identified by a red “P” in a circle stamped on the shell. And as a reminder, the health department says to never eat uncooked cookie dough or batter, which may contain raw eggs.

Leftovers: Refrigerate leftovers as quickly as possible, preferably in shallow containers that can cool off more quickly. The shelf-life of leftovers varies, but most are only good for three to four days. Frozen leftovers will last between two and six months. Reheat all leftovers to 165 degrees Fahrenheit throughout or until steaming hot. Soups, sauces and gravies should be brought to a rolling boil for at least one minute.

Signs and Symptoms of Foodborne Illness

Food poisoning symptoms may range from mild to severe and may differ depending on the germ. The most common symptoms are upset stomach, stomach cramps, nausea, vomiting, diarrhea and fever. Symptoms may take hours or days to show up. The federal Centers for Disease Control and Prevention recommends seeing a health care provider if your symptoms are severe, including bloody stools, a temperature over 102 degrees Fahrenheit, frequent vomiting, signs of dehydration and diarrhea that lasts more than three days.

Each year, the CDC estimates one in six Americans get sick from eating contaminated food, and of those 48 million people, 128,000 are hospitalized and 3,000 die.

Thursday, November 21, 2019

Kentucky offers free service to help teens quit vaping and smoking; Courier Journal reports on how few teen options exist

In an effort to help teenagers stop vaping, the Kentucky Department for Public Health has launched a free service called “My Life, My Quit.”

The service allows teens who want to quit using electronic cigarettes or other tobacco products to text or call a toll-free number, 1-800-891-9989, and be connected with a "quit coach" who will provide up to five confidential, free sessions to help the teen create a personalized quit plan. 

"The quit coach will help them develop strategies to cope with stress, address symptoms of withdrawal, and navigate social situations," says the news release.

“We know how difficult it is for young people to find effective help quitting tobacco products, especially help that is tailored just for them,”  the health department’s Elizabeth Anderson-Hoagland said in the release. “But we also know that with help and support, young people can successfully quit tobacco, including vaping.”

Data from Kentucky Incentives for Prevention survey; graphic from
Sept. 18 DPH Power-Point presentation
E-cigarette use among Kentucky's teens nearly doubled from 2016 to 2018, with more than one in four high-school seniors and one in seven eighth-graders reporting use last year, according to the Kentucky Incentives for Prevention study.

Bailey Loosemore of the Louisville Courier Journal reports in detail about the difficulties in finding help for teens who want to quit vaping. She writes, "As the health community plays catch-up with the electronic devices, advocates admit little research has been done on cessation for teens."

A Louisville mother told Loosemore about her son who at age 17 started using Juul products, the most popular brand of e-cigarette. She said at minimum he used "at least a pod a day," which is the equivalent of a full pack of cigarettes. This, she said, has led to an addiction to nicotine that he is unable to kick, despite trying several nicotine replacement therapies. He is now 19.

The mother said she has since learned that "patches cannot replace the amount of nicotine that's in these pods" and that they are looking at inpatient therapy programs as an option for her son.

"He wants to stop," she told Loosemore. "I'm telling you, he can't."

In a letter to the U.S. Food and Drug Administration, the mom writes, "There are countless victims like my son who desperately need help."

Loosemore offers several tips to help teens quit, including:

Kentucky’s diabetes problem continues to worsen; rate now at nearly 13%, seventh highest in the nation

The number of adults with diabetes and pre-diabetes in Kentucky continues to rise, according to the 2019 Kentucky Diabetes Report. The number of adults in the state with diabetes has nearly doubled since 2000 to 12.9 percennt, or more than 440,000 adults. In 2000, that rate was 6.5%. Kentucky ranks seventh highest in the nation for this measure. November is National Diabetes Month.

Most adults in Kentucky with diabetes have type 2 diabetes, which occurs when a person's body becomes resistant to insulin, the hormone that helps the body use blood sugar for energy, or stops producing enough insulin to maintain normal blood sugar levels. Because of this, their blood sugar levels rise. A person with type 1 diabetes makes no insulin, and needs to take some every day to live.

The diabetes rate is even greater in Appalachian Kentucky, where 17% of the population has been diagnosed with the disease, compared to 11.2% in the non-Appalachian counties. They were also higher among Kentucky’s Medicaid population, 16.2%.

Pre-diabetes rates have also gone up, with one in 10 Kentucky adults being told they had pre-diabetes in 2017, or more than 288,000 people. That rate was 7.8% in 2011, the first year it was measured.

That said, it is estimated that one in three Kentucky adults, or 1.1 million, have pre-diabetes.

Pre-diabetes is a condition that occurs when the body's blood sugar levels are abnormally high, but not quite high enough to be considered type 2 diabetes.

And while many think that pre-diabetes is nothing to worry about, often saying they have "just a touch of sugar," it should be taken seriously because it puts that person at high risk of getting type 2 diabetes, which can cause a long list of health conditions.

The Mayo Clinic says type 2 diabetes "dramatically increases the risk of heart disease, stroke, high blood pressure and narrowing of blood vessels" and can also lead to nerve, kidney, and eye damage, slow healing, hearing impairment, skin conditions, sleep apnea and Alzheimer's disease.

Diabetes can be deadly. In 2016, Kentucky had the fourth highest mortality rate due to diabetes, an increase from 14th in 2014, says the report. It also points out that four of the five area development districts with the highest diabetes death rates were in Eastern Kentucky. The district with the highest diabetes death rate was the Pennyrile ADD in Western Kentucky.

According to the federal Centers for Disease Control and Prevention, a person is at risk for developing pre-diabetes and type 2 diabetes if they are overweight, 45 or older, have a family history of type 2 diabetes, are physically inactive or have ever had gestational diabetes or given birth to a baby who weighed more than nine pounds. African-Americans, Hispanic and Latinx Americans also have a higher chance of developing the disease.

The CDC says that you can prevent or delay type 2 diabetes with simple, proven lifestyle changes such as losing weight if you are overweight, eating healthier foods, and getting more exercise.

The report found that only 60.4% of Kentucky adults have been screened for diabetes or pre-diabetes, and screening rates have remained essentially the same since 2011.

Wednesday, November 20, 2019

Ky. has improved on several measures of children's health, but some counties continue to lag far behind and get worse

By Melissa Patrick
Kentucky Health News

Almost one in four Kentuckians are children. How goes their health?

Most have health insurance, fewer teenagers are getting pregnant, and fewer babies are being born at a low birth weight -- but those situations vary widely by county, according to the annual Kentucky Kids Count County Data Book.

The report, released Nov. 19 by Kentucky Youth Advocates and the Kentucky State Data Center at the University of Louisville, is part of the 29th annual release of Kids Count, a nationwide initiative of the Annie E. Casey Foundation to track the status of children in the United States.

The Data Book provides information on the overall well-being of children in each county, through 17 measures in four areas: economic security, education, community strengths, and health and family.

Map from Kids Count County Data Book; click on it for a larger version.
One great health concern in Kentucky is the 18.7 percent of women who smoke during pregnancy. Nationally, the rate is 6.9%, according to the United Health Foundation.

Kentucky's rate has stayed about the same for the past few years, the good news is that it has lower that the 20.7% recorded five years ago.

But in some places, the problem is getting worse; 29 counties saw higher rates of pregnant women smoking during pregnancy in 2018. The number of counties where 30% or more pregnant women smoked rose from 22 to 24. In Lee and Owsley counties, more than 40% of pregnant women smoked.

"Smoking during pregnancy remains a serious health problem in Kentucky for both mothers and their babies," Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, said in a news release about the report. "It's an incredibly difficult addiction to break, and it increases health risks for babies both before and after they're born, even raising the risk of sudden infant death syndrome."

The foundation's agenda for the upcoming legislative session includes more money for smoking prevention and cessation.  "Expanding quit-smoking programs, and increasing education campaigns, are essential to reducing smoking during pregnancy," said Chandler.

Smoking during pregnancy also increases the risk of preterm birth, which the March of Dimes says is the leading cause of infant death, low-birthweight babies, and birth defects of the mouth and lip, says the federal Centers for Disease Control and Prevention.

In 2015-17, 8.8% of Kentucky babies were born with a low birth weight, defined as less than 5.5 pounds. That was down slightly from 9% in 2010-12. But again, those rates varied across the state, with 45 counties showing an increase, and 19 counties with rates higher than 10.3%. Lyon County had the lowest rate, 5.1% and Union County had the highest, 12.9%.

The state's teen pregnancy rate also continues to drop. It declined to 29.7 teen births per 1,000 females aged 15-19 in 2015-17. That was 31% less than the 42.9 per 1,000 recorded five years ago. That said, it's still about 58% higher than the national rate of 18.8 teen births per 1,000.

And like so many measures in the report, the differences between counties is great, ranging from a low of 8.5 teen births per 1,000 in Oldham County to a high of 73.6 in Elliott County.

Compared to 2010-12, nine counties had higher teen pregnancy rates: Breathitt (57.5 teen births per 1,000 females 15-19 in 2015-17), Edmonson (36.5), Elliott (73.6), Green (34.6), Greenup (39.2), Jackson (57.7), Lee (48.7), Monroe (36.3) and Nicholas (47.8), which saw the greatest increase, 8.2 per 1,000, over 2010-12.

Other key findings about Kentucky's children in the report include:
  • 96% of Kentucky's children have health insurance, and all 120 counties showed improvements.
  • Nearly one in four Kentucky children live in poverty, defined in 2017 as an annual household income of $24,858 or less for a family of four. That rate improved to 22.1% in 2017 from 26.5% in 2012. The poverty rate decreased in 107 of the 120 counties.
  • One in eight, or 12%, of Kentucky's children live in deep poverty, defined in 2017 as $12,429 or less for a family of four. This rate hasn't changed since 2008-12. Of the 106 counties that were ranked for this measure, 20 had rates between 21% and 31%. 
  • Fewer Kentucky children suffer from food insecurity, down to 18% in 2017 from 22% in 2013. This rate improved in 113 counties, though 17 had rates between 24.8% and 31.5%, mostly in Eastern Kentucky.
  • 115 of the state's 172 school districts saw an increase in the rate of students graduating from high school on time. However, that rate declined in 49 districts. About 91% of Kentucky's students graduate on time. 
This year's report also took a deep dive into four additional areas, including child-care supports, teen suicide, the connection between schools and health, and racial disparities in the child-welfare system.

Terry Brooks (Kentucky Youth Advocates photo)
It also goes into detail about the 2020 census and why it is critical that every child get counted. KYA Executive Director Terry Brooks pointed out at a Nov. 19 news conference in Louisville that Kentucky gets billions of dollars based on the census count.

"If you are interested in school funding for low-income kids and special-needs kids, it's based on the census. If you are interested in childcare supports and food and nutritional support programs, it's based on the census," he said. "The list goes on and on. So in a state where we argue about where to get more revenue, one of the most clear and unifying ways to get more revenue is to make sure that every kid is counted."

The report says that more than 12,000 Kentucky children under age 5 were not counted in the 2010 census, costing the state more than $12 million per year for just five large programs for which data is available.

Brooks stressed the importance of using the report to drive policy changes to benefit Kentucky's children. "Data has to demand action," he said. "We know that what gets measured gets attention and what gets attention gets changed. That's the whole premise of Kids Count."

The 2019 Kentucky County Data Book was made possible with support from the Casey Foundation and other sponsors, including  Passport Health Plan, Kosair Charities, Avesis, Corona Spanish Media, Delta Dental, and Mountain Comprehensive Care.

The Kids Count Data Center provides easy access to county and school district data for about 100 indicators and allows the user to rank states, counties and school districts; to create customized profiles of the data ; to generate customized maps; and to embed maps and graphs in websites or blogs. Click here to see your county's profile.

Grant will help UK Cooperative Extension Service expand opioid prevention and recovery efforts

The University of Kentucky Cooperative Extension Service has received a two-year grant to further its statewide efforts in opioid prevention and recovery, Katie Pratt reports for UK.

The more than $1 million grant from the Substance Abuse and Mental Health Services Administration will allow the program to expand its efforts to Southern and Western Kentucky.

As part of the grant, the program will offer an Addiction 101 course to discuss the science behind addiction, including genetic and hereditary risk factors for developing addiction disorder. Pratt reports that the course will be geared toward health-care workers, extension agents and community leaders and will be led by Alex Elswick, UK extension specialist for substance use prevention and recovery.

“We want to remove the stigmas associated with addiction, so health care workers and community members feel more comfortable and equipped to help those struggling with opioid use addiction and recovery,” Elswick told Pratt.

Other grant programs will include administering an evidence-based substance abuse program for middle-school students, called Botvin LifeSkills Training and an art program to provide individuals with a therapeutic outlet to express their feelings related to substance use and addiction, she writes.

In addition, Pratt reports that the extension program will be expanding its financial-education curriculum that specifically addresses money issues faced by those in recovery. The program, called "Recovering your Finances," was developed by Elswick and Kelly May, a UK senior extension associate. It is  being piloted in Mercer County and will be offered in Boyd, Bourbon, Knox and Leslie counties through a separate grant from the U.S. Department of Agriculture.

Pratt notes that many of these programs grant will build on the extension service’s existing programs to reduce opioid use and help recovery efforts, including efforts to teach gardening, nutrition and life skills to those in recovery, and support programs for families with a loved one with a substance-use disorder. Extension will also continue to offer support to local community health coalitions that address substance-use prevention and recovery, Pratt reports.

“The Kentucky Cooperative Extension Service is currently recognized as a leader among the land-grant university system for outreach efforts targeting substance use prevention and recovery,” Jennifer Hunter, assistant director for family and consumer sciences extension and one of the co-leaders on the grant, told Pratt.  “We are excited to be able to continue to expand our educational efforts and enhance the level of resources available at the community level.”

Monday, November 18, 2019

Pushback makes Trump back off electronic-cigarette flavor ban

The industry organized opposition to the flavor ban, (Photo: Dylan Hollingsworth, Bloomberg News)
President Trump has decided not to go through with the ban on electronic-cigarette flavors that he announced more than two months ago, report Josh Dawsey and Laurie McGinley of The Washington Post.

"On Nov. 4, the night before a planned morning news conference, the president balked," the reporters write. "Briefed on a flight to a Lexington, Ky., campaign rally, he refused to sign the one-page 'decision memo,' saying he didn’t want to move forward with a ban he had once backed, primarily at his wife’s and daughter’s urging, because he feared it would lead to job losses, said a Trump adviser who spoke on the condition of anonymity to reveal internal deliberations."

Trump reversed himself "because of worries that apoplectic vape shop owners and their customers might hurt his reelection prospects, said White House and campaign officials. He also believed job losses tied to the ban would cost him as he sought to trumpet economic growth," the Post reports.

"Whether or when the administration will unveil a new policy to combat underage vaping is now unclear," the paper reports. "Given Trump’s record of zigzags, some officials cautioned the president could reverse course again. Or he might back some ban on flavored e-cigarettes that exempts vape shops. Others said the White House might pursue a different tack altogether by endorsing legislation that would raise the minimum federal age for buying tobacco products to 21 from 18, or take other steps to try to prevent teens from getting access to the products. Some bet the anti-vaping effort is dead, though, especially because the administration could argue the youth vaping problem has been greatly eased by Juul Labs’ recent decision to stop selling its popular mint-flavored nicotine pods."

Sunday, November 17, 2019

'Stop using this criminal-justice hammer to address a public-health nightmare,' state justice and public safety secretary says of drugs

By Melissa Patrick
Kentucky Health News

ASHLAND, Ky. – At a day-long workshop for journalists on covering substance abuse and recovery, state Justice and Public Safety Secretary John Tilley said it's time to "stop using this criminal-justice hammer to address a public-health nightmare."

Justice Secretary John Tilley at workshop
Tilley said some in Kentucky are still trying to eliminate syringe exchanges that prevent spread of disease and other risks from dirty needles, and others want to limit the programs to one-for-one exchanges, which doesn't support the goal of the program to reduce the spread of HIV and hepatitis C among intravenous drug users.

He said a "needs-based model" is by far the most effective model to meet this goal, but some who opposed it when it was adopted in 2015 "still have it in for that policy."

Tilley, a Democrat, was instrumental in getting syringe-exchange programs in a big anti-heroin bill when he was chair of the state House Judiciary Committee. Late in the year, Republican Gov. Matt Bevin named him justice secretary. He has often been mentioned as a possible holdover with Democratic Gov.-elect Andy Beshear.

Tilley, 50, spoke at Covering Substance Abuse and Recovery: A Workshop for Journalists, sponsored by the University of Kentucky's Institute for Rural Journalism and Community Issues and Oak Ridge Associated Universities.

He told the journalists at the Marriott Delta Hotel that it is time to stop criminalizing substance-use disorders, and that it is long past time to take a public-health approach that focuses on recovery and treatment.

He said the only logical explanation for the state's prison population growing from 3,000 in 1970 to more than 24,000 today, or 702 percent – when the state's population has only grown by 39% – is "the war on drugs." 

Tilley, a lawyer and former television journalist who has worked for three decades in criminal justice, said it's past time to take a different approach. He said the legislature has adopted none of the 23 recommendations by the Criminal Justice Policy Assessment Council.

"I think it's high time that we quit tweaking and we begin with a new model," he said. "And the most simple way I can put it is that we stop using this criminal-justice hammer to address a public-health nightmare."

He said the state needs to start funding things that will provide a better return on investment, such as better community supervision for the 50,000 people who are either on probation or parole, and increased access to drug treatment and programming such as job-skills training.

Kentucky has 135,000 children who have been affected by incarceration, more than any other state, and the "vast majority" of the nearly 10,000 children in the foster-care system have had a parent in prison, he said, adding that the state ranks third for per-capita incarceration of women.

Tilley also talked about the challenges of recovery and addiction, pointing to a Harvard University study that found it takes a person with a drug addiction four or five tries at treatment over eight years to gain one year of sobriety.

"There's an idea that we should give folks a second chance," he said. "Well, what we know by the very nature of addiction is that it is a disease of relapse. So why would we just give someone a second chance?"

He said many of the state's judges need more education about addiction, along with more resources. For example, he said that while he is a big fan of pre-arrest diversion, for that to work, crisis-stabilization locations are needed for people who are in distress. "The idea that putting someone in jail is a lifesaver is such a fallacy," he said.

He also called for reform of state criminal-justice laws, saying 1,500 people in Kentucky are serving state prison time solely for simple possession alone, not trafficking, and the state has the most liberal and misused definition of trafficking, "any transfer." He told of a woman who is serving five years for giving someone two pills.

"We can hold people accountable without state prison time," he said. "Justice doesn't always equal punishment."

He said the focus needs to be on prevention, getting rid of the demand for the drugs – because no matter how many traffickers Kentucky puts in jail, as long as there is demand, another trafficker will follow.

He asked, "Why don't we remove the criminal justice system and let public health and let our medical professionals and our treatment professionals and our mental health professionals try to dig us out of this mess?"

Tilley ended his discussion on a positive note, pointing out that while the rest of the nation saw a 5% reduction in its drug overdose deaths, Kentucky's drop was 15%. Tilley attributed much of this drop to the state's aggressive harm-reduction efforts, including its wide distribution of naloxone, a drug that reverses the effect of overdoses,

He added that the partnership between the Cabinet for Health and Family Services and the criminal justice system has been recognized nationwide. "When you pull back the curtain," he said, "there are so many stories to tell."

March of Dimes gives Ky. D-minus for high rate of pre-term births; maternal deaths spike; new collaborative will work on such issues

By Melissa Patrick
Kentucky Health News

Childbirth, which should be one of life's most joyous occasions, has become more deadly for Kentucky mothers, and remains problematic for many Kentucky babies because it comes too early.

One in nine Kentucky babies are born prematurely, so many that the March of Dimes gave the state a D-minus on its 2019 Premature Birth Report Card. And the rate of Kentucky women who died as a result of pregnancy complications nearly doubled from 2017 to 2018.

A baby is premature if born before 37 completed weeks of pregnancy, which is four weeks short of full term. In 2018, Kentucky had 6,109 pre-term births, 11.3 percent of live births. The national average is 10%, a rate that has risen four years in a row.

Because important growth and development happens in the last weeks of pregnancy, pre-term babies are at an increased risk of neurological disorders, intellectual disabilities, and respiratory and digestive problems. They are also more likely to have vision and hearing problems. Complications from being born early is the main overall cause of newborn death, the March of Dimes says.

Pre-term babies are also more at risk for long-term challenges, including chronic diseases such as heart disease, high blood pressure and diabetes, says University of Kentucky HealthCare.

November is Prematurity Awareness Month. The cause of about half of premature births is unknown, but the March of Dimes says there are common risk factors, the strongest being a history of pre-term birth, multiple pregnancy and certain uterine or cervical conditions.

Other factors in the mother that can increase risk include being underweight or overweight, diabetic or older than average for a mother; smoking or using drugs during pregnancy; or having preeclampsia, a type of high blood pressure that some women get during or right after pregnancy.

Kentucky has one of  the highest rates of smoking during pregnancy in the nation, with nearly 18% of pregnant women in the state smoking cigarettes at some time during their pregnancy. The national rate is 6.9%, according to the United Health Foundation's health rankings.

This year's March of Dimes report also looks at several factors that are linked to adverse maternal and infant health outcomes, such as whether a mother has health insurance or prenatal care or if they live in poverty. It also looks at racial disparities in pre-term birth, beyond the aforementioned factors.

In Kentucky, 7% of women between 15 and 44 were uninsured, and 18.6% of them lived in poverty. Among those who were pregnant, 14% received inadequate prenatal care. The pre-term birth rate among African American women in Kentucky is 30% higher than the overall state rate.

In addition to the increasing rates of pre-term birth, the report notes that more than 22,000 babies a year in the U.S. die before their first birthday. That's about two babies every hour.

Number of maternal deaths nearly doubles

The report also says that a woman in the U.S. dies from pregnancy complications about every 12 hours, and more than 60% of those deaths are preventable.

Kentucky's maternal mortality rate nearly doubled in 2018, said Dr. Connie White, deputy commissioner for clinical affairs in the state Department for Public Health. In 2017, the state had 39 maternal deaths, with substance abuse a factor in 62% of them; in 2018, that number increased to 76, with at least half related to substance abuse, according to death certificates.

White said the state is still reviewing patients' medical records for 2018, but the numbers are evidence that "We are failing as a system" of delivery hospitals and providers, which should prompt all to ask where that failure exists.

To tackle these problems, the state recently launched the Kentucky Perinatal Quality Collaborative. It will work toward reducing premature births, maternal mortality and neonatal abstinence syndrome, and improving maternal and infant health outcomes. "Perinatal" refers to care given before and after the birth of a child.

White said the collaborative will ask key questions: "Are we not getting people into treatment? Are we not connecting them?" she asked. "Are we not following up afterwards? Are we working with women who have had their children taken away from them? What are we doing to really wrap our arms around these women?"

White said the collaborative will also look at data and recommendations from a new Maternal Mortality Review Committee to create evidence-based interventions that all providers and delivery hospitals can implement.

"This quality collaborative can now take those recommendations and we hope start making inroads into decreasing Kentucky's maternal death rate," she said, adding later, "There are evidence-based things that we can do, but we need to all be rowing in the same direction."

The collaborative is funded by a three-year grant from the federal Centers for Disease Control and Prevention. White said there was a great "pent-up" need for this collaborative, shown by 78% of the state's 46 birthing hospitals being represented at the collaborative's Oct. 22 launch in Louisville. Those hospitals represented 91% of the state's births.

White said the state is applying to become part of the Alliance for Innovation on Maternal Health program, which has created "bundles" of evidence-based protocols and training modules to address many of the problems that contribute to poor maternal and child outcomes, such as hypertension, hemorrhage, and maternal opioid use. After the state becomes part of the program, these bundles would be available to all of the state's providers and delivery hospitals.

She noted that six counties in Kentucky offer the Sobriety Treatment and Recovery Teams program to help parents with addictions to keep their children out of foster care while keeping the child safe. The counties with START are Kenton, Jefferson, Boyd, Martin, Daviess and Fayette.