Friday, June 30, 2023

Lexington marks 20 smoke-free years, but smoking bans still haven't caught on in most of Ky. despite tobacco's toll on health

Lexington Mayor Linda Gorton led a celebration of the 20th anniversary of the city's ordinance banning smoking in indoor workplaces and public spaces. (WEKU photo by Stu Johnson)
Kentucky Health News

Twenty years ago, Lexington became the first city in the South of Midwest to make indoor smoking in public places illegal. It's had a big impact there and in several other Kentucky cities, but only three in eight Kentuckains live in a place with such an ordinance.

“Lexington’s ordinance has had an enormous impact on the health of Lexington citizens,” said Mayor Linda Gorton said at a celebration of the anniversary. “In terms of public health, it is one of the most important, if not the most important, ordinance we have passed in the last 20 years. It has saved countless lives.”

Tom Latek of Kentucky Today reports, “After the measure took effect, there was a reduction in heart attacks and emergency-department visits for asthma, and the smoking rate in Fayette County declined nearly 32%, resulting in 16,500 fewer smokers for an estimated annual health-care cost savings of $21 million.”

In 2014, electronic cigarettes, "addictive and popular among youth, were added to the ban," Latek notes. "In the 20 years since Lexington’s smoke-free law passed, 57 additional Kentucky municipalities have passed smoke-free laws, protecting 38% of Kentuckians."

"The number of people benefiting is considerably higher, as residents of counties that don’t protect against secondhand smoke travel to cities that do in order to work, shop, do business, dine and have fun," writes Jamie Lucke of Kentucky Lantern.

But despite Kentucky's high smoking rate and tobacco's effect on the state's health, bills to enact a statewide indoor-smoking ban couldn't get through the General Assembly even when the House was conrolled by Democrats, and now that it and the Senate are heavily Republican, advocates have given up on the idea, at least for now. So they concentrate on local ordinances.

Ellen Hahn, Ph.D., R.N.
“Policy change takes time, often decades,” says Ellen Hahn, the University of Kentucky nursing professor who has been the leading advocate of smoke-free ordinances. “Policy change is also a team sport. While a few people can make a difference, I could not stick with it without support from others.

“As a nurse, I am naturally a patient advocate, giving voice to the voiceless, and as a public health nurse, my patient is the community. I am willing to wait for effective change. . . . The payoff for society is definitely worth the wait.”

Hahn told Lucke that she wishes for four things: “A comprehensive smoke-free law that covers every community in the state . . . a strong, hard-hitting media campaign” against heavily promoted tobacco products; higher cigarette taxes, which Lucke notes "deter young people from starting and to motivate adults to quit;" and more smoking-cessation services. "Kentucky spends just 3.5% of what the Centers for Disease Control and Prevention recommends on tobacco control and prevention," Lucke notes.

“It’s really not a shock that we have such high smoking rates,” Hahn told Lucke. “We don’t invest in prevention. And the sad part is we know what works to reduce smoking. We’re just not doing it.”

Ticks can't jump, but static electricity can throw them onto hosts

Static electricity that is naturally produced by animals,
humans included, can attract ticks onto their hosts.
(Video by England and Lihou, Current Biology)
By Melissa Patrick
Kentucky Health News

One more thing to know as you work to guard against the influx of ticks in Kentucky this year: Static electricity that is naturally produced by humans and other animals can cause a tick to be pulled onto them, a new study shows. 

“Until now, we had no idea that an animal could benefit from static electricity in this way, and it really opens up one’s imagination as to how many invisible forces like this could be helping animals and plants live their lives,” lead author Sam England of the University of Bristol said in a news release.

The findings, published today in Current Biology, are the first known example of static electricity being implicated in the attachment of one animal to another, the release says. 

The study also offers an explanation for how ticks make contact with hosts that seem beyond their reach, because ticks are not capable of jumping.

The researchers first tested the potential of static electricity to help ticks bu using electrically charged rabbit fur and other materials. They found that the ticks were pulled through the air for several millimeters or even centimeters toward the charged surfaces. (One inch has 2.54 centimeters.)

They said the distance the ticks were pulled, compared to their size, was like humans being pulled up several flights of stairs. 

The study also determined that the minimum strength of a static-electricity field needed to attract a tick was comparable to the field between a charged animal and grass, suggesting that this is a likely way some ticks end up on their hosts. 

The researchers suggested that these findings likely apply to other parasitic animals, like mites, fleas and lice.

They also say this study could lead to new ways to prevent tick bites, like creating anti-static sprays.

For now, you can protect yourself from ticks by wearing an insect repellent, such as diethyltoluamide, or Deet, when outside. And for those who don’t like to wear Deet, you can use oil of lemon eucalyptus, IR 3535, or picaridin. All of these products are readily available at stores.

Other ways to protect yourself from ticks include wearing light-colored clothing, so ticks can be spotted more easily; tucking pants legs into socks or boots and shirttails into pants; taping the area where pants and socks meet, so ticks can't crawl under your clothes; walking in the center of trails, and avoiding other tick-likely areas.

It's also important to check for ticks every time you come inside from being outdoors, even for just 10 minutes. And if you’ve been out longer, you should disrobe and check your whole body, especially around ankles, waist, navel, armpits and the nape of the neck. And check pets for ticks.

And if you get a tick, it's important to remove it properly by grasping it as close to the skin as possible with a pair of tweezers and pulling it straight out with gentle, even pressure.

Kentucky gets $2.25 million to expand, restructure reserve corps of medical and non-medical workers who help in times of need

Kentucky Health News map from iStock base map
By Melissa Patrick
Kentucky Health News

With a $2.25 million grant, Kentucky will expand and restructure its Medical Reserve Corps to cover every county in the state.  

The corps comprises medical and non-medical personnel who volunteer their time and expertise to supplement public-health resources during emergencies and other times of community need.

Kentucky's corps supported emergency-shelter operations following storms in December 2021 in Western Kentucky; the flooding, mudslides and landslides in Eastern Kentucky last July; and during extreme weather events, such as the temperature plunge last December. Volunteers helped with testing and vaccine distribution during the pandemic, and typically provide medical support and first aid at large public gatherings such as the Kentucky Derby. 

“These volunteers have been crucial in aiding with disaster responses, and their invaluable impact has especially been felt during recent years,” Gov. Andy Beshear said in a news release. “We have faced unimaginable challenges such as natural disasters, a once-in-a-century global pandemic and so much more. With this funding, the administration will be able to provide direct financial support, technical assistance, resources and training to help our regional units and strengthen communities.”

The Medical Reserve Corps has 29 locally housed units with volunteers in 78 counties. The 42 counties not covered by the Medical Reserve Corps are Adair, Allen, Barren, Bath, Bracken, Breathitt, Butler, Calloway, Casey, Clay, Clinton, Cumberland, Edmonson, Estill, Green, Hardin, Hart, Jackson, LaRue, Laurel, Lewis, Logan, McCreary, Madison, Marion, Marshall, Meade, Menifee, Metcalfe, Monroe, Morgan, Nelson, Powell, Pulaski, Rockcastle, Rowan, Russell, Simpson, Taylor, Warren, Washington and Wayne. 

The state plans to use the grant money to restructure and consolidate the units into eight regionalized units that will cover all 120 counties. The corps will be housed under "Kentucky’s Healthcare Coalitions" in the preparedness branch of the state Department for Public Health.

“The regionalization of the Medical Reserve Corps program will provide a more robust and equitable coverage of volunteers across our commonwealth and will enhance the quantity and quality of partnerships with key stakeholders we already partner with, such as hospitals, universities and local health departments,” Cabinet for Health and Family Services Secretary Eric Friedlander said in the release. 

Of the 33 states and jurisdictions recently granted awards through the American Rescue Plan Act to strengthen the Medical Reserve Corps network across the country, Kentucky received the fourth largest. 

Deputy Health Commissioner Connie White told the legislature's Interim Joint Health Services Committee June 21 that the money will provide the funding needed to strengthen the program. 

"We're really going to work hard with our local providers to be sure that they know in case of emergency, that's not when you have a training. In case of emergency, that's when you call and say, 'Remember those desktop trainings that we did? Well, it's time to kick that into gear, because we need you.'"

Veterans' advocates tell legislators they need help to prevent veteran suicide; Ky. loses about 118 veterans to suicide per year

This story deals with suicide. If you or someone you know is contemplating suicide, please call or text the National Suicide and Crisis Lifeline at 988.

By Melissa Patrick
Kentucky Health News

The legislature's Interim Joint Committee on Veterans, Military Affairs and Public Protection spent over two hours hearing from organizations advocating for resources to prevent veteran suicide at its June 21 meeting.

“We owe these men and women a tremendous debt of gratitude and it is paramount that legislators work to protect and care for Kentucky’s military service members and retirees," Rep. Walker Thomas, co-chair of the committee, said in a news release.

"According to the U.S. Department of Veterans Affairs, in 2020, 119 of the 6,146 veteran suicides nationwide were Kentucky veterans. In comparing the suicide rate of Kentucky veterans to the suicide rate of all Kentuckians, the difference is staggering—with Kentucky veterans’ rate at 41.3 and Kentucky’s total rate at 22.4," says the release.

Michael Stoyonovich, with the Kentucky unit of the Disabled American Veterans, asked the lawmakers to consider a bill to prevent veteran suicide that would strengthen and coordinate proven suicide prevention programs and connect more veterans and their families to mental-health services.

Stoyonovich shared statistics from the University of Kentucky College of Public Health: In 2017, 124 Kentucky veterans died by suicide; in 2018, 126; in 2019, 103; in 2020, 125; and in 2021, 111.
Rep. Pamela Stevenson at the June 21 Joint
Committee on Veterans, Military Affairs and 
Public Protection. (Legislative photo) 
Rep. Pamela Stevenson, a Democrat from Louisville who served in the Air Force for 27 years, called on Stoyonovich and the others who spoke to hold the lawmakers accountable. 

"We can pass legislation," she said. " If we don't pass this legislation to stop veterans from killing themselves, then all we've done is made it a bumper sticker.  . . . Everyone here has said they believe in what you said . . . everyone that's testified. Now it's time for you to call us and say, 'Where's the legislation?' We've proven we could get something done in an hour on the floor. Let's get this done in an hour on the floor."

Juan Renaud, the deputy commissioner of the state Department of Veterans Affairs, shared data from Kentucky's Community Mental Health Centers that shows the need in Kentucky is great. In Fiscal Year 2022, which ended last June 30, the centers served 2,372 veteran and active-duty personnel; 601 of them were active and 1,771 were veterans.

He also told the members that a 2012 study found higher rates of suicidal ideas and behaviors among National Guard members after deployment (31 per 100,000) than among actives (20.2) or reserves (24).

Rep. Steve Bratcher, R-Elizabethtown, who is in the Guard, said one reason could be that states are relying on Guard members to do so much more than their monthly commitment, especially in Kentucky with its Covid-19 response, riots, tornadoes and flooding. And on top of that, he said they hold regular jobs.

"I don't think that people realize the challenges that it takes on you personally," he said. "So that's why you probably see a difference in the amount of increase in suicides in the National Guard; they do reserve and active duty." 

Retired Brig. Gen. Steven P. Bullard, who works with the Kentucky Commission on Military Affairs, talked about how hard it is to return to the community after serving in the military.

“I went from commanding a combat squadron during Iraqi Freedom to being with my family in Walt Disney World 48 hours later—and it was the single worst experience I ever went through in my entire life, I can’t tell you how terrible it was for me," he said. "You come back as a guardsman. . . . You’re released back into your community … and you're not in that cocoon any longer and you’re with people who just don’t understand.”

Matt Castor, vice-president of government and corporate relations with USA Cares, a national organization headquartered in Louisville, said his organization works to remove some of the triggers of veteran suicides, like housing, financial struggles and transitioning into a career and that he, like the other organizations who help veterans, needed more funding.

"Simply put, we need your help," he said. "We are looking at the highest number of veterans coming to us this year than we've ever had in 20 years."

Castor said when they started the organization 20 years ago they were largely helping veterans with physical injuries from the war in Iraq, but since those needs have changed.

"Over the last 20 years, those needs have transitioned and we deal now with more of the invisible injuries of post-traumatic stress and traumatic brain injury," he said. "And as we do that, we've realized a few things . . . we may not be able to stop a suicide directly but we may be able to eliminate the factors that push somebody to make that type of terrible decision." 

Castor said in 2022 they received 224 applications for assistance, but could only help 15.3% of them due to a lack of funds. He said it cost about $4,000 per family to stop eviction from their home or foreclosure. He also talked about helping veterans with their car payments, noting that this allows them to take care of their families and get to their jobs.

"These are all triggers. These have a direct and profound impact on these families, that if we don't address these particular issues, then this rate will continue," he said. 

Also at the meeting were representatives for Project Diehard, which provides a respite for struggling veterans, and Check A Vet, a program that calls on people to become educated about suicide and prevention and to meaningfully and routinely engage with veterans. This program is also working on a veteran peer-to-peer pilot program in Kentucky.

Thursday, June 29, 2023

Federal judge blocks part of Senate Bill 150 that would block gender-affirming health care for transgender minors in Kentucky

By Sarah Ladd
Kentucky Lantern

A federal judge has blocked, at least temporarily, part of a recently passed state law banning gender-affirming health care for transgender minors.

U.S. District Judge David J. Hale ruled on Senate Bill 150, which the General Assembly passed in April. “The treatments barred by SB 150 are medically appropriate and necessary for some transgender children under the evidence-based standard of care accepted by all major medical organizations in the United States,” he wrote.

The American Civil Liberties Union of Kentucky filed to block SB 150 in May, asking for a preliminary injunction to block part of the bill while the larger legal challenge plays out. The legislation was to take effect Thursday.

The ACLU specifically took issue with the portion of the bill that prohibits health-care providers from prescribing puberty blockers or hormones, performing surgeries like phalloplasty and vaginoplasty or hysterectomies and vasectomies on minors. 

Judge David J. Hale
Hale wrote, “These drugs have a long history of safe use in minors for various conditions. It is undisputed that puberty blockers and hormones are not given to pre-pubertal children with gender dysphoria.”

Hale was appointed by Barack Obama in 2014. In Tennessee, a federal judge appointed by Donald Trump ruled likewise in a similar case on the same day Hale ruled. Earlier, there were such rulings from an Obama-appointed judge in Arkansas and one in Florida named by Bill Clinton.

Judge Eli Richardson of Tennessee wrote, "To the court’s knowledge, every court to consider preliminarily enjoining a ban on gender-affirming care for minors has found that such a ban is likely unconstitutional."

Transgender advocates have said such surgeries on minors are not happening in Kentucky. The state's first openly trans elected official, Berea school board member Rebecca Blankenship, said on a recent KET appearance that “every LGBT organization in the commonwealth said that we were absolutely fine with banning those sorts of surgeries for minors. . . . We might as well ban unicorn attacks; it makes no difference.”

Attorney General Daniel Cameron called the ruling “misguided.” Cameron, the Republican nominee for governor, said in a press release that SB 150 is a “commonsense law that protects Kentucky children.”

“There is nothing ‘affirming’ about this dangerous approach to mental health,” hesaid. “My office will continue to do everything in our power to defend this law passed by our elected representatives.”

Cameron’s opponent, Democratic Gov. Andy Beshear, vetoed SB 150, but Republican-controlled legislature easily overrode him.

Blankenship, executive director of Ban Conversion Therapy Kentucky, said in a joint statement with Michael Frazier, a lobbyist for the group, that “puberty blockers and hormone therapy save lives.”

National Center for Lesbian Rights Legal Director Shannon Minter called the decision a “a huge relief for the families targeted by this unnecessary and harmful law. She said the law “prevents doctors from doing their jobs and parents from making medical decisions for their own children.”

Backers of laws on transgender care often have misconceptions and misinformation that make details of care hard to understand

Movement Advancement Project chart, adapted by KHN; click to enlarge; notes and details are here.
By Helen Santoro
KFF Health News

Legislators in states that have limited gender-affirming treatment for minors say their intent is to protect children and families from pressure “to receive harmful, experimental puberty blockers and cross-sex hormones and to undergo irreversible, life-altering surgical procedures,” as a new Montana law puts it.

“Gender transitions involving major surgeries not only result in sterility, but other irreversible negative biological effects,” said Montana state Sen. John Fuller, the Republican who introduced the bill.

Such laws and policies — and statements such as Fuller’s that are used to justify them — can reflect misconceptions and misinformation that conflate and confuse different treatments.

Gender-affirming care is a broad term for many distinct treatments provided to children, teens, and adults. Puberty blockers, for example, are medications that inhibit puberty by suppressing the body’s production of sex hormones, while hormone therapy is the administration of testosterone or estrogen to alter secondary sex characteristics.

One common misbelief heard when legislation is discussed is that gender-affirming medical interventions are provided immediately to any trans or nonbinary child who walks into a gender clinic.

The reality is that the process informing these treatments is long and intensive. Before any medical or surgical interventions, kids must first be diagnosed with gender dysphoria, which, for pre-pubescent youth, involves experiencing significant distress for at least six months from at least six of a set of causes, including a strong desire to be of the other gender, and a strong dislike of one’s sexual anatomy. Youth who have gone through puberty must meet two of the criteria for a diagnosis.

Standards of care set by the World Professional Association for Transgender Health encourage health care professionals to perform a comprehensive assessment of a child’s or teen’s “strengths, vulnerabilities, diagnostic profile, and unique needs” before providing any medical or surgical interventions. Without this assessment, other mental health issues “that need to be prioritized and treated may not be detected.”

The time it takes to perform this assessment varies from patient to patient, said Jack Turban, an assistant professor of child and adolescent psychiatry at the University of California-San Francisco. Turban may see someone who is 12 years old and asking for puberty blockers. This hypothetical patient has known they are trans since they were 5, and has already adopted a new name and pronouns that match their gender identity.

“That’s going to be a much shorter assessment to know that they are ready for treatment when compared to somebody who has only understood their trans identity for six months” and has other complex mental health conditions like schizophrenia, Turban said.

To receive puberty blockers, kids must also have experienced the onset of puberty, or Stage 2 on the Tanner Scale of developmental change. This is marked by physical changes like the development of breast buds or testicle growth, and tends to happen between the ages of 9 and 14 in children with testes and 8 and 13 in those with ovaries. By pausing puberty, these drugs buy children more time to explore their gender identity before undergoing permanent and potentially unwanted pubertal changes.

The age at which trans minors receive gender-affirming hormone therapy depends on the patient’s ability to provide informed consent for the treatment, which can happen when they’re as young as 12 or 13 years old. The Endocrine Society says most adolescents have “sufficient mental capacity” to consent by the time they’re 16.

“We offer hormones to patients who are experiencing gender incongruence when patients and families are ready. This may be at an earlier age so that patients can go through puberty alongside their cisgender peers, or later, if they choose to,” said Mandy Coles, co-director of the Child and Adolescent Transgender Center for Health at Boston Medical Center. “If someone says, ‘I’m interested in estrogen,’ I say, ‘Great. What are the things that you are hoping to get out of that?’ Because it’s incredibly important to speak to patients and families about what medications can do, and what they can’t do.”

Coles said she also makes sure to talk continuously about consent with both the child and parents throughout the treatment process and lets her patients know they can stop taking hormones at any time.

Some physical changes brought about by gender-affirming hormone therapy are reversible. For example, decreased muscle strength and body-fat redistribution caused by estrogen can reverse once a person stops taking the hormone, though these changes become more fixed the longer someone uses it — but breast growth from estrogen or a deepening of the voice caused by testosterone are not reversible.

If a trans person decides to receive gender-affirming surgery, clinics require that the individual receive letters from one or more providers stating they have persistent and well-documented gender dysphoria, any significant mental health concerns they have are sufficiently controlled, and they can consent to the surgery. For genital, or “bottom,” surgery, the letter may also need to state that the individual has been living full time in their “identified gender” for at least 12 months.

Most medical centers require individuals to be at least 18 years old for bottom surgery and chest, or “top,” surgery, though some do perform top surgery on younger teens if the patient, their parents, and health care providers agree the procedure is appropriate.

Much of the confusion is over puberty blockers, drugs that have been used for decades for children who enter puberty too early. A common assertion that anti-trans groups and legislators make is that puberty blockers are dangerous and lead to infertility. This is not the case, said Coles. “Puberty blockers are fully reversible medications. They work like a pause button on puberty.”

Fertility may be impaired, however, in those who go straight from puberty blockers to hormone therapy, which is why the current medical guidelines require fertility counseling prior to any gender-affirming medical care, said Turban.

The Food and Drug Administration has not approved the use of puberty blockers for gender-affirming care. However, 10 to 20% of prescriptions across all medications are for “off-label,” or unapproved, use — and the rate is even higher for prescriptions to children.

“We know that taking away the decision to use blockers from parents and providers leads to poor health outcomes for patients,” said Coles.

A study by Turban and colleagues found that trans adults who received puberty blockers during adolescence were less likely to have suicidal thoughts than those who wanted puberty blockers but did not receive them. The same benefits have been found with gender-affirming hormone therapy.

In a study of data from nearly 28,000 trans adults who responded to the 2015 U.S. Transgender Survey, Turban and fellow researchers found that people who received gender-affirming hormone therapy during adolescence had more favorable mental health outcomes than those who didn’t take hormones until they were adults.

Additionally, a study of 104 young trans and nonbinary patients at the Gender Clinic of Seattle Children’s Hospital found those who had started on puberty blockers or hormone therapy had 60% lower odds of depression and 73% lower odds of self-harm or suicidal thoughts than peers who hadn’t received those treatments.

There is much misinformation claiming that providers of gender-affirming care are permanently harming vulnerable children, said Coles. “Denying access to care harms transgender and gender-diverse kids,” she said. “Gender-affirming care is not new. It’s the attacks on care that are new.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at the Kaiser Family Foundation, an independent source of health policy research, polling, and journalism. Learn more about KFF.

Wednesday, June 28, 2023

E. Ky. clinics get $887,152 federal grant to train APRNs, clinical social workers and counselors in substance-abuse counseling

MCHC has 13 clinics in seven counties. (MCHC/KHN map)
Mountain Comprehensive Health Corp. of Whitesburg has received a federal grant of nearly $900,000, one of only 20 such grants in the nation, to improve substance-abuse treatment in Eastern Kentucky.

MCHC and the University of Louisville’s Trager Institute will "use the money for a five-year program to create training programs to increase the number of substance-use-specific treatment providers in the region and improve access to services, said a press release published by The Mountain Eagle of Whitesburg. "The grant totals $887,152 and comes from the U.S. Department of Health and Human Services Administration Bureau of Health Workforce. . . . Other recipients include Yale University, Emory University and Texas A&M University."

The program will focus on increasing the number of advance practice registered nurses, clinical social workers, and professional counselors trained in substance abuse counseling. The U of L program will have an onsite element at MCHC, adding four providers a year in southeastern Kentucky.

"MCHC has provided substance abuse treatment in Letcher and the surrounding counties since 2016," the release said. "It also serves as a training site for doctors, nurse practitioners, nurses, social workers, counselors, physician assistants, medical assistants, and advanced practice students of all healthcare professions who are working toward a career in abuse treatment."

Tuesday, June 27, 2023

Headed to the water? Wear a swimsuit with colors that are easy to see, and remember, drowning rarely happens as you see it on TV

This girl is wearing a swimsuit with contrasting colors, easily
seen in the water. (Photo by Alex Bard, iStock/Getty Images Plus)
By Sherri Hannan
University of Kentucky

The temperature is rising, and everyone is heading to the pool, lake or beach to cool off. But did you know the color of your swimsuit plays a big part in water safety? And that drowning rarely looks like how it is represented on television and in motion pictures?

Drowning is the leading cause of death for children ages 1 to 4, and the second leading cause of death for children ages 5 to 14, according to the Centers for Disease Control and Prevention. Black children's chances of drowning are more than seven times greater than white children's.

Even if drowning doesn't cause death, drowning injuries can cause brain damage and other serious outcomes, including long-term disability.

Experts are urging parents and caregivers to avoid putting children in blue and green swimsuits. Even in shallow water, blue and green are very difficult to see. Drowning can happen very quickly and quietly, and visibility is important when supervising kids around water. Stick with bright, neon colors for swimsuits, pool toys and floatation devices.

Remember, drowning doesn’t look like drowning. In TV and movies, a drowning person waves their hands and calls for help. In reality, drowning is silent. A drowning person may appear to be relaxed and quietly treading water. If you see someone with their head tilted back and they look like they are climbing an invisible ladder, call for help immediately.

Here are some other tips to keep kids safe in and around water this summer:
  • Use designated swimming areas and recreational areas whenever possible. Look for posted signs about open water hazards. Also look for signs that say when lifeguards will be present.
  • Avoid distractions when your child is in or around water. Drowning is often silent and can occur in minutes. Put away phones, books and magazines.
  • Choose a water watcher. When there are several adults present, alternate who is responsible for watching children in or near the water.
  • Keep your ears open as well as your eyes. If your child gets quiet, find out why.
  • Wear a U.S. Coast Guard-approved life jacket when boating or participating in other water activities. Choose a life jacket that is right for your child’s weight and water activity. Weak swimmers and children who cannot swim should wear life jackets when they are in or near water.
  • Learn CPR and basic water rescue skills. It is important to know how to respond in an emergency without putting yourself at risk of drowning. Local chapters of organizations such as the Red Cross offer CPR and water safety courses.

Monday, June 26, 2023

Matthew Coleman is new director of state Office of Rural Health

Matthew Coleman
By Beth Bowling
University of Kentucky

HAZARD, Ky. — Matthew Coleman has been named director of the Kentucky Office of Rural Health at the Hazard-based University of Kentucky Center of Excellence in Rural Health, effective July 1. He succeeds Ernie Scott, who died unexpectedly March 12.

Coleman has more than a decade of experience in health care and public education and has served in various roles at the KORH since 2021, working as a project manager and a program specialist.

As director, Coleman will oversee a number of federally funded programs, including the Small Rural Hospital Improvement Grant Program, the Kentucky State Loan Repayment Program, the Kentucky Rural Hospital Flexibility Program, and a variety of other services and activities geared toward veterans, emergency-management leadership, rural health clinics and critical-access hospitals.

“We are pleased to welcome Matt into his new role as a strong leader who possesses the education, knowledge and experience to bring leadership to KORH" and the Center of Excellence in Rural Health "as we strive to improve the health and well-being of the Commonwealth,” center director Fran Feltner said. As the federally designated state office of rural health, her center oversees KORH.

Coleman said, “During my time at KORH, I have been fortunate to work with a great team and to collaborate with hospitals, clinics and many community partners. I look forward to building upon this foundation to continue engaging with rural stakeholders with a focus on advancing rural health across the state.”

Coleman holds a master's degree in strategic management from the University of the Cumberlands in Williamsburg and a bachelor's degree in education from Morehead State University. He lives in Beattyville with his wife Glenna and their four children.

The Kentucky Office of Rural Health is a federal-state partnership authorized by a 1990 federal law passed to promote access to rural health services. KORH helps clinicians, administrators and consumers find ways to improve communications, finances, and access to quality health care while ensuring that funding agencies and policymakers are made aware of the needs of rural communities. It provides a framework for linking small rural communities with local, state and federal resources while working toward long-term solutions to rural health issues.

A 1990 state law created the Center of Excellence in Rural Health to address health disparities in rural Kentucky and unique challenges faced by rural communities. Its mission remains to improve the health and well-being of rural Kentuckians.

Sunday, June 25, 2023

Kentucky farmers deal with uncontrollable stressors; there's a mental-health coalition that helps them

Sarah Jones poses for a photo a flock of her sheep at he family's Red Hill Farms, which straddles the state line in Allen County and northern Tennessee. (Photo by Austin Anthony for the Kentucky Lantern)
By Sarah Ladd
Kentucky Lantern

This story discusses suicide and mental health among farmers. If you or someone you know is contemplating suicide, please call or text the National Suicide Prevention Lifeline at 988. You can also text “KY” to 741741.

A thousand hungry mouths must be fed before farmer Sarah Jones can eat.

Seven days a week — sometimes during 100-hour work weeks — Jones and her family tend their land and animals in southern Kentucky and northern Tennessee.

They put the earth, their animals and hired hands before themselves. Finding time for self-care when your job is a 24/7 lifestyle is nearly impossible.

That’s why experts say farmers face unique mental health challenges that a coalition called Raising Hope, out of the Kentucky Department of Agriculture, is aiming to address. Staff know of at least four people who are alive today because of the coalition’s efforts. It was established in 2021.

Stressors stretch beyond the hours of labor the Jones family puts into Red Hill Farms, though finding laborers “willing to smell like a pig” and put in long hours has become more challenging with time.

The availability and affordability of land, too, is a challenge for farmers looking to start or expand. They’re often up against developers. Weather is unpredictable. Everything – from labor to feed – costs more now.

And, Jones said, it’s concerning when members of the public don’t understand what farmers do.

“That’s changed dramatically as more and more people are more and more generations removed from agriculture and the farming lifestyle,” she said. Many “really don’t understand where their food comes from.”

Elizabeth Gordon, who does marketing work with Raising Hope, said the coalition’s mission is twofold. It seeks to decrease mental health stigma and suicide rates among farmers, which may be worse than numbers show thanks to underreporting in rural areas. But it also exists to educate non-farmers about the farming lifestyle.

“It’s hard to appreciate when you don’t understand,” said Gordon.

In addition to destigmatizing mental health, she said, Raising Hope staff also try to destigmatize the farmers themselves.

“They don’t stand in a field with pitchforks,” she said. “They’re … very technologically advanced.”
The needs: more access to mental health resources, less stigma

In 2020, someone in America died by suicide every 11 minutes, the Centers for Disease Control and Prevention found. Rates were worse in rural areas, yet rural folks tend not to get mental health help as frequently as those in urban areas, according to the National Library of Medicine.

The University of Kentucky said in 2022 that at least 109 farmers in Kentucky died by suicide between 2004 and 2017. Farmers 64 and older were at higher risk. From 2012 to 2015, male farmers were twice as female farmers likely to take their lives.

Farms make up a massive chunk of the commonwealth’s land, according to Kentucky AgriTech.

In 2022, there were more than 73,000 farm operations in the state, according to the State Agriculture Review. Chickens, calves and cows were the biggest livestock productions reported in that data. Kentucky produces the most beef of any state east of the Mississippi River, making it a massive contributor to the food supply.

The lifestyle comes with a measure of independence, experts said, that can make reaching out difficult.

Cheryl Witt, a researcher and sixth generation farmer from central Kentucky, said stigma and cultural differences sometimes keep farmers from getting help.

“In the general population, there’s high rates of stigma seeking help for mental health,” said Witt, whose doctoral dissertation was on depression rates among female farmers in Kentucky and Tennessee.

“But when you deal with a farming population, particularly men, you have that masculine, highly independent, self-reliant, male attitude or cultural beliefs … you just don’t do that. That’s just not something you do,” she added. “You can handle it, or you’re going to handle it yourself.” 

And often, they must handle it alone because the public doesn’t understand what they face – and not all health care providers are culturally competent enough to understand their unique challenges.

Jeanne Ward, whose passion for mental health advocacy grew during her Ph.D. research into rural health disparities, said it’s crucial that health-care providers understand those specific stressors in order to best treat the whole farmer.

“When you go to the fair, you see the shiniest stuff,” the former nurse explained. “You see the beautiful animals and that happy version of farmers that we’re used to.”

But behind the scenes, in the day-to-day, she said, “farmers are really faced with a lot of uncertainty that makes the occupation more challenging.”

They are, Ward said, disproportionately affected by suicide as a result.
Raising Hope – one coin and conversation at a time

Raising Hope got its start in 2021 and is a holistic, multi-faceted approach to improving Kentucky farmers’ wellbeing.

Sarah Jones holds her Raising Hope challenge coin.
(Photo by Austin Anthony for the Kentucky Lantern)
Coalition members go to farming events around the state and do physical health screenings. They also educate non-farmers about farming.

The physical screenings are important because poor physical health can contribute to poor mental health – and many in rural communities live far from primary care. Driving to a doctor may take too long, causing a to-do list to grow even longer. Telehealth helps, but isn’t always possible or applicable.

Staff also distribute mental health challenge coins and have passed out more than 1,300 since Raising Hope launched.

The coins are small, physical tokens meant to remind farmers that they and their work are appreciated. They also encourage them to reach out for help when they need it. 

Jones keeps her challenge coin in her wallet. It is, she said, “a continuous reminder that … I’m not alone. That there is somebody that understands and … has an appreciation … to what I might be experiencing.”

Beyond individual help, the coins can help build connectedness among farmers, which Ward said is a “protective factor against suicide.”

“Self compassion is really important too. We want people to understand that we’re all imperfect, and everybody has mental health challenges,” she said. “We want to normalize it and get people talking about it versus facing these problems alone, which often doesn’t have a very good ending.”

On top of the coins, the coalition puts out ads about mental health and sets up booths at farming events. The digital side of the coalition is huge, Ward said.

“With the stigma of suicide and mental health issues, not everybody wants to come up to us at a booth at an event,” she explained. “So that’s why these digital campaigns are so powerful, because we are actually able to confidentially serve farmers and the farm communities.”

Witt, the researcher, said primary coping mechanisms for farmers that she’s found include faith, prayer and social interaction with likeminded people.

Staff will also distribute small bluetooth speakers for farmers whose trucks or tractors don’t have radios, Gordon said.

A good podcast or music can “free their mind a little bit so they don’t just worry all the time,” she said. 
Other interventions include teaching nursing students how to interact with and treat farmers in a culturally competent way, as well as providing farmers the option when calling 988 to identify as a farmer and get specialized help.

These interventions take money, which is why Raising Hope staff want to move toward forming a nonprofit. Doing so would allow it to accept donations.

A health care workforce that understands farming is important, though. Without it, Jones said, stigma worsens.

“We make up such a small percentage of the population. There are very, very few people that can even fathom the stress and the workload that I have,” she said.

Talking about it is nothing to be ashamed of, she said.

“Farmer mental health is an issue and it’s not something to keep a secret. It’s okay to share,” she said. “It’s normal for farmers to feel stress…it’s normal for farmers to feel defeated. And so if you’re having those thoughts, there are other people that have had those thoughts too.”

Just “take care of those thoughts,” she said. And: Have a conversation with someone about how you’re feeling. You’re not alone.

Friday, June 23, 2023

Kentucky keeps losing doctors when it needs more of them; in the 2022 fiscal year it had only seven for every eight it had in 2018

Ky. Health News graph from UK Center for Excellence in
Rural Health data; there are no data for Fiscal 2021 due to
the pandemic. (Click on any image to see a larger version.)
Kentucky Health News

Kentucky is losing physicians at a time when it needs many more of them, the top executive of the Kentucky Medical Association told a legislative committee Wednesday.

From 2019 to 2022, the last fiscal year for which data are available, “We lost 590 physicians out of the state . . . at a time that we needed more physicians in the state,” KMA Executive Vice President Patrick Padgett told the Interim Joint Committee on Health Services.

And the loss is even bigger going back to Fiscal 2018, the year that the number of licensed physicians in Kentucky peaked at 11,437. (Fiscal years run from July 1 to June 30.) In Fiscal 2019, the number dropped to 10,592. That was a drop of 7.4 percent. The decrease from 2018 to 2022 was just over 12.5 percent. That's one-eighth, so for every eight doctors in 2018, the state had only seven in 2022.

The decline in primary-care physicians was much less, 3.4 percent: from 2,825 to 2,729. However, 43 of the state's 120 counties are considered short of primary-care doctors, and Kentucky ranks 40th in the nation in the number of primary-care physicians per 100,000 people, according to a report by the University of Kentucky's Center for Excellence in Rural Health. It says 25 counties are considered short of doctors overall, and "Almost a third of Kentucky physicians have been licensed between 31 and 50-plus years," meaning many will retire relatively soon.

Padgett told John McGary of WEKU-FM that having fewer doctors overall "means that people have to wait longer to see a physician. I think that anyone around the state who tries to get in to see a physician, whatever the physician specialty, wherever they're located, when you have to wait weeks, or sometimes months to get in to see a physician, you're experiencing this problem." 

KMA executive Patrick Padgett
Padgett told the committee, “Three years ago, I would have come here to say that Kentucky badly needed more physicians. And unfortunately, the situation has only gotten worse. And we really need to work to not only bring in more physicians but keep the ones that we already have.”

A KMA survey last fall "showed many of the state’s physicians are dealing with increased levels of stress," notes Sarah Ladd of the Kentucky Lantern. "The degree to which that affected their work varied. Most cited administrative burdens such as prior authorization requirements as a driving force behind their stress. During the 2023 legislative session, legislators considered adding exemptions to the state’s prior authorization requirements, but the bipartisan bill was stuck in a committee."

The General Assembly did pass a bill to protect Kentucky doctors who seek mental-health help from wellness programs, by saying doctors don't need to report their participation, Ladd notes: "Their jobs will also be safe if they do so."

Much of the decline in licensed physicians came during the Covid-19 pandemic, when much attention was given to the increasing shortage of nurses. Delanor Manson, CEO of the Kentucky Nurses Association, told the committee that the state needs to improve the health-care workforce pipeline and keep nurses in the profession, Ladd reports.

“Health care is the engine for the economy,” Manson said. “And nurses are the engine for health care.”

Nominations sought by Aug. 31 for Dan Martin Award, which recognizes a lifetime contribution to rural health in Kentucky

The Kentucky Rural Health Association is seeking nominations for the 2022 Dan Martin Award, which honors an individual's lifetime contribution to rural health in Kentucky.

The award is named for its first recipient, a physician at the Trover Foundation in Madisonville. Winners' contributions have come in areas of direct patient care, health-professions education, health administration, health promotion and public advocacy.

To nominate someone, please complete this form no later than Aug. 31.

If a nominee is deemed appropriate, the award will be presented at the KRHA annual conference, Nov. 16-17, in Bowling Green.

For further information or questions, contact Garrett Anspach at

Electronic cigarette sales are way up, and so are calls to poison-control centers about children's exposure to the devices

Truth Initiative photo
By Melissa Patrick
Kentucky Health News

Electronic cigarette sales are up, and so are calls to poison control centers, according to two new reports from the Centers for Disease Control and Prevention. 

E-cigarette sales increased by nearly 47% over the past three years, increasing from 15.5 million units per four-week period in January 2020 to 22.7 million in December 2022, according to a CDC market analysis published in the agency's June 23 Morbidity and Mortality Weekly Report

The data includes sales from brick-and-mortar retailers only and does not include sales data from vape shops and internet retailers.

The study also found that during the three-year period, the number of brands increased by 46%, from 184 to 269 brands. Sales of re-filled devices decreased (75% of total sales to 48%), while disposable devices increased (25% to 52% of sales); while sales of youth-appealing flavors—such as fruit, candy, and desserts—increased.

"The surge in total e-cigarette sales during 2020-22 was driven by non-tobacco-flavored e-cigarette sales, such as menthol, which dominates the prefilled-cartridge market, and fruit and candy flavors, which lead the disposable e-cigarette market," Fatma Romeh, lead author of the study, said in a news release. " Data from the 2022 National Youth Tobacco Survey also highlight the popularity of these flavored e-cigarettes among U.S. middle and high school students.”

The good news is that sales slowed down in the later months of the study, with overall monthly sales of e-cigarettes showing a decline from May to December 2022. The report says this decrease could be attributed to several factors, including local and state restrictions on sales of flavored tobacco products,  Food and Drug Administration regulatory actions, potential Covid-19 supply chain disruptions, inflation and a change in the products that allow more "puffs" and stronger doses of nicotine. 

In December 2022, the five top-selling e-cigarette brands were Vuse, Juul, Elf Bar, Njoy and Breeze Smoke, respectively, with Elf Bar (now marketed as EBDesign) emerging as the top-selling disposable brand in the United States. 

According to the 2021 Youth Behavioral Risk Factor Surveillance System data, 45% of Kentucky's high-school students said they had ever used an electronic vapor product, 22% of them were current users, 8% were frequent users, and 7% used the products daily. 

Asked how they got them, 11.7% of them said they usually got their electronic vapor products by buying them themselves in a convenience store, supermarket, discount store or gas station. 

All of these rates are higher than the national average. 

The FDA is working to address e-cigarettes that have high youth appeal, including flavored disposable products. On June 22 it issued a warning letter to 189 retailers it said were selling unauthorized tobacco products, specifically Elf Bar and Esco Bar, which are disposable products that come in flavors known to appeal to youth. 

“All players in the supply chain—including retailers—have a role in keeping illegal e-cigarettes off the shelves,” Brian King, director of the FDA’s Center for Tobacco Products, said in a news release. “This latest blitz should be a wake-up call for retailers of Elf Bar and Esco Bars products nationwide. If they’re waiting for a personal invitation to comply with the law, they might just get it in the form of a warning letter or other action from the FDA.”

Poison control calls doubled

In a separate CDC report, researchers from the FDA found that nationwide, from April 2022 to March 2023, poison-control centers received 7,043 e-cigarette exposure calls, representing a 32% increase, from 476 in April 2022 to 630 in March 2023. And, they had nearly doubled in 2018. 

The report says about 88%, or nearly nine in 10 cases, involved exposures to children under 5. Most of the calls involved inhalation (61%) and ingestion (40%). 

Overall, the study found that 43 cases of exposure resulted in hospital admission and 582 of them required treatment in a healthcare facility. One case resulted in death, a suspected suicide of a person 18 years or older. 

Among the limited number of cases with brand information reported from April 2022 to March 2023, the researchers found that  Elf Bar was cited more than all other brands combined, with nearly all Elf Bar cases occurring among children younger than 5 years old. 

According to data provided by the Kentucky Poison Control Center, housed at Norton Children's Hospital in Louisville, Kentucky saw a 93% increase in reported electronic cigarette exposures during that time frame, with 92 reports of e-cigarette exposure reported in 2018 and 178 reported from April 2022 and March 2023. 

"In general, during those years, 77% of the cases were under the age of 6, 10% were ages 6-18, and the rest were adults," Joe Hall, manager, Norton's public-relations manager, said in an email. 

That said, Hall offered a word of caution about the data: "Reporting is voluntary, and while the data may be representative of the trend in the general population, we do not know the true numerator, and many exposures are not reported. Additionally, exposure does not mean severe poisoning," he said. 

The researchers closed the CDC report by saying that continued surveillance is critical to prevent e-cigarette exposure, particularly among young children. 

The FDA explains in a consumer update about the report that e-liquids with even small amounts of nicotine can be dangerous to children if they touch or drink it. They stress that adults who use e-cigarettes should store them and e-liquids in a safe , elevated location, out of children's reach and view.

"Young children can be severely hurt by drinking e-liquids," the update says. "Harmful effects can include seizure, coma (long period of unconsciousness), respiratory arrest (which happens when a person stops breathing), and death. Children may also accidentally be exposed to e-liquids and their contents, including nicotine, through contact in the mouth, contact on the skin (i.e., spilled e-liquid), or by inhaling the e-liquid aerosol. It’s important to remember that containers for e-liquids can seem tempting to children of all ages for many reasons. But these products are not meant for children, teens, or young adults."

E-cigarettes get bigger and badder: Sales up rose 47% in last 3 years, nicotine content up 76% in last 5; FDA struggles to regulate

Disposable e-cigarette sales soared after the Food and Drug Administration banned fruity and minty flavors in cartridge-based devices such as Juul. (Centers for Disease Control graph; click to enlarge)

By Liz Szabo

When the Food and Drug Administration first asserted the authority to regulate electronic cigarettes in 2016, many people assumed the agency would quickly get rid of vapes with flavors like cotton candy, gummy bears, and Froot Loops that appeal to kids.

Instead, the FDA allowed all e-cigarettes already on the market to stay while their manufacturers applied for approvals to market them. Seven years later, vaping has ballooned into an $8.2 billion industry, and manufacturers are flooding the market with thousands of products — most sold illegally and without FDA permission — that can be far more addictive.

Sales of e-cigs have risen almost 47 percent in the last three years, according to the Centers for Disease Control and Prevention, and their nicotine content has gone up 76% over five years.

“The FDA has failed to protect public health,” said Eric Lindblom, former senior adviser in the FDA’s Center for Tobacco Products. “It’s a tragedy.”

The FDA isn’t the only entity that has tolerated the selling of vapes to children. Many players have declined to act, tied the agency’s hands, or neglected to provide the FDA with needed resources. Barack Obama and Donald Trump both prevented the FDA from broadly banning candy-flavored vapes.

Meanwhile, today’s vapes have become “bigger, badder, and cheaper” than older models, said Robin Koval, CEO of the Truth Initiative, a tobacco-control advocacy group. The enormous amount of nicotine in e-cigarettes can addict children in a matter of days, Koval said.

“We really don’t know the long-term health implications,” said Matthew Myers, president of the Campaign for Tobacco-Free Kids.

E-cigarettes in the U.S. now contain nicotine concentrations that are, on average, more than twice the level allowed in Canada and Europe. The U.S. sets no limits on the nicotine content of any tobacco product.

Elijah Stone of California was 19 when he tried his first e-cigarette at a party. He was a college freshman, grappling with depression and attention-deficit/hyperactivity disorder, and “looking for an escape.” Store clerks never asked for his ID. Stone said he was “hooked instantly.”

“The moment I felt that buzz, how was I supposed to go back after I felt that?” asked Stone, now 23.

The e-cigarette industry says higher nicotine concentrations can help adults who smoke heavily switch from combustible cigarettes to vaping products, which are relatively less harmful. The FDA has approved high-nicotine, tobacco-flavored e-cigarettes for that purpose, said April Meyers, CEO of the Smoke-Free Alternatives Trade Association.

“The goal is to get people away from combustible products,” said Nicholas Minas Alfaro, CEO of Puff Bar, one of the most popular brands with children last year. “These products are addictive products; there’s no hiding that.”

E-cigarettes don’t produce tar like combustibles, but contain harmful chemicals such as formaldehyde. The surgeon general has warned that vaping poses significant risks, including damage to the heart, lungs, and brain parts that control attention and learning, plus higher risk of addiction to other substances.

More than 2.5 million children used e-cigarettes in 2022, including 14% of high school students, according to the Centers for Disease Control. Most teen vapers in the U.S. begin puffing within an hour of waking up, according to a survey of e-cigarette users ages 16 to 19 presented at the Society for Research on Nicotine and Tobacco in March.

The potential for profits — and lax enforcement of vaping laws — has led to a gold rush. The number of unique vaping products, as measured by their bar codes, quadrupled in just one year, rising from 453 in June 2021 to 2,023 in June 2022, according to a Truth Initiative review of U.S. retail sales data.

FDA officials say they’ve been overwhelmed by the volume of e-cigarette marketing applications — 26 million in all.

“There is no regulatory agency in the world that has had to deal with a volume like that,” said Brian King, who became director of FDA’s Center for Tobacco Products in July 2022.

The agency has struggled to stop e-cigarette makers who continue selling vapes despite the FDA’s rejection of the products, as well as manufacturers who never bothered to apply for authorization, and counterfeiters hoping to earn as much money as possible before being shut down.

In 2018, public-health groups sued the agency, charging that the delay in reviewing applications put children at risk. A court ordered the FDA to finish the job by September 2021, but the FDA missed that deadline. An estimated 1.2 million people under the legal age of 21 began vaping in the next year, says a study published in May in the American Journal of Preventive Medicine.

The FDA recently said it has made decisions on 99% of applications, had rejected millions and authorized only 23. All authorized products have traditional tobacco flavors, and were deemed “appropriate for the protection of public health” because tobacco-flavored products aren’t popular with children but provide adult smokers with a less dangerous alternative, King said.

However, the agency has yet to make final decisions on the most popular products. Those applications are longer and need more careful scientific review, said Mitch Zeller, former director of the Center for Tobacco Products.

The FDA said it would not complete reviewing applications by the end of June, as it previously forecast, but would need until the end of the year.

Before the FDA can announce new tobacco policies, it needs approval from the president, and the White House doesn’t always agree with the FDA’s priorities.

Obama rejected FDA officials’ proposal to ban kid-friendly flavors in 2016, and in 2020, Trump backpedaled on his own plan to pull most flavored vapes off the market. Instead of banning all fruit and minty flavors, the administration banned them only in “cartridge-based” devices such as Juul. The flavor ban didn’t affect vapes without cartridges, such as disposable e-cigarettes.

The result was predictable, Zeller said. Teens switched in droves from Juul to brands that weren’t affected by the ban, including disposable vapes such as Puff Bar, which were allowed to continue selling candy-flavored vapes.

After receiving its own warning letter from the FDA last year, Puff Bar now sells only zero-nicotine vapes, Alfaro said.

When the FDA does attempt bold action, legal challenges often force it to halt or even reverse course.

The FDA ordered Juul to remove its products from the market in June 2022, but Juul sued and federal judges temporarily stayed the FDA’s order. Within weeks, the FDA announced it would hold off on enforcing the order because of “scientific issues unique to the Juul application that warrant additional review.”

E-cigarette makers Logic and R.J. Reynolds Vapor Co. both sued the FDA after the agency ordered them to stop selling menthol vapes, which are popular with teens. In both cases, court-imposed stays halted the FDA’s orders pending review and the companies’ menthol products remain on the market.

Under the Biden administration, the FDA has stepped up enforcement efforts. It fined 10 e-cigarette manufacturers more than $19,000 each, and issued more than 1,500 warning letters to manufacturers. It also issued warnings to 120,000 retailers for selling illegal products or selling to customers under 21, King said.

Five companies that received warning letters made vapes decorated with cartoon characters, such as Minions, or were shaped like toys, including Nintendo Game Boys or walkie-talkies.

In October, the Justice Department for the first time filed lawsuits against six e-cigarette manufacturers on behalf of the FDA, seeking “to stop the illegal manufacture and sale of unauthorized vaping products.” In May, the FDA put Elfbar and other unauthorized vapes from China on its “red list,” which allows FDA agents to detain shipments without inspection at the border.

Some lawmakers say the Justice Department should play a larger role. “There are more than six e-cigarette manufacturers selling without authorization on the market,” Senate Majority Whip Dick Durbin of Illinois said in a March letter. Children are “vaping with unauthorized products that are on store shelves only because FDA has seemingly granted these illegal e-cigarettes a free pass.”

KFF Health News, formerly known as Kaiser Health News, is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at the Kaiser Family Foundation — the independent source for health-policy research, polling, and journalism.

Thursday, June 22, 2023

Herald-Leader digs into idea of using a psychedelic drug to treat opioid-use disorder, talks to a Ky. woman about her use of it

The head of the Kentucky Opioid Abatement Advisory Commission has suggested using up to $42 million of the more than $900 million in settlement funds with drug companies to invest in clinical trials to study a psychedelic drug, ibogaine, as a treatment for opioid-use disorder.

Ibogaine is a powerful psychedelic that comes from a plant found in Africa that is anecdotally reported to stop the withdrawal symptoms of opioid dependence. It is not approved for use in the United States.

Jessica Blackburn
(Herald-Leader photo by Silas Walker)
Alex Acquisto and Taylor Six of the Lexington Herald-Leader tell the story of a Kentucky woman who took ibogaine for opioid-use disorder. Jessica Blackburn, 36, told the reporters that she had success taking ibogaine in her 20s to help end her addiction to OxyContin, the leading brand of oxycodone.

Blackburn, of Floyd County, recounted her struggles with addiction and attempts at recovery, including many stints at a residential treatment center, attempts with abstinence-based recovery programs, and taking buprenorphine, or Suboxone, to help wean her cravings. She also told of her repeated arrests on drug-related charges. 

"But no recovery attempts or her lengthening criminal record dissuaded her from returning to OxyContin," the Herald-Leader reports. After years of trying to stop, she said her father told her about ibogaine.

"In 2008, with roughly $6,000 in cash, Blackburn traveled alone to Jalisco, Mexico. There, in a house in a small village, she took two doses of ibogaine under the watch of strangers. The only medical device present was a battery-operated blood pressure cuff," the newspaper reports. "For the next 24 hours, Blackburn lay in a bed, largely immobile with ataxia, a side effect of the drug. She sweated, her heart rate slowed and accelerated, and she hallucinated vividly." 

“It was not a fun trip,” said Blackburn. “It was violent, like being choke-slammed by God.”

When she woke up, she no longer had a craving for oxycontin and did not have withdrawal symptoms, no longer desired cigarettes, and had lost her compulsion to bite her nails, Blackburn told the newspaper. Further, she said ibogaine changed how she viewed her addiction at an emotional and spiritual level. 

Blackburn said she had relapsed twice since taking the first ibogaine treatment, that the psychedelic worked a second time, and she has been sober for six years after being put on Vivitrol to suppress her cravings.

Bryan Hubbard, the chairman and executive direcor of the opioid commission, which operates under Attorney General Daniel Cameron, asked it to consider funding clinical research into use of ibogaine as a treatment for opioid-use disorder, with the hope of getting it approved by the Food and Drug Administration.

In June, the commission scheduled two public hearings to learn more about the drug, July 17 and Aug. 16, from 9 a.m. to 3:30 p.m. in Room A125 of the Administrative Office of the Courts Building, 1001 Vandalay Dr,, Frankfort, at the northeast quadrant of the I-64/US127 interchange.

The Herald-Leader looked at research on ibogaine research, and its risks. "Though anecdotes and case studies show ibogaine reduces withdrawals and cravings, it has also caused 'severe toxic adverse events,' detailed in the Journal of Substance Use and Addiction Treatment," the newspaper reports. "More than 30 deaths associated with ibogaine ingestion have been reported in peer-reviewed scientific literature, according to the Multidisciplinary Association for Psychedelic Studies."

The reporters add, "Ibogaine's exact impact on the brain is less clear. . .The drug does show promise for its ability to curb withdrawals and cravings, but its impact on cardiac activity is what makes it risky."

Kentucky is already part of National Institute of Health-funded research that is built on expanding existing addiction medications already approved by the FDA, and described it as "an endeavor still stymied by state policy and stigma," the reporters write.

Dr. Margaret McGladrey, a drug researcher with the University of Kentucky, told the Herald-Leader, “I feel like investing in something largely untested [in the U.S.] doesn’t make a lot of sense when we have so much effort that needs to be poured into making sure we are ensuring this kind of equitable access to the three FDA medications at our disposal.”

McGladrey is part of UK's $87 million grant-funded HEALing Communities study, which seeks to build a model to reduce opioid overdoses by 40% in 16 Kentucky counties. If successful, that model will be applied to the rest of the state.