Tuesday, February 27, 2024

Bryan Hubbard, who wanted Ky. to help finance research into psychedelic for drug treatment, takes his cause to State of Ohio

Bryan Hubbard (Herald-Leader photo by Alex Acquisto)
Kentucky Health News

The man who wanted Kentucky to use some of its opioid-settlement money for research that could lead to legalizing a psychedelic drug to treat addiction, but lost his job when a new attorney general was elected last fall, is taking his cause to the State of Ohio.

"Bryan Hubbard, former executive director of the Kentucky Opioid Abatement Advisory Commission, has signed a contract with the State of Ohio," report Alex Acquisto and Austin Horn of the Lexington Herald-Leader. "His job: To help build public-private partnerships for potential projects 'related to the treatment of traumatic brain Injury, post-traumatic stress disorder and other related and unrelated mental-health and substance-use conditions,' according to a spokesperson in the office of Ohio Treasurer Robert Sprague. . . . Hubbard will be paid $45,000 for his independent contracting services, according to his contract, which was reviewed by the Herald-Leader."

Brittany Halpin, Prague’s press secretary, told the newspaper in an email, “In part, the work is set to assist the treasurer’s office with determining the feasibility of potential solutions with ResultsOhio and other pay-for-success models.” ResultsOhio uses public and private funding to address Ohio’s “most pressing social and public health challenges,” according to the treasurer’s website

Hubbard told the Herald-Leader that as he works with the state to “deliver novel treatment access and research opportunities for veterans and opioid dependent individuals,” he is partnering with an Ohio-based foundation to “create the framework for ibogaine clinical trials in Ohio.”

Ibogaine is a psychedelic derived from the African iboga plant. It is illegal everywhere except Mexico and New Zealand and has been reported to reduce or eliminate drug-withdawal symptoms while posink risks to the heart. Hubbard wanted the Kentucky commission to spend $42 million, 5 percent of what the state had received in lawsuit settlements from drug makers and distributors, to help fund research that could lead to legalization of the drug as a treatment for addiction.

Hubbard's boss was then-Attorney General Daniel Cameron, who countenanced Hubbard's advocacy but did not endorse it outright as he ran for governor. He was succeeded by Russell Coleman, a former U.S. attorney who was not keen on ibogaine or Hubbard, and asked him to resign.

Hubbard told the Herald-Leader that he was “saddened that a lack of courage and vision from [Coleman] has deprived Kentucky of its opportunity to lead the nation in the development of ibogaine’s revolutionary therapeutic potentials. However, I am strongly encouraged that genuine leaders exist across the river to ensure that ibogaine’s promise has an opportunity to be fulfilled for all who may choose to seek it.” Coleman’s office did not respond to emailed questions from the Herald-Leader.

Hubbard is part of a broader ibogaine effort. Last week, the REID (Reaching Everyone in Distress) Foundation announced that he would “research and raise awareness for emerging therapies such as ibogaine as potential breakthrough treatments for PTSD and opioid addiction in Ohio.”

"The REID Foundation was created by Rex Elsass, who lost his son to addiction in 2019," the Herald-Leader reports. "Elsass is also one of the nation’s premier Republican operatives. In 2016, GQ magazine dubbed him “The Most Powerful Man in the GOP (And You’ve Never Heard Of Him).” His political media and consulting firm is called The Strategy Group. Elsass has been close to Kentucky Sen. Rand Paul, serving as a key adviser in Paul’s 2016 bid for president. As senator, Paul has spearheaded efforts into seeking alternative therapies to treat addiction. A donor with close connections to Paul, Jeff Yass, was the primary funder of outside groups" that helped Cameron's challenge to Democratic Gov. Andy Beshear. "Elsass’ political firm has performed work for those groups."

Yass’ investment firm "has some interest in biopharmaceutical companies with a focus on psychedelic addiction treatments like ibogaine," the Herald-Leader notes. "Elsass’ advocacy for ibogaine can be traced back to Hubbard’s time in Kentucky." He did that at an opioid-commission meeting, and "a former executive assistant at his political operation started a group called the Kentucky Ibogaine Initiative. Elsass and the current president of The Strategy Group, Ryan Rodgers, are still listed as directors" with the Kentucky secretary of state.

Monday, February 26, 2024

Anti-fluoride legislators cry 'local control' and 'forced medication;' dentists say it's been proven to reduce tooth decay for 70+ years

Centers for Disease Control and Prevention graphic; click to enlarge
By Deborah Yetter
Kentucky Lantern

As a dental hygienist working with low-income schoolchildren in Louisville, Jennifer Hasch said the untreated tooth disease she saw was shocking.

Some teens had decay so severe they had to have all their teeth pulled and be fitted with dentures. Middle-school kids reported being unable to sleep because of pain from infected and abscessed teeth. First- and second-graders required inpatient oral surgery under anesthesia because of the severity of tooth and gum disease.

“It was heart-wrenching,” said Hasch, who’s on the steering committee of the Kentucky Oral Health Coalition.

Adults don’t fare much better.

Kentucky ranks 49th in overall oral health and is among the top states in the number of toothless, older adults. And last year, a University of Kentucky oral health physician described to legislators patients being air-lifted to the UK hospital because of life-threatening infections from dental disease.

Yet a group of lawmakers led by Rep. Mark Hart, R-Falmouth, is pushing a bill to make fluoridation optional for local water districts, despite what Hasch and others, including the American Dental Association and the Kentucky Dental Association, say is overwhelming evidence fluoride safely helps reduce tooth decay.

“It’s a bill that will undo an unfunded mandate and return the issue to local control,” Hart said, speaking before the Feb. 7 meeting of the House State Government Committee in support of his House Bill 141.

Hasch and other oral health professionals are fighting HB 141, which would eliminate the fluoridation mandate established in 1954.

“There are kids that already are suffering,” Hasch said. “Water fluoridation protects that from getting worse.”

Dr. Stephen Robertson, executive director of the state dental association, urged lawmakers to reject HB 141, saying “Kentucky is not in a position to take a step backward in oral health.”

“Please listen to our professional advice and continue to provide consistent fluoride access to our patients in community water supplies,” urged Mary Ann Burch, representing the Kentucky Association of Dental Hygienists.

They didn’t.

Instead, the committee approved HB 141 by a vote of 16-1, framing it not as a public health issue but rather one of local autonomy. The bill now is pending in the House.

“This is a local control issue,” said co-sponsor Rep. William Lawrence, R-Maysville. His city was the first in Kentucky to add fluoride to its drinking water supply in 1951.

“Local control — that’s what this bill is about,” said Rep. Steve Rawlings, R-Burlington, also a co-sponsor.

“Let’s just leave it to local control,” said Rep. Kevin Bratcher, R-Louisville.

In all, six members of the committee cited “local control” as grounds for passing HB 141. Rep. Keturah Herron, D-Louisville, cast the only no vote.

Bill hasn't moved since Feb. 9

After getting out of committee, the bill went to the House Rules Committee, which is controlled by House leaders. It has been there since Feb. 9, which could indicate that its sponsors haven't yet rounded up the votes to pass it through the full House.

Meanwhile, though, the prospect of allowing local water utilities to eliminate fluoride from drinking water has Kentucky dental and public health officials frantic.

“Other than setting my hair on fire, there’s not enough words I can say that this is a critically important step, if Kentucky takes it, to harm developing teeth, children’s teeth and adult teeth,” Dr. Connie White, Kentucky’s deputy public health commissioner, said on a recent call with health advocates.

Fluoride reduces cavities by 25%, White said.

Not only will it lead to even more tooth decay than Kentucky already has, she said, it will drive up costs of Medicaid, a government health plan for low-income individuals that covers nearly half of Kentucky’s children.

Filling one cavity in a child costs Medicaid about $250, which could add million of dollars to the cost of the program, White said.

Already facing a shortage of dentists in the state, especially pediatric dentists, removing fluoride from community water supplies will mean longer delays in care, Hasch said.

“We don’t have the resources to handle that increase,” Hasch said. “All these dental providers are desperately trying to catch up with the current need.”

Dr. Bill Collins, a longtime dentist in Eastern Kentucky, said too many children in rural areas on well or cistern water already lack access to fluoridated water and suffer much more from dental decay as a result. Compounding the problem is high use of sugary sodas and lack of access to oral health care throughout the state.

He said he’s baffled about why lawmakers want to remove the fluoride mandate.

“They don’t see the need for fluoride because they haven’t experienced the decay that we have out in the rural areas,” said Collins, director of the Red Bird Mission dental clinic in Beverly, in northern Bell County. “If this happens, they’re going to experience it and they should be held responsible.”

‘Grounded in science’

Kentucky's statewide adoption of fluoridation, hailed as one of the major public-health advances of the past century by the U.S. Centers for Disease Control and Prevention, has made Kentucky a national leader, advocates said.

A naturally-occurring mineral, flouride helps strengthen tooth enamel and prevent decay when added to water in small amounts, Hasch said. It helps when children’s teeth are developing, but the main benefit is topical exposure to fluoride from drinking treated water.

The recommended level is 0.7 parts per million, which Hasch said is comparable to adding one drop of fluoride to about 11 gallons.

The Louisville Water Co., the state’s largest public water provider, has been adding fluoride to water it gets from the Ohio River since 1951, said spokeswoman Kelley Dearing Smith.

The river water already contains some natural fluoride and the water company adds enough to bring it to the recommended level, she said.

“We are grounded in public health,” she said. “Everything we do is grounded in science.”

The Louisville Water Co. joined insurer Delta Dental of Kentucky, the dental and dental hygienists associations, the Oral Health Coalition and the Kentucky Primary Care Association in a letter to legislators urging them to reject HB 141.

“Community water fluoridation is a safe, reliable cost-effective prevention measure to keep teeth strong and reduce cavities by at least 25%,” the letter said. “We are deeply concerned about any efforts to make water fluoridation programs optional in our communities.”

‘Forced medication’

Questions about fluoride’s safety and efficacy have persisted over the years, despite evidence to the contrary. 

Four rural water districts submitted letters in support of HB 141: the Grayson County Water District, Irvine Municipal Utilities, the Martin County Utility Board and the McCreary County Water District.

Craig Miller, division manager for the Martin County water utility.], wrote, “The facts are out there proving fluoridation of water is dangerous to human health.” He said eliminating fluoridation would save Martin County about $14,000 a year, which he said could be better spent upgrading the problem-plagued water system.

Nina McCoy, a longtime activist for better water in Martin County and a member of the utility board said she wasn’t consulted on HB 141 and the board didn’t vote on the matter. She suggested legislators defer to public health officials. “I don’t pretend to be an expert in this at all,” she said.

A letter from Stephen Whitaker, superintendent of the McCreary water district, cited potential “adverse effects of fluoridation” including thyroid, tooth and bone problems.

Lawrence, a co-sponsor of HB 141, called adding fluoride to water “forced medication.”

Hasch, with the Oral Health Coalition, dismissed claims of studies linking water fluoridation to health problems as “junk science” and said the overwhelming body of research supports it as safe and effective.

Collins, who has practiced dentistry in Eastern Kentucky for more than three decades, said he doesn’t understand persistent distrust of fluoride.

“I really don’t understand why they are so adamant about removing this,” he said. “It’s something that’s time-tested and shown to be a good thing and it’s safe. It’s just mind boggling.”

Sunday, February 25, 2024

Bills aim to stop people from coming to Ky. to have Medicaid pay for addiction treatment; programs could have to get them home

By Melissa Patrick
Kentucky Health News

A bill aimed at preventing people from coming to Kentucky solely to establish residency so that they can sign up for drug treatment to be paid for by the federal-state Medicaid program passed unanimously out of the state House Health Services Committee Thursday, Feb. 22.

Rep. Shane Baker
Rep. Shane Baker, R-Somerset, said House Bill 408 was born out of a situation in Pulaski County that has been repeated in "many other communities" and added to homelessness in Kentucky.

It's "an issue of people recruiting individuals from out of state and bringing them to the commonwealth, putting them on Kentucky Medicaid in a drug- treatment facility and then when they're finished, they're homeless on our streets," he said.

The bill would prohibit someone from relocating to Kentucky solely for the purpose of receiving medical services using Medicaid. 

Pulaski County Government Public Information Officer John Alexander told the committee that local governments want to make sure that anyone who leaves the treatment programs are able to return home. 

"If they bring someone from out of the community, especially out of the state, the basic, humane thing to do is that if they don't make it in the program, for whatever reason, that they are able to find their way back home," Alexander said.

Actiong Somerset Police Chief John Wesley said law enforcement has had to deal with such people stealing vehicles or engaging in other crimes in efforts to return to their home community. 

The Kentucky Association of Independent Recovery Organizations told Kentucky Health News that they share many of the concerns that this bill addresses: "KAIROS is aware of the problems many of our communities face with substandard, and often times unethical, practices implemented by some less-than-reputable recovery providers across Kentucky, and we share many of these same concerns. 

"We appreciate the efforts of Rep. Baker with HB 408 and Sen. [Phillip] Wheeler with his companion bill, SB 71, to address this issue. These bills and others pending in the General Assembly will go a long way in closing the loopholes that unsavory actors have used to exploit people at their most vulnerable, when they could be getting lifesaving help from reputable, evidence-based providers."

SB 71 was approved by the Senate Health Services Committee on Feb. 21 and awaits a vote on the Senate floor. Its sponsor is a Republican from Pikeville.   

HB 408 would require the recovery facility to provide transportation for the individual to get them back home if they "voluntarily" leave the treatment program. The bill list several ways this could happen, including the engagement of a mobile response team.

The bill also has provisions to ensure that these recovery facilities don't recruit patients who are on Medicaid. Baker said changes made in committee moved the penalties from the individual to the provider. 

If passed, the bill would prohibit treatment centers or programs licensed as a chemical-dependency treatment service from recruiting out-of-state residents if they are enrolled in Medicaid, or with the purpose of enrolling them in Kentucky Medicaid.

It would require the facility to submit the recipient's proof of residency when submitting a request for Medicaid reimbursement, and says any out-of-state resident found to be ineligible for Kentucky Medicaid as a result of failure to establish Kentucky as their official residence must reimburse the state for any Medicaid fees that have been paid on their behalf. 

The recovery program would be fined not less than $500 for each day an out-of-state resident received Medicaid services in Kentucky, and face a general fine of $20,000 per offense. 

Rep. Lindsey Burke, D-Lexington, suggested that the bill exclude people who have significant ties to Kentucky or ones that previously lived here.

"Perhaps we wouldn't want to include them if this is the best community for them to return to, to gain sobriety," she said. "So I don't know if there's an opportunity to create an amendment that someone who has substantial connections here may not be subject to this provision or not." 

Baker said they would look into that. Rep. Kim Moser, R-Taylor Mill, chair of the committee and a co-sponsor on the bill, said she wasn't sure if this is something they could resolve in this bill.

Saturday, February 24, 2024

Emergency-department visits and hospitalizations for respiratory illness in Kentucky were down slightly from last week's uptick

State Department for Public Health graphs, adapted by Kentucky Health News

By Melissa Patrick
Kentucky Health News

While still considered high, Kentucky hospitalizations for respiratory disease dropped 15% in the week ending Feb. 17 after increasing in the previous week. 

The state Department for Public Health's weekly respiratory-illness report says 454 Kentuckians were hospitalized during the week, with big drops in all three respiratory viruses the state tracks -- flu, Covid-19 and respiratory syncytial virus (RSV). 

However, even with an 11% drop in Covid-19 hospitalizations, 15 Kentucky counties had a Covid-19 hospitalization rate between 10 and 10.9 per 100,000 people, considered an elevated or medium rate by the Centers for Disease Control and Prevention, and four Kentucky counties continued to have high rates of Covid-19 hospitalizations: Elliott, Menifee, Morgan and Rowan, all with rates of 21.2 per 100,000. 

The counties with medium rates of Covid-19 hospital admissions were Pike and Letcher, in far eastern Kentucky; Daviess, McLean, Ohio and Hancock, in western Kentucky; and Ballard, Carlisle, Crittenden, Graves, Hickman, Livingston, Lyon, Marshall and McCracken, in far west Kentucky.

Emergency-department visits for respiratory illness in Kentucky dropped 4% in the week ended Feb. 17, to 3,481. The biggest drop was among patients with RSV (down 27%), followed by a drop in Covid-19 visits (down 12%). 

ED visits by 5- to 17-year-olds leveled off, largely because flu visits, while still high, leveled off. During the week, 880 children in this group visited EDs for flu. 

Both flu and Covid-19 saw slight drops in laboratory-confirmed cases in the week ended Feb. 17. Lab-confirmed flu cases dropped to 3,860 and lab-confirmed Covid-19 cases dropped to 2,430. 

Since the respiratory-illness season began the first week in October, 361 Kentuckians have died from Covid-19, and 51 from the flu, according to the health department. One Covid-19 victim and one flu victim have been children. 

It's important to remember that flu and Covid-19 related deaths are reported in the week they happened, which can create an uptick in these numbers on any given week even though the deaths did not happen in that week. 

For example, this week's report shows an increase of 34 Covid-19 deaths and an increase of 23 flu deaths over the last report even though no new deaths were reported in the week ended Feb. 17.

Friday, February 23, 2024

Vaping bill stripped of licensing requirements and stiffer penalties passes House; sponsor says alternate bill on retailing is expected

By Melissa Patrick
Kentucky Health News

The House passed a watered-down bill to address youth vaping Thursday, Feb. 22, after a committee removed provisions to require vape shops be licensed and raise penalties for their violations. 

Rep. Mark Hart, R-Falmouth
The bill's sponsor, Rep. Mark Hart, R-Falmouth, told Kentucky Health News that he took out the licensing and penalty provisions because Rep. Rebecca Raymer, R-Morgantown, was expected to file a bill to address those issues without the education components of his bill. The deadline for new House bills is Monday, Feb. 26, but new legislation can also be added by amendments.

"So I pulled all the education stuff out of the vaping bill and I carried just that portion," he said. "So my bill only addresses how to  deal with vaping for kids in the  school system."

Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, said it is unnecessary to put youth penalties in law because schools already have that authority, but licensing vape shops is critical. 

"I don't think there's any question about this, you need to license the people who sell the vapes. We don't even know who's selling the vapes. That's the first thing," he said. " And then the second thing is, you need to do something about these flavors. It's well established that the kids are attracted to the flavors. And why the legislature won't do something about the flavors is a mystery to me." 

Chandler said it is time to solve this problem, and Hart's bill will not do that. "I would think you'd want to try to find the solution, and this is not it." 

Griffin Nemeth, coordinator of the University of Kentucky's #iCANendthetrend Youth Advisory Board, said in an email that tobacco retail licensing should be a priority because it has helped reduce youth nicotine use in the approximately 40 of 50 states that have some form of licensing.

Tobacco retail licensing "faces particularly strong opposition in Kentucky despite its success in other states," Nemeth said. "The removal of the vapor retail licensing component of HB 142 is not surprising and will likely improve its chances of being passed."

The current version of House Bill 142 would require school districts to adopt specific policies that penalize students for possessing "alternative nicotine products, tobacco products, or vapor products." 

The policy would require the school to confiscate nicotine products from students and, if it's a first incident, to give the student and family evidence-based, age-appropriate information about nicotine cessation. A second incident would require the student to receive disciplinary action established by the school's policies. 

Any incident beyond a second offense would require the student to receive an in-school or out-of-school suspension. Upon suspension, the school must also provide the opportunity for the student to complete an evidence-based, age-appropriate nicotine education program during an in-school suspension. 

Asked why such policies need to be legislated, Hart said it is important to put these requirements into law because it gives school administrators something to "hang their hat on" when they confiscate products and penalize students. 

"They could write their policies and stuff, but now that we're making this a law, it's going to give the administrators some teeth . . . this will give them some protection because this says in law now, you've got to do this." 

One of the challenges administrators are facing, he said, is that parents don't want their kids punished for vaping and want their vaping devices returned to them because they are buying these products for their kids. 

"We've got parents out there that think it's perfectly safe and all right for their kids to vape," he said.  

The 2021 Youth Risk Behavior Survey found that 4.9% of Kentucky high-school students said they smoked cigarettes and 21.9% said they used electronic vapor products. Among middle schoolers, 1.7% said they currently smoked cigarettes and 11.3% used a vapor product. “Current use” is considered having used a product at least once during the 30 days before the survey.

Among other things, the bill requires school boards to report the number of nicotine-related behavior incidents in schools and the number that required medical intervention by Aug. 1 of each year to the state Department of Education, which would have to compile the data and submit it to the legislature before Sept. 1.

Hart said the reporting requirements will allow legislators to track this issue: "In a couple of years, if things aren't getting any better or it is still as big a problem as it is, then we can take steps to change the law or do whatever we have to at that time."

Opioid epidemic is in a 'fourth wave,' seeing multiple substances being used at the same time, and fentanyl is the most common

A person uses fentanyl in Portland, Oregon, Jan. 23. (Photo: Patrick T. Fallon, AFP, via Getty Images and KFF)
By Colleen DeGuzman
KFF Health News

The United States is knee-deep in what some experts call the opioid epidemic’s “fourth wave,” which is not only placing drug users at greater risk but is also complicating efforts to address the nation’s drug problem.

These waves, according to a report from Millennium Health, were the crisis in prescription opioid use, followed by a significant jump in heroin use, then an increase in the use of synthetic opioids like fentanyl.

The latest wave involves using multiple substances at the same time, combining fentanyl mainly with either methamphetamine or cocaine, the report found. “And I’ve yet to see a peak,” said one of the co-authors, Eric Dawson, vice president of clinical affairs at Millennium, a specialty laboratory that provides drug-testing services to monitor use of prescription medications and illicit drugs.

The report, which takes a deep dive into the nation’s drug trends and breaks usage patterns down by region, is based on 4.1 million urine samples collected from January 2013 to December 2023 from people receiving some kind of drug-addiction care.

Its findings offer staggering statistics and insights. Its major finding is how common polysubstance use has become. According to the report, an overwhelming majority of fentanyl-positive urine samples — nearly 93% — contained additional substances. “That is huge,” said Nora Volkow, director of the National Institute on Drug Abuse at the National Institutes of Health.

The most concerning, Volkow and other addiction experts said, is the dramatic increase in the combination of methamphetamine and fentanyl use. Meth, a highly addictive drug often in powder form that poses several serious cardiovascular and psychiatric risks, was found in 60% of fentanyl-positive tests last year. That is an 875% increase since 2015.

“I never, ever would have thought this,” Volkow said.

Among the report’s other key findings:
  • The nationwide spike in methse alongside fentanyl marks a change in drug use patterns.
  • Polydrug use trends complicate overdose treatments. For instance, naloxone, an opioid-overdose reversal medication, is widely available, but there isn’t an FDA-approved medication for stimulant overdose.
  • Both heroin and prescribed-opioid use alongside fentanyl have dipped. Heroin detected in fentanyl-positive tests dropped by 75% since peaking in 2016. Prescription opioids were found at historic low rates in fentanyl-positive tests in 2023, down 89% since 2013.
But Jarratt Pytell, an addiction medicine specialist and assistant professor at the University of Colorado’s School of Medicine, warned these declines shouldn’t be interpreted as a silver lining.

A lower level of heroin use “just says that fentanyl is everywhere,” Pytell said, “and that we have officially been pushed by our drug supply to the most dangerous opioids that we have available right now.”

“Whenever a drug network is destabilizing and the product changes, it puts the people who use the drugs at the greatest risk,” he said. “That same bag or pill that they have been buying for the last several months now is coming from a different place, a different supplier, and is possibly a different potency.”

In the illicit drug industry, suppliers are the controllers. It may not be that people are seeking out methamphetamine and fentanyl but rather that they’re what drug suppliers have found to be the easiest and most lucrative product to sell.

“I think drug cartels are kind of realizing that it’s a lot easier to have a 500-square-foot lab than it is to have 500 acres of whatever it takes to grow cocaine,” Pytell said.

Dawson said the report’s drug use data, unlike that of some other studies, is based on sample analysis with a quick turnaround — a day or two.

Sometimes researchers face a months-long wait to receive death reports from coroners. Under those circumstances, you are often “staring at today but relying on data sources that are a year or more in the past,” said Dawson.

Self-reported surveys of drug users, another method often used to track drug use, also have long lag times and “often miss people who are active for substance use disorders,” said Jonathan Caulkins, a professor at Carnegie Mellon University. Urine tests “are based on a biology standard” and are good at detecting when someone has been using two or more drugs, he said.

But using data from urine samples also comes with limitations. For starters, the tests don’t reveal users’ intent.

“You don’t know whether or not there was one bag of powder that had both fentanyl and meth in it, or whether there were two bags of powder, one with fentanyl in it and one with meth and they took both,” Caulkins said. It can also be unclear, he said, if people intentionally combined drugs for an extra high or if they thought they were using only one, not knowing it contained the other.

Volkow said she wants to learn more about the demographics of polysubstance drug users: “Is this pattern the same for men and women, and is this pattern the same for middle-age or younger people? Because again, having a better understanding of the characteristics allows you to tailor and personalize interventions.”

All the while, the nation’s crisis continues. According to the Centers for Disease Control and Prevention, more than 107,000 people died in the U.S. in 2021 from drug overdoses, most because of fentanyl. In 2022 in Kentucky, 2,135 residents died from overdoses, and fentanyl was identified in more than 1,500 of the deaths, 72% of them.

Caulkins said he’s hesitant to view drug-use patterns as waves because that would imply people are transitioning from one to the next.

“Are we looking at people whose first substance use disorder was an opioid use disorder, who have now gotten to the point where they’re polydrug users?” he said. Or, are people now starting substance use disorders with methamphetamine and fentanyl, he asked.

One point was clear, Dawson said: “We’re just losing too many lives.”

KFF Health News is a national nonprofit newsroom producing in-depth journalism about health issues. 

Thursday, February 22, 2024

UK study estimates more than 134,000 cases of cancer went undiagosed in the first 10 months of the pandemic, due to it

Markey Cancer Center (University of Kentucky photo)
By Elizabeth Chapin
University of Kentucky

More than 134,000 cancer cases went undiagnosed in the U.S. during the first 10 months of the Covid-19 pandemic, according to a new University of Kentucky Markey Cancer Center study.

The report, published in JAMA Oncology Feb. 22, provides the first estimates of missed cancer diagnoses in 2020 using nationwide surveillance data.

Researchers have expected impacts to cancer detection as a result of delayed screenings and missed health care appointments due to the pandemic, but the extent of this impact had not been quantified until recently. The study’s findings foreshadow even greater consequences.

“The longer cancer exists undetected, the lower the chances of positive patient outcomes. Every missed detection is a lost opportunity to beat cancer at its most treatable stage,” said the paper’s senior author, Krystle Lang Kuhs, co-leader of Markey's Cancer Prevention and Control Research Program and associate professor in the College of Public Health. “This research reminds us to prioritize our health and get back on track with recommended cancer screenings and routine office visits so we can live longer, healthier lives.”

Findings from this report will help to inform where the U.S. health-care system can make up ground in cancer screening and detection and give insight on how similar disruptions could impact cancer diagnoses in the future.

The research underscores the importance of timely dissemination of data, says Todd Burus, the study’s lead author and part of the Markey center's Community Impact Office.

"It is unfortunate that we are only able to perform this assessment over two years after the fact,” said Burus. “We must invest the resources necessary to have more timely tracking of trends in cancer incidence so that we can target responses to the places they're needed sooner."

The study relied on data from the U.S. Cancer Statistics Public Use Database June 2023 release—the first release available with 2020 cancer incidence data for all 50 states. Using trends from previous years, the team calculated the expected cancer rates for March through December 2020 and compared this with what was actually reported.

Results showed that overall cancer diagnoses were 13% lower than expected during those 10 months, including a 28.6% reduction from expected during the period of widespread stay-at-home orders in March to May 2020.

Researchers also examined incidence rates by cancer type and stage of diagnosis, and among different populations. Key findings include:
  • Prostate, female breast, and lung cancers had the largest numbers of potentially missed cases during the 10-month period at 22,950 cases, 16,870 cases and 16,333 cases, respectively.
  • Cancers with recommended, high-evidence screenings (female breast, cervical, colorectal and lung) saw a total rate reduction of 13.9% versus expected. Rates of female breast cancer showed signs of recovery to previous trends following the first three months of the pandemic, but levels remained suppressed for cervical, colorectal and lung cancers throughout the 10 month period.
  • Significant reductions occurred among both early and late-stage diagnoses of most cancer sites examined.
  • States that implemented stay-at-home orders in excess of six weeks saw a greater disruption to cancer diagnoses than those that undertook less restrictive measures, particularly among lung, kidney and pancreatic cancers.
The paper’s authors also stress the need to continue following this data in the coming years to understand how undetected cases from 2020 impact future trends in cancer mortality and survival.

“There will undoubtedly—and unfortunately—be a subsequent bump in cancer mortality,” the authors note. “How much, and for how long, will provide a more complete picture of the consequences of Covid disruptions on the burden of cancer in the U.S.”

Wednesday, February 21, 2024

President's brother promoted the failed hospital chain that ran Pineville's community hospital into the ground, Politico reports

Pineville Community Health Center (Photo from Pineville Sun and Cumberland Courier)
Kentucky Health News

In May 2017, three men came to Pineville, Ky., the Bell County seat of 1,700 people, looking for business from Pineville Community Hospital, which had just been bought by a company that was buying financially distressed hospitals. One of them was James Biden, a brother of Joe Biden, who five months earlier was the vice president of the United States and is now president.

As the business relationship between then-hospital owner Americore and Biden's firm Fountain Health developed, Americore listed Jim Biden as a partner, identifying him as "Brother and campaign finance chair of former vice president Joe Biden," and Jim Biden began using his connections with current and former federal officials to help Americore, which was having trouble operating the facility that it had renamed Southeastern Kentucky Medical Center, reports Ben Schreckinger of Politico.

"Several former Americore executives said Joe Biden was central to Jim Biden’s ambitions for the company," Schreckinger writes. "One said that Jim Biden explained to him, 'His brother was very interested in rural health care and very interested in veterans’ health care and it was something he really wanted to get behind.' In fact, Jim Biden told the executive, if Americore successfully demonstrated a model for revitalizing rural health care, Joe Biden could run on it in 2020. 'This would help his brother get elected if it were to take off and go,' the former executive explained."

James Biden (Photo illustration by Politico)
There's no evidence that Joe Biden became involved in his brother's business, but his son Hunter Biden discussed with Jim Biden and Americore "the possibility that Americore could land an investment from associates of Jim and Hunter Biden affiliated with CEFC, a Chinese energy firm, according to a person familiar with the conversation," Schreckinger reports.

But no investments were made, and by January 2018, Americore was insolvent, according to a Securities and Exchange Commission complaint against hedge-fund manager Michael Lewitt, who was working with Jim Biden and Americore. Nevertheless, Politico reports, Jim Biden "waded deeper into the business," the financial model of which appeared to be based on taking advantage of federal rules that allow rural hospitals to charge more for laboratory work.

In Pineville, where Americore had renamed the hospital Southeastern Kentucky Medical Center, it was having trouble meeting payroll. Then it "stopped paying health-insurance premiums for its Pineville employees," Schreckinger reports. "Staffers, who continued to have the premiums deducted from their paychecks, only learned of the problem when their insurance claims met with surprise rejections. As a result, when the husband of one longtime employee, Betsy Marsee, died, her life insurance claim was denied, according to Pineville Mayor Scott Madon, a former executive at the hospital, and a report in the Middlesboro News."

In mid-2018, Jim Biden ended his relationship with Americore. In 2019, Medicare and Medicaid, which covered more than 90 percent of the Pineville hospital's patients, cut off payments to it. The hospital wenyt into bankruptcy, was sold in a bankruptcy auction to a local bank that essentially acted as an angel to save a hospital that had been a great source of pride for the town. 

January 2019 report by the Centers for Medicare & Medicaid Services, part of the Department for Health and Human Services, says that "Over the course of 2018, doctors left, equipment went without maintenance and medical supplies became scarce," Schreckinger reports. "At times, staffers had to leave the operating room mid-surgery to track down missing gauze. . . In October, the report said, a surgeon quit after concluding that operating there was 'endangering the lives of my patients.'

"Then, just after 8 p.m. on the first Tuesday of December, a patient arrived in the throes of cardiac arrest. Twice, the patient needed epinephrine to stimulate their heart, but the hospital did not have enough of the drug on hand, and staff from the ambulance service had to provide it. A doctor ordered an X-ray of the patient’s chest, but it appears none was taken: A nurse later told an HHS investigator that there were no radiology staffers on hand that night. At 9:55, the patient, identified by HHS only as Patient #12, was pronounced dead."

The hospital is the only one so far to get financial aid from a new state fund to help rural hospitals. The $1 million loan at 1% interest over a five-year term was approved by the Kentucky Economic Development Finance Authority in December 2021.

Renamed Pineville Community Healthcare, it was sold in 2023 to Michael Fry of Nashville but offers only limited services, such as an emergency room and outpatient surgery. The first option in its telephone list is the laboratory.

Tuesday, February 20, 2024

Half of rural hospitals lose money; firm says 418 could close; Ky. not a standout except in Medicare Advantage, which is a threat

Map by Chartis Center for Rural Health, labeled by Kentucky Health News
Kentucky Health News

Rural hospitals are in more trouble than ever, and 418 of them are “vulnerable to closure,” according to a study of their finances by Chartis, a Chicago-based health-care consultancy that specializes in tracking the business of rural health.

The Chartis Center for Rural Health says rural hospitals are entering "a startling new phase of this crisis as rural hospitals fall deeper into the red, 'care deserts' widen throughout rural communities, and the increasing penetration of Medicare Advantage could further disrupt rural hospital revenue."

The top warning signal cited in the study is that half of rural hospitals are losing money, up from 43 percent a year ago. That news is especially bad for independent rural hospitals, 55% of which are in the red, while only 42% of rural hospitals affiliated with groups are operating at a loss. "Nearly 60% of rural hospitals are now affiliated with a health system," Chartis reports.

Most people on Medicare now have Medicare Advantage, private insurance plans that get lump sums from Medicare to cover members and look for ways to attract customers while limiting claims. "Medicare Advantage now accounts for 35% of all Medicare-eligible patients in rural communities," Chartis reports, saying Advantage plans' share of rural residents has risen 48% since 2019. 

Chartis map, labeled by Ky. Health News; click on it to enlarge
That's a problem for rural hospitals designated as "critical access" because Medicare Advantage plans' net reimbursement to such hospitals "is often lower for similar services than that of traditional Medicare because Medicare Advantage does not follow cost-based reimbursement" as traditional Medicare does for such hospitals, Chartis reports. Insurance companies negotiate those rates with hospitals, and in many rural areas, hospitals are at a negotiating disadvantage because few insurers operate in their service areas.

Also, "Medicare Advantage may not cover all the services traditional Medicare does, including swing beds, which provide skilled nursing care for patients and are often a strong source of revenue stability for rural hospitals," Chartis notes. "Rural providers may not be equipped to efficiently navigate administrative requirements for payment introduced by Medicare Advantage, such as prior authorizations, which can lead to increased denials."

Since 2010, "167 rural hospitals have either closed or converted to a model that excludes inpatient care," Chartis says. The firm says its estimate that 418 are “vulnerable to closure” is based on "a new, expanded statistical analysis" of their finances, gleaned from cost reports they file with Medicare.

The report does not give details for each state, but places each one in certain ranges. It deems fewer than 10% of Kentucky rural hospitals "vulnerable to closure" but places the state in the highest range of rural Medicare Advantage growth. As for being in the red or the black, it puts Kentucky among the states where 41% to 60% of the rural hospitals are losing money.

Myths surround the deadly drug fentanyl; here are the facts

Photo illustration by CorbalanStudio, iStock/Getty Images Plus
By faculty and staff of the HEALing Communities Study
University of Kentucky

Fentanyl is a synthetic opioid that is about 50 times stronger than heroin, making it an incredibly powerful drug. It is often made illegally and added to other drugs like heroin, methamphetamine, cocaine, ecstasy and benzodiazepines such as Xanax. In Kentucky, illicit fentanyl has become a significant concern, and was detected in over 70% of overdose deaths in the state 2022.

Unfortunately, the spread of misinformation surrounding fentanyl has fueled unnecessary fear, leading to stigmatization of people who use drugs that can prevent them from seeking treatment and essential harm reduction services. Additionally, it may prevent someone experiencing an overdose from getting life-saving help. Let's address some of the most common myths:

Myth: Fentanyl is naloxone-resistant.
Fact: Naloxone is a medication that quickly reverses the effects of opioids and helps restore breathing in someone who is experiencing an overdose. Naloxone does work to help reverse a fentanyl overdose. Make sure you always call 911 in the event of any overdose.

Myth: People can overdose by touching or inhaling fentanyl by accident.
Fact: Despite sensationalized news stories, simply touching or coming into contact with someone who has overdosed does not cause an overdose. Secondhand exposure poses no danger, so don't hesitate to administer naloxone and save a life.

Myth: You can tell if fentanyl is in your drug by looking at it.
Fact: It is very difficult to know if what you are using contains fentanyl just by looking at it, tasting it, or smelling it. Fentanyl test strips can help you find out if what you are using may have fentanyl or fentanyl analogs in it, but they are not always 100% accurate. It is always safest to assume fentanyl may be present. Try not to use alone and have someone who can administer naloxone present in the case of an overdose.

Monday, February 19, 2024

Eastern Ky. towns fight to recover from opioid epidemic, with help from newcomers and recovering addicts, national author reports

An event in downtown Hazard: “When somebody gets clean, they want to change the world,” Stephanie Callahan, a former addict and current business owner in Hazard, said of the town’s new can-do spirit. “You do something just to prove you can do it.” (Photos by Stacy Kranitz for The Free Press)
By Sam Quinones
Republished from The Free Press

In early 2020, Mandi Fugate Sheffel, 42, opened a tiny bookstore in her hometown of Hazard. Everyone thought she was crazy.

Downtown Hazard was a forbidding place to start any business, much less a bookstore. Most coal mines that once supported the area had closed. Many brick buildings from Hazard’s heyday were gone, bequeathing a gap-toothed look to Main Street.

What’s more, Fugate Sheffel couldn’t afford a website or employees. She had never run a business before. And she had a complicated personal history to wrestle with.

But she loved to read—particularly contemporary Appalachian authors like Silas House, James Still and Gurney Norman, who told stories that felt real to her. She figured others in town were tired, like her, of driving two hours to Lexington to buy books.

So, on January 30, she opened Read Spotted Newt in a 250-square-foot space—the size of a small bedroom.
I met Fugate Sheffel last spring when I visited Hazard for the first time. I came to speak about my book, The Least of Us, about America’s drug-addiction epidemic. I had heard about the town, and had formed an image of it as the buckle on Eastern Kentucky’s opioid belt.

Mandi Fugate Sheffel poses outside her bookstore in Hazard.
From Fugate Sheffel, though, I heard another story—one that I heard elsewhere in the Appalachian coalfield.

“When you don’t have industry, you’re having ecological disaster and a drug epidemic—you would think all those things would get us to a place where the town would be uninhabitable,” Fugate Sheffel told me. “But that’s not what I’m seeing at all. I’m seeing a lot of people rally.”

The loping hills of Eastern Kentucky are studded with scores of towns like Hazard—and nearby Prestonsburg and Pineville and Corbin—that, over the centuries, emerged in the valleys and along its rivers. By the early 20th century, coal dominated the region, with roughly 700,000 men and boys toiling in the mines of Kentucky and neighboring West Virginia.

In the 1990s, “as one declined and things got worse, the other increased and things got worse,” Les Stapleton, the mayor of Prestonsburg, pop. 4,000, 35 miles northeast of Hazard, told me about the correlation between jobs and drugs.

Larger forces over which locals had little or no control exacerbated things: the rise of natural gas for power plants, new environmental standards, our shifting political and cultural landscape.

By the early 2000s, the region had become the epicenter of the new opioid epidemic, which had its epicenter in Eastern Kentucky, West Virginia, and southwest Virginia.

Downtowns emptied out. Buildings were abandoned. Business startups seemed dominated by “pill mills”—clinics that prescribed huge quantities of prescription painkillers. In the little evangelical churches, they prayed for an end to “hillbilly heroin.”

The state cracked down on the pill mills, but by 2017, Perry County was the worst-hit county in the United States when it came to hospitalization for opiate addiction.

But then, weirdly and unexpectedly, at the same time that everything was falling apart, things started to get better—and that old world started, very tentatively, to build itself back up.

In the past few years, some 43 businesses have opened in Hazard, creating 171 new jobs, said Bailey Richards, the town’s coordinator of downtown development. That includes a toy store, a café, a women’s boutique, a quilt and apparel place, and a smoothie shop. A longtime restaurant just moved downtown.

The population, which declined for most of the latter half of the 20th century, now appears to be inching up. The growth was driven mostly by outsiders—new families, mostly from cities in Kentucky, in search of a better future, and immigrants, including health-care workers a nascent Latino community.

Shane Barton, the downtown-development coordinator at the University of Kentucky’s Community and Economic Development Initiative, went so far as to call Hazard “a hip destination for young people.”

It was hard to say why this was happening. Gradually, people were becoming more aware of the crisis of Appalachia and were doing things trying to help. Covid-19 pushed people to move out of the cities. And there were the recovering addicts; they weren’t expensive to hire if you needed a barista or someone to stock your shelves or paint your walls, and they were eager to work, to live.

In Hazard, about a quarter of the new jobs are held by recovering addicts. In Pineville, an hour and a half southwest of Hazard, one-third of new jobs are filled by people in recovery, said Jacob Roan, who oversees economic development in the Bell County seat.

“When somebody gets clean, they want to change the world, and have ideas of how to change the world,” Stephanie Callahan, a former addict and current business owner in Hazard, told me. “You do something just to prove you can do it.”

Joey Jones poses in his Ready Set Play toy store in Hazard.
That’s what inspired Joey Jones—the can-do spirit.

Jones and his wife, Nikki, grew up in Hazard, went to the University of Louisville, and in 2019, returned home after ten years away, now with two kids.

Though a trained social worker, Joey Jones opened a toy store. This was last year. He called it Ready Set Play, and it’s on Main Street. Jones advertises on social media and, despite selling toys that are available online, he is expanding.

“The small business community here feels like family,” Jones said. Mandi Fugate Sheffel, who knew something about hard times and people coming together, agreed.

She had been in high school in the 1990s, as the mines were closing and pain pills were invading. “One day, we were drinking beer in the back of a truck,” she said. “Then, all of a sudden, these pills were everywhere.” By 1997, she was an OxyContin addict.

The addicts dubbed a local park “Pillville,” and Fugate Sheffel got out. She moved to western Kentucky, came home in 2002, got sober, married, had a son. She survived.

So did her bookstore, against all odds.

A few days after she opened it, in 2020, it was flooded. Then Covid hit and Kentucky’s governor banned in-store shopping, and Fugate Sheffel thought this might really be it for Read Spotted Newt.

But after news media reported on Read Spotted Newt’s woes, Fugate Sheffel started getting orders from all over. Soon, she said, “I was shipping books everywhere—Boston, Florida, Texas, L.A.  Anybody who had any tie to Eastern Kentucky who knew this was going on were like, ‘We gotta make sure she makes this work.’”

By late 2020, she had moved to a larger space—a triangular building on a corner that once housed Hazard’s tourist welcome center. The city renovated it for her.

There are other pockets of hope scattered across the region.

In Prestonsburg, an hour north of Hazard, there are five locally owned restaurants, all but one of which opened in the last five years. An Indian restaurant is coming soon. The two-block historic downtown once had eleven abandoned buildings. Now, all are occupied.

In Pineville, pop. 1,600, the downtown was similarly decimated. Now there are boutiques, a hair salon, a furniture store, and several restaurants. Importantly, noted Roan, the economic-development director, “Those businesses are still in business six, seven years after opening.”

In Corbin, pop. 8,000), just up the Cumberland Gap Parkway from Pineville, several old buildings have been redone. They now house restaurants, a clothing boutique, a print shop, a café, an ice cream parlor, a record store, and a pinball museum.

“Everybody is like, ‘What can I start? What’s missing around here?’ ” Corbin Mayor Suzie Razmus told me.

Something else locals are starting to see in these places: people. On the street, outside their favorite coffee shop, chatting with a friend through an open car window.

In the past, a town grew from a big factory that employed hundreds or more people. But no one’s waiting any longer for factories or big-box stores—to say nothing of the mines or unions—to save them.

Prestonsburg Mayor Les Stapleton: “If a deer gets killed on the
highway, I pull over and put it in the truck and get rid of it . . .
I don’t want people seeing that the first time they drive into town.”
“Too many have come in to try to save us, and they don’t,” said Stapleton, the Prestonsburg mayor. “We got to do it ourselves.”

Now, he’s facing a problem he could never have anticipated: a shortage of affordable housing. This has been driven, he added, by outsiders who, since Covid, have been moving to Prestonsburg and other towns across the region.

Jeff Siegler, whose firm Revitalize, or Die advises small towns on rebuilding, said the area’s success “has to be about small, incremental victories—one business at a time.”

The new generation of mayors, town councilors, and city planners across much of Appalachia, who had come through the disaster of the last three decades and seemed inspired by recovering addicts in their own communities, understood what Siegler was saying: small is good; local is good; people are good.

Instead of trying to lure massive out-of-state companies with tax incentives, they were thinking about beautification projects and homeowners and places where people could congregate.

“That’s the shift,” said UK's Shane Barton. “How can we make our communities people-ready as opposed to industry- or investment-ready?”

Still, progress is uneven, and many small-town economies are frail. Self-reliance may take them only so far.

The drug problem rages on. Fentanyl seems to be mixed into everything on the street, creating staggering numbers of overdoses. On top of all this, a form of perverse gentrification has taken hold that’s peculiar to this birthplace of the opioid epidemic. Legions of national drug treatment centers catering to the addicts have moved to the region—sopping up cheap real estate and pricing lower-income buyers and start-ups out of the market.

But at this point, that seems like a minor, mostly surmountable hurdle, at least to the people here who have stopped waiting for outsiders—coal companies, big-box retailers, Frankfort, Washington—to save them.

That is definitely the way Stephanie Callahan, in Hazard, sees things.

Now in her early forties, Callahan, like Mandi Fugate Sheffel, was part of the generation consumed by Oxycontin. She got clean when she had a baby—this was 15 years ago—and built a career as a showroom saleswoman at a local furniture company. But she yearned to do something on her own.

She loved fashion. For two years, she had been running a side hustle out of her bedroom, selling plus-size clothes. She hated that she had to go to Lexington every time she needed a new top or skirt.

So, in the summer of 2021, Callahan quit her full-time job and rented a space in downtown Hazard that had once been a gym. Her father said she’d lost her mind, opening a women’s clothing store during Covid. She did it anyway, calling it Hot Mess Express, which is what her mother and friends often called her.

She showed them: in her first two years, Callahan had 2,000 repeat customers. She now has nine part-time employees and will soon open a men’s store.

It wasn’t just about the clothes. It was about people in Hazard, like so many towns, trying to find their way back to each other.

“When I was growing up, we had arcades, movie theaters, mom-and-pop restaurants,” Callahan said. Now, “there’s no place for people to go talk to each other.”

So, she put a brown leather couch, almost as an afterthought, in the middle of the store, intending it for men accompanying their wives and girlfriends to sit and scroll through their phones or read a magazine—kill time. Instead, it became the focal point of the store, and it made Hot Mess Express a community hangout as well as a women’s boutique. A little place, or nook, where people would say hi, catch up, laugh, hug, gossip.

“It’s comfortable,” Callahan told me, referring to the couch. “I have a photo of the mayor asleep on it.”

Sam Quinones is the author of four books, including his latest, The Least of Us: True Tales of America and Hope in the Time of Fentanyl and Meth. You can follow him on X at @samquinones7.

Heart Association gives UK grant to spur 'food as medicine' effort

By Grace Sowards
University of Kentucky

The Food as Health Alliance at the University of Kentucky has received a grant from the American Heart Association. UK is among the first recipients of AHA’s Health Care by Food Initiative awards.

Alison Gustafson (UK photo by Sabrina Hounshell)
FAHA director Alison Gustafson is a faculty member in the University of Kentucky Martin-Gatton College of Agriculture, Food and Environment. She will use the $386,000 grant over the next year and a half to see how a user-centered design program can improve screening, referral enrollment and engagement in food-as-medicine programs for adults with food insecurity and high blood pressure or other diet-sensitive chronic diseases.

This grant also involves UK HealthCare and Appalachian Regional Healthcare, with key partnerships from Instacart, Kroger Health with Soda Health, Mom’s Meals and Food City.

“We are looking forward to working with our partners across the state to improve screening, referral and enrollment practices to improve patient outcomes,” said Gustafson, a professor in UK's Department of Dietetics and Human Nutrition.  She has partnered with Instacart, Mom’s Meals and Food City on current pilot projects across Kentucky to help develop the infrastructure for patients receiving food-as-medicine programs.

The grant team is developing a referral hub for health-related social needs with key organizations in Kentucky. FAHA is bringing together diverse health-care, managed-care, non-profit and industry collaborators to facilitate screening, referral and enrollment to identify the most suitable and effective model(s) in the short term, while considering design for long-term sustainability.

FAHA seeks to bring together clinical and community research spanning across agriculture, food, health care and nutrition to address food insecurity and diet-related chronic disease. Researchers, community partners, food commodity producers, health care partners and students will explore innovative strategies to improve patient clinical outcomes and Kentuckians’ health.

“This award is an acknowledgment of the tremendous work the Food as Health Alliance has already been doing to address inequities related to food insecurity and chronic disease across Kentucky,” said Carolyn Lauckner, assistant professor in the Department of Behavioral Science at the UK College of Medicine and co-principal investigator on the grant with Gustafson.

“The grant demonstrates an investment in our efforts to use food as medicine to improve individuals’ health by targeting the link between food insecurity and cardiovascular disease,” Lauckner said. “I am thrilled to be working with this outstanding group of scholars and practitioners committed to using innovative, community-engaged research methods to improve the health of all Kentuckians.”

For more information on FAHA, visit https://foodashealthalliance.ca.uky.edu. For more information about the American Heart Association’s Health Care by Food Initiative, visit https://healthcarexfood.org.

Sunday, February 18, 2024

Respiratory illness in Ky. resurged in the week ended Feb. 10, with 5-to-17-year-olds having an 84% jump in ED visits for the flu

State Department for Public Health graphs, adapted by Kentucky Health News
By Melissa Patrick
Kentucky Health News

After weeks of overall decline, three major respiratory illnesses increased in Kentucky during the week ended Feb. 10, with children between the ages of 5 and 17 getting hit hard by influenza.  

The Kentucky Department for Public Health's weekly report says flu and Covid-19 activity is elevated and increasing and hospitalizations for respiratory illnesses are considered high.  

Emergency-department visits for the three respiratory viruses tracked by the state -- flu, Covid-19 and respiratory syncytial virus (RSV) -- increased nearly 16% in the week ended Feb. 10, to 3,583.  

This increase was driven by a 16% increase in visits for flu, to 2,745, and a 26% increase in Covid-19 visits, to 740. RSV visits dropped 26%, to 98. 

In the same week, Kentucky hospital admissions for the respiratory diseases increased 6% from the previous week, to 509. Flu was the only one of the tracked viruses to see an increase in hospital admissions in the week ended Feb. 10, with a 17% increase to 288. Covid-19 and RSV admissions had slight drops.  

Four northeastern Kentucky counties had high rates of Covid-19 hospital admissions in the week, according to the Centers for Disease Control and Prevention, which considers high to be 20 or more admissions per 100,000 residents. Rowan, Morgan, Menifee and Elliott counties had 27 Covid-19 admissions per 100,000. 

Ten Kentucky counties had admission rates between 10 and 19.9 Covid-19 admissions per 100,000, a rate the CDC considers "medium." They were Pike County, in far Eastern Kentucky, and McCracken, Marshall, Lyon, Livingston, Hickman, Graves, Crittenden, Carlisle, and Ballard counties, in far Western Kentucky. 

Children between the ages of 5-17 saw an 84% jump in emergency-department visits for respiratory illness in the week ended Feb. 10, to 970. This was driven by flu-related visits, which were up 82% over the previous week, to 876. Hospital visits for this age group dropped to 15 in that week, down from 22 the prior week. 

In the week ended Feb. 10, the state reported 3,912 laboratory-confirmed cases of the flu, up 17% from the prior week. It reported 2,459 laboratory-confirmed cases of Covid-19, up 16% from the week prior. 

Since the respiratory-illness season began the first week in October, 327 Kentuckians have died from Covid-19, and 28 from the flu, the health department says. One Covid-19 victim and one flu victim have been children.

Saturday, February 17, 2024

Bill to raise annual purchase limit on pseudoephedrine (Sudafed) and remove package-per-transaction limit moves to Senate

By Melissa Patrick
Kentucky Health News

A bill to raise the annual purchase limit on pseudoephedrine, the active ingredient in the decongestant Sudafed, has passed the state House and is in the Senate for consideration.  

Rep. Robert Duvall
"This is a pro-consumer, reasonable accommodation for Kentucky families seeking to find relief from congestion associated with the common cold and allergies," said the bill's sponsor, Rep. Robert Duvall, R-Bowling Green. "It simply increases access to affordable health care."

House Bill 386 passed the House Feb. 12 on a vote of 80-9, with Republican Rep. Danny Bentley, a pharmacist from Russell (Greenup County), abstaining.

This bill is in response to Kentucky and federal laws passed in 2005 that restrict the sale of products with pseudoephedrine, which at the time was a key ingredient for methamphetamine production. Kentucky strengthened this law in 2012. Since the passage of these laws, most meth in the U.S. comes from Mexico, according to the  2020 National Drug Threat Assessment report.

"Under current law, a Kentucky resident can only purchase up to a three months’ supply of the decongestant medication spread out over the course of a year, and they cannot purchase more than three packages at a single time," said a legislative news release. "HB 386 would eliminate these restrictions and replace them with a monthly limit."

The bill protects the original intent of the legislation, said Duvall. He said Kentucky will continue to be 20% more restrictive than the federal government's monthly purchase limits. 

"Kentucky has one of the strictest pseudoephedrine access laws in the country and will continue to do so," he said.

The bill would change the current 24-gram annual limit to an 86.4 grams, and remove the limit on the number of packages per transaction.

Duvall said these changes would bring Kentucky's law closer in line with the rest of the country, and explained why they are needed. 

"Under current law, an individual has access to just over three months' supply of over-the-counter medication per year. This means that individuals with chronic sinus congestion would have to ask their spouse or their other family members to purchase more pseudoephedrine for them after only three months," he said. "And for reference, the 7.2 gram per month maximum allows these allergy sufferers to take one pill every 24 hours to provide relief." 

He noted, "The current 24-gram annual limit is 78% less than what is typical for an American to purchase annually."

Duvall said the bill would not change the requirement to show a driver's license when purchasing the drug and the per-purchase limits will continue.

Duvall also pointed out that pseudoephedrine and phenylephrine are the two main oral decongestants in products available over the counter, but the U.S. Food and Drug Administration has concluded that phenylephrine in its oral form, as the main ingredient in many popular over-the-counter decongestants, doesn't thwart nasal congestion. 

If pseudoephedrine were pulled from the market, he said, "That would leave only one oral decongestant available over-the-counter." 

Friday, February 16, 2024

Senate sends House bill to have Medicaid cover midwife services

By Sarah Ladd
Kentucky Lantern

Kentucky Medicaid would begin covering licensed certified professional midwife services under a bill the state Senate sent to the House Thursday by a vote of 34-3, after little discussion.

The primary sponsor, Sen. Shelley Funke Frommeyer, R-Alexandria, said the legislation is a chance to “innovate” in Kentucky.

Under her bill, she said, a Medicaid-insured patient with a low-risk pregnancy could have the costs of using a certified professional midwife for a home birth covered by the federal-state program, which already pays for about half of all Kentucky births.

State Sen. Shelley Funke Frommeyer, R-Alexandria
Funke Frommeyer, who is also an advocate for freestanding birth centers in Kentucky, cited previously reported numbers showing the state recorded 177 home births in 1988 and 900 in 2021, said mothers should have “maternity care options,” and gave some:

“We see people doing one of the following: They may forego the care truly desired and plan a hospital birth, which is covered by Medicaid. They may make sacrifices and find a way to pay out of pocket for LCPMs. They may have a home birth without a trained provider — or sometimes without anyone at all.”

Sen. Karen Berg (D-Louisville), a physician, asked if a midwife could do an episiotomy if needed, and Funke Frommeyer said the procedure is within the scope of their practice. An episiotomy is an incision in the tissue between the vagina and the anus, which may be necessary if the baby’s shoulder is stuck behind the pelvic bone, among other reasons. Midwives may also suture the incision.

Thursday, February 15, 2024

Kentucky rises to No. 2 in the nation in screening for lung cancer, which lowers the chances that the disease will be fatal

Tony Stumbo (Photo by Veronica Turner for KFF Health News)
By Charlotte Huff
KFF Health News

Dr. Tony Stumbo’s heart sank after the doctor shared his mother’s chest X-ray.

“I remember that drive home, bringing her back home, and we basically cried,” said the internal medicine physician, who had started practicing in Eastern Kentucky near his childhood home in Floyd County shortly before his mother began feeling ill. “Nobody wants to get told they’ve got inoperable lung cancer. I cried because I knew what this meant for her.”

Now Stumbo, whose mother died the following year, in 1997, is among a group of Kentucky clinicians and researchers determined to rewrite the script for other families by promoting training and boosting awareness about early detection in the state with the highest lung cancer death rate.

For the past decade, Kentucky researchers have promoted lung cancer screening, first recommended by the U.S. Preventive Services Task Force in 2013. These days the Bluegrass State screens more residents who are at high risk of developing lung cancer than any state except Massachusetts — 10.6% of eligible residents in 2022, more than double the national rate of 4.5% — according to the most recent American Lung Association analysis.

The effort has been driven by a research initiative called the Kentucky LEADS (Lung Cancer Education, Awareness, Detection, and Survivorship) Collaborative, which launched in 2014 to improve screening and prevention in order to identify more tumors earlier, when survival odds are far better. The group has worked with clinicians and hospital administrators statewide to boost screening rates both in urban areas and regions far removed from academic medical centers, such as rural Appalachia.

However, a decade into the program, the researchers face an ongoing challenge as they encourage more people to get tested: the fear and stigma that swirl around cancer.

Lung cancer kills more Americans than any other malignancy, and the death rates are worst in a swath of states including Kentucky and its neighbors Tennessee and West Virginia, and stretching south to Mississippi and Louisiana, according to the Centers for Disease Control and Prevention.

It’s a bit early to see an impact on lung-cancer deaths, because people may live for years with a malignancy, LEADS researchers said. Plus, other factor such as improvements in treatments may also help reduce death rates. Still, data already shows that more cancers in Kentucky are being detected before they become advanced and thus more difficult to treat.

Of total lung cancer cases statewide, the percentage of advanced cases — defined as cancers that had spread to the lymph nodes or beyond — hovered near 81% between 2000 and 2014, according to the Kentucky Cancer Registry. By 2020, that number had declined to 72%, according to the most recent data available.

“We are changing the story of families. And there is hope where there has not been hope before,” said Jennifer Knight, a LEADS principal investigator.

Older adults in their 60s and 70s can hold a particularly bleak view of their mortality odds, given what their loved ones experienced before screening became available, said Ashley Shemwell, a nurse navigator for the lung cancer screening program at Owensboro Health.

“A lot of them will say, ‘It doesn’t matter if I get lung cancer or not because it’s going to kill me. So I don’t want to know,’” said Shemwell. “With that generation, they saw a lot of lung cancers and a lot of deaths. And it was terrible deaths because they were stage 4 lung cancers.” But she reminds them that lung cancer is much more treatable if caught before it spreads.

The collaborative works with several partners, including the University of Kentucky, the University of Louisville, and GO2 for Lung Cancer, and has received grant funding from the Bristol Myers Squibb Foundation. Leaders have provided training and other support to 10 hospital-based screening programs, including a stipend to pay for resources such as educational materials or a nurse navigator, Knight said. In 2022, the state legislature established a statewide lung cancer screening program based in part on the group’s work.

Jacob Sands, a lung-cancer physician at Boston’s Dana-Farber Cancer Institute, credits the LEADS collaborative with encouraging patients to return for annual screening and follow-up testing for any suspicious nodules. “What the Kentucky LEADS program is doing is fantastic, and that is how you really move the needle in implementing lung screening on a larger scale,” said Sands, who isn’t affiliated with the Kentucky program and is a volunteer spokesperson for the American Lung Association.

In 2014, Kentucky expanded Medicaid under the 2010 Patiemt Protection and Affordable Care Act. That increased the number of lower-income people who qualified for lung-cancer screening and related treatment. Adults 50 to 80 years old are advised to get a CT scan every year if they have accumulated at least 20 pack years and still smoke or have quit within the past 15 years, according to the latest task force recommendation, which widened the pool of eligible adults. (To calculate pack years, multiply the packs of cigarettes smoked daily by years of smoking.) The lung association offers an online quiz, called “Saved By The Scan,” to figure out likely eligibility for insurance coverage.

Half of U.S. patients aren’t diagnosed until their cancer has spread beyond the lungs and lymph nodes to elsewhere in the body. By then, the five-year survival rate is 8.2%. Regular screening boosts those odds. When a CT scan detects lung cancer early, patients have an 81% chance of living at least 20 years, according to data published in November in the journal Radiology.

Some adults, like Lisa Ayers, didn’t realize lung-cancer screening was an option. Her family doctor recommended a CT scan last year after she reported breathing difficulties. Ayers, who lives in Ohio near the Kentucky border, got screened at University of Kentucky King’s Daughters Hospital in Ashland. The scan didn’t take much time, and she didn’t have to undress, the 57-year-old said. “It took me longer to park,” she quipped.

She was diagnosed with a type of lung tumor that can grow in various parts of the body. Her cancer was considered too risky for surgery, Ayers said. A biopsy showed the cancer was slow-growing, and her doctors said they would monitor it closely. That type of cancer isn’t typically linked to smoking, but Ayers quit anyway, feeling like she’d been given a second chance to avoid developing a smoking-related cancer: “It was a big wake-up call for me.”

Kentucky is second only to West Virginia in the percentage of adults who smoke. Adults with a smoking history often report being treated poorly by medical professionals, said Jamie Studts, a health psychologist and a LEADS principal investigator, who has been involved with the research from the start.

Studts said the goal should ne to avoid stigmatizing people and instead to build rapport, meeting them where they are that day: “If someone tells us that they’re not ready to quit smoking but they want to have lung cancer screening, awesome; we’d love to help. You know what? You actually develop a relationship with an individual by accepting ‘No’.”

Nationally, screening rates vary widely. Massachusetts reaches 11.9% of eligible residents, while California ranks last, screening just 0.7%, according to the lung association analysis.

In hospitals of Appalachian Regional Healthcare, 3,071 patients were screened in 2023, compared with 372 in 2017. “We’re just scratching the surface of the potential lives that we can have an effect on,” said Stumbo, the chief medical officer in ARH's Big Sandy Region.

The doctor hasn’t shed his own grief about what his family missed after his mother died at age 51, long before annual screening was recommended. “Knowing that my children were born, and never knowing their grandmother,” he said. “Just how sad is that?”

KFF Health News is a national newsroom producing in-depth journalism about health issues. It is a core operating program of the Kaiser Family Foundation, an independent source of health policy research, polling and journalism.