How to keep your family safe in pools, lakes, streams and oceans

Photo by Marina Kuzminykh, iStock/Getty Images Plus

By Sherri Hannan
Safe Kids Fayette County

Ask any child about the best part of summer, and chances are many will say it’s going to the pool or beach. And even though parents are aware of the risk of drowning, it remains the number one cause of death in children ages 1-4, as well as a leading cause of death among teens. Nearly 1,000 children drown each year, and more than 8,700 children were hospitalized for a near-drowning event. It’s quick and silent, and it can happen to any family.

The American Academy of Pediatrics recommends swimming lessons as a layer of protection against drowning; that can begin for many children starting at age 1. Even if your child has had lessons, they should never be unsupervised in water. Toddlers are the highest risk for drowning; their curious nature will lead them to explore areas that are dangerous for them but seem innocuous to adults. A good rule is “touch supervision,” meaning young children should always be close enough to touch when around water.

Other tips include:

• Choose a safe place to swim. Ensure that swimming pools are enclosed by a fence on all sides. In oceans, be aware of strong currents and waves.
• Instead of “floaties,” have your child wear a Coast Guard-approved life jacket in and around water.
• Watch kids when they are in or around water without being distracted. Young children can drown in as little as one inch of water, so it’s important to keep them within an arm’s reach of an adult. Assign a “water watcher,” an adult who will pay constant attention to children in the water. Switch off with another adult for breaks.
• Children should wear brightly colored swimsuits that contrast against the water, such as yellow, orange and pink.
• Empty small kiddie pools immediately after use. Store them upside down and out of children’s reach.

Kentucky’s numerous lakes are a fun summer getaway. However, teens and adolescents have a greater risk of death or injury in natural bodies of water because they overestimate their abilities and underestimate dangerous situations. They may feel pressure from their friends even if they don’t have strong swim skills or experience. They may also seek out unsafe areas such as waterfalls and rivers. Encourage them to only swim where lifeguards are present.

Familiarize yourself with the signs of drowning. It’s not the dramatic splashing you see in movies but is actually subtle and silent. If you see someone vertical in the water with their mouths near the surface, and they appear to be “climbing an invisible ladder,” get them out of the water as soon as possible.

One of the best ways to prepare for summer safety is to learn CPR. Contact your local community center or the Red Cross to find certification courses near you.

This is the latest weekly health column provided by the University of Kentucky Office of Public Relations and Strategic Communications.

Recovering alcoholic built Kentucky's largest substance-use treatment provider, which has 1,800 beds and 1,350 employees

Map from Addiction Recovery Care website, via Kentucky Lantern, adapted by Ky. Health News

By Deborah Yetter
Kentucky Lantern

LOUISA, Ky. — Around the office at Addiction Recovery Care, Vanessa Keeton is still known as “Client One” — marking her status as the first client of the first recovery center ARC opened as a group home in Lawrence County.

Vanessa Keeton (Lantern photo by Matthew Mueller)

But her official title is vice president of marketing, where she has worked since 2012, a little more than a year after she entered the program known as Karen’s House — choosing it over jail for a string of drug and alcohol-related offenses.

“Dec. 2, 2010, that was my first day,” she said. “That’s a day I’ll never forget as long as I live. That’s the day that everything changed.”

ARC, too, has changed dramatically since it started as a treatment home for women run by volunteers, based largely on Bible study and prayer.

It now operates as a for-profit company paid $130 million last year by Medicaid, the federal-state health plan which in 2014 expanded access to addiction treatment, or substance-use disorder, as it’s now known.

Gov. Andy Beshear has praised ARC for helping Kentucky — ravaged in recent years by addiction and overdose deaths — become the state with the most treatment beds per resident in the nation, according to an East Tennessee State University study.

“With the help of organizations like ARC, we are working to build a safer, healthier commonwealth for our people,” Beshear said, speaking at an ARC ribbon-cutting for a new facility in March.

Owned by founder and CEO Tim Robinson and his wife, Lelia, the company provides the couple an annual income of about $533,400, according to a 2022 tax-filing by Odyssey Inc., a non-profit affiliated with ARC.

Robinson said he and his wife struggled financially for years while establishing the treatment business — facing potential foreclosure on their home and repossession of their car. He doesn’t think that income is unreasonable.

“We took a lot of risks,” said Robinson, 48, a lawyer and recovered alcoholic who says he has been sober since 2006 — two years before he started building the faith-based treatment business that would become ARC. “I’m living the American dream. I’m doing better than I ever thought I could be doing financially.”

Kentucky’s largest provider

The fast-growing company is by far the state’s largest substance-use treatment provider, with 1,800 residential beds in 24 Kentucky counties, and reaches hundreds more clients through outpatient services. ARC, which estimates it provides 75% of treatment beds in Kentucky, also is planning programs in Ohio and Virginia.

Earlier this year, ARC opened a 40-bed behavioral health unit with plans to expand to 300 at the former Our Lady of Bellefonte Hospital in Ashland, which closed in 2020. In 2020, ARC opened its largest center — with a capacity for 700 — on the campus of St. Catharine College in Springfield, which closed in 2016.

ARC is no longer simply a treatment organization, said Matt Brown, a former ARC client who overcame addiction and now serves as ARC’s chief administrative officer and president of ARC Healthcare. “We view ourselves as a behavioral health system,” Brown said.

While Christian faith remains at the heart of its mission, ARC relies on professional therapists, medical specialists including nurses and doctors, a structured treatment program and medication such as Suboxone to reduce the cravings of some patients for drugs and help them maintain sobriety, Robinson said.

Its religious component — which includes tracking how many clients decide “to follow Christ” (1,320 in 2023) — is strictly voluntary, according to Robinson, who said he was able to get sober in 2006 with the help of a local pastor and friend who “led me to the Lord.”

More importantly, he said, is that the number of clients who agree to stay in long-term treatment up to six months has increased steadily, which he thinks is the best indicator of effectiveness of the program.

Medicaid, which funds the majority of substance treatment, doesn’t require programs to measure outcomes.

But ARC measures its own outcomes, which it reports to Medicaid quarterly, Robinson said. That includes a retention rate of around 70% of its clients in treatment for up to six months and even longer through periodic contact with a case manager.

“I’ve been in this a long time,” Robinson said. “Long-term residential treatment is the reason people recover.”

As an indicator of success in addressing addiction, the Beshear administration points to the decline, for the second year in a row, of overdose deaths in Kentucky.

The state’s latest overdose report, released in June, shows a decrease in deaths to 1,984 from 2,200 the year before, a decline of 9.8%.

Last year, ARC received about $130 million in payments from Kentucky’s Medicaid program — more than double the amount of its closest competitor, Spero Health, a Nashville- based company that received $60 million in Kentucky Medicaid funds in 2023, according to the Cabinet for Health and Family Services, which licenses and oversees treatment facilities and Medicaid.

ARC accepts private insurance, but Robinson and Brown said almost all of the company’s revenue is from Medicaid, since their clients generally have lost jobs and any health insurance because of addiction.

The state spent $1.2 billion on substance-use-disorder services in the fiscal year that ended June 30, 2023, with most funds coming from the federal government, according to the cabinet.

Robinson, a former county prosecutor who started his business from a home office in Louisa, has emerged as a major political donor and well-connected business leader who recently joined the Kentucky Chamber of Commerce board.

Beshear singled out Robinson for recognition in his State of the Commonwealth speech in January, calling him “an essential partner in our fight against addiction.”

Robinson, a lifelong Republican, is effusive in praise for Beshear, a Democrat, in part because of the governor’s emphasis on addiction treatment and the governor’s frequent references to his own religious faith.

“I’ve never been for anybody like I’ve been for Andy Beshear,” Robinson said. “I hope he runs for president.”

‘Treatment on demand’

ARC employs 1,350 people, 500 at its headquarters in Louisa, population 2,600, perched above the forks of the Big Sandy River, across from West Virginia. The company is Lawrence County’s largest employer, even more than the school system.

About 40% of its workers are “graduates” of its treatment program, Robinson said, and most of its upper management — himself included — are in recovery from addiction.

ARC promises “treatment on demand,” and operates a 24-hour hotline people can call to identify help within 15 minutes, including transportation, if needed, to one of its centers. Last year it served more than 12,000 individuals from 119 of Kentucky’s 120 counties.

Tim Robinson in front of one of his buildings in 
downtown Louisa (Lantern photo by Deborah Yetter)

It has developed a network of job-training programs including welding, automotive repair, lawn service, culinary arts, chaplaincy and food service. As part of that, ARC has rebuilt more than a block of rundown buildings in downtown Louisa into a coffee shop, commercial kitchen, community theater and an event space.

It offers clients a chance to get certification toward a trade and get college credit for some training.

ARC owns a pharmacy used to provide medication to clients, a laboratory for medical testing and operates a health clinic in Louisa. Also, Tim and Lelia Robinson founded the private Millard School, a Christian academy in Louisa attended by some children of their employees.

Vanessa Keeton and her husband James live in Louisa and their son attends the Millard School. James, a 2011 ARC graduate, manages the Second Chance garage which repairs and restores vehicles for the public as well as maintaining an ARC fleet of about 200. “We restore cars and we restore lives,” he said.

ARC runs a sophisticated marketing program complete with a website, billboards, television and radio commercials, a social media presence, sponsorships and news releases, contracting with the Louisville-based public relations firm, RunSwitch. Scott Jennings, a CNN commentator and Republican political consultant, is one of RunSwitch’s founding partners. ARC spends about 4.5% of its revenue, or about $5.8 million a year on marketing.

Vanessa Keeton said the marketing is important to promote awareness of its services to those in need, “to meet people where you are.”

‘Dangerously brilliant’?

Some outsiders criticize ARC for its rapid growth, its size and Robinson’s political giving, including Mark La Palme, the founder and former CEO of Isaiah House, a treatment program based in Harrodsburg.

La Palme, now retired, said he worked with Robinson on a project in the mid-2000s but parted ways over disagreement with practices including designating clients as “interns” in ARC programs for low pay while in treatment, saving the company the cost of paying a regular employee.

He calls ARC “huge,” has called it a “bully” in a social media post and questions its rapid expansion. La Palme also questions the prolific giving of Robinson and ARC entities, which rank among the state’s major political contributors.

“It seems like you’re buying political influence,” he said.

But he acknowledges that Robinson has been highly effective in building ARC into the state’s largest treatment system: “He’s dangerously brilliant.”

Robinson said he considered La Palme a friend and colleague but they parted ways after a proposed collaboration fell through. Robinson said ARC’s programs meet all state standards, are accredited and the company works to provide high quality care.

He said internships are a way of introducing people to job skills they will need to succeed once they leave treatment and interns in various job training programs receive a paycheck either through ARC or an outside employer.

Robinson said he doesn’t apologize for political giving, seeing it as a way to support causes and politicians he believes in.

And he doesn’t think ARC is too big, saying that the company had to expand to remain viable within the constraints of Medicaid reimbursement, which pays for most of its clients. “We had to grow to survive,” he said.

The Robinson employees who spoke with Kentucky Lantern, including Brown, are highly enthusiastic about the boss.

Brown, trained as a physical therapist, battled addiction for 18 years before coming to ARC as a patient and remaining as an employee.

Robinson is “a visionary,” Brown said during a tour of ARC properties in Louisa, “He sees things in people before they see it in themselves.”

‘Papaw taught me’

Robinson said he grew up in adjoining Martin County, in “the poorest part” of a poor county. His introduction to business came from his grandfather who owned a country store. “He put me on a pop carton to run the cash register,” he said. “Papaw taught me about business.”

Another boyhood business venture of Robinson’s — selling baseball cards — would provide a life-changing entrée into college and law school, when he was befriended by Inez banker and businessman Mike Duncan, a former Republican national chairman and mentor to many young people in Martin County.

Robinson said he and Duncan crossed paths when he began selling baseball cards to Duncan's son, Robert M. “Rob” Duncan, who was appointed U.S. attorney for Eastern Kentucky under Donald Trump. Duncan is now the top deputy to state Attorney General Russell Coleman.

Robinson said he considers both Duncans friends but remains closest to Mike Duncan, a trusted friend and adviser. He said Mike Duncan, showed interest in his boyhood baseball-card venture and became a mentor, encouraging Robinson to go to college — a prospect he hadn’t considered.

“Nobody in my family ever went to college,” Robinson said.

But with Duncan’s encouragement, Robinson graduated from the University of the Cumberlands in Williamsburg, earned a law degree from the University of Kentucky and was elected student body president at both institutions.

Good times and bad times

“He helped me through the good times and the bad times,” Robinson said.

Among the worst times: Robinson’s 2003 indictment for felony vote fraud while he was student body president at UK, after some 750 voter registration cards collected during a student government drive were never turned in. Apparently forgotten, they were later found in a student-government office, according to a 2003 Lexington Herald-Leader story.

“It was devastating,” Robinson said. “I thought my whole life was over.”

Instead, with the help of his lawyers, Robinson pleaded guilty to a lesser misdemeanor charge of failing to turn in the registration cards and paid $90 restitution. Robinson said he dropped out of law school during the legal case, but was readmitted and graduated.

Tim Robinson (Lantern photo by Matthew Mueller)

But that ordeal, plus the death of his mother while he was at UK, “finished my mental health off,” Robinson said. He returned home to Eastern Kentucky to work but alcohol by then had a powerful hold on his life.

Back in Lawrence County, Robinson joined in law practice with a friend and became an assistant county attorney but by then said he had become a “raging alcoholic” though still somehow able to perform his job.

He would drink on weekends, come to work on Mondays hung over and avoid alcohol on days he had to be in court. Toward the end of the week, Robinson said, he’d resume drinking and stay drunk till the following Monday. “I was leading kind of a double life,” he said.

That continued until a deputy sheriff at the courthouse where Robinson worked intervened. The deputy, also a pastor and a recovering alcoholic, helped Robinson stop drinking through prayer and support — taking him with him to nightly events where he would preach and play Bluegrass music.

Though Robinson said he knew nothing about treatment or programs such as Alcoholics Anonymous, he decided he needed to expand services in the region that in the mid-2000s offered little.

“I was convinced God was calling me to stop practicing law and start a recovery center,” Robinson said.

So he did, leaving his law job and starting out of a home office on Nov. 3, 2008.

Robinson got help from Rev. Ralph Beiting, a Catholic priest who founded the Christian Appalachian Project. Together they opened a recovery house for women in Lawrence County called Karen’s House.

It was a makeshift operation run by volunteers with donated goods, including some old Army cots. Meanwhile, Robinson was taking men to the closest treatment center, Chad’s Hope in Clay County, getting occasional funding from Operation UNITE, launched in 2003 by U.S. Rep. Hal Rogers to help Kentucky battle rising addiction — in particular the tide of opioid pain pills engulfing the state.

But broke and discouraged, Robinson was close to quitting when he contacted a consultant who suggested he expand by opening a second recovery center for men. He located a site in Fleming County and in 2013, Belle Grove Springs was opened by the company that would become ARC.

Brown, now ARC’s chief administrative officer, was among the first clients admitted to the men’s center.

The following year, under the expansion authorized by the Patient Protection and Affordable Care Act, Medicaid began funding substance use disorder services and a reliable funding stream opened. Kentucky was among the first states to include addiction as a service covered by Medicaid.

While the income was welcome, it wasn’t enough to finance ARC’s operation and Robinson said the company’s only choice was to expand and recoup more money through a higher volume of clients. “People thought we were growing because we were booming but we had to grow to survive,” he said. “You cannot make it on a couple of small facilities.”

ARC didn’t show a positive cash flow until 2019, he said.

‘Take our time’

While ARC expansion has slowed, Robinson said the company is still looking at other opportunities, including expansion into Virginia, which has far fewer treatment beds than Kentucky. “We’re going to take our time,” he said.

ARC also was flagged in a budget item this year by the state General Assembly with a $12 million allocation over two years directed to the Life Learning Center in Covington, an organization aimed at helping people develop skills to improve their lives “through gainful employment.”

The budget line says the funds are to be distributed to the center to support “treatment, rehabilitation, and community reintegration in partnership with Odyssey Inc.,” the non-profit arm affiliated with ARC.

Robinson said he expects Odyssey to submit a proposal as treatment provider for a program the center plans to establish in Somerset.

And while his work has expanded statewide and beyond, Robinson said he’s committed to staying in Louisa and keeping his company headquartered there.

“I’m where I’m going to be,” he said. “This is my adopted hometown.”

Doctor-journalist says pain doesn't belong on a scale of zero to 10

Illustration of the pain scale by iStock/Getty Images Plus, via KFF Health News

OPINION by Elisabeth Rosenthal
KFF Health News

Over the past two years, a simple but baffling request has preceded most of my encounters with medical professionals: “Rate your pain on a scale of zero to 10.”

I trained as a physician and have asked patients the very same question thousands of times, so I think hard about how to quantify the sum of the sore hips, the prickly thighs, and the numbing, itchy pain near my left shoulder blade. I pause and then, mostly arbitrarily, choose a number. “Three or four?” I venture, knowing the real answer is long, complicated, and not measurable in this one-dimensional way.

Pain is a squirrely thing. It’s sometimes burning, sometimes drilling, sometimes a deep-in-the-muscles clenching ache. Mine can depend on my mood or how much attention I afford it and can recede nearly entirely if I’m engrossed in a film or a task. Pain can also be disabling enough to cancel vacations, or so overwhelming that it leads people to opioid addiction. Even 10+ pain can be bearable when it’s endured for good reason, like giving birth to a child. But what’s the purpose of the pains I have now, the lingering effects of a head injury?

The concept of reducing these shades of pain to a single number dates to the 1970s. But the zero-to-10 scale is ubiquitous today because of what was called a “pain revolution” in the ’90s, when intense new attention to addressing pain — primarily with opioids — was framed as progress. Doctors today have a fuller understanding of treating pain, as well as the terrible consequences of prescribing opioids so readily. What they are learning only now is how to better measure pain and treat its many forms.

About 30 years ago, physicians who championed the use of opioids gave robust new life to what had been a niche specialty: pain management. They started pushing the idea that pain should be measured at every appointment as a “fifth vital sign.” The American Pain Society went as far as copyrighting the phrase. But unlike the other vital signs — blood pressure, temperature, heart rate, and breathing rate — pain had no objective scale. How to measure the unmeasurable? The society encouraged doctors and nurses to use the zero-to-10 rating system. Around that time, the Food and Drug Administration approved OxyContin, a slow-release opioid painkiller made by Purdue Pharma. The drugmaker itself encouraged doctors to routinely record and treat pain, and aggressively marketed opioids as an obvious solution.

To be fair, in an era when pain was too often ignored or undertreated, the zero-to-10 rating system could be regarded as an advance. Morphine pumps were not available for those cancer patients I saw in the ’80s, even those in agonizing pain from cancer in their bones; doctors regarded pain as an inevitable part of disease. In the emergency room where I practiced in the early ’90s, prescribing even a few opioid pills was a hassle: It required asking the head nurse to unlock a special prescription pad and making a copy for the state agency that tracked prescribing patterns. Regulators (rightly) worried that handing out narcotics would lead to addiction. As a result, some patients in need of relief likely went without.

After pain doctors and opioid manufacturers campaigned for broader use of opioids — claiming that newer forms were not addictive, or much less so than previous incarnations — prescribing the drugs became far easier and were promoted for all kinds of pain, whether from knee arthritis or back problems. As a young doctor joining the “pain revolution,” I probably asked patients thousands of times to rate their pain on a scale of zero to 10 and wrote many scripts each week for pain medication, as monitoring “the fifth vital sign” quickly became routine in the medical system. In time, a zero-to-10 pain measurement became a necessary box to fill in electronic medical records. The Joint Commission on the Accreditation of Healthcare Organizations made regularly assessing pain a prerequisite for medical centers receiving federal health-care dollars. Medical groups added treatment of pain to their list of patient rights, and satisfaction with pain treatment became a component of post-visit patient surveys. (A poor showing could mean lower reimbursement from some insurers.)

But this approach to pain management had clear drawbacks. Studies accumulated showing that measuring patients’ pain didn’t result in better pain control. Doctors showed little interest in or didn’t know how to respond to the recorded answer. And patients’ satisfaction with their doctors’ discussion of pain didn’t necessarily mean they got adequate treatment. At the same time, the drugs were fueling the growing opioid epidemic. Research showed that an estimated 3% to 19% of people who received a prescription for pain medication from a doctor developed an addiction.

Doctors who wanted to treat pain had few other options, though. “We had a good sense that these drugs weren’t the only way to manage pain,” Linda Porter, director of the National Institutes of Health’s Office of Pain Policy and Planning, told me. “But we didn’t have a good understanding of the complexity or alternatives.” The enthusiasm for narcotics left many varietals of pain underexplored and undertreated for years. Only in 2018, a year when nearly 50,000 Americans died of an overdose, did Congress start funding a program — the Early Phase Pain Investigation Clinical Network, or EPPIC-Net — designed to explore types of pain and find better solutions. The network connects specialists at 12 academic specialized clinical centers and is meant to jump-start new research in the field and find bespoke solutions for different kinds of pain.

A zero-to-10 scale may make sense in certain situations, such as when a nurse uses it to adjust a medication dose for a patient hospitalized after surgery or an accident. And researchers and pain specialists have tried to create better rating tools — dozens, in fact, none of which was adequate to capture pain’s complexity, a European panel of experts concluded. The Veterans Health Administration, for instance, created one that had supplemental questions and visual prompts: A rating of 5 correlated with a frown and a pain level that “interrupts some activities.” The survey took much longer to administer and produced results that were no better than the zero-to-10 system. By the 2010s, many medical organizations, including the American Medical Association and the American Academy of Family Physicians, were rejecting not just the zero-to-10 scale but the entire notion that pain could be meaningfully self-reported numerically by a patient.

In the years that opioids had dominated pain remedies, a few drugs — such as gabapentin and pregabalin for neuropathy, and lidocaine patches and creams for musculoskeletal aches — had become available. “There was a growing awareness of the incredible complexity of pain — that you would have to find the right drugs for the right patients,” Rebecca Hommer, EPPIC-Net’s interim director, told me. Researchers are now looking for biomarkers associated with different kinds of pain so that drug studies can use more objective measures to assess the medications’ effect. A better understanding of the neural pathways and neurotransmitters that create different types of pain could also help researchers design drugs to interrupt and tame them.

Any treatments that come out of this research are unlikely to be blockbusters like opioids; by design, they will be useful to fewer people. That also makes them less appealing prospects to drug companies. So EPPIC-Net is helping small drug companies, academics, and even individual doctors design and conduct early-stage trials to test the safety and efficacy of promising pain-taming molecules. That information will be handed over to drug manufacturers for late-stage trials, all with the aim of getting new drugs approved by the FDA more quickly.

The first EPPIC-Net trials are just getting underway. Finding better treatments will be no easy task, because the nervous system is a largely unexplored universe of molecules, cells, and electronic connections that interact in countless ways. The 2021 Nobel Prize in Physiology or Medicine went to scientists who discovered the mechanisms that allow us to feel the most basic sensations: cold and hot. In comparison, pain is a hydra. A simple number might feel definitive. But it’s not helping anyone make the pain go away.

Bowling Green's Med Center Health acquires Russellville hospital

Sign on chain's flapship hospital in Bowling Green

Kentucky Health News

Med Center Health, the nonprofit hospital chain based in Bowling Green, is now the owner of 75-bed Logan Memorial Hospital, and has changed its name to The Medical Center at Russellville. That extends the chain to seven like-named hospitals in Southern Kentucky, from Russellville to Albany.

Med Center Health said the facility will have will have six ICU/CCU beds and 10 swing beds, and serve a population of about 45,000. The purchase, finalized July 1, also includes three medical office buildings on the main campus as well as rural health clinics in Russellville, Auburn and Elkton.

“Med Center Health’s mission is to care for people and improve the quality of life in the communities we serve,” President and CEO Connie Smith said in a news release. “This acquisition aligns perfectly with that mission as we look to further enhance healthcare services for residents of Logan County and surrounding communities. We have a proven track record of improving access to care and services in our rural communities, and we could not be more excited to do the same for our friends and family in Logan County.”

The hospital was owned by the county until 1989, when it was sold to Nashville-based Hospital Corp. of America, which had managed the facility for several years. HCA later became Columbia/HCA Healthcare. In 1999 the hospital was part of that company's spinoff of rural hospitals into a new firm called Life Point. In 2022, when Life Point acquired Kindred Healthcare, it became part of a new company call ScionHealth, which sold it to Med Center Health.

Dr. Kamal Singh of Russellville, a member of the hospital's board, said in the release, “We are proud of the quality patient care that we deliver at Logan Memorial Hospital to the local families, Individuals, and our neighbors, and we are very pleased with the progress we have made under ScionHealth’s ownership. We are confident that Med Center Health’s breadth and depth of care services will best serve the local community as they seek to expand services and offer the resources of the most comprehensive health system in the region.”

Med Center Health, which grew out of the government-owned Bowling Green-Warren County Hospital, says it has more than 3,500 employees and 150 employed health-care providers.

State accepting applications for medical-cannabis licensing lottery and prescribing authority; patient cards not available until Jan. 1

Rep. Jason Nemes, R-Middletown, and Sen. Stephen West, R-Paris,
discussed medical cannabis legislation before a committee in March.
(Photo by Legislative Research Commission Public Information)

By Sarah Ladd
Kentucky Lantern

Kentuckians can now begin applying for a cannabis business license, and medical providers can apply to the state Board of Medical Licensure and Board of Nursing for authority to write cannabis prescriptions.

This is thanks to a bipartisan House Bill 829 that became law during this year’s legislative session and moved up the medical cannabis timeline from January 2025 to July 1. In 2023, the legislature legalized medical marijuana for Kentuckians suffering from specified chronic illnesses.

Patients who qualify — with a history of post traumatic stress disorder (PTSD), cancer or other approved medical conditions — still won’t be able to apply for cannabis cards until Jan. 1.

Applications for dispensers and cultivators will remain open until Aug. 31. A limited number of licenses will be awarded, and winners will be chosen in a regional lottery system. The state will award 48 licenses to dispensaries in 11 regions, 10 to processors and 16 to cultivators.

Lottery winners are expected to be announced in October, Gov. Andy Beshear has said. Filling the applications via lottery, Beshear said in April, is a way to keep the process more equitable.

“It creates a more fair process,” he said. “Not one where people bid against each other and only then the big companies can be a part of it.”

Applicants will be required to pay an application fee and provide documentation including business history, operating plans and financial information.

“The program is focused on ensuring cannabis business licensing is fair, transparent and customer-service oriented,” Sam Flynn, executive director of the Kentucky Office of Medical Cannabis, said in a statement.

Rep. Jason Nemes, R-Middletown, the primary sponsor of HB 829, said the new timeline is “the culmination of a long effort to provide for the safe use of medical marijuana to provide relief to Kentuckians suffering from pain and disease.”

“We’re taking the regulatory process seriously,” Nemes said, “and looking forward to seeing it move forward.”

For more information on applying, visit this website.

Your Local Epidemiologist says gun violence is public-health issue

Graph from New England Journal of Medicine; Annotated by Your Local Epidemiologist

OPINION By Katelyn Jetelina
Your Local Epidemiologist

On June 24, U.S. Surgeon General Vivek Murthy declared gun violence a public-health crisis. Many narratives immediately pushed back that this isn’t public health’s lane.

Let me say this loud and clear: Gun violence is absolutely in the purview of public health. And until society accepts it as such, we will continue to lose tens of thousands of Americans annually, leaving behind massive ripples in the community. Thankfully, momentum is changing.

What is public health? It’s broader than you might think. Public health—also called population health—came into the limelight with Covid-19, but it’s much broader than a pandemic or infectious diseases. It is the science of protecting and improving the health of people and their communities.

Public health is everywhere—think seatbelts, non-smoking areas, vaccines, airbags, clean drinking water, cleaner indoor air, food security, and cancer prevention. Experts are in health departments, nonprofits, government agencies, academic institutions, and the private sector. That’s because public health is most effective when combining science, education, policy, advocacy, and innovation.

Epidemiology, one subset of public health, is charged with finding patterns: Who is impacted? What predicts certain health outcomes? Because if it’s predictable, it’s preventable.

Violence epidemiology was born out of a case study a few decades ago, which showed that clusters of cholera in Bangladesh mirrored clusters of gun violence in Chicago. This meant gun violence wasn’t random; certain factors predispose a person or community. The field has grown to study suicide, child abuse, domestic violence, and, yes, gun violence.

Gun violence patterns—who are being impacted, where, and why—have slowly emerged, providing hints about tangible and effective public health solutions. For example:

• Firearm injuries are the leading cause of death in children. It surpassed motor vehicle crashes in 2020 for the first time.
• 2 out of 5 homes have at least one firearm.
• 4.6 million kids live with unlocked, loaded gun.
• 1 in 3 youth suicides and unintentional deaths can be prevented by securing guns.
• 8 out of 10 children that used a firearm say it belonged to a family member.

These patterns suggest safe storage and education for parents, for example, could (and are) move the needle.

Suicides account for most gun deaths, followed by homicides. This is why some states have passed bipartisan legislation, like red-flag laws, to temporarily remove firearms from people who have been deemed a threat to themselves. It’s estimated one suicide is prevented for every 10–20 red flag orders issued.

Cause and risk are not uniform. Gun injuries and deaths differ by race/ethnicity, physical location, age, and many other factors. This suggests who and how we engage with matters to make an impact.

There are ripple effects. A single neighborhood murder can impact as many as 200 people in a community. Randomized control studies have shown that community-level interventions, like replacing vacant spaces with green spaces, break cycles of violence.

Finding answers has been a slow crawl. Although we’ve found some patterns, we’ve only scraped the surface. Progress has been plagued by an unfortunate series of events.

Rewind to 1993. A famous study published in the New England Journal of Medicine found that having a gun in the home increased the risk of homicide in the home. This set off a political domino effect, and three years later, Congress inserted the Dickey Amendment into the CDC spending bill. The provision stated, “None of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention may be used to advocate or promote gun control.” The language was unclear; the epidemiologist on the 1993 study famously said, “Precisely what was or was not permitted under the clause was unclear. However, no federal employee was willing to risk his or her career or the agency's funding to find out. Extramural support for firearm injury-prevention research quickly dried up.”

This set gun violence research back decades, as it was completely reliant on nonprofits and philanthropy support. This is helpful but not enough to match the scope of the problem.

But, momentum is shifting. We see this from several angles:

• Engagement from the bottom up. A plethora of public-health experts have partnered with groups directly impacted by gun violence. For example, working with gun owners and gun ranges to curb suicide or communities (see Cure Violence) to build solutions.
• Funding for research. In 2020 —for the first time in 25 years—our federal budget included $25 million for the CDC and NIH to research reducing gun-related deaths and injuries. This is a start, but to be clear, it’s estimated that we need $1.4 billion to curb this epidemic. (For context, NIH gets $6.56 billion allocated for cancer research.)
• State and federal initiatives. For example, the Office for Violence Prevention was established in 2023 to focus on key legislative actions. You may be surprised to hear that many policies have bipartisan support. Earlier this month, the office hosted 160 hospital executives and leaders to discuss the importance of using health system data to better understand patterns.

Gun violence is absolutely in the public-health lane. This is what we do. We’ve been able to do unimaginable things and save millions of lives by approaching problems with a public-health lens, like cigarettes and motor-vehicle crashes. Public health can help reduce gun violence in the U.S., and we will. But only at the speed at which society recognizes and supports it.