Kentucky judges and court staff will be offered opportunities to learn more about addiction, recovery and treatment

By Melissa Patrick
Kentucky Health News

Kentucky will soon offer an educational program to its judges and court staff that will provide "trauma-informed, evidence based content" around the issues of opioid- and substance-use disorders, treatment and recovery as a way to help them make informed decisions in cases that involve substance-use disorders.

Chief Justice John D. Minton Jr.
(Photo by Melissa Patrick)

The program is called RESTORE, for "Responsive Education to Support Treatment in Opioid Recovery Efforts." It is part of the Kentucky Opioid Response Effort, or KORE, which is funded by a $10.5 million federal grant. 

"We want to prepare our court officials to make decisions that support recovery rather than to hinder it," Chief Justice John D. Minton Jr. said as he announced the program in the state Supreme Court chamber. "Our vision for RESTORE is that we will gain a shared understanding of substance use disorders and embrace best court practices in courts in dealing with this disease all across the commonwealth."

State Justice and Public Safety Secretary John Tilley alluded to the need for this education in March when he told a room full of visiting Fulbright scholars at the University of Kentucky that Kentuckians with addictions are treated differently across the state when arrested, depending on judges' understanding of addiction and the availability of wrap-around services to help offenders.

"It's incredibly disparate, and it's unjust," Tilley said at UK. "It is injustice at its best." He was unable to attend the launch of the program because of scheduling issues.

The program does not offer a required course of action for the judges to follow for such offenders, but to laughter in the room full of judges, Family Court Judge Janie McKenzie-Wells of the 24th Judicial Circuit said, "When the chief makes a suggestion, we usually take it."

She then added, "Obviously you have to buy in to this program and part of the educational piece . . . is to sell what we are doing to the judges and staff."

The program will consist of two one-day summits in each of Kentucky's seven appellate-court districts. The summer session is titled "Understanding Opioid and Substance Use Disorder;" the fall session is titled, "Understanding Treatment and Recovery."

Minton said the justice system offers a unique opportunity to help people with substance-use disorders.

"The decisions made at each point of contact within the justice system can profoundly affect the recovery process of each adult, youth and family who interacts with the courts," he said. "We have a duty to understand what research puts forth as the most effective court processes, the most effective practices, interventions and treatment models that can support lifelong recovery."

Wendy Morris, commissioner of the state Department for Behavioral Health, Development and Intellectual Disabilities, which oversees KORE, said Kentucky's collaboration across departments on this issue is unique.

As examples, she pointed to the Department of Public Health's commitment to harm reduction, the Department of Community Based Services' work with families who are affected by substance abuse, Medicaid's robust array of treatment options, judges who volunteer their time in drug and family courts, and their own work to oversee it all. She added that the involvement of the criminal justice system will provide yet another opportunity for intervention with this population.

Van Ingram, executive director of the Kentucky Office of Drug Control Policy, said the state's collaborative efforts against what he called "the worst drug epidemic our country has ever seen" are paying off.

Ticking off a long list of things the state is doing to combat this epidemic, Ingram said the numbers show that we are headed in the right direction, with fewer emergency-room overdose deaths and fewer hospitalizations in 2018 than the prior year, and an upcoming report that will show for the first time in 15 years, overdose deaths in Kentucky are declining.

"It's been a long fight, but we are beginning to see some progress," said Ingram. "And it's really because of these kinds of collaborations."

McKenzie-Wells talked at length about the Johnson County Community of Hope, a program that works in Family Court to address a whole array of issues commonly faced by people with substance-use disorders, whether that be access to housing or as is often the case, the need for a gas card to get them where they need to go.

She reminded everyone that whether you know a person with a substance-use disorder personally or not, these are people who live in our communities and need our help. "This is a community problem, so let's work on the solution as a community," she said. "And I think that's what RESTORE is aimed at."

Kentucky gets approval to expand and improve treatment for substance-use disorder among people on Medicaid

Kentucky has gained more flexibility to provide substance-use-disorder (SUD) services for people on Medicaid as part of the state's new Medicaid plan, most of which was vacated by a judge in June, according to a state news release.

Kaiser Family Foundation map shows ranges of opioid addiction among
Medicaid beneficiaries before the program was expanded in 2014.

The Centers for Medicare and Medicaid Services approved the "substance use disorder implementation protocol" portion of the plan, called Kentucky HEALTH, for "Helping to Engage and Achieve Long Term Health," on Oct. 5. So far, it is the only part of the state's request for a waiver of the rules to overhaul its Medicaid program that has been approved.

“Expanding access to treatment and recovery services for individuals with substance use disorder is critical to our efforts to combat the opioid epidemic in Kentucky,” Health Secretary Adam Meier said in a news release. “We have worked diligently to identify areas within the Medicaid program where care and treatment options can be expanded and improved. This demonstration waiver gives us the opportunity to help more Kentuckians get treatment and start on the path to recovery.”

The approval of this new program will expand access to SUD providers, will allow Medicaid to reimburse for short-term residential stays up to 30 days in mental-health facilities, and will allow Medicaid to pay for methadone, a drug used in medication-assisted treatment for addiction. It will also increase bed capacity for residential treatment facilities and will elevate program standards regarding the types of services, hours of clinical care and staff credentials.

In 2017, 1,565 people died in Kentucky from a drug overdose, up 11.5 percent from the prior year.

Kentucky Voices for Health, a consumer advocacy group, said this about the approval of expanded and improved SUD services in an email to members: "Kentucky Voices for Health and our partners applaud any efforts to combat the substance use disorder epidemic gripping our commonwealth. CMS approval of these services demonstrates that we can leverage our Medicaid program to be innovative and responsive to the needs of our Commonwealth without the harmful barriers the rest of the 1115 waiver would place in the way of Kentuckians struggling with addiction and other basic needs."

Drug overdose deaths in Kentucky rose 11.5% in 2017; highest rates in Estill, Kenton, Campbell, Boyd, Mason, Jessamine

Chart by Chris Ware, Lexington Herald-Leader

By Melissa Patrick
Kentucky Health News

Kentucky saw an 11.5 percent increase in drug-overdose deaths in 2017, with more than half of the them from fentanyl, a synthetic opioid that can be up to 50 times more potent than heroin. The number of heroin deaths decreased, but overdose deaths from methamphatime surged, according to to the annual Kentucky Office of Drug Control Policy report.

The state recorded 1,565 overdose deaths in 2017, and has toxicology reports for 1,468. Among those, fentanyl was found in 763, or 52 percent, up from 47 percent in 2016. The 2016 report is available here.

"Fentanyl is the deadliest and most addictive drug our nation has ever seen,” Van Ingram, executive director of the ODCP, said in a news release. “The fact that people continue to use it – despite the obvious risk – shows just how addictive these drugs are. People have become powerless against them. That’s why we have to make every effort to intervene with a comprehensive treatment response.”

Fentanyl has been a leading factor in overdose deaths since 2015 and is often mixed with heroin or put in pills, making it difficult to determine the dosage. Ingram notes that drug cartels in China and Mexico have turned to fentanyl because it is cheap to produce and provides a higher profit margin.

Lethal amounts of heroin, fentanyl
and carfentanil (Photo: Kensington
Police Service via Courier Journal)

Beth Warren of the Louisville Courier Journal reports that "a dose as small as two milligrams, the size of Abraham Lincoln's cheek on a penny, can be lethal." Carfentanil, a synthetic opioid that is used as an elephant tranquilizer, is even stronger.

The report also said three other drugs contributed to more overdose deaths last year than heroin: alprazolam, gabapentin and methamphetamine.

Alprazolam is an anti-anxiety medicine that is often known by its brand name Xanax. It was detected in 36 percent of the toxicology reports. Gabapentin, which is sells under the brand names Neurontin, Gralise and Horizant, and is often taken along with other illicit drugs to enhance their effects, was found in 31 percent. Methamphetamine, a stimulant that has long plagued Kentucky, was found in 29 percent, more than double last year's total.

"Autopsies and toxicology reports from coroners show that approximately 22 percent of overdose deaths involved the use of heroin in 2017, down from 34 percent in 2016," the report says.

County numbers

Estill County, with a population of 14,375, had 11 overdose deaths in 2017, giving it the state's highest rate of drug-overdose deaths, 7.7 per 10,000 residents, according to a table in the report.

Kenton and Campbell counties in Northern Kentucky had the next highest rates, 6.95 and 6.6 per 10,000. Then came Boyd, at 6.46, Mason, 5,82; Jessamine, 5.65; Montgomery, 5.37; Harrison, 5.32; Franklin, 4.95; Madison, 4.71; Jefferson, 4.56; Grayson, 4.17; Nelson, 4.16; Knox, 4.16; Greenup, 3.94; Fayette, 3.82; Harlan, 3.74; Floyd, 3.31; and Whitley, 3.31.

Other counties' rates were less than the state average of 3.3 per 10,000, or their rates were not published because they had fewer than five overdose deaths last year. The latter group included Leslie, Bell, Powell and Gallatin counties, which led last year's list with rates of 6.6 to 5.6 per 10,000.

The state's two most populous counties, Jefferson and Fayette, had the most overdose deaths in 2017, 426 and 123 respectively. The largest numerical increase in overdose fatalities occurred in Jefferson, which had 62 more than in 2016. Fayette went up by 49, Campbell by 26 and Kenton by 17. The largest decrease was in Madison County, which had nine fewer last year than in 2016.

Like last year, most of the Kentucky deaths were among people between 35 and 44, followed by those 25-34, then 45-54.

Gov. Matt Bevin said the report “underscores just how much is at stake in the ongoing battle against the nation’s opioid epidemic. This is a fight we must win for the sake of our families, our communities, and the commonwealth as a whole. We will continue to leverage every available resource to close off the funnel of addiction and to help our fellow Kentuckians who are struggling against this scourge.”

Kentucky has launched a number of initiatives to battle the epidemic, including a public awareness campaign called "Don't Let Them Die" that offers information on substance use disorder, treatment and naloxone, a drug that can reverse an overdose.

Kentucky State Police have launched the Angel Initiative, which allows those seeking treatment to visit a KSP post, where they would be directed to treatment.

The General Assembly has passed several laws in recent years, including a crackdown on pain clinics, limiting opioid prescriptions for acute pain to a three-day supply (with exemptions), tougher penalties for heroin dealers, more funding for drug treatment, and paying for increased access to naloxone. The attorney general's office has sued pharmaceutical companies.

Data for the report was compiled from the Kentucky Medical Examiner’s Office, the Kentucky Injury Prevention & Research Center and the state Office of Vital Statistics.

State urges hepatitis shots for everyone in 10 counties with outbreaks; also: keep hands washed, but not with gels

Acting Health Commissioner Dr. Jeffrey Howard (left) and
Cabinet for Health and Family Services spokesman Doug Hogan
talked about the hepatitis A outbreak in a Facebook Live event.

By Melissa Patrick
Kentucky Health News

As the number of hepatitis A cases continues to rise in Kentucky -- up to 629 this week -- and the number of counties with an outbreak has increased by four, the state's top health official encouraged Kentuckians to be aware and take precautions against the highly contagious liver disease -- but to keep calm.

"I don't think there is a necessity to panic, but people do need to be aware that there is an outbreak going on in the state and take appropriate precautions," Dr. Jeffrey Howard, acting commissioner of the Department for Public Health, said during a May 24 Facebook Live event.

Howard offered these suggestions to protect yourself from the disease, which is typically caused by ingesting food or drink that is contaminated with fecal matter: avoid hand-to-mouth contact, get vaccinated and wash your hands with soap and water.

"The most important thing that someone can do in the state of Kentucky right now is wash your hands appropriately," Howard said, which he said means washing your hands with soap and water for at least 20 seconds and then drying them off.

He added, "Hand gels are not an alternative. They do not kill hepatitis A."

Howard also advised anyone living in Boyd, Bullitt, Carter, Greenup, Hardin, Jefferson, McCracken, Meade, Montgomery and Warren counties, where outbreaks have been identified, to get vaccinated. Immunization requires two vaccines, six months apart.

McCracken, Meade, Montgomery and Warren counties are new to the list this week. Each of these counties have had four or more cases reported, according to the health department.

Howard announced that the department will provide each of the local departments in the 10 counties with money to buy an additional 1,000 doses of the vaccine, a total of 10,000 doses.

He urged vaccination for anyone at high risk for getting the disease: people who use illegal drugs, are homeless or have unstable housing; men who have sex with men; people recently in jail or prison; and people with underlying liver disease.

Howard also advised anyone who works with any of these high-risk populations to get vaccinated, including health care workers, church or ministry workers and volunteers.

To the concerns of some about whether they should eat out or not, Howard said, "We've had zero cases related to a food worker," and the virus in this outbreak is spreading "via contaminated environments," at least for now. The department's website says the increase in cases have primarily been among the homeless and drug users.

Howard added that Kentucky hasn't singled out food workers to get vaccinated, as West Virginia has, because the state's recommendation is for everyone in an outbreak area get vaccinated, which includes food workers.

He encouraged people with insurance to go to their health-care provider or a local pharmacist to get vaccinated, and for those without insurance or in one of the high-risk categories to go to their local health department.

The most common symptoms of hepatitis A are fatigue, low-grade fever, loss of appetite, joint pain, sudden nausea and vomiting, yellow eyes or skin, abdominal pain, pale stools and dark urine. A person with the virus is contagious for up to two weeks before showing symptoms and one week after. Symptoms usually last less than two months, but 10 percent to 15 percent of victims remain sick for up to six months.

Howard noted that hepatitis A is "a very rare disease," and that the state normally only has about 20 cases a year. He added that the U.S. Centers for Disease Control and Prevention is working to figure out why this outbreak is occurring across the country.

Law allowing petition for involuntary drug and alcohol treatment was passed in 2004, but is seldom used; big problem is cost

Information about Casey's Law can be found at
caseyslaw.org/KY_Files/About.htm

A law that allows families and others to file a petition to request involuntary, court-ordered drug treatment for their loved ones has been "slow to catch on around the state, even though the number of overdose deaths continues to rise," Miranda Combs reports for Lexington's WKYT-TV.

Combs reports that from December 2017 through April 2018, Rowan County attorneys filed 19 petitions under Casey's Law -- but before that, they had never used the law to involuntary order drug treatment. The law has been around since 2004.

"The law is for involuntary treatment," Combs writes. "This means a friend, co-worker or family member can file a petition requesting a judge order them to drug treatment. If the user doesn't follow appointments and court dates, a warrant can be issued for their arrest."

Assistant Rowan County Attorney Ashley Adkins, who coordinates the Casey's Law petitions, told Combs that after studying the law she quickly realized that the main barrier for family members to use the law is the expense, which she said costs about about $500 to execute.

"A lot of these families spent money in the past for their loved ones to go to rehab," Adkins says, "They've given them money to help support them so they don't have anything when they come to us. So we realized, if we want to make this work for everyone, there has to be funding available."

To help defray this cost, Adkins told Combs that the county had received a $20,000 grant through Pathways, an addiction resource center, that covers the full cost for families and friends to file a petition under Casey's law, and is also used to help fund the county's syringe-exchange program and efforts aimed at preventing drug abuse.

"The success of the county's way of operating has put Adkins on the road, teaching other counties how to successfully navigate Casey's Law," Combs writes.

"A lot of counties have had some confusion about how it works, or who pays for it," Adkins said. "You run into a lot of roadblocks that you learn along the way. So a lot of counties are just now starting to take advantage of Casey's Law."

Brad Stacy of The Morehead News wrote about a local effort organized by Adkins to educate their community about Casey's Law in January.

He reported that the Rowan County Agency for Substance Abuse Policy board and the county attorney's office held two free Casey's Law trainings in January, including how to manage the legal processes.

The class was led by Charlotte Wethington, who was instrumental in getting the law passed after losing her son Casey to a heroin overdose in 2001. She has since dedicated herself to advocating for Casey's law, which is officially called the "Mathew Casey Wethington Act for Substance Abuse Intervention."

In March, Beth Warren of the Louisville Courier Journal wrote a detailed article showing families and others how to invoke Casey's Law in Louisville. Warren notes a webpage with a step-by-step guide and video on to file a petition in Louisville, which links to another statewide resource: caseyslaw.org/Treatment.htm. She noted that 60 petitions were filed in Louisville in 2017, compared to 27 in 2016.

Warren also notes that parents and others who need added support with Casey's law can ask to join the closed Casey's Law group on Facebook, which has over 1,500 members.

In February, Sam Knef of the Tristate Homepage wrote about a Henderson woman who was forced into rehab through Casey's Law, but not before her family met some roadblocks from a local attorney.

Taylor Willoughby, who was addicted to drugs and ordered into treatment through Casey's law, told Knef, "If they hadn't forced it on me, I don't think I would be alive today."

But her mother, Teresia Johnston, told Knef that when she initially called a local attorney, he "kind of laughed me off, said it doesn't work unless they put themselves in rehab," and called the law "a joke."

However, the Henderson County attorney disagreed and told Knef that Casey's law is an effective way to get people into treatment before they get arrested.

“Court ordered treatment is just effective or more effective as that treatment that somebody decides to go in themselves,” Steve Gold said. “So I’m a believer.”

Knef also notes that the cost of court fees and treatment are huge deterrents to the law, but adds that there are many state-funded centers that offer court-ordered rehab for free.

Meth resurges in Ky. and is cheaper and more lethal than ever

"While Louisville frantically tries to rescue residents from heroin, fentanyl and pain pills, another drug is creeping back to prominence: crystal meth," Beth Warren reports for the Louisville Courier Journal.

And while the drug can be made through a "simple but dangerous process of mixing easy-to-get ingredients," there are fewer local labs these days and most of it now is being made in Mexico by cartels and is "cheaper, easier to get -- and more lethal," Warren writes. "And sometimes it's secretly mixed with fentanyl, which is even deadlier than heroin."

"It's deadlier than the public perceives," Russell Coleman, U.S. attorney for Western Kentucky and a former FBI agent who has worked drug cases, told Warren. "Methamphetamines are the next phase of the drug epidemic in this commonwealth."

Steven Bell, a spokesman for the U.S. Drug Enforcement Administration, told Warren that today's meth, often dubbed "ice," has a purity often close to 100 percent, which is "much more lethal than the 50 percent purity of local one-pot labs."

Warren notes that meth never really went away, but instead has "resurged."

Dave Thompson of The Paducah Sun recently reported that in Western Kentucky and Southern Illinois, methamphetamine is the "drug of choice," according to law enforcement and rehabilitators in the region.

"Meth-related deaths in Kentucky more than tripled from 2013 to 2016, when 252 people died, according to the Kentucky Injury Prevention and Research Center. More than a third of those deaths were in Jefferson County," she writes. "Police across Kentucky intercepted more than triple the amount of meth last year than they did in 2013, according to a recent state police report. Nearly 11,000 drug seizures submitted to the state crime lab last year were meth — more than heroin, cocaine and fentanyl combined."

Coleman pointed out that because meth damages the body over time, causing things like convulsions, strokes and heart attacks that aren't always associated with the drug, it isn't always recognized for the "havoc it wreaks," Warren writes.

She notes that today's meth looks like chunks of clear glass with a slightly blue tint and can also come in white pills that can be crushed into a powder.

Charles Wilson, 32, a self-described "meth head" who is in recovery, told Warren, "It's safer and cheaper" to purchase meth from a cartel instead of a local lab, adding that he used to pay about $700 for an ounce of meth in Albany, Ky. Louisville Metro Police Sgt. Paul Neal, a veteran narcotics detective, told Warren that the drug is cheaper in Louisville, as low as $300 per ounce, because there is more available.

Coleman told her that police now are finding as much meth as marijuana on interstate and local roadway traffic stops. And because meth causes its users to become paranoid and agitated, it's often referred to as "the drug of violence," especially compared to heroin which causes user to become lethargic.

Unlike heroin, there's no antidote or medication-assisted-treatment for meth, though addiction specialists told Warren that they are optimistic that these intervention and treatment options will eventually be developed and approved.

Most Kentucky adults believe addiction is a disease but a fourth of them think it is not

It is widely understood by health professionals that addiction is a disease, and a recent poll found that most Kentucky adults believe that, too. But one in four think it is not.

The Kentucky Health Issues Poll, taken Oct. 24 through Dec. 2, found that 70 percent of Kentucky adults believe addiction is a disease, with no discernible difference between those who knew someone with an addiction and those who didn't. The poll also found that 26 percent of Kentucky adults believe that addiction is not a disease, while 4 percent said they didn't know.

"Treating addiction as a disease, and then working together to magnify the treatment programs that are working, is the only way we are going to move from our substance use crisis to long-term recovery - both for individuals, and for the Commonwealth," Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, which co-sponsors the poll, said in a news release.

Responses to the question varied by location, with those living in large urban areas more likely to believe that addiction is a disease than those in largely rural areas.

Kentucky adults in the Lexington region, at 76 percent, are most likely to believe that addiction is a disease. In Eastern Kentucky the figure is 62 percent. Those figures, and those for other regions, are subject to error margins of plus or minus 5.2 to 5.6 percentage points; the margin of error for statewide results is 2.4 percentage points.

Among Kentucky adults who recognized addiction as a disease, 81 percent said they believed it to be both a physical and psychological disease, which is correct; 17 percent said it was psychological, and 1 percent said it was a physical disease only.

Chandler noted that Kentucky is one of the hardest-hit states when it comes to opioid and other substance-use disorders, noting that the state's number of drug overdose deaths jumped 12 percent between 2015 and 2016. The 2015 Behavioral Health Barometer for Kentucky found that, in a single-day count in 2015, 23,565 Kentuckians were enrolled in substance-use treatment, compared to 20,481 in 2011, a 15 percent jump.

To that end, Kentucky lawmakers recently passed a law to require the Cabinet for Health and Family Services to conduct a comprehensive review of all state substance-use disorder programs and services, and to only pay for and license those that follow nationally recognized, evidence-based protocols, subject to available funding.

The National Institute on Drug Abuse describes addiction as a "chronic disease characterized by drug seeking and use, despite harmful consequences" that can be affected by the biology, environment and development of an individual. This shift in thinking, based on scientific research and evidence, has changed the way substance-use disorders (once simply called substance abuse) are perceived and subsequently treated.

Dr. Mina "Mike" Kalfas, a certified addiction expert in Northern Kentucky, told Terry DeMio of the Cincinnati Enquirer that this shift in thinking has been necessary to provide effective treatment.

"Every facet of our mission -- from using Narcan to medication-assisted treatment to syringe exchange -- relies on general consensus recognizing this as a disease," he told DeMio.

In the same news release, the foundation also announced that this year's annual Howard L. Bost Memorial Health Policy Forum, to be held Sept. 24 in Lexington, will explore the state's substance use epidemic and examine the latest solutions. Registration for the conference will open soon.

The poll was funded by the foundation and Interact for Health, a Cincinnati-area foundation. It surveyed a random sample of 1,692 Kentucky adults vial landlines and cell phones.

Surgeon general urges friends and relatives of drug users to get overdose-reversing drug naloxone; issues public health advisory

Adams and Jody Jaggers of Kentucky Pharmacists
Association's Pharmacy Emergency Preparedness
(Photo by Mary Meehan, Ohio Valley ReSource)

The U.S. surgeon general has issued the first health advisory in 13 years, calling for everyone who has family or friends with any risk of opioid overdose to get naloxone, a drug that can reverse an opioid overdose, and learn how to use it. More than 1,400 Kentuckians died from an overdose in 2016.

“We want every community member to be able to recognize who’s at risk for an overdose, to recognize signs and symptoms of an overdose, and if someone in your orbit is at risk for an overdose, we want you to know about, to carry and to know how to administer naloxone," Surgeon General Jerome Adams said during a tour of the Northern Kentucky Health Department April 9 in Florence.

Adams mentioned the challenges of the stigma that surrounds addiction, and referred his younger brother, Philip, who he said has struggled from a substance-use disorder for years and is imprisoned for crimes he committed to feed his addiction, Terry DeMio reports for the Cincinnati Enquirer.

"We need to see addiction as a chronic disease, not a moral failing," Adams said.

Adams called on the "medical community to step up" and to learn to recognize "who is at risk and to be able to intervene, or to refer where appropriate," Don Weber reports for Spectrum News.

He also said that while health-care providers are "doing a much better job of not over-prescribing," this often causes people to shift over to illegal heroin, "and there's a separate heroin epidemic within the opioid epidemic." Adams urged connecting people to evidence-based treatment, including the use of medication-assisted therapies, like naltrexone, methadone and buprenorphine.

Adams said he is well aware that many people say administering naloxone to revive an overdose victim is enabling further drug use, but he disagrees with them, Weber reports.

"I say that we are enabling recovery," Adams said. “I’ve heard from four different individuals this morning who were resuscitated each multiple times with naloxone. One is out sharing the good news about his fate, another one has two children who now have a father because of naloxone.”

Adams praised Kentucky for having more than 50 syringe exchange programs to combat the infectious diseases that come with intravenous drug use, like hepatitis C and HIV. He encouraged all communities to "have a conversation" and consider having one.

The Kentucky Office of Drug Control Policy's website KyStopOverdoses allows you to search for pharmacies that carry naloxone by city, county or ZIP code. The cost varies, and insurance plans often cover it but may require a co-payment. Some health departments provide naloxone training and offer kits for free. You do not need a prescription for naloxone in Kentucky.

Feds will nearly double funding for research on addiction and opioid abuse; detailed at Rx Drug Abuse and Heroin Summit

The National Institutes of Health said at the National Rx Drug Abuse and Heroin Summit April 4 that it will increase funding for research on addiction and opioid abuse to $1.1 billion this year.

Funding for the initiative, called Helping to End Addiction Long-term (HEAL), comes from Congress's $500 million increase in NIH funding, Laura Ungar reports for the Louisville Courier Journal.

The money will be used to focus on best methods treatment and prevention, and the search for non-addictive therapies for pain. "The aim is to stem a crisis that devastates millions of families and kills 115 Americans every day," Ungar writes.

NIH Director Dr. Francis Collins made the announcement at the seventh annual summit that hosted more than 3,000 experts in addiction, medicine and law enforcement April 2-5 in Atlanta.

“We all gather here not to think about how hard it is (to tackle the epidemic), but what we can do,” Collins told the crowd. “All of us hope to see this opioid crisis come to an end. But we’re all about action.”

Collins said his agencies are working on initiatives to determine which patients are more likely to develop chronic pain after surgery and are looking at genetic and social factors that put patients at risk of opioid addiction.

In addition, they are looking at non-drug therapies for pain management, pursuing public-private partnerships to develop new non-addictive pain medicines, looking at options for medication assisted therapies for addiction and evaluating treatments for infants born dependent on drugs.

“We also need to know what happens to these children” as they grow up, Collins said.

On April 5, Surgeon General Dr. Jerome Adams issued an advisory urging more Americans to carry the opioid overdose-reversing drug, naloxone, sold under the brand name Narcan. This was the first surgeon-general advisory in 13 years; the last one focusing on alcohol use during pregnancy, Ungar Ungar reports for USA Today. 

"Surgeon-general advisories are issued when there is a major health problem and a need for a call to action," Adams told Ungar. "One of the things we're trying to do is help the public understand that we're losing a person every 12.5 minutes from an opioid overdose, and . . . over half of these overdoses are occurring at home.

"So we have firefighters, we have EMTs, we have police officers carrying naloxone, but we can save so many more lives if we can empower the citizens, the loved ones, the family members to carry naloxone."

In Kentucky, specially trained pharmacists can dispense naloxone without a prescription. It’s also available through the Kentucky Harm Reduction Coalition. More than 1,400 Kentuckians died from drug overdoses in 2016.

Adams and other health officials rejected criticism that naloxone enables addicts, Ungar reports. They compared it to cardiopulmonary resuscitation (CPR) for the heart and lungs, or the EpiPen, a device for injecting epinephrine to reverse symptoms of allergic reactions.

"We don't give you one shot at a lifesaving intervention and then just leave you," Adams said.
"We treat you as if you have a problem that is going to take a long time to definitively fix. Addiction's a chronic disease. It's not a moral failing and there's not going to be a magic fix. It's important that we use naloxone as a bridge to definitive treatment and long-term recovery."

Ungar notes, "Nationally, an estimated 2.1 million people struggle with opioid addiction, and opioid overdose killed more than 42,000 in 2016 alone."

On the summit's first day, U.S. Rep. Harold "Hal" Rogers of Eastern Kentucky's Fifth District received the summit's inaugural Beacon of Hope Award for his efforts to fight drug abuse in the district. The award will be named after Rogers moving forward, Tom Valentino reports for Addiction Professional.

The summit began in 2012 under the leadership of Operation UNITE, which Rogers founded in 2003 to "rid communities of illegal drug use through a comprehensive approach that includes educating youth and the public, coordinating substance-abuse treatment and providing support for families and friends of substance abusers," says the Summit's website. UNITE, which stands for Unlawful Narcotics Investigations, Treatment and Education, Inc., serves 32 counties ion Eastern and Southern Kentucky.

State gets $10 million grant to integrate primary and behavioral health care, in yet another initiative to combat substance abuse

The Cabinet for Health and Family Services has been awarded a $10 million federal grant to integrate primary care and behavioral health care in two regions of the state, as part of an effort to combat the state's opioid epidemic.

Kentucky is one of three states chosen by the Substance Abuse and Mental Health Services Administration to receive the five-year grant, which will be provided to two community health centers -- Centerstone in Louisville and Mountain Comprehensive Care Center in Eastern Kentucky.

The project will integrate primary care and behavioral health, focusing on individuals with physical health conditions who are at risk of developing chronic health conditions, including those with substance use disorders, says the news release.

 “The project presents a unique opportunity to improve health outcomes for Kentuckians with behavioral health and chronic health issues,” said Dr. Allen Brenzel, medical director for the Department of Behavioral Health, Development and Intellectual Disabilities. “Centerstone of Kentucky and Mountain Comprehensive Care Center are ideal partners because of their track record of collaborative community relationships and commitment to integrated treatment services.”

The project will begin next month with the formation of local implementation teams and advisory councils.

Building community as a way to combat opioids was a resounding theme at Foundation for a Healthy Kentucky's annual policy forum

By Melissa Patrick
Kentucky Health News

What if ending the opiod epidemic boiled down to re-building local communities, and re-thinking how we raise our children?

That may sound like a pie-in-the-sky ideal, but it resonated with many who attended the Foundation for a Healthy Kentucky's Howard L. Bost Memorial Health Policy Forum in Lexington Sept. 25.

Ben Chandler and Sam Quinones at Bost Forum
(Foundation for a Healthy Kentucky photo)

Keynote speaker Sam Quinones, author of Dreamland: The True Tale of America's Opiate Epidemic, told the sold-out crowd that the opioid epidemic is about so much more than drug trafficking and drug marketing; it is also about the isolation that has resulted from the loss of community.

Quinones talked about how we've moved away from the desire to invest in places that allow us to come together, likely referencing a now-closed community swimming pool called Dreamland that had once been the social epicenter of Portsmouth, Ohio, a town that is now ravaged by the opioid epidemic -- and the namesake of his book.

"Heroin is the perfect symbol for how isolated we have become as Americans, and how much we have killed off or ignored what would bring us together," he said. "I believe therefore more strongly than ever that the antidote to heroin is not Naloxone, it is community."

Ben Chandler, president and CEO of the foundation, passionately agreed with Quinones. He said improving communities would improve the overall health of Kentuckians.

"Every man for himself is unhealthy," Chandler told reporters. "We are social animals. We need each other desperately and when we are isolated from each other, which has become more and more the case in our society, we are less healthy on a number of different fronts."

He added, "But I can tell you we need to get the resources necessary to create community -- and you say the word tax, say it one time and immediately in this country we think it is a nasty word."

Chandler, a former congressman and state attorney general, said that now that he is out of politics he can talk about that "nasty word" and said it's time for a much higher cigarette tax in Kentucky.

"We need more funding for a lot of things and we need more funding for these heath matters," he said. "The cigarette tax is a beautiful tax for a state like Kentucky. We lead the country in smoking. We lead the country in cancer. What's better than to try to cut our health problems with smoking cigarettes and cancer and at the same time provide $260 million annually to the budget. We can do that. The General Assembly can do that in January."

Van Ingram, executive director of the Kentucky Office of Drug Control Policy, noted that while state and federal support is necessary, the real work of fighting this opioid epidemic is often done one community at a time, adding that some towns are more ready than other.

"When the community is behind these efforts, the folks who are elected get behind these efforts," he said.

Harvey Milkman
(Foundation for a Healthy Ky. photo)

Harvey Milkman, a professor of psychology at Metropolitan State College of Denver, told the group about an initiative in Iceland that has dramatically decreased the drinking and smoking rates of its high-school students and suggested that it could be replicated anywhere.

"I'd rather build a child than repair an adult," he said.

In addition to maintaining a regular student survey that pinpoints risky behaviors, the initiative centers around local programs that provide regular, organized, after-school activities for students as well as community efforts that promote family time, positive peer interactions and a sense of general well being.

Since Iceland instigated this initiative, the percentage of high-school students who had been drunk in the previous month dropped from 42 percent in 1998 to 5 percent in 2016; the percentage who had ever used marijuana is down from 17 percent to 7 percent; and the smoking rate fell from 23 percent to 3 percent.

Milkman added that his own research found that people who use drugs are addicted to changes in their brain chemistry and will often choose one that complements how they naturally deal with stress. For example, people who choose heroin want to shut down, and those who choose an amphetamine tend to be more hyper-active.

From this research, he created a program that took kids who had problems with drugs and offered to teach them anything they wanted to learn -- like music, hip-hop or martial arts -- with the idea that these activities could also alter their brain chemistry. At the same time, they were given life-skill training. Milkman said the program, which lasted 10 years, had "significant positive results," which were instrumental in informing the Iceland project.

"So it's really a social engineering project. How do you engineer communities that provide the needs that are really conducive to healthy living," Milkman said, adding that it can be done, but requires a collaboration between research, policy and practice -- along with ongoing dialogue.

Quinones advised parents to stop trying to protect their children from pain, both physical and emotional, noting that our desire to not feel any pain has only fed the opioid epidemic.

"You want to keep your kids off heroin, make sure people in your neighborhood do things together in public often. Make sure you kids ride bikes outside. Let them skin their knees. Don't protect them, let them fail. Don't protect them from the consequences of their failure," he said.

He added: This epidemic "is a powerful force for change in our society. It seems to me to be calling us as Americans to really examine how we've been living -- and we would be foolish to miss the opportunity that it provides."

Author of Dreamland says opioid epidemic is making people talk about addiction, a first step in finding solutions

By Melissa Patrick
Kentucky Health News

Since Dreamland: The True Tale of America's Opiate Epidemic was published in 2015, the author says the nation has seen both positive and negative changes in the epidemic that is sweeping Kentucky and other states.

"The negative changes are pretty dramatic," Sam Quinones said in a telephone interview with Kentucky Health News. "The number of people who are dying from this is every year more, and there doesn't seem to be an end in sight. . . . It's a very scary time."

On the other hand, individuals and families have "come out of the shadows" and are now telling their stories of addiction, which he said will help lead to solutions.

Quinones came to Kentucky to speak at the Foundation for a Healthy Kentucky's annual Howard Bost Memorial Health Policy Forum, Monday, Sept. 25 in Lexington. It sold out.

He said in the interview that it's hard for him to talk about positive reactions to the epidemic, given the torment it has caused so many families. But he's glad there is talk.

"And that's what happened with AIDS. When people came out of the shadows, we found solutions to AIDS," he said. "With more awareness, more people are working together on this . . . and I definitely believe that is a crucial part of this whole response."

He added, "You have a lot more political action, you've got a lot more budgetary action, you've got media paying far, far greater attention to this than even a few years ago -- and so all of that is for the positive."

He also said the epidemic has caused people to question old dogma and re-think how the nation, the state and communities have treated addiction and its victims.

“In Kentucky, I would say one of the most radical ideas that has been tried – I would give it enormous applause – is you have two dozen counties at least that are now transforming part of their jails, pods that are within their jails, to full-time rehabilitation clinics," he said. "I think that is magnificent."

Dreamland, named for a huge, old swimming pool in Portsmouth, Ohio, a town ravaged by the opioid epidemic, is a collection of stories that traces the origins and effects of the epidemic, which started 20 years ago.

It tells the story of  a society that wants to be pain-free, both physically and emotionally; an extremely addictive prescription painkiller and its aggressive marketing campaign; the subsequent shift in how the medical community viewed pain, and how it became the fifth vital sign; and how a heroin trafficking operation out of Mexico, using a customer-service business model, forever changed how illicit drugs are delivered in America.

Sam Quinones

Quinones emphasized that he left his "politics at the door" when he wrote Dreamland and encouraged others to do the same when they read it, and not "cherry-pick" aspects of the book that suit their point of view, which he said sometimes happens.

"It's a big picture," he said. "It's a mosaic of things that went into this and you need to consider them all."

He said it will take a variety of responses to deal with the epidemic, including individual and humane care for patients who are addicted to prescription opioids, instead of just cutting them off; appropriate use of medication-assisted therapies, along with supportive group therapies; and a shift in the way we view pain, both physically and emotionally.

Quinones said the epidemic seems to be calling into question parenting practices that aim to protect children from all pain, such as the practice of giving all kids in an event a participation trophy; to question whether or not possessions actually lead to happiness; and to examine the role of personal responsibility related to diet and exercise as ways to approach issues of physical pain.

"I think there are a lot of ways in which this epidemic is calling us to question how we've been living."

State panels to hold a full-day meeting on heroin, other opioids

By Melissa Patrick
Kentucky Health News

State officials will hold what amounts to a symposium on heroin and other opioids, at an all-day meeting of two committees in Frankfort on Wednesday, Sept. 20.

The Interim Joint Committee on Health and Welfare and Family Services and the Medicaid Oversight and Advisory Committee will meet jointly from 10 a.m. to 3:30 p.m. in Room 154 of the Capitol Annex. The meeting also includes an invitation-only working luncheon that will be televised in rooms 149 and 154 for those who would like to listen to the panel discussion.

Kentucky has the third highest drug-overdose rate in the country. The Kentucky Office of Drug Control Policy reported a 7.4 percent increase in overdose deaths in 2016, and of the 1,404 overdose deaths in the state, more than half involved fentanyl, a synthetic opioid that is up to 50 times more potent than heroin, and one-third involved heroin. The National Institute on Drug Abuse reports that 80 percent of heroin use starts with a prescription opioid.

The number of Kentuckians who know someone who uses heroin or abuses prescription drugs in the state is growing.

The latest Kentucky Health Issues Poll on this topic found that 17 percent of Kentucky adults know someone who is using heroin, up from 9 percent in 2013 and 13 percent in 2015. It also found that 27 percent of Kentucky adults say they know someone who has abused prescription pain medications.

The House Health and Family Services Committee chair, Rep. Addia Wuchner, told Don Weber of Spectrum News that she has been evaluating treatment centers in Kentucky and surrounding states to see which model might best serve the state's growing addiction crisis.

"Some are good, some maybe not so good," said Wuchner, a Republican from Florence. "We’re putting a lot of money into it, you know; families are paying money, Medicaid is paying money, insurance companies are paying money, but what are the best practices?" she asked.

Wuchner, who is also a nurse, told Weber that the Sept. 20 meeting will look for "smart and effective" solutions, adding, "It will be a full day committee committed to just this issue."

The agenda shows a host of experts speaking throughout the day on the status and overall impact of the heroin and opioid crisis in Kentucky, including awareness and prevention programs, harm reduction programs, treatment and recovery options, and programs that affect special populations, like pregnant mothers and their infants and the justice populations. The day-long program will wrap up with a look at the progress that has been made and the work that lies ahead.

The luncheon panel includes Dr. Phillip Chang, chief medical officer at the University of Kentucky, who will discuss hospital-based efforts; Dr. Kelly Conrad, medical science director for Addiction Alkermes, who will discuss neuropsychology and opioid use disorder; and Dr. Michael Sprintz, founder and CEO of Sprintz Center for Pain and Recovery, Cellerian Health, who will discuss a physician's journey from addiction to recovery.

Here is the agenda for the main part of the meeting:

OPIOIDS IN KENTUCKY

Awareness, Prevention, and Treatment of Heroin and Opioid Use, Misuse, and Abuse

I. Overview of the Epidemic and Scope of the Crisis: Introductory Remarks (10 minutes): Reps. Addia Wuchner, R-Florence, and Kimberly Moser, R-Taylor Mill

II. OPIOIDS IN KENTUCKY MORNING PANEL I (30 minutes): Status and Overall Impact of the Heroin and Opioid Crisis
a.  Status of Heroin and Opioid Crisis: Van Ingram, Executive Director, Office of Drug Control Policy
b.  Health-care Impact: Dr. Gil Liu, Medical Director, Department for Medicaid Services
c Employment and Economic Impact: Dave Adkisson, President and CEO, Kentucky Chamber of Commerce

III. OPIOIDS IN KENTUCKY MORNING PANEL II (20 minutes): Awareness and Prevention
a. Children and Youth and the Impact of Adverse Childhood Experiences: Dr. Allen Brenzel, clinical director, state Department for Behavioral Health, Developmental and Intellectual Disabilities
b. Core-Life: Bonnie Hedrick, program manager/liaison, Northern Kentucky Office of Drug Control Policy

IV. OPIOIDS IN KENTUCKY MORNING PANEL III (40 minutes): Special Populations Part I: Pregnant/Parenting Women and Infants
Video: "Katie’s Story"
Jennifer Hancock, president and CEO, Volunteers of America Mid-States Freedom House
Teri Wilde, nurse manager, Baby Steps Program, St. Elizabeth Healthcare
Dr. Henrietta Bada, University of Kentucky

V. Harm Reduction: Safe Drug Disposal (15 minutes)
Sen. Alice Forgy Kerr, R-Lexington

VI OPIOIDS IN KENTUCKY AFTERNOON PANEL I (20 minutes): Treatment and Recovery Options, Part I: Medication Assisted Treatment
Dr. Mark Jorrisch, president, Kentucky Chapter of the American Society of Addiction Medicine
Dr. Molly Rutherford, founder, Bluegrass Family Wellness
Dr. Allen Brenzel, clinical director, Department for Behavioral Health

VII. OPIOIDS IN KENTUCKY AFTERNOON PANEL II (25 minutes): Special Populations, Part II: Justice Population
a. Quick Response Teams: Linny Cloyd, deputy, Quick Response Team Coordinator, Boone County Sheriff’s Office; Independence Fire Chief Scott Breeze
b. Angel Initiatives: Mike Ward, Chief, Alexandria Police Department
c Jail Substance Abuse Program: Jason Merrick, Director of Addiction Services, Kenton County Detention Center

VIII. OPIOIDS IN KENTUCKY AFTERNOON PANEL III (45 minutes): Treatment and Recovery Options, Part II
a. Outpatient Treatment: David Hayden, Vice President of Clinical Operations, SelfRefind; William Carter II, CEO, The Infinity Center
b. Long-Acting Injections: Steve Cummings, Our Lady of Peace; Chris Harlow, St. Matthew’s Pharmacy
c. Residential Treatment: Mike Cox, president, Isaiah House; Tim Robinson, founder and CEO, Addiction Recovery Care
d. Comprehensive Approaches: Nancy Hale, president and CEO, Operation UNITE

IX. The Progress Made and the Work Ahead (15 minutes)
a. Current Initiatives in the Department for Behavioral Health, Developmental and Intellectual Disabilities: Dr. Allen Brenzel, clinical director
b. Closing Remarks: Reps. Addia Wuchner and Kimberly Moser

Research associates painkillers with 1/5 of recent reduction in labor force; Kentucky is among the most affected states

Brookings Institution map; click on it to see a larger version that displays counties more clearly.

Princeton University economist Alan Krueger found in 2016 that almost half of prime working-age (25-54) men who are not in the labor force take pain medication daily, two-thirds of them by way of prescriptions. He has taken a closer look at the data, and says increased use of opioids could account for one-fifth of the recent shrinkage in the American workforce—as defined by the rate of participation in the labor force, the proportion of people employed or looking for work. That phenomenon is seen in Kentucky more than in most other states.

Krueger's new paper and data, published in the Fall 2017 edition of Brookings Papers on Economic Activity, "suggests that the increase in opioid prescriptions from 1999 to 2015 could account for about 20 percent of the observed decline in men’s labor-force participation during that same period, and 25 percent of the observed decline in women’s labor-force participation," Fred Dews reports for the Brookings Institution. "Over the last 15 years, the labor-force participation rate fell more in counties where more opioids were prescribed."

Kentucky Chamber of Commerce chart; for report, click here.

Labor-force participation has been declining for about 15 years, "reaching a near 40-year low of 62.4 percent in September 2015," Dews notes. "The participation rate of American women had fallen from the top group of OECD countries to near the bottom," according to the international Organization for Economic Cooperation and Development.

Kentucky's labor-participation rate is lower, 57.6 percent in 2016, the fourth lowest in the nation; it was 62 percent in February 2009, the low point of the recession, before unemployment benefits began to run out and more people started dropping out of the workforce. It dropped sharply in 2014.

Krueger's earlier research cited several possible causes for shrinking labor forces, all of which plague Kentucky: Incarceration, disability, drug and alcohol abuse and demographics (low education attainment, dropout rate, poverty, health status). Krueger's latest work suggests that while much of the decline comes from the aging population "and other trends that pre-date the Great Recession (for example, increased school enrollment of younger workers), an increase in opioid prescription rates might also play an important role in the decline, and undoubtedly compounds the problem as many people who are out of the labor force find it difficult to return to work because of reliance on pain medication," Dews writes.

But is the trend more because people on painkillers are less likely to work, or because people not working are more likely to be on painkillers? “Regardless of the direction of causality, the opioid crisis and depressed labor-force participation are now intertwined in many parts of the U.S,” Krueger writes.

The research reveals regional differences in medical practices. "A 10 percent increase in the amount of opioids prescribed per capita in a county is associated with a 1 percent increase in the share of individuals who report taking a pain medication on any given day, holding health and other factors constant," Dews reports.

UK program that cares for addicted moms and their babies during and after pregnancy could become new model of care for nation

Mya Slone, a mother in the program
(Photos by Cassandra Giraldo, Vice News)

Kentucky Health News

An innovative program in Lexington that treats addicted babies, while making sure the moms aren't using drugs, has shortened hospital stays for the infants and empowered the mothers to be part of their care.

As part of a series of stories titled "A Nation in Recovery,"  Keegan Hamilton of Vice News paints a picture of what it's like to be pregnant, addicted to painkillers and heroin and having to make the hard choice to continue on a prescribed medication that is also an opioid -- just like heroin -- that helps her not use drugs or go cold turkey and risk relapse.

The story follows Mya Slone, identified only as a 26-year-old from "rural Kentucky" 34 weeks pregnant with her third child, through the last weeks of her pregnancy as she participates in the innovative PATHways program. She told Hamilton that she had almost lost her kids because of her drug use, and was determined not to let that happen again, even if it meant continuing on her buprenorphine, also known as Suboxone or Subutex.

The drug would ease Slone's cravings and would likely reduce the chances that the baby, a girl she planned to call Emma Grace, would be born addicted and have withdrawal, but that risk isn't entirely eliminated, Hamilton reports. “I don’t want her to have to go through that,” said Slone.

But under the care of a physician, they both agreed that it was the right decision to take the Subutex -- though no-one but her fiancé, who was also recovering from heroin addiction, knew about it and Slone was afraid to tell them.

Hamilton goes into detail about the struggles pregnant women with addiction face, including the stigma that surrounds medication-assisted therapies, laws that can put pregnant addicts in jail, the guilt and shame and the real fear that their kids will be taken away.

Vice News chart

But it's a problem that's not going away. The number of babies born with Neonatal Abstinence Syndrome, the medical term for babies who are born addicted to drugs, "has overwhelmed the medical system, and many intensive care units for newborns are at capacity," Hamilton writes. The rate of babies being born with NAS has increased 400 percent since 2000, with one baby born with the syndrome every 25 minutes. In Kentucky, one out of every 50 newborns has NAS.

“You go to Tennessee, Kentucky, West Virginia — they’re building special hospital units for these kids,” Matthew Grossman, a pediatrician at Yale-New Haven Children’s Hospital and a Yale Medical School professor, told Hamilton. “It’s become a major, major issue.”

The program, called PATHways, is "one of only a handful nationwide," but is "shifting the paradigm," Hamilton writes. It is a " one-stop shop for pregnant women in recovery, offering counseling, medication-assisted treatment, prenatal care, and parenting classes."

Kristin Ashford, UK College of Nursing, an architect of program

The program was created in 2014 by an all-female team of four doctors and nurses with the University of Kentucky, Hamilton reports, adding that more than 190 women have participated since it opened, and only one has tested positive for illicit opioids at her child's birth.

"It’s the type of care that every woman in Slone’s shoes deserves," he writes. "And if it becomes the norm, it could help break the cycle of addiction."

Hamilton continues the story with detailed explanations of how PATHways differs from a traditional plan of care for babies born with NAS, including keeping the mother and baby in the same room instead of treating the baby in the ICU and sending the mom home, and using a holistic approach to sooth the addicted babies, like swaddling and a special type of massage, instead of immediately using opioids to wean the baby from their addiction.

“The real key to babies doing well is being with their mothers,” said Lori Shook, a neonatologist involved with PATHways. “We’re empowering them rather than taking their babies away.”

The new approach is working. "The average length of stay for NAS babies in her NICU has decreased from 29 days to six, and 97 percent of the babies who stay with their mothers during treatment require no opioid medications," Hamilton writes.

Hamilton notes that PATHways learned early on that these moms continue to need support long after their babies are born and have adjusted it to follow them up until two years post-partum.

Annual Bost Health Policy Forum to be held in Lexington Sept. 25; focus will be on "Kentucky's Substance Use Crisis"

The 2017 Howard L. Bost Health Policy Forum, "Kentucky's Substance Use Crisis: Solutions and Strategies" will have as its keynote speaker Sam Quinones, author of the book Dreamland, which chronicles the rise of prescription opioid abuse and subsequent addiction across the nation. Much of the book focuses on Portsmouth, Ohio, just across the river from Kentucky.

"Quinones' narrative is a compelling account of the opioid crisis that took 1,400 lives in Kentucky last year," Ben Chandler, Foundation for a Healthy Kentucky president and CEO, said in the news release. "Kentucky's experience with both prescription and illicit opioids has been more severe and longer-lived than in most other states. Quinones and other presenters will help us better understand how we got to where we are today, how to climb our way out of this crisis, and the policy changes that can prevent this from happening again."

The annual forum is sponsored by the foundation with support from Gilead Sciences Inc., a research-based bio- pharmaceutical company, in memory of Dr. Howard L. Bost, who helped create Medicare and Medicaid, developed the Appalachian Regional Hospital system, improved mental-health services in Kentucky and created the vision for the foundation.

It will be held at the Marriott Griffin Gate Resort in Lexington on Monday, Sept 25. Attendance is free, but registration is required. Click here to register.

The forum will also feature a series of TED-style talks and afternoon breakout sessions that will explore where Kentucky stands related to the opioid epidemic; how evidence-based policy can work as a tool to address the social, economic and health impacts of opioid addiction; and prevention and intervention strategies.

State starts awareness campaign about opioid abuse, treatment and naloxone; calls on all citizens to help fight opioid abuse

Kentucky has launched a public awareness campaign called "Don't Let Them Die" that focuses on the dangers of opioid abuse, treatment and a drug that can reverse an opioid overdose called naloxone.

“We don’t have the luxury of pretending there isn’t a problem,” Gov. Matt Bevin said in a news release. “Every life is worth saving. There is not a person we would not want to see redeemed and removed from this addiction, and it is up to all of us to work together and find solutions.”

Kentucky saw a 7.4 percent increase in drug-overdose deaths in 2016, largely driven by heroin and fentanyl, a synthetic opioid that is up to 50 times more potent than heroin. Of the 1,404 overdose deaths in Kentucky, more than half involved fentanyl and a third involved heroin. Kentucky has the third highest drug-overdose rate in the country.

“Behind each number is a suffering soul and a wounded family that has often struggled with substance abuse for decades,” Justice Secretary John Tilley said in the release. “However, we also hear stories almost every day of hope and recovery. That’s why it’s essential that every Kentuckian joins this battle to preserve life. With the right support and resources, we know recovery is possible.”

The campaign will be conducted online and through statewide advertising that encourages Kentuckians to "learn about the risk of opioid abuse and spread the word." A recent study found that 80 percent of heroin use starts with a prescription opioid, says the release.

Radio and television ads, and the recently launched DontLetThemDie.com website, will feature audio from Nikki Strunct's 911 call when she discovered her son, Brandon, dying from an overdose in January 2016. Strunct is from Richmond.

The initial ads will aim to raise awareness about opioids and the realities of addiction; future ads will focus on resources and treatment. The website will be updated as new initiatives are introduced.

Number of drug overdose deaths in Kentucky continues to rise: 1,404 in 2016, a 7.4 percent increase from 2015

By Melissa Patrick
Kentucky Health News

Kentucky saw a 7.4 percent increase in drug-overdose deaths in 2016, largely driven by heroin and a synthetic opioid called fentanyl that is 30 to 50 times more potent than heroin and is often mixed with other drugs, according to a state report.

Lexington Herald-Leader maps

Of the 1,404 overdose deaths that occurred in Kentucky in 2016, almost half (623) involved fentanyl and one-third (456) of them involved heroin, according to the Kentucky Office of Drug Control Policy report.

“Fentanyl’s impact is really unprecedented,” Van Ingram, executive director of the ODCP, said in a news release. “Users have no way of knowing what drugs they are taking, and even the smallest amounts can trigger a lethal reaction. We’ve seen cases where a bad batch of drugs has led to dozens of overdoses in a single community overnight.”

Ingram added that while a drug that can reverse an opioid overdose called Naloxone is now widely available in Kentucky, he said it is not always effective against fentanyl and often requires several doses to revive the victim.

Three of the top five counties for the highest number of overdose deaths per person were in Eastern Kentucky -- Leslie, Bell and Powell -- along with Gallatin and Campbell counties in Northern Kentucky.

The top five counties for heroin related overdose deaths, fentanyl-related deaths and deaths involving both heroin and fentanyl were all in the state's most densely populated areas: Jefferson, Fayette, Kenton, Campbell and Boone.

Jefferson County had the most overdose deaths at 364, up from 268 in 2015;  followed by Fayette County at 162, up from 141 in 2015. Kenton County saw the largest decrease in overdose deaths, dropping to 90 deaths in 2016 from 112 in 2015. Bell and Knox counties also saw significant declines in overdose deaths, both by half. Click here for county-by-county data.

“Nearly every community in Kentucky experienced a fatal drug overdose last year— if that’s not a wake-up call, I don’t know what is,” Gov. Matt Bevin said in the release. “We don't have the luxury of pretending there isn't a massive problem."

2016 Kentucky overdose
deaths by age group 

The report found that Kentuckians between the ages of 35 and 44 died most frequently of a drug overdose, followed by those aged 45 to 54. More than 400 Kentuckians in the 35 to 44 age group died in 2016 from a drug overdose and more than 300 died in the 45 to 54 age group.

The report also showed that the number of deaths involving prescription painkillers decreased. Oxycodone was detected in 19 percent of deaths, down 4 percent since 2015, and hydrocodone was detected in 16 percent of deaths, down 5 percent. Alprazolam, or Xanax, a benzodiazepine, was detected in 26 percent of the deaths.

Ingram said Kentucky is taking a multi-faceted approach to battle the opioid epidemic: "Government, healthcare, law enforcement -- we are all working furiously to save lives," he said.

Most recently, a law just went into effect that gives the state the ability to schedule new fentanyl derivatives as they arrive on the street, increase penalties for drug dealers and limit the number of painkillers that can be prescribed for acute pain to three days, with some exceptions.  The state has also increased funding toward anti-drug efforts -- $14.7 million in 2016, $15.7 million in 2017 and rising to $16.3 million for fiscal year 2018.

"The consequences of the opioid crisis are far-reaching, affecting every corner of our communities. We must stand united against the opioid scourge and work together to find solutions. Failure is not an option," Bevin said.

In a June 27 Facebook Live video, the governor announced a public service campaign to raise awareness about the dangers of opioids. The campaign website ,DontLetThemDie.com, says Kentucky has the third highest drug overdose rate in the U.S.

Data for the report was compiled from the Kentucky Medical Examiner’s Office, the Kentucky Injury Prevention & Research Center and the Kentucky Office of Vital Statistics.