Carrying naloxone, now available over the counter, saves lives; bystanders are present in more than 1/3 of opioid overdoses

Photo by Pete Comparoni, University of Kentucky

By Trish Freeman

Professor, University of Kentucky College of Pharmacy

Chances are you or someone close to you has been directly impacted by the opioid epidemic, which continues to afflict Kentucky. In 2021, the state's overdose deaths reached an all-time high of 2,250, with 90% involving an opioid.

Because bystanders are present in more than a third of opioid overdoses, hundreds of these deaths could have been prevented with naloxone, a lifesaving medication that is accessible, safe and easy to administer.

What is naloxone? Naloxone is a medication that can save someone’s life if they are overdosing on opioid medications, heroin, or other drugs (such as cocaine or methamphetamine) that are mixed or laced with the opioid fentanyl. Naloxone quickly reverses the effects of opioids and helps restore breathing in someone who is experiencing an overdose.

There are two Food and Drug Administration-approved formulations of naloxone: injectable and prepackaged nasal spray. The nasal spray, which is available as generic naloxone, Narcan or Kloxxado, may be easier for loved ones or bystanders without special training to use.

Who should carry naloxone? People who are at high risk for opioid overdose — including those who take high dose opioid medications and those who use illicit opioids like heroin — should carry naloxone. Families with loved ones who are at risk should also have naloxone nearby. Because opioid overdoses sometimes happen in public places, anyone can carry naloxone and be prepared to respond as a community bystander. If you're at risk for an opioid overdose, let others know you have naloxone and where it is located.

Where can I get naloxone? In Kentucky, naloxone is available without a prescription at many pharmacies and through community-based naloxone programs. Many syringe services programs also offer naloxone, along with clean needles and other harm reduction supplies. Soon, naloxone nasal spray will be available over the counter (OTC) at pharmacies and other retail stores that sell OTC products.

To find a location near you where naloxone is available, visit the Kentucky Office of Drug Control Policy website at https://odcp.ky.gov/Stop-Overdoses/Pages/Locations.aspx.

When to use naloxone: Signs of an opioid overdose may include: unconsciousness, very slow or shallow breathing, a limp body and not responding when called or touched.

If you suspect someone is experiencing an opioid overdose, call 911 immediately and give naloxone as quickly as possible. Naloxone is a temporary treatment that can help restore breathing but it’s not a substitute for emergency medical care.

Poll finds rise in Ky. adults who misuse prescription drugs, but experts say that likely stems from more awareness, not more use

A new poll shows an uptick in the number of Kentucky adults who report knowing someone who misuses prescription drugs, but experts say that's likely the result of an increase in knowledge about what addiction is -- and a decrease in stigma about it, Terry DeMio reports for the Cincinnati Enquirer.

The Kentucky Health Issues Poll found that the number of adults in the state who said they know someone who has experienced problems as a result of abusing prescription drugs jumped to 38 percent in 2019, up from 30% in 2018 and 24% in 2017.

That's likely a result of Kentuckians knowing more about addiction, not because of an increase in it, leaders in the fight against the opioid epidemic told DeMio.

In the poll results, "We can't separate an increase in knowledge versus an increase in use," Colleen Desmond, research associate with Interact for Health, told DeMio.

The Foundation for a Healthy Kentucky sponsors the poll with Interact for Health, a Cincinnati-area foundation. Interact's poll in Ohio found 33 percent of people in that state said they knew someone with problems from abusing prescription drugs, a number that has remained steady for several years.

The Kentucky poll found that 22% of adults in the state said they knew someone who has a problem with methamphetamine, and 20% knew someone who had a problem with heroin. Both of these rates changed little from last year's poll.

"Every factor" related to prescription opioid painkillers, such as hospitalizations and emergency-room visits related to overdoses, shows a downward trend, Van Ingram, director of the Kentucky Office of Drug Control Policy, told DeMio.

A national-level expert agreed. "More people could be responding that they know someone with substance use disorder related to prescription pain medication because as a society, we are now more aware than ever of addiction," Robyn Oster, research associate with the Center on Addiction of New York City, told DeMio. She added that sigma about addiction has also decreased, which could lead to greater disclosure.

At 66%, a clear majority of Kentucky adults believe that addiction is a disease, the poll found. Among those people, 82% believe it is both a psychological and a physical disease; 14% believe it is a psychological disease only; and 4% believe it is only a physical disease.

When asked whether they would know how to help someone with an addiction disorder find treatment, 56% said they would.

"It's gratifying that Kentucky's efforts appear to be significantly reducing overdose deaths, which were down 15 percent in 2018 over the year before, but this poll tells us we're still in the midst of an addiction crisis," Ben Chandler, president and CEO of the foundation, said in a news release.

"Expanding and getting the word out about treatment options, recognizing that recovery is a long-term process, and reducing the stigma associated with addiction, remain critical to continued progress."

For information on how to access addiction treatment in Kentucky, call 1-833-8KY-HELP (1-833-859-4357) or go to FindHelpNowKY.org. Both options will connect you to a specialist who will conduct a brief screening assessment and connect you to the most appropriate treatment services.

The poll surveyed a random sample of 1,559 Kentucky adults via landlines and cell phones from Oct. 16 through Dec. 6.. The margin of error for each number in the overall results is plus or minus 2.5 percentage points.

Transport and fears of stigma and lack of confidentiality biggest barriers to accessing rural syringe exchanges, study concludes

Counties in study are in red; click on the image to enlarge it.

By Heather Chapman
Kentucky Health News

Rural residents who inject drugs say they are less likely to access syringe exchange programs because of transportation problems, inability to get to the service at times it's open, and concerns about stigma, lack of confidentiality, and law enforcement. So says a newly published study examining barriers that can prevent people who inject drugs (PWIDs) from accessing syringe service programs (SSPs) in Appalachian Kentucky.

The researchers surveyed 186 PWIDs who used their local health department SSPs in three rural counties in 2018: Clark, Knox and Owsley (though Clark is in a metropolitan area, much of it is rural). Kentucky leads the nation in the number of SSPs, partly because it has 120 counties. As of July 2019, it had 52 SSPs that aim to reduce the spread of HIV and hepatitis C by giving PWIDs clean needles and disposing of dirty ones, and often offer more information about addiction treatment services when the person is ready.

Among the study's participants, 53.2 percent were male, 92.5% were non-Hispanic whites, and 78.5% had Medicaid coverage. About 39% said they injected more than one drug; methamphetamine was the single most popular drug, with 45.2% reporting it as the primary drug they inject. The next most popular was non-prescribed buprenorphine, which is sold legally as Suboxone for drug treatment (25.8%), followed by heroin (16.1%), other non-prescribed opioids (11.3%), and various other drugs (1.6%).

The biggest barrier to SSP use was the lack of transportation, with 18.3% reporting it as the primary barrier. Other barriers were: inability to access the program during operating hours, which are often limited (12.9%); concerns about stigma, privacy, and/or law enforcement (9.1%), not enough syringes (5.4%); and the location of the program (4.8%).

Participants' concerns varied based on the degree of their county's rurality. In Clark and Knox counties, the least rural, transportation was the most frequently cited barrier. But in Owsley, the most rural county, fear of stigma and lack of confidentiality ranked highest.

Rurality also factored into participants' consistency in accessing the SSPs. Participants in Knox and Owsley were more likely to consistently use the program than participants in Clark. The researchers believe the more consistent uptake in rural areas is because people in rural areas tend to have higher residential stability. However, Clark County participants may be less likely to consistently use SSPs because they're more likely to have an alternate means of accessing clean needles.

The study is part of a larger National Institutes of Health-funded effort to learn about SSP uptake in rural areas. This study's authors recently published another study about PWIDs in the same three counties, focused on what kind of interventions are most effective and which drug users are most likely to seek treatment.

47 Ky. counties have syringe exchange programs, but only half of the 54 at higher risk of HIV and hepatitis C outbreaks have them

By Melissa Patrick
Kentucky Health News

Kentucky leads the nation in the number of syringe exchange programs, but passing such programs continues to require great amounts of public education and perseverance.

Daviess County, home of Owensboro, the state's fourth-largest city, is the latest to launch a syringe exchange. That brings the number of exchange locations to more than 50, in 47 of the state's 120 counties. Graves County has approved a program, but it's not yet operational.

Western Kentucky has been slow to adopt such programs, which were approved by the state legislature in the 2015 anti-heroin bill as part of an effort to decrease the spread of HIV and hepatitis C, which are commonly spread by the sharing of needles by intravenous drug users.

Daviess County's program, which will serve residents of the seven counties in the Green River health district, is the fourth syringe exchange to open west of Louisville. The others are in Muhlenberg, Warren and Barren counties.

Daviess County Judge-Executive Al Mattingly said the slow embrace of exchanges in Western Kentucky is because there has been less need for the programs in that part of the state, Katie Pickens reports for The Owensboro Times, an online newspaper.

The latest Kentucky Health Issues Poll found that the percentage of adults in Western Kentucky who knew someone who used heroin was 12 percent, compared to 36 percent in Northern Kentucky, 24 percent in Lexington and Louisville and 21 percent in Eastern Kentucky.

Daviess County is not one of the 54 Kentucky counties listed by the federal Centers for Disease Control and Prevention to be most at risk to outbreaks of HIV or hepatitis C as a result of IV drug use, but it is near three counties that are on that list that haven't approved syringe exchange programs: Breckinridge, Grayson and Edmonson. None are in the Green River health district.

Of those, Grayson County has come closest to getting one. The county health board and the Leitchfield City Council have already approved it, but the county Fiscal Court failed to get a second to a motion for it on Jan. 15, Matt Lasley reports for the Grayson County News-Gazette. (The health board, fiscal court and the legislative body of the city where the exchange is to be located must approve it.) UPDATE: The fiscal court unanimously rejected the idea on Feb. 8.

The first failed vote followed two hours of testimony, both for and against the program, Lasley reports. And it seems the course of these discussions are similar across the state.

Proponents, largely from the medical community, line up to present evidence-based research about syringe exchange programs that shows how they do not encourage people to start using IV drugs,or increase the frequency of use among current users; how they reduce the spread of infections like HIV and hepatitis C; how they do not increase community crime; how they do increase community safety by taking dirty syringes off the street; and how they are known to help connect people to treatment, with one study finding that syringe-exchange participants are five times more likely to enter a drug treatment program than non-participants.

Opponents say they believe that the programs enable addiction, increase drug use or would bring drug users from neighboring counties into their communities, which could lead to more crime. Others struggle with providing an addict with a tool to feed their addiction. And many simply say they don't believe the research.

"Commonwealth's Attorney Rick Hardin said he was hesitant to believe statistics that say needle exchange programs actually increase an individual's likelihood to attend rehabilitation, as well as whether they cut down the spread of diseases such as hepatitis and HIV," Lasley reported for the Leitchfield newspaper. Hardin also prosecutes felony cases in Breckinridge and Meade counties.

Dr. Joe M. Lee

On Jan. 22, the News-Gazette published a guest editorial by Dr. Joe M. Lee, medical director of the local health department, that tried to overcome the opposition by giving the paper's readers more information. "Part of the magistrates’ concern was that the people they represent don’t understand the program and were generally opposed to it," Lee wrote. He said there had been "huge increase in Hepatitis C and HIV/AIDS" in the county, mainly as a result of intravenous drug use.

"This is a public health emergency," he wrote in bold letters."Please encourage your magistrate to vote YES and let's help our county begin recovery from this epidemic. You may be saving the life of a child, a loved one, a neighbor or a friend." Grayson County Judge-Executive Kevin Henderson said he may call up the issue again, Lasley reports.

Meanwhile, the Twin Lakes Regional Medical Center in Leitchfield will soon offer an opioid medical stabilization program for expectant mothers. CEO Wayne Meriwether said he started the program because one of the hospital's OB-GYNs said he cares for a large number of mothers who are addicted to drugs, Amy Lindsey reports for the News-Gazette.

Farther east, in the Bluegrass region, Scott County is one step closer to adopting a syringe exchange. After the fiscal court voted it down in December, with two magistrates absent, it was called back up for a vote in January and passed 5-3. The program already has the approval of the county's board of health and now must be approved by the Georgetown City Council, Paul Watson reports for the Georgetown News-Graphic. Scott County has been debating the issue for about two years.

Other localities that are actively considering a syringe exchange program are Henderson and Todd counties and Cave City in Barren County.

State Rep. Kim Moser

The chair of the House Health and Family Services Committee, Rep. Kim Moser, R-Taylor Mill, told Kentucky Health News that she would like to see the law changed to let the local health board and health department start syringe exchange programs on their own.

"This is the only issue that the legislature gets involved with in telling the health department what to do," said Moser, who once ran the Northern Kentucky branch of the state Office of Drug Control Policy.

Needs-based vs. one-for-one syringe exchanges

Another point of contention is whether these programs should be based on the weekly injection needs of the client – called needs-based – or whether they should require a one-for-one exchange of syringes.

Health officials say that if the goal of the program is to stop the spread of infectious diseases such as HIV and hepatitis C, Kentucky must allow intravenous drug users to have as many needles as they need in order to have a clean one for every injection, and that a one-for-one requirement defeats that purpose.

A one-for-one model is also listed on the Cabinet for Health and Family Services' website as one of the "practices to avoid" because it "results in sharing of needles."

Senate Majority Floor Leader Damon Thayer, R-Georgetown, a critic of the program since its inception, has filed Senate Bill 69 that would require syringe exchanges to dispense only one clean needle for each used needle.

Sen. Damon Thayer

"I would love to get rid of the needle exchange altogether," Thayer told Lawrence Smith at WDRB, "but I don't think I could get that passed." He added, "I respect the public health argument. I just am philosophically opposed to taxpayers paying for a needle for someone to do an act that is illegal."

Moser said she doesn't support Thayer's bill and hopes it doesn't get out of the Senate Health and Welfare Committee. "I oppose it," she said. "I do not think that removing programs that are working, that are getting people into treatment is the way to go."

Moser pointed out that health departments are statutorily required to reduce communicable diseases, and that's what a syringe exchange program does. Further, she said Kentucky can't afford to pay $80,000 per hepatitis C treatment for its Medicaid patients, when a "very simple, cost effective" solution to prevent hepatitis C is a six-cent needle.

Dr. Lynne Saddler, Northern Kentucky Health Department's district director, also opposes Thayer's bill. She told Terry DeMio of the Cincinnati Enquirer, "The science is clear that a 1:1 [one-for-one syringe] policy is not effective in stopping the spread of HIV through injection drug use."

The Louisville and Fayette County programs use a needs-based model, as do some others. But many of them start off by giving out a set number of needles on an as-needed basis, and then move to a one-for-one model. Counties that use any grant money from the Kentucky Agency for Substance Abuse for their syringe exchange programs are required to use a one-for-one model.

Poll: Reported heroin, methamphetamine and painkiller use has increased; 44 percent of those needing treatment didn't get it

Overall, 31 percent reported drug abuse by friend or relative in the last year.

Nearly a third of Kentucky adults reported having a family member or friend with a drug problem in the past 12 months, and just over half of those with problems got any sort of treatment, according to the latest Kentucky Health Issues Poll.

The increase in knowledge of friends or relatives abusing prescription drugs was the largest annual increase ever seen in the eight years of the poll, which has been taken each fall. There was also a record rise in reported use of methamphetamine, which has been included in four polls. The increase in reported heroin use continued an upward trend that had slacked off in the 2017 poll.

Reported use of prescription drugs, such as OxyContin, Percocet, Vicodin and codeine, increased to 30 percent from 24 percent; methamphetamine use increased to 22 percent from 16 percent; and heroin use increased to 20 percent from 16 percent. The polls margin of error is plus or minus 2.5 percent for each number.

The poll found that of the 54 percent of friends and family members who got treatment, 36 percent entered treatment because others intervened, 18 percent entered treatment on their own, and 44 percent never entered treatment.

The most frequent reasons given for why their friend or family member didn't seek treatment was that they didn't want to quit using drugs, or they didn't think they had a problem. Nine percent of the respondents said their friend or family member had died. Others said they didn't seek treatment because they "can't afford it" or "no treatment available nearby."

"Our message is that treatment works and recovery is possible," Katie Marks, project director for the Kentucky Opioid Response Effort, said in a news release from the Foundation for a Healthy Kentucky, which co-sponsors the poll. "Engagement in evidence-based treatment enables a person to address the biological, psychological, and social factors associated with a substance use disorder."

The poll is co-sponsored by Interact for Health, a Cincinnati area foundation. It surveyed a random sample of 1,569 Kentucky adults via landline and cell phone. Its margin of error for the statewide samples is plus or minus 2.5 percentage points.

The poll, conducted Aug. 26-Oct. 21, found that heroin and methamphetamine use also varied by region.

Adults in Northern Kentucky were three times as likely as those in Western Kentucky to report knowing someone with a heroin problem (36 percent and 12 percent, respectively). In the Lexington and Louisville areas, 24 percent reported knowing someone with a heroin problem; 21 percent did in Eastern Kentucky.

Regionally, methamphetamine seems to be a bigger problem in Eastern and Western Kentucky, with 29 percent of adults in the east and 24 percent in the west reporting they knew someone who has a problem with meth, compared to 18 percent in the rest of the state.

Kentucky offers a website to help residents find addiction treatment called Find Help Now. Click here to learn more or call 1-833-8KY-HELP. Additional resources can be found on Kentucky's Office of Drug Policy or at the Cabinet for Health and Family Services Adult Substance Abuse Treatment and Recovery Services Branch.

Study finds 9.2% drop in annual rate of opioid-overdose deaths from November 2017 to March 2018 in Ky., nearly 3% in U.S.

By Melissa Patrick
Kentucky Health News

As national and state reports showed the number of deaths related to opioids may be at a plateau, or declining, President Donald Trump has signed a comprehensive, bipartisan opioid bill that includes both law-enforcement and public-health measures.

"Together we are going to end the scourge of drug addiction in America," Trump said Oct. 24. "We are either going to end it or we are going to make an extremely big dent in this terrible, terrible problem."

CDC graphic

The Centers for Disease Control and Prevention's preliminary data shows that the 12 month period ending March 2018, the most recent data compiled, saw a decline of nearly 3 percent in the number of reported overdose deaths, to 68,690, when compared to the 12 month period ending November 2017, when the number of overdose deaths was at its highest ever, 70,780.

The same CDC report shows an even greater drop in Kentucky of 9.2 percent. In the 12-month period ending November 2017, Kentucky reported 1,594 overdose deaths -- also its peak-- and in the 12-month period ending in March of this year, it reported 1,446 deaths.

Kentucky Injury Prevention and Research Center graphic

A preliminary report from the Kentucky Injury Prevention and Research Center also shows a drop in overdose deaths in Kentucky between the last quarter of 2017 and the first quarter of 2018, with declines in deaths involving fentanyl and heroin, but not in the number of deaths involving methamphetamine.

KIPRC's provisional data shows that between the fourth quarter of 2017 and the first quarter of 2018 the total number of overdose deaths dropped from 366 to 344; heroin-related OD deaths dropped from 57 to 44; fentanyl-involved OD deaths dropped from 187 to 180; and ODs involving methamphetamine increased from 79 to 82.

In his prepared remarks for the Oct. 23 Milken Institute healthcare summit, the nation's top health official was cautiously optimistic about the CDC report and referred to the results as a plateau.

"Plateauing at such a high level is hardly an opportunity to declare victory," said Health and Human Services Secretary Alex Azar. "But the concerted efforts of communities across America are beginning to turn the tide."

Paige Winfield Cunningham of The Washington Post lists five measures of the opioid crisis:

1. Overdose deaths: While the new law and the CDC report offer a glimmer of hope, the grim reality is that in 2017 nearly 72,000 people died from an overdose death, and almost 50,000 of them were from opioids. In Kentucky, 1,565 people died from a drug overdose in 2017, an 11.5 percent increase from the prior year.

2. Number of opioid prescriptions: According to the CDC, opioid-prescription rates fell last year to the lowest level in a decade, 58.7 prescriptions per 100 people.

The firm IQVIA reported in August that there has been a 22 percent decrease in opioid prescriptions nationally between 2013 and 2017, but other studies don't show this decrease, Cunningham reports, noting a Mayo Clinic report in August that said little had changed in the past five years on the prescribing front. "Researchers found that while prescriptions seemed to be leveling off, they weren’t decreasing among most groups of patients," she writes.

CDC map shows ranges of opioid prescribing by state in 2017

The CDC report shows the number of opioid prescriptions dispensed in Kentucky is also dropping, but the state's rate is still higher than the national rate at its very highest in 2012 -- 81.3 prescriptions per 100 people. Kentucky's rate in 2017 was 86.9 prescriptions per 100. The peak in Kentucky was in 2011 at 137 per 100.

Between 2011 and 2016, 70 million fewer opioid prescriptions have been dispensed in Kentucky, according to a 2017 state report.

Toward the goal of decreasing opioid prescriptions, Kentucky passed a law in 2017 to limit most painkillers to a three-day supply for acute pain, but it also came with a long list of exemptions.

3. Prescribing rates for drugs that reverse overdoses or that are used in medication-assisted therapies for addiction: Azar said that since January 2017, the number of patients receiving buprenorphine and naltrexone, medications to treat opioid abuse, has increased by 21 percent and 47 percent, respectively. And the number of prescriptions dispensed monthly for naloxone, often sold under the brand name Narcan, has increased 368 percent.

In Kentucky, an Urban Institute analysis found that the number of annual units reimbursed by Medicaid for buprenorphine rose 382 percent from 2011 to 2017, from 2 million units to 9.8 million respectively. During that time, the number of annual naltrexone unites increased 502 percent, and naloxone jumped 709 percent. (The 2017 numbers are projected, meaning that they include data from only the first two quarters of the year, which have been extrapolated to an annual figure.)

The analysis shows the biggest jump in Kentucky's Medicaid reimbursements for all of these drugs happened between 2013 and 2014, when the the state expanded Medicaid to those earning up to 138 percent of the federal poverty level under the Patient Protection and Affordable Care Act. For example, the number of units of buprenorphine rose 108 percent, from 3.2 million units to 6.7 million units.

In 2015, Kentucky permits certified pharmacists to dispense naloxone under a physician-approved protocol. A map on KyStopOverdoses.ky.gov shows more than 372 pharmacies across the state that distribute Narcan and the interactive website allows a person to type in a ZIP code to find the closest location. Naloxone does not require prescription in Kentucky.

Dr. Michelle Lofwall, a University of Kentucky psychiatry professor and part of the College of Medicine Center on Drug and Alcohol Research, told the UK Board of Trustees Oct. 8, at a day-long meeting dedicated to opioids, that the need for medication-assisted treatments remains great.

She said only 20 percent of persons with opioid-use disorder get any sort of specialty addiction treatment and among those, only 37 percent receive these FDA-approved medications. She said the main reasons for this are stigma, discrimination and concerns about diversion of drugs to illegal use.

4. Number of babies born addicted to opioids (neonatal abstinence syndrome): Using its most recent statistics available, the CDC says the incidence of NAS increased about 400 percent nationally from 2000 to 2012.

Kentucky Department for Public Health graphic

"By 2012, on average, one NAS-affected infant was born every 25 minutes in the United States," says the CDC.

Kentucky saw a slight drop in the number of reported NAS babies in 2016 to 1257 from 1,354 in 2015, which amounts to about 100 per month, according to a state Department for Public Health report.

5. Fentanyl and heroin deaths: Fentanyl is a synthetic opioid that is at least 50 times stronger than heroin and is often mixed with other drugs. It is a leading cause of overdose deaths.

The provisional CDC data estimated there were more than 27,000 reported synthetic-opioid overdose deaths in the 12 months through September 2017 and nearly 29,000 such deaths in the 12 months through March 2018. Reported heroin-overdose deaths dropped from 15,983 to 14,964.

In Kentucky, fentanyl was involved in 52 percent of the state's 1,565 deaths in 2017, up from 47 percent in 2016, according to the annual Kentucky Office of Drug Control Policy report. About 22 percent of the deaths involved heroin, down from 34 percent in 2016.

260 in Morehead hear speakers on opioid recovery and solutions to the epidemic: rebuilding communities and long-term treatment

By Melissa Patrick
Kentucky Health News

Treating opioid-use disorder as a chronic disease, finding local solutions and restoring communities were the overarching themes of an event in Morehead Sept. 5 for health professionals: "Recovery and Solutions: The Next Chapter in Northeast Kentucky's Opioid Epidemic."

Sam Quinones at Morehead

About 260 people heard keynote speaker Sam Quinones, author of Dreamland: The True Tale of America's Opiate Epidemic, say that he started out to write a book about drug trafficking and marketing, but soon realized it was a "much bigger story" and that "at the root of the problem" was the destruction of American communities.

Quinones' book is named for a now-closed community swimming pool that was once the social epicenter of Portsmouth, Ohio. A town ravaged by the epidemic, it is across the Ohio River from South Shore, Ky.

He told the crowd, "Heroin is a final expression of values that we have fostered for 35 years in this country. A final expression for our fetish for the private at the expense of the public, for isolation at the expense of community It is a final 'stuff' for a culture that is convinced that consumption, that buying stuff, is the path to happiness. Heroin is the final expression of that idea."

Added to this "scourge of isolation," Quinones said the opioid epidemic flourished as Americans became a people who wanted easy answers to complex problems and took on unrealistic expectations of how much pain they should tolerate, both physically and emotionally. And, he added, we became "ferocious" in our efforts to keep our kids from feeling any pain.

"It's all connected," he said, adding later, "Why do we wonder that heroin is everywhere? It seems to me that our search for painlessness, convenience and comfort above all other things is a lot about what led us to it."

Quinones said the epidemic requires not one solution, but a "symphonic" approach that will come from communities working together toward this common goal.

"Isolation is heroin's natural habitat," he said. "I believe more strongly than ever before that the antidote to heroin is not naloxone, it is community. . . . There is no silver bullet, it is only through collaboration that innovation comes."

Asked after his talk if he thought marijuana should be legalized, he said yes, but said we should proceed "slowly, humbly and cautiously," and that it should also be regulated for potency. He added that we also need to learn from the heroin epidemic: "A supply of high potency drugs matters."

Alex Elswick

Alex Elswick and his mother Shelley Elswick, the co-founders of Voices of Hope Lexington, told their stories of addiction and recovery from a family perspective and an individual one. Voices of Hope is a nonprofit that offers recovery support to people with substance-use disorders.

Shelley Elswick simply asked for compassion: "I'm asking for compassion for families when we don't know what's happening in the beginning, when we're looking for solutions once we know we have a problem and at the end when we get our loved ones into recovery and we don't know what to do."

Alex Elswick, a doctoral student in the Department of Family Sciences at the University of Kentucky, told the story of his heroin addiction, which started with prescription oxycodone, and his rocky path to long-term recovery. He stressed that finding a solution to the opioid epidemic must include treating addiction like a "chronic disease."

"Because the inevitable result of mismatching a chronic disease with acute treatment is a huge gap in management," he said. "And it is in that gap that people relapse. And unfortunately in the context of an opioid epidemic, it is in that gap that people we care about lose their lives."

He added later, "I think as soon as we begin to fill gaps in treatment, to create a continuum of care that helps people get to that critical five year mark where the risk of relapse drops below 15 percent, that's when we'll see some changes."

Dr. Michelle Lofwall

Dr. Michelle Lofwall, a UK psychiatry professor and part of the College of Medicine Center on Drug and Alcohol Research, talked about the hope that comes with treatment and recovery, and the need for more of it.

"We see people getting better that have been so, so ill and have suffered so much and that very clearly turn their lives back around and give back to their communities," she said. "It is an illness and it is treatable."

Lofwall also emphasized that people with opioid-use disorders need ongoing care.

"We really need treatment to be more continuous because it is frequently chronic, and the drug supply, the way it is right now is that one single lapse can be deadly . . . It's important that we stop just doing these acute episodes of treatment," she said.

She noted that only a small percentage of people with opioid-use disorder are getting treatment, with only 20 percent getting specialty addiction treatment and among those, only 37 percent receiving medications approved by the Food and Drug Administration. In addition, she said opioid-related inpatient hospital stays are increasing, up 64 percent nationally between 2005 and 2014, often for conditions like heart-valve replacements, which can cost "hundreds of thousands of dollars."

"How senseless is it if we are not treating the underlying disorder -- opiate-use disorder -- especially when we have really effective, evidence based medications," she said. "And we need to couple them with counseling and all the other important wrap around services. That is not rocket science."

Lofwall said we need to make drug screening, treatment, naloxone and syringe exchanges more accessible; improve treatment retention; train a larger work force to treat opioid use disorders; and better link recovery services and treatment.

The event was sponsored by the Northeast Kentucky Area Health Education Center.

Ashland Middle School students invent device to pick up needles, win $150,000 technology grant for school

A group of middle school students at Ashland Middle School were inspired to create a device to pick up used syringes after learning that first responders had only rubber gloves and tongs to pick them up. The students have been recognized nationally for their invention.

Ashland Middle School was one of three schools to win the 2018 Samsung Solve for Tomorrow Contest for inventing a device to pick up dirty needles, winning the school a $150,000 technology grant. The annual contest challenges sixth through 12th graders to use science, technology, engineering arts and mathematics to address real-world issues and inspire local change.

The device is slightly longer than a syringe and about two inches wide; it looks like a small plastic box with teeth. To pick up the needle, the box is placed over it, teeth side down, then squeezed to pick up then needle, without anyone touching it. The device can then be placed in an evidence cylinder.

"This doesn't solve the drug crisis; it just helps us stay safe while we are trying to solve the drug crisis," Aubree Hay, a student who worked on the project, said on a recent Kentucky Educational Television program, "Disrupting the Opioid Epidemic: A KET Forum."

The students created the device after their school resource officer, Troy Patrick, pitched the idea to their science and technology teacher and explained to them the dangers first responders face when they come upon dirty needles left behind by intravenous drug users, including exposure to HIV/AIDS, hepatitis C and leftover drug residue.

"This is something that could be nationwide," Patrick said. "It could be used in every ambulance and every police department in the nation."

Ashland Middle School is in Boyd County, which has been particularly hard hit by the opioid epidemic. The state's 2017 Overdose Fatality Report found that the county ranked fourth for overdose deaths per person, at 64.6 per 100,000 residents.

Will Wright of the Lexington Herald-Leader reports that staff at the local elementary schools in Boyd County scan playgrounds every day for discarded needles.

The students started working on the project last fall and won the state level competition in December, an honor that came with a $50,000 technology award. In March, they became one of 10 national finalists and after presenting their projects to a panel of judges in New York in April, they were chosen as one of three 2018 national grand prize winners, according to the news release.

The New York Post reports that Ashland Middle School was also named the Community Choice Award winner, based on the public's votes, which will bring a further $20,000 of technology to the school.

The students have also created an online database where people can report where they find used needles, as a way to map the areas most likely to encounter drug paraphernalia.

Ann Woo, senior director of corporate citizenship for Samsung, told Wright that the Ashland project stood out because it could be utilized in communities across the world that are impacted by the drug epidemic. “We loved the creativity and ingenuity,” Woo said, adding that the invention “can actually have impact in other communities across the nation.”

The other two grand-prize winners were Cavallini Middle School in Upper Saddle River, N.J., which developed a helmet concussion sensor, and Thomas Jefferson Middle School in Winston-Salem, N.C., which built a smart water-sensor system that automatically deploys water barriers during floods.

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.

Kentucky Public Health Association honors 10 public-health leaders, two health departments and a racetrack

Public health promotes and protects the health of people and their communities, largely through surveillance and prevention programs, and much of what people in public health do often goes unnoticed. But once a year the Kentucky Public Health Association honors outstanding contributors to public health. Here are the award winners for 2018, honored during the association's 70th annual conference on April 27 in Covington.

Sue Thomas-Cox, a nurse administrator with the Chronic Disease Branch of the state health department, won the Outstanding Public Health Nurse Award. Among other achievements, Thomas-Cox was instrumental in obtaining a multimillion-dollar Centers for Disease Control and Prevention grant to increase colorectal cancer screening in the state. Due in large part to her work, the state has moved from 49th to 19th in colorectal cancer screening, annual cases of such cancers have declined more than 25 percent, and mortality from them has fallen more than 30 percent.

Melinda Carey, an administrative specialist with the department's Division of Epidemiology and Health Planning, won an award for her contributions in the area of administrative support. Carey's nomination came with 26 letters of support, several of which described her as "the go-to person" who "goes the extra mile and makes the workplace enjoyable."

Robert Slaton of Georgetown, who has served in various health leadership capacities for more than five decades, was honored for his lifelong contribution to the improvement of public health. He was state health commissioner,  Gov. Brereton Jones' special assistant for health reform, external affairs director for the former Trover Clinic in Madisonville, and held several positions with the University of Louisville. He was a founding member of the group that developed Passport Health Plan. He is chair of the Community Advisory Council of the Foundation for a Healthy Kentucky and the national advisory board of the Institute for Rural Journalism and Community Issues, which publishes Kentucky Health News. “His contributions to improved health outcomes in the commonwealth will long outlive his numerous years of service to the people,” a nominator wrote.

Jennifer Hunter, director of clinical services at the Northern Kentucky District Health Department, received a career achievement award. Hunter has worked as a public-health nurse for 28 years. A few highlights: leading a team of six nurses in relief efforts in Mississippi after Hurricane Katrina in 2005; and her work around the heroin epidemic, including a hepatitis C testing pilot that has since gone statewide, advocating for syringe exchange programs, and her work with women with substance-use disorders.

Doraine F. Bailey, who works with the breastfeeding support services at the Lexington-Fayette County Health Department, was honored for her "exceptional contribution to the health and well-being of mothers and children in Kentucky."  Bailey was described as a "tireless champion for breastfeeding and maternal education," going beyond her job requirements to promote breastfeeding at community events and by serving as a guest lecturer in the University of Kentucky nutrition and dietetics program.

John Q. Moses, an HIV linkage navigator with the Lexington health department, was honored for his "significant contribution to benefit our most vulnerable population -- the indigent and uninsured." Moses has spent his career serving those at risk for and affected by HIV and STDs and was instrumental in launching Lexington's syringe exchange program.

The Christian and Todd County Health Departments were honored for their work on the August 2017 solar eclipse, which required several years of "hard work and planning to prepare for the influx of people and potential dangers." Visitors from over 47 states and 25 countries attended events in the area.

Nancy Merk, a board-certified lactation nutrition supervisor and regional breastfeeding coordinator with the Northern Kentucky Health Department, was honored for her 30 years in public health. Merk's leadership was instrumental in the health department receiving the Loving Support Award of Excellence Gold Level Award for Exemplary Breastfeeding Support and Practices from the U.S. Department of Agriculture.

Shana M. Peterson, a health educator at the Jessamine County Health Department, was awarded for her exceptional contribution in health education. Peterson has implemented many evidence based health education prevention programs in schools and has been a strong advocate for local smoke-free policies.

Lorrene Rawlins, nursing director at the Wedco District Health Department in Bourbon, Harrison and Scott counties, was honored for her exceptional home health services. Through her leadership, Rawlins was able to reduce costs in other areas of her department to create a budget to directly care for indigent patients.

Jody L. Schweitzer, a state epidemiologist, won the first-ever Outstanding Epidemiologist of the Year award. She was honored in large part for her work in implementing the state's immunization information system, the Kentucky Immunization Registry, which has been recognized on the state and national level.

Kentucky Speedway was honored "as an industry who has demonstrated exemplary leadership for the commonwealth's health. "

Poll: 24% of Kentucky adults know someone with a pill problem and 16 percent know someone with a heroin or meth problem

By Melissa Patrick
Kentucky Health News

Whether it's the misuse of prescription pain relievers, heroin or methamphetamine, the latest Kentucky Health Issues Poll findings indicate that many Kentuckians have a drug problem.

The poll, conducted Oct. 24 to Dec. 2, found that nearly one in four Kentucky adults, or 24 percent, said they knew someone who had experienced problems as a result of prescription pain relievers. That number has remained largely the same since 2013, but it indicates the depth of the problem.

"Misuse of opioids such as OxyContin, Vicodin, Percocet and codeine remains a critical public health and safety issue for Kentucky," Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, which co-sponsors the poll, said in a news release. "Not only are we losing more than 1,600 lives a year to overdoses, we are facing incredible losses in quality of life, workplace productivity, and business competitiveness."

The good news: Kentuckians said they are being prescribed pain relievers less often. In 2011, the poll found that 55 percent of Kentucky adults said they had been prescribed a pain reliever in the past five years; in the latest poll, the number dropped to 34 percent.

"Perhaps all of the education that's being done about the dangers of over-prescribing narcotic pain relievers is starting to make a difference, both in the number of people getting prescriptions and the amount of the pain medication they receive," Chandler said.

Seven percent of those polled said they weren't prescribed enough pills to control their pain; 21 percent said they were prescribed the right amount; and 6 percent said they were prescribed more than needed.

The poll also found regional differences in prescribing. The highest percentage of Kentucky adults who said they had been prescribed a pain reliever in the past five years was in the Louisville area (41 percent) and Northern Kentucky (40 percent). In was 37 percent and 36 percent in Lexington and Western Kentucky, respectively. The lowest share, 26 percent, was in Eastern Kentucky. That is the region where problems with drug addiction and overdoses are greatest, so the numbers could indicate that users are using illegal drugs or getting prescription medicines from illegal sources.

Click on any chart to view a larger version of it.

The poll found that 16 percent of Kentucky adults said they knew someone who had problems as a result of using methamphetamine or heroin. Both numbers were unchanged from the prior poll.

The poll shows that problems with heroin increased steadily between 2013 and 2016, but remained steady over the last year. Meth problems have remained steady since 2013.

Responses to these questions also varied by region with the percentage of adults who said they knew someone with problems due to heroin highest in Northern Kentucky (29 percent) and lowest in Western Kentucky (11 percent). The percentage of adults who said they knew someone with problems due to methamphetamine was highest in Eastern Kentucky (22 percent) and lowest in the Lexington area (13 percent).

Since 2013, the percentage of Kentucky adults who said they knew someone with a heroin problem has remained about the same in Northern Kentucky, which is often called ground-zero for this issue. However, this number has risen significantly in Louisville (from 8 percent in 2013 to 23 percent in 2017), Lexington (from 9 percent to 18 percent) and Eastern Kentucky (from 8 percent to 14 percent), with a lesser increase in Western Kentucky (from 7 percent to 11 percent).

Since 2013, Kentucky adults reporting they knew someone with a meth problem increased in Louisville (from 6 percent in 2013 to 16 percent in 2017) and Northern Kentucky (11 percent to 17 percent) and declined in the Lexington area (19 percent to 13 percent). The numbers remained about the same in Eastern and Western Kentucky.

"This poll is yet another piece of evidence that Kentucky's focus on resolving the drug abuse crisis must continue," Chandler said. "And it must involve multiple sectors of our society working together to engage all individuals struggling with addiction."

The news release about the poll notes that a National Vital Statistics Report shows meth use may be rising to problematic levels similar to heroin use; the National Institute on Drug Abuse reports that Kentucky had the fifth highest death rate due to drug overdose in 2016; and a CDC report found opioids, including prescription drugs, are the most common cause of overdose deaths.

Kentucky passed a law last year that generally limits painkiller prescriptions to a three-day supply if prescribed for acute pain, which lines up with the Centers for Disease Control and Prevention's guidelines for prescribing opioids. The limit does not apply to prescriptions for chronic pain.

This year the legislature passed a law to require pharmacists to tell patients how to safely dispose of unused opioids and other controlled substances, and either provide or offer to sell them a product designed to neutralize the drugs for disposal, or provide on-site disposal. Nearly 80 percent of Americans using heroin, including those in treatment, reported misusing prescription opioids first, according to the National Institute on Drug Abuse.

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 via landlines and cell phone. The poll's margin of error for each statewide result is plus or minus 2.4 percentage points.

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.

House bill to allow detention and treatment of revived overdose victims falls short in Senate panel and is likely dead for session

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- Despite considerable support for the concept, a bill to allow first responders to detain and hospitalize individuals who have been revived after an overdose is likely dead for this legislative session, due to concerns about liability and personal freedom.

Rep. Kim Moser

House Bill 428, sponsored by Kim Moser, R-Taylor Mill, would have applied only in Lexington, Louisville and Northern Kentucky because they have resources in place to immediately connect overdose victims with treatment.

Moser, who is also the director of the Northern Kentucky Office of Drug Control Policy, told the Senate Health and Welfare Committee that the bill was inspired by first responders who are often called to resuscitate the same person for opioid overdose multiple times, but can't get them to treatment.

Moser said the bill also has the support of citizens who are increasingly frustrated with the ever-increasing use of expensive Narcan to revive overdose victims at taxpayer expense, with no requirement for treatment. Currently, victims can refuse further treatment and simply walk away. She said the number of overdose deaths is "going down because we are saving people with Narcan, but we are not able to get them into treatment."

Moser and her guests at the March 8 House Health and Family Services Committee meeting said the average cost of Narcan is $110 per dose and the state spent $1.66 million in 2017 to administer 15,000 doses of Narcan, not including Louisville's Narcan expense -- or the cost of ambulance runs.

The House committee approved the bill without dissent and the House passed it 92-3, but it couldn't muster enough support in the Senate health committee. The chair, Sen. Julie Raque Adams, R-Louisville, passed up a vote after a long debate and said the bill would remain on the committee agenda.

Sen. Danny Carroll, R-Paducah, a former police officer, voiced concerns about the liability the bill would place on police officers and their departments because of the fine line between detention and arrest.

"I question the legality of doing this without actually having a criminal statute to detain them," Carroll said. "Don't get me wrong, I applaud you for the effort and I understand that we need to take stricter measures to control these situations. I don't want to put our officers at risk of civil suits."

Moser responded that the bill's "immediate detention form," which must be signed by a peace officer, covers this concern, making the bill "legal and constitutional." Christopher Nieves, special agent with the federal Bureau of Alcohol, Tobacco, Firearms and Explosives, cited a Supreme Court case to support Moser's claim, but Carroll and Sen. Reginald Thomas, D-Lexington, disagreed.

"Under criminal law jurisprudence, arrest is defined as the absence of freedom of movement," Thomas said, and suggested that the bill should have probably been placed in the Judiciary Committee. "I have no problem with the intent of this bill," he said. "But I just think that this bill, as presently written, is flawed and I can't vote for it."

Republican Sen. Ralph Alvarado, a Winchester physician, voiced concerns about infringing on individuals personal freedoms, adding that as a physician he can recommend treatment all he wants, but people don't have to follow his recommendations.

"It's not necessarily holding them against their will in the ER," said Moser. "As with any other patient, they can get up and leave. It does get them to the hospital. The immediate detention is creating a touch point."

Sen. Steve Meredith, R-Leitchfield, suggested that the program be called a pilot because otherwise it would create a dual standard of care that could create confusion. "I do appreciate what you are attempting to accomplish," he said.

Earlier, Nieves noted that HB 428 was modeled after an Indiana bill to address the same problem, and that he had found it to be effective. He said that simply giving Naloxone without connecting the individual to treatment was nothing more than a band-aid. "I think we are shortchanging ourselves if we don't get these people long-term treatment," he said.

Sen. Julian Carroll, D-Frankfort, also a lawyer, agreed with Moser and Nieves. "We need to do something," he said.

Steve Rath, assistant chief of Southgate Volunteer Fire Department in Campbell County, told the panel that the bill had wide support among firefighter organizations and that this bill would give them another tool in their toolbox to get people to treatment, and also create a record of repeat offenders.

Moser told Kentucky Health News  the bill is likely dead but she would continue to work on it.

Rep. Addia Wuchner, R-Florence, who chairs the House health committee and was standing nearby, said, "Nothing is buried until sine die," the final motion of any session.

Interactive map shows county data on Appalachian opioid overdoses, correlated with social and economic data

Lexington Herald-Leader map, drawn from Appalachian regional map by NORC, University of Chicago

A new data visualization tool offers in-depth, county-by-county information about the impact of the opioid epidemic in Appalachia and how it relates to factors such as unemployment, poverty, education and disability.

Screen grab of interactive map shows overdose rates with
highest in dark blue. (Click on the image to enlarge it.)

The Appalachian Overdose Mapping Tool, developed by a research organization and the Appalachian Regional Commission, "integrates overdose mortality rates for each Appalachian county with data on unemployment, poverty, and disability, as well as other socioeconomic variables. Users can compare county-level information with regional and national data and see changes in the data between 2006–2010 and 2011–2015. The mapping tool can also generate fact sheets to assist in community planning and response efforts," Wendy Wasserman of ARC reports in a press release.

"Residents across Appalachia are 55 percent more likely to die from a drug overdose than people in the rest of the country, but the disparity is even higher in some Eastern Kentucky counties.
In Leslie County, for instance, the overdose death rate is five times the national average," Bill Estep reports for the Lexington Herald-Leader. Leslie's rate is the highest in Kentucky; four West Virginia counties had higher rates.

Read more here: http://www.kentucky.com/news/state/article206168339.html#storylink=cpy

Socioeconomic correlations shown by the interactive map include:

• In Central Appalachia, counties with the highest rates of overdose are often the same counties with the highest rates of people on disability.
• In Central Appalachia, the counties with the highest overdose rates are often the same counties with the lowest rates of educational attainment.
• In Northern and Southern Appalachia, the highest overdose rates are in urban counties.
• While Central Appalachia remains the most highly affected subregion of Appalachia, other subregions are experiencing increasing rates of overdose.

The map was developed by ARC and the University of Chicago's NORC, which was known as the National Opinion Research Center before its work expanded beyond opinion research.