Coleman wants opioid commission to shift focus to prevention, especially among youth; leaves small door open to ibogaine

By Melissa Patrick
Kentucky Health News 

Kentucky Attorney General Russell Coleman laid out his mission for the next phase of the Kentucky Opioid Abatement Advisory Commission Tuesday, calling on them to focus on building a "gold-standard statewide prevention program" with settlements paid by opioid makers and distributors.

Attorney General Russell Coleman (Photo provided) 

"It's a plan of zealous collaboration, zealous collaboration," he said. "To be successful, the Office of the Attorney General and this commission must have a strong partnership. We must also further connect this body with organizations throughout our commonwealth . . . to focus on that necessary three-legged stool of treatment, prevention and enforcement." 

Coleman called on the commission to focus on prevention as it considers the coming round of grant applications. "I encourage you to place a strong emphasis on boosting Kentucky’s critically needed prevention efforts," he said.

Coleman added that his office is in the midst of developing new youth prevention initiatives that focus on education.  

"When we're in an environment where children are experimenting with these dangerous substances as early as 11 – we're seeing it in late elementary school – we have to have conversations with our kids earlier and earlier," he said. Later adding, "It's our responsibility, yours and mine, to prepare them for this threat they are facing in a new threat environment." 

When asked what his vision for a statewide prevention program would look like, Coleman told reporters that it will be important to look at what states such as Georgia, Tennessee, Virginia and Mississippi are doing. 

He said Virginia has a robust "one pill can kill" prevention effort and Mississippi had rolled out a "very creative approach that uses name, image and likeness of Ole Miss players to be able to engage and get that message out there, to permeate in the social media space. I would love to institute a program here that looks a lot like what is ongoing in the state of Mississippi." 

As for treatment and enforcement, Coleman said Kentucky is doing a great job in most of the state when it comes to treatment beds, and he told reporters that the drug cartels in Mexico are doing a great job of getting these substances into the U.S., which means collaboration is key, saying there is a need to "tear down the silos between federal, state and local" enforcement efforts.

"Again, we have to do very strong enforcement piece, but it has to be alongside a stronger prevention effort and continuing to treat our addicted neighbors," he said. 

In Kentucky, half of the nearly $900 million in settlement money is being distributed among cities and counties, and the other half is controlled by the commission, which is housed in Coleman's office.

So far, the commission has awarded 59 grants totaling about $21.5 million, with 23 aimed at prevention, totaling about $8 million; and 36 toward treatment and recovery, totaling about $13 million – but in addition to $10.5 million the legislature allocated in 2022 for behavioral-health treatment as an option to incarceration in Clark, Christian, Daviess, Greenup, Hopkins, Kenton, Knox, Mason, McCracken and Warren counties.

So, only about a fourth of the total state funding from the settlements has gone to prevention, which Coleman wants to emphasize.

Ibogaine

Coleman asked the commission to drop a proposal by its previous director to fund research aimed at legalizing the psychedelic drug ibogaine for drug treatment, saying he had given the idea "careful study, thorough consideration and honest conversation." 

"In that spirit, I respectfully ask this commission to step back from previous proposals to allocate $42 million to ibogaine research and the unproven, expensive clinical trial for a psychedelic that is, as you know, currently a Schedule 1 drug in the United States."

Noting that some call the settlements "blood money," he said "This is too precious to gamble away with that degree of risk at that amount."

He said he will ask Commission Director Chris Evans to propose a $5 million pool of resources for research and innovation grants that could be open to applications for funding research on ibogaine. 

"If someone brings forward an ibogaine research proposal that fits the criteria of this new innovative grant proposal, I hope this commission will give it full and fair consideration," he said. "It's not zero sum."

Ibogaine is a psychedelic derived from the African iboga plant. It is illegal everywhere except Mexico and New Zealand and has been reported to reduce or eliminate drug-withdrawal symptoms, but comes with some risk to the heart in some people. 

The proposal to commit about 5 percent of the settlement money on clinical trials that could lead to federal approval of the ibogaine for treatment of opioid-use disorder was led by former director Bryan Hubbard, who had been appointed by then-Attorney General Daniel Cameron.

Hubbard is continuing this effort in Ohio. The Lexington Herald-Leader reported in late February that he has signed a contract with the State of Ohio. Hubbard told the newspaper he is working for the state to “deliver novel treatment access and research opportunities for veterans and opioid-dependent individuals” and is partnering with an Ohio-based foundation to “create the framework for ibogaine clinical trials in Ohio.”

Bipartisan praise from commission

Commission member Karen Butcher, whose son died of an opioid overdose, told Coleman that she was pleased that ibogaine could still be considered for clinical research. "It's no secret that I've been the loudest proponent for that," she said. 

State Health Secretary Eric Friedlander, after describing himself as on the other end of the spectrum in support of ibogaine, praised the vision of Coleman, who is a Republican.

"I want to thank you. You're laying out a vision for us. You're here with us today. You are really taking the bold step and the responsible step and the brave step of putting yourself out there. Giving us a vision around prevention, addressing head-on some of the things that we haven't agreed on in this committee," said Friedlander, who works for Democratic Gov. Andy Beshear.

Commission member Jason Roop, a pastor who has said he is in recovery, called on Coleman to not lose sight of the fact that addiction is generational, saying it is important to tackle this problem holistically and not in silos: "I would encourage all of us to consider addiction from a holistic standpoint, prevention, treatment, law enforcement, all of it kind of going together to represent our efforts."

If subpoenaed, pharmacy chains hand over customers' private medical information; lawmakers say warrants should be required

ECommerce360 graphic; other chains are involved.

"The nation’s largest pharmacy chains have handed over Americans’ prescription records to police and government investigators without a warrant, a congressional investigation found, raising concerns about threats to medical privacy," reports Drew Harwell of The Washington Post. "Though some of the chains require their lawyers to review law enforcement requests, three of the largest — CVS Health, Kroger and Rite Aid, with a combined 60,000 locations nationwide — said they allow pharmacy staff members to hand over customers’ medical records in the store."

Sen. Ron Wyden of Oregon and Reps. Pramila Jayapal of Washington and Sara Jacobs of California, all Democrats, revealed the policy in a letter Monday to Health and Human Services Secretary Xavier Becerra. They investigated the practice "after the Supreme Court’s decision last year in Dobbs v. Jackson Women’s Health Organization ended the constitutional right to abortion," Harwell reports. In Kentucky, the legislature has banned abortion except to save the woman's life or prevent serious imparment of a life-sustaining organ.

"Pharmacies’ records hold some of the most intimate details of their customers’ personal lives, including years-old medical conditions and the prescriptions they take for mental health and birth control," Harwell notes. "Because the chains often share records across all locations, a pharmacy in one state can access a person’s medical history from states with more-restrictive laws. Carly Zubrzycki, an associate professor at the University of Connecticut law school, wrote last year that this could link a person’s out-of-state medical care via a 'digital trail' back to their home state."

Officials with eight large pharmacy chains — Walgreens Boots Alliance, CVS, Walmart, Rite Aid, Kroger, Cigna, Optum Rx and Amazon Pharmacy — told congressional investigators that they required only a subpoena from law enforcement, not a warrant issued by a judge, to share the records. The lawmakers said employees face “extreme pressure to immediately respond.” Harwell notes, "To obtain a warrant, law enforcement must convince a judge that the information is vital to investigate a crime."

The senators and representatives asked Becerra to strengthen HIPAA’s rules and make pharmacies insist on a warrant, noting that the tech industry did likewise a decade ago.

The companies told the investigators that they get "tens of thousands of legal demands every year, and that most were in connection with civil lawsuits," Harwell reports. "It’s unclear how many were related to law enforcement demands, or how many requests were fulfilled. Only one of the companies, Amazon, said it notified customers when law enforcement demanded its pharmacy records unless there was a legal prohibition, such as a gag order, preventing it from doing so, the lawmakers said."

The Health Insurance, Portability and Accountability Act allows Americans to ask drug companies if they’ve disclosed their information, "but very few people do," Harwell reports. "CVS, which has more than 40,000 pharmacists and 10,000 stores in the United States, said it received a 'single-digit number' of such consumer requests last year."

CVS, the largest pharmacy chain by prescription revenue, told Harwell that most subpoenas include a directive that the information remain confidential, and if it does not, the company considers “on a case-by-case basis whether it’s appropriate to notify the individual.”

"A Walgreens spokesman said the company’s law enforcement process follows HIPAA and other applicable laws," Harwell reports. "A Walmart spokeswoman said the company takes its 'customers’ privacy seriously as well as our obligation to law enforcement.' An Amazon spokeswoman said that the company cooperates with law enforcement requests as required. . . . Rite Aid declined to comment. The other companies did not respond to requests for comment."

Carmel Shachar, a Harvard Law School professor who studies health law and policy, said pharmacies have a “ton of sensitive data” and pharmacists are likely not trained to "evaluate the merits or validity of a police request — or to turn an officer down," as Harwell put it. Shachar said, “These need to go to someone who understands privacy law for review. probably feels very nerve-racking to get a subpoena and tell the person who gave it to you, ‘Oh, you’ll have to wait.’”

Harwell writes, "The pharmacy data could be especially concerning for the nearly one in three women ages 15 to 44 who a Post analysis found live in states where abortion is fully or mostly banned," including Kentucky. "In Texas, Attorney General Ken Paxton has warned pharmacies they could face criminal charges for providing women with 'abortion-inducing drugs'," which are used for most abortions in the U.S.

State's first detailed report on domestic-violence cases has a wealth of data on how courts and law enforcement handle them

The report's court data is by area development district, not by judge or county, but it has data on how individual law-enforcement agencies served emergency protective orders. (Map from report, adapted by KHN; to enlarge, click on it.)

Kentucky Health News

"Kentucky has long had a problem with domestic violence," the Lexington Herald-Leader reports. "A 2012 survey found that 45% of women and 35% of men" in the state have been victims of domestic violence, sexual violence or stalking, "according to a new report released Friday, marking the first time the commonwealth has ever tracked the data. Now the commonwealth will begin to dig into the details with a debut domestic-violence report that will set a baseline for police reports, protective orders issues, court cases and other information."

The 207-page report has a wealth of information about how domestic violence is handled by courts and law-enforcement agencies at regional and local levels. It covers the 14,199 charges and 8,867 arrests related to domestic violence in 2022, and the outome of the 19,986 petitions courts received for emergency protective orders in criminal and civil cases.

For example, it gives the average number of days that it takes individual law-enforcement agencies to serve EPOs on people accused of domestic violence or threats of violence, based on reports by the agencies. Statewide, the average is 2.22 days, but in many counties, especially in Appalachian Kentucky, service is much slower, perhaps putting potential victims at greater risk.

Law-enforcement agencies that averaged 10 days or more (excluding those with fewer than 10 EPOs served) to serve EPOs were: Adair County sheriff (12 days), Bell County sheriff (13), Breckinridge County sheriff (12), Calloway County sheriff (14), Corbin Police Department (19), Garrard County sheriff (15), Laurel County sheriff (10), Lawrence County sheriff (11), Martin County sheriff (11), McCreary County sheriff (15), Perry County sheriff (10), Rockcastle County sheriff (15), Spencer County sheriff (13), Wayne County sheriff (10), Whitley County sheriff (12), Williamsburg Police Department (10); and Wolfe County sheriff (13).

Agencies that averaged 7 days or more (excluding those with fewer than 10 EPOs served) were: Anderson County Sheriff's Department (8 days), Danville Police Department (8), Estill County sheriff (9), Fayette County sheriff (7), Franklin County sheriff (7), Grayson County sheriff (7), Harrison County sheriff (7), Jefferson County sheriff (7), Jessamine County sheriff (7), Knox County sheriff (9), Letcher County sherifff (7), Lincoln County sheriff (7), Marshall County sheriff (7), Pendleton County sheriff (8), Pulaski County sheriff (8), Russell County sheriff (7), and Todd County sheriff (9).

Data on how courts handle domestic violence is not given by judge, court or jurisdiction, but by the state's 15 area development districts.

It shows that judges in the Lincoln Trail ADD (Meade, Breckinridge, Grayson, Hardin, LaRue, Marion, Nelson and Washington counties) approved only 40 percent of the petitions for EPOs regarding domestic violence, and 31 percent of those for tempotrary interpersonal protective orders.

Judges in the Northern Kentucky ADD (Boone, Kenton, Campbell, Carroll, Gallatin, Owen, Grant and Pendleton counties) had the next lowest approval rates, 63 and 45 percent. The statewide averages, respectively, were 72 and 60 percent.

In divorce and other civil cases where domestic violence was alleged, judges in the Cumberland Valley ADD (Jackson, Rockcastle, Laurel, Clay, Knox, Whitley, Bell and Harlan counties) had the lowest approval rate, 16.9%. Lincoln Trail was second-lowest at 19.8%, just ahead of the Kentucky River ADD (Wolfe, Owsley, Lee, Breathitt, Leslie, Perry, Knott, and Letcher counties), at 19.9%.

In civil cases where other interpersonal violence was alleged, judges in the Gateway ADD (Bath, Montgomery, Menifee, Rowan and Morgan counties) had the lowest approval rate, 9.1%. The next lowest rate, 12 percent, was in the adjoining Fivco ADD (Boyd, Carter, Elliott, Greenup and Lawrence counties). It was 14.9% in the Cumberland Valley ADD.

Generally, judges in the Bluegrass, Purchase and Green River ADDs were the most likely to issue protective orders.

The report was required by a 2022 law sponsored by state Sen. Whitney Westerfield, a Republican from Christian County. "Before this report, domestic violence advocacy groups had used a newspaper clipping service to keep track of domestic violence homicides," the Herald-Leader reports.

Westerfield, chair of the Senate Judiciary Committee, learned of the lack of centralized reporting from Herald-Leader Opinion Editor Linda Blackford. “It’s just unacceptable,” he told her as the bill mved through the legislature. “We can’t make informed public policy decisions without good information.”

In first gubernatorial debate, Cameron says he could sign a medical-cannabis bill; Keck favors exceptions to abortion law

Candidates who debated, clockwise from upper left:
Somerset Mayor Alan Keck, Attorney General Daniel
Cameron, state Auditor Mike Harmon, Commissioner
of Agriculture Ryan Quarles (Spectrum News image)

By Al Cross
Kentucky Health News

Attorney General Daniel Cameron said Tuesday night that he could sign a medical-marijuana bill as governor if it law-enforcement and medical experts "can get around a framework that is responsible."

Cameron was one of four Republican candidates for governor who appeared in the first debate of the race, held in Louisville by Spectrum News, a cable-television service.

Somerset Mayor Alan Keck separated himself from the other three by saying "there should be some exceptions" to the law that bans abortion except in cases of threat to the woman's life.

When Cameron ran for attorney general four years ago he was "absolutely" against medical marijuana, Nick Storm of Kentucky Fried Politics noted in his post-debate analysis for Spectrum. Then, he was the candidate of law enforcement, but now polls show overwhelming voter support for medical cannabis, Storm noted.

Agriculture Commissioner Ryan Quarles, who came out for medical cannabis a week earlier, said whatever law the state had needs "a very narrow framework." Keck said he "came out with this policy position months ago," and said it is "another example of Kentucky lagging behind. . . . We need to get the Senate on board and get it done.”

The Senate has not taken up medical-cannabis bills that the House, also controlled by Republicans, has passed in two legislative sessions. Late last year, Democratic Gov. Andy Beshear used his pardon power to allow people with a doctor's certification that they have at least one of 21 specified medical conditions to possess up to eight ounces of cannabis bought legally in another state.  

State Auditor Mike Harmon, who answered the question last, said "I'm not there yet, but I am open to discussion."

The debate did not include former United Nations ambassador Kelly Craft, who declined the invitation from Spectrum and the Jefferson County Republican Party, which co-sponsored the event.

On abortion, Cameron, Harmon and Quarles said they support the current law, but Keck said, "I struggle, candidly, with this . . . I'm absolutely pro-life . . . I do believe there should be some exceptions … there has to be consideration for the woman in the event of violent trauma to them, especially in adolescence."

Asked if they would support greater public availability of Narcan, which counteracts drug overdoses, Harmon said he would be. Cameron said local officials should make the decision, and Keck said he is "a big believer in local control." Quarles said he would have to discuss the idea with legislators, law enforcement and people in public health.

UK HealthCare spending $5 million on security upgrades, setting new policies amid gun violence at health facilities in other states

Screenshot from UK Police website, adapted by Kentucky Health News

The University of Kentucky is bolstering security at health-care campuses "in response to increasing reports of violence taking place across the nation in health-care settings," a news release said Friday.

UK said its police began using handheld metal detectors on all patients and visitors entering emergency departments in April 2021, followed by installation of fixed metal detectors in July 2021. Other recent measures include having at least one police officer at each of the emergency departments around the clock.

The release said UK will spend $5 million on health-care safety, including:

• Addition of electronic access control to all perimeter doors to restrict public access as well as replacement and modernization of aged entryways.
• Utilization of emerging technology to enhance threat detection and expanding panic alarms and lockdown capabilities.
• Increased security camera coverage to improve situational awareness.
• Addition of UK Blue emergency towers to walkways where staff and patients travel frequently.
• Enhancement of exterior lighting to improve visibility around UK HealthCare facilities.

At a virtual forum for UK HealthCare employees, Executive Vice President for Health Affairs Mark Newman and UK Police Chief Joe Monroe discussed their efforts to improve the safety and security of employees, patients and visitors.

“We also are researching better ways to make UK HealthCare a weapons-free location through screening technology and looking at strategic efforts to increase dedicated police presence on the UK HealthCare campus,” Monroe said.

The moves were announced in the wake of the June 1 killings of four people at a Tulsa hospital by man who blamed his doctor for pain after back surgery and also killed himself, but the news release said UK Police have worked for a year with a security consultant on the first phase of a continuing security review "with an initial focus on enhancing perimeter security and fortifying the emergency departments at UK Chandler Hospital and UK Good Samaritan Hospital," the news release said.

"Hospital trauma departments are on the front lines whenever there's a mass shooting, but when those spaces are targeted, staff must mobilize to not only protect their patients but themselves," Axios Vitals reports. "And yet, efforts to fortify health facilities could also conflict with their traditional roles as community resources and safe spaces.

Axios Vitals notes that "From 2010 to 2020, shootings resulted in 39 deaths at health-care facilities accredited by the Joint Commission. From 2000 to 2011, researchers found there were 154 hospital-related shootings in the U.S. A survey from the American College of Emergency Physicians in 2018 concluded that nearly half of emergency- room doctors have been assaulted at work."

OPINION: Kentucky's governor could legalize medical marijuana with 'a game of constitutional chicken,' advocate writes

By Jim Higdon

Gov. Andy Beshear is the first governor in the history of Kentucky to call for legalizing cannabis. Following the failure of the Kentucky legislature to pass a medical marijuana bill last month, the governor has asked the public for input on what he can do by executive order. It’s about time that political leaders in Kentucky prioritize this issue to legalize cannabis.

The vast majority of Kentuckians agree with Gov. Beshear that medical marijuana should be legal in Kentucky, including a majority of Republicans. However, among the minority that disagrees with him is Senate President Robert Stivers, who single-handedly denied the opportunity to vote on this issue before the end of the legislative session, after the bill had passed the House for a second time.

Sen. Stivers responded quickly to Gov. Beshear’s call for ideas on executive action, saying in a statement that the governor "simply can’t legalize medical marijuana by executive order … because it’s a constitutional separation of powers violation."

Sen. Stivers was wrong to deny a floor vote on medical marijuana when so many Kentuckians are desperate for it, but he’s correct that the governor lacks authority to create a functioning medical marijuana program on his own under the Kentucky Constitution. That’s the legislature’s job, even when they refuse to do it.

Jim Higdon

Kentucky is one of 13 states without legal access to medical marijuana. That number will continue to drop this year as more states join the modern world, despite the lingering federal prohibition still in place.

By the end of this year, Kentucky will most likely be on a list of fewer than 10 states without legal medical marijuana – which will only add to the stigma that Kentucky is 20 years behind every other state. For reference, California legalized medicinal cannabis in 1996, more than 25 years ago.

What can the governor do to change this narrative? According to the Kentucky Constitution, there’s quite a bit he can do to lead Kentucky in the right direction, even when the legislature refuses to do its job.

Under Section 75 of the Kentucky Constitution, written in 1891, the governor is commander-in-chief of the army, navy and militia. In present-day terms, that means the governor is in charge of the Kentucky National Guard and the Kentucky State Police. These two agencies spend untold hours flying above Kentucky in helicopters for the sole purpose of eradicating illegal cannabis crops.

The governor has the power under the constitution to ground these helicopter missions until further notice. Anti-cannabis helicopters are an extraordinary waste of taxpayer resources and a use of military hardware against our own citizens. They should end immediately.

Under Section 77 of the Kentucky Constitution, the governor has the power to grant pardons. Gov. Beshear should use this constitutional power to pardon every person convicted of marijuana crimes under Kentucky law. Whether for possession, trafficking, or cultivation, Gov. Beshear should pardon all Kentuckians with marijuana felonies on their records. With the stroke of a pen, the governor would signal a new era.

And under Section 80 of the constitution, the governor has the power to call a special session of the legislature. Under normal circumstances, there’s an agreement between the governor and legislative leaders about the need for a special session before the governor calls for it. Otherwise, legislators can come to Frankfort, gavel in, and then immediately gavel out and go home.

In other words, the governor can lead a legislature to session, but he can’t make them work. In ordinary times, this would make a governor look weak and wasteful of government resources if legislators came to Frankfort only to turn around and immediately return home. But these are not ordinary times. If legislative leaders come to Frankfort for a special session called by the governor to consider medical marijuana but then gavel out without considering a bill, who is the loser? Which side looks weak?

To maximize the impact, the governor should call this special session as close to the general election as possible. Call the legislature into session in mid-October and dare Republican leadership to deny a vote on medical marijuana just weeks before Election Day.

It’s a game of constitutional chicken that the governor can win.

Jim Higdon of Louisville is co-founder of Cornbread Hemp and author of The Cornbread Mafia, the first book about Central Kentucky's marijuana-growing industry. He is a native of Lebanon, Ky.

Frankfort paper names local health agency Newsmaker of Year

Franklin County Health Department staff pose for a photo taken by Deputy Director Brittany Parker.

The pandemic has been very hard on local health departments, which in many if not most cases haven't received the respect and recognition they deserve for bearing the extra workload and putting up with coronavirus skeptics who harass or abuse them. At least one got very prominent recognition at year's end, as The State Journal of Frankfort named the Franklin County Health Department its Newsmaker of the Year.

"It is because of their tireless efforts to keep the community healthy, while dealing with an increasingly hostile environment and constant threat of possible contamination," Harrison Wagner writes. "From organizing a way to administer tests and multiple doses of the vaccines, to creating informational materials about virus prevention, all while attempting to keep a healthy work-life balance and still perform their normal duties, the Franklin County Health Department has managed to weather the storm of the pandemic."

Health departments also enforce rules at workplaces, and "there were instances of hostility towards health environmentalists, or health inspectors, while they were enforcing safety guidelines at businesses," Wagner reports, quoting Director Judy Mattingly: “There were quite a few scary situations where their strict instructions from me were that if any business owner is hostile with you in any way, shape or form, that you are to leave immediately. There were situations at that time where our environmentalists were able to call our police partners or sheriff partners and be accompanied on those inspections.”

On the bright side, the pandemic has raised the profile of the department "and its other healthy-living initiatives," Wagner writes. "The staff has become closer as a result of working together at the testing and vaccination drive-thrus. Mattingly said this has led to Secret Santa gift exchanges and Friendsgivings, which has made the department more tightly knit."

Grayson County sheriff says he got covid-19 because he and wife didn't wear a mask enough; urges his friends to wear masks

The sheriff of a rural Kentucky county, stricken with covid-19, pleaded on Facebook today for his readers to wear a mask. Grayson County Sheriff Norman Chaffins, a former state trooper, said he thought he got the coronavirus on a Western RV trip. "We maintained our distance as much as we could, but did not always wear a mask," he wrote. "I am now paying the price." His post follows.

Lauren and Norman Chaffins (Facebook photo via WBKO-TV)

To All My Friends and Family,
     I make this post while I have been in bed unable to move for the past six days, so please bear with me.
     Yes, Lauren, Greyson and I are positive for the coronavirus. Greyson and Lauren have had mild symptoms with low-grade fever, coughing and fatigue while mine have been more severe.
     We traveled out West near the end of June and while the incubation period, according to the experts, is 2-14 days, we likely contracted it while we were out there. We traveled via RV to the two states with the lowest number of covid cases at the time (Wyoming and Montana) in the nation. It's important to note that we had less contact with people while out West than I had here in Grayson County just going about our regular duty and day.
     When we returned on Saturday, July 4, I had a low grade fever of 99, which is not unusual for me especially after returning from a long trip with a significant altitude change. At the time, neither my son, nor my wife had any symptoms. As the weekend went on Greyson went to a friend's house (they have been notified) and he developed a cough. Out of abundance of caution we picked him up within a couple of hours of him arriving. (Again, the family has been notified). My symptoms started to worsen. Neither myself or Lauren had any close contact with anyone else either here at home or at my work. If we did come in contact with someone, they were notified by the Grayson County Health Department or other reporting agency.
     I am going to share with you my symptoms and at the end I will explain why. As I said before, it started out with a low grade fever. On Monday, I lost my sense of taste and smell and developed a severe headache -- a severe headache that stayed with me until today. All of us also got tested on Monday. We received the positive results on Wednesday morning.
     By late Wednesday morning my symptoms were fever (100.3-100.9), severe headache, earache, intense stomach pain, nausea, bone and joint pain, cough, sore throat, severe knee pain and inability to sleep. I started vomiting on Saturday. Each day after first diagnosis the symptoms intensified. Since Monday the 6th, I have not slept for more than two hours intermittently per day. What’s really weird is that Friday I started to hallucinate by seeing frightful images on my ceiling in my bedroom. I couldn’t sleep long enough to have a nightmare. The only drugs I took were Tylenol for fever and Phenegran the last couple of days. I assume the hallucinations were from lack of sleep and pain.
     I could get no relief from the headaches and body aches, and began to think that I may be taking a turn for the worse. The only symptom I have not had is trouble breathing. The worst thing during this is that when one symptom starts to subside, I would develop two different ones. It is almost like someone is controlling them and taking turns turning them up and down as a sick joke.
     Ladies and gentlemen, I have had the flu. I’ve had the mumps (on the pancreas), chicken pox, measles, broken neck, and had total knee replacement. If you were to combine the painful effects of all those into one, it would not touch the hell I experienced the past six days with this coronavirus. There is no comparison. Nothing that I know of or have ever experienced compares to it.
     I consider myself a tough guy, but I am telling you that it brought me down quick and there is nothing I can do about it. I am not in control, and at times think I am losing it. As I type this I can feel a fever coming back.
     I’m telling you this because I want you to wear your mask. Not because I am the sheriff, not because the governor said so, and not because the business tells you to. I want you to wear a mask because I do not want anyone to have to go through what I went through. I want you to wear a mask because I don’t want my kids or grandbabies to get sick. I want you to wear a mask because it’s just the right thing to do. It may not 100% guarantee that you won’t contract it, but wearing a mask will certainly reduce your chances.
     Please understand this: I am not telling you to wear a mask. We are not going to fine you or insist that you wear a mask. As your friend, I am asking you to wear a mask when you are around others and when you go out into public at least until there is a vaccine. We maintained our distance as much as we could, but did not always wear a mask; I am now paying the price. One thing that is worse than battling the virus is battling the heaviness of the burden that we could have infected someone else.
     Lastly, thank you for all the phone calls and prayers sent out on our behalf. We love our friends and family so much. Please, if you are going to go negative on me and judge me or my family, please go to Topix for that. I will not be making any more posts or answering questions regarding this until we are clear of this virus. God bless each of you!

Editorial in Frankfort's newspaper says drug addiction should be treated as a health issue, not a crime

The State Journal

With rising inmate populations and crumbling prison infrastructure depleting the state of much-needed funding, it is time to stop treating drug addiction as a crime and start regarding it as the public health issue that it is.

We agree with the Kentucky Chamber of Commerce that reclassifying drug possession charges to misdemeanors and investing in treatment over incarceration will serve a dual purpose — save the state money on prison costs, which grew 15.9 percent between 2016 and 2020, and help to break the cycle of drug addiction through education and treatment.

The cost to incarcerate a state inmate in Kentucky is $18,406 per year. The approximately 4,500 inmates in prison for drug offenses in 2016 cost taxpayers more than $82 million per year.

According to data from the Criminal Justice Policy Assessment Council, a working group established by former Gov. Matt Bevin charged with developing “fiscally-sound, data-driven criminal justice policies,” the number of offenders imprisoned for drug trafficking between 2012 and 2016 jumped 25.6% (1,525 in 2012 to 1,916 in 2016). However, there was a 101.5% increase in the number of offenders (911 in 2012 to 1,836 in 2016) jailed on drug possession charges.

In fact, it was a year ago this week that a Franklin County Regional Jail inmate was discovered dead in his cell after what a lawsuit alleges were days without treatment for withdrawal symptoms related to drug use.

Dylan Stratton, 21, was booked into the jail Jan. 17, 2019, on a drug charge and was placed in the detox holding cell for observation. According to the lawsuit, he refused meals and began vomiting. A day later he had a seizure, reportedly from benzodiazepine withdrawal, and died.

This case is just one of many that illustrate how Kentucky’s jails are ill-equipped to handle drug addicts. Instead of spending money to punish drug users, the state should increase funding for substance abuse treatment.

Justice Department gives Eastern District of Kentucky a new prosecutor to fight fentanyl, U.S. Attorney Duncan says

The chief federal prosecutor for the eastern half of Kentucky says his office is getting a new prosecutor dedicated to fighting fentanyl, the powerful opioid that was found in more than half the people who died of drug overdoses in the state last year.

U.S. Attorney Rob Duncan

"We will aggressively prosecute cases involving the distribution of fentanyl and other synthetic opioids — because with these drugs, there is no such thing as a small case," U.S. Attorney Robert M. Duncan Jr. wrote in an op-ed for the Lexington Herald-Leader.

Attorney General Jeff Sessions announced in July that Kentucky was one of eight states that would be getting a total of 10 fentanyl prosecutors.

"The Eastern District of Kentucky is at Ground Zero in the overdose crisis," Duncan wrote. "During 2017, in the 67 counties comprising our district, we had 894 overdose deaths, approximately 61 percent of the resident overdose deaths for the entire state. More alarmingly, the top five counties in the commonwealth, with the highest per capita overdose death rates, are all in our district. Similarly, four of the top five counties with the most fentanyl-related overdose deaths are also in our district."

The top five Kentucky counties for overdose deaths in 2017 were Estill, Kenton, Campbell, Boyd and Mason. The next five (Jessamine, Montgomery, Harrison, Franklin and Madison) are also in the district.

The anti-fentanyl effort "is based on a successful initiative in Manatee County, Florida, where law enforcement aggressively prosecuted fentanyl-distribution cases, helping in the reduction of overdose death rates," Duncan wrote. "The program resulted in a significant number of federal prosecutions."

Duncan said his office "will investigate and aggressively prosecute doctors who prey on opioid addiction here in Kentucky and defraud the government in the process. Finally, as part of our mission to reduce access to all illegal drugs, we will continue our support of the Organized Crime Drug Enforcement Task Force, a multi-agency effort to disrupt and dismantle the most significant drug trafficking and criminal organizations." (Read more)

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.

Kentucky gets $12.2 million as part of national EpiPen settlement; money will go to Medicaid, which was defrauded

A pharmaceutical company that makes EpiPen and EpiPen Jr., Mylan Inc., has been ordered to pay a $465 million nationwide settlement for knowingly avoiding the payment of rebates to Medicaid programs. Kentucky's portion of the settlement is $12.2 million.

Attorney General Andy Beshear said $8.5 million will be returned to the federal Medicaid program and $3.7 million will be returned to Kentucky’s program. The federal government pays about 70 percent of Medicaid costs in the state.

Federal law requires makers of brand-name drugs to pay higher rebates to Medicaid, and Mylan was found to have avoided paying these higher rebates by improperly classifying the brand name drug as a generic one.

It's time to clean out your medicine cabinet for the National Prescription Drug Take Back Day on April 29

Do you know the expiration dates of the medicines that have been piling up in your kitchen cabinet? If not, you might want to check those dates and throw away old medicine as part of the National Prescription Drug Take Back Day Saturday, April 29. The Kentucky State Police are partnering with the U.S. Drug Enforcement Agency to not only encourage citizens to remove potentially dangerous medicines from their homes, but to also dispose of them safely.

"Prescription medications play an important role in the health of millions of Americans. However, leftover or expired drugs can be harmful in a variety of ways,” KSP Commissioner Rick Sanders said in a press release. He noted that expired medications can lose their effectiveness and pollute water supplies if disposed of improperly. He warns, “Unused medicines in homes can also be accidentally ingested by children, stolen, misused and abused."

Rates of prescription drug abuse in the U.S. are at alarming levels and are showing no signs of slowing down. According to the DEA, "the majority of prescription drug abusers report that they get their drugs from friends and family including the home medicine cabinet," the release said.

Americans disposed of 447 tons of unneeded medications during last year’s National Prescription Drug Take-Back Day. Kentucky had 50 collection sites totaling 9,752 pounds in 2016.

This year, KSP has again set up 16 locations throughout Kentucky to serve as collection points for the safe, convenient and responsible disposal of unused or expired prescription drugs. For a list of locations click here. Collection activities will take place from 10:00 a.m. through 2:00 p.m. on Saturday, April 29. For more information about the ‘Take Back’ program, contact KSP at 502-782-1780 or visit the DEA website.

Louisville's PharMerica is still a defendant in federal cases in which big drug makers have paid billions in fines

Abbott Laboratories has paid billions, and Amgen Inc. has paid millions, in fines for offering "rebates" or "kickbacks" to get pharmacy companies to increase their prescriptions of drugs in nursing homes, and PharMerica Corp. of Louisville is the remaining defendant in both civil cases, according to a detailed report by James McNair at the Kentucky Center for Investigative Reporting.

PharMerica manages drug benefits for nursing homes, hospitals and assisted living facilities. McNair paints a dismal picture of nursing homes and says they are ripe for this type of abuse, writing that they house "people with age-weakened bodies, multiple ailments and, often, severe mental impairment. Many are over-medicated. Many have no visitors. A third of them will die within a year of admission." (Click on chart for larger version)

McNair notes that a whistleblower lawsuit first called attention to Abbott Labs, which pled guilty in 2012 to a criminal charge, settled civil kickback and fraud claims, and paid $1.5 billion in fines for its role in paying millions of dollars in "rebates" to get pharmacy companies to increase prescriptions for an anti-seizure drug, Depakote, for uses beyond its Food and Drug Administration approval. Medicaid payments for this drug "went on to top $7 billion," McNair reports.

Amgen also enlisted these same pharmacy companies to promote its anemia drug, Aranesp, for uses beyond its FDA approval, and after pleading guilty settled civil kickback and fraud charges and paid a total of $762 million in fines.

These two cases brought more government attention to such schemes, which are "standard practice in the pharmaceutical industry," and also on the pharmacy companies that are on the receiving end of the payoffs, McNair writes.

McNair describes PharMerica as the "second-biggest operator of nursing home pharmacies in the country" and writes that it had " $1.9 billion in revenue last year," making it the "10th-biggest publicly traded company in Kentucky, according to rankings by The Lane Report." Since 2007, the chief executive has been Gregory Weishar (pronounced WISH-er) .

Companies like PharMerica, and its larger competitor Cincinnati-based Omnicare Inc., act on behalf of the nursing homes, buying drugs from the pharmaceutical companies in bulk and then dispensing them under the supervision of "consultant pharmacisits," McNair reports.

The Abbott Labs and Amgen lawsuits assert that PharMerica gave "certain drugs to nursing home patients in return for drug company kickbacks, not because they were the "right medication."" McNair reports that the suits were filed by drug company insiders who have knowledge of these payoffs disguised as "rebates" or "discounts."

"PharMerica denies the claims," writes McNair. But the company has been in this type of case many times since 2005, McNair reports: It has agreed to pay $40 million in fines to settle federal complaints, five additional closed cases connected to this company.

McNair also reports that just last week, the Justice Department said PharMerica will pay $31.5 million for dispensing addictive painkillers to nursing home patients without prescriptions, then falsely billing Medicare. As part of this settlement, PharMerica also agreed to a five year "corporate integrity agreement," which McNair notes later in the article are rarely enforced.

McNair goes on to list the details of several other cases PharMerica has been involved in, one of them "deemed so flagrant that the inspector general sought to ban PharMerica from federal health-care programs for 10 years."

PharMerica declined to make its executives available for an interview with the Kentucky Center for Investigative Reporting but said in a statement: “PharMerica is committed to outstanding compliance and the highest standards of ethical conduct, and we are diligent in ensuring that we comply with all applicable law and regulation,”

Jan Scherrer, vice president of Kentuckians for Nursing Home Reform, a non-profit advocacy group based in Lexington, told McNair that the CEOs of companies involved in kickback schemes should be held personally accountable, "These are not victimless crimes," he said.

“It’s the same players -- PharMerica and Omnicare,” Scherrer continued. “They keep doing this over and over and over, and all they get is a fine. And for them that fine is nothing more than the cost of doing business.” (Read more of this detailed report by clicking here.)

Elizabethtown cancer clinic pays $3.7 million to resolve claims it diluted drugs, prolonged chemotherapy to make more money

Elizabethtown Hematology Oncology PLC and its owners has paid $3,739,325 to settle claims "that they submitted false claims for payment to the Medicare, Medicaid and the military's medical provider for extending the duration of chemotherapy infusion treatment to patients and inappropriately billing office visits for infusion therapy," Andrew Wolfson reports for The Courier-Journal.

"To subject cancer patients to unnecessary treatments that are physically draining and emotionally stressful is utterly unconscionable," said Patrick McFarland, inspector general of the U.S. Office of Personnel Management.

The settlement agreement not only explains that the clinic's owners, Dr. Rafiz Ur Rahman and Dr. Yusuf K. Deshmukh, extended the time period of chemotherapy and infusion treatments for patients just to make more money but also says the clinic wrongly billed for office evaluations of patients getting chemotherapy, Wolfson writes.

"Manipulating treatment protocols and lengthening infusion times to increase reimbursement reflect an extraordinary lack or regard for patient welfare and the integrity of our health care system," David Hale, U.S. attorney for the western half of Kentucky, said in a news release.

In 2011, Dr. Ijaz Mahmood of Elizabethtown filed a lawsuit against the clinic, saying it created written protocols designed to prolong chemotherapy infusion times "by a factor of three or more beyond what is generally recognized." Mahmood said Deshmukh and Rahman provided patients with the correct dose of chemotherapy but administered it over a longer period of time by diluting it. They could make more money that way because Medicaid and Medicare pay partially based on how long a procedure takes.

Aside from the $3.7 million payment, the inspector general of the U.S. Department of Health and Human Services will monitor the clinic for three years. The clinic will still be allowed to bill federal medical programs, Wolfson writes. The government could still potentially prosecute the doctors. (Read more)

As heroin use increases in Kentucky, new report shows its strong connections to abusers of prescription pain medicines

Kentucky's law-enforcement agences, policymakers and public-health advocates have taken serious measures to curb the state's rampant prescription drug abuse problem, and recent state and national news stories suggest that the reduced supply of these painkillers, at least the ones in a non-crushable form, has driven pill abusers to heroin. Now there's research to support this theory.

Non-medical use of prescription pain medication may raise the risk of heroin use, says a new report by the Substance Abuse and Mental Health Services Administration. SAMHSA says people aged 12 to 49 who previously used prescription pain relievers non-medically were 19 times more likely than non-abusers to have started using heroin over the past year.

Proving the connection, the converse was true: Almost 80 percent of those who started to use heroin over the past year had abused prescription pain relievers. These findings are part of a larger effort to identify some risk factors of heroin use, and also to understand the "dependence and initiation that have occurred in the past few years," says a SAMHSA news release.

Heroin use, which had already become a problem in Northern and Central Kentucky, has been spreading to the Southern and Eastern Kentucky. The drug is becoming more popular throughout the state and nation because it is cheaper and easier to get than prescription painkillers, specifically opioid medications.

The number of U.S. heroin users has increased by about 60 percent from 2007 to 2011, says the 2011 National Survey on Drug Use and Health.  And while some can argue for the benefits of prescription medication, that same risk-benefit analysis doesn't apply to heroin, which has only risk.

The SAMHSA report offers another risk of prescription drugs: “Prescription pain relievers when used properly for their intended purpose can be of enormous benefit to patients, but their nonmedical use can lead to addiction, serious physical harm and even death,” said Dr. Peter Delany, director of SAMHSA’s Center for Behavioral Health Statistics and Quality. “This report shows that it can also greatly increase an individual’s risk of turning to heroin use – thus adding a new dimension of potential harm.” 

Spring-clean the cabinet and dump your drugs Saturday, April 27

Dump your unwanted prescription drugs this Saturday, April 27, from 10 a.m. to 2 p.m. as part of the National Prescription Drug Take-Back Day, which in the past has coordinated with local law enforcement to haul in more than than 2 million pounds or 1,018 tons of prescription medications.

According to the Drug Enforcement Administration, the National Prescription Drug Take-Back Day aims to provide a safe and convenient way to throw away unwanted or unused drugs, keeping them out of the wrong hands while also educating the general public about the potential for abuse of these medications.

This is a great opportunity for those who missed the previous events or those that have accumulated unwanted, unused prescription drugs since the last event to safely dispose of them. Click here to find the nearest collection site and here to learn more about the DEA initiative.

New law will allow officers to make arrests in emergency-room assaults that they do not witness

Emergency-room workers who treat individuals under the influence of drugs or alcohol will have greater legal protection, and those who misbehave in ERs will have less protection, under a law that will take effect next month.

The measure, sponsored by Sen. John Schickel, R-Union, will allow peace officers to make an arrest or issue a citation for a fourth-degree assault that occurs in a hospital emergency room, even if the officer didn’t witness the crime, as long as the officer has probable cause to believe the offense occurred.

“Hospital emergency personnel treat individuals in the worst of conditions – and sometimes that means putting themselves at risk, if a patient comes in intoxicated or high,” Gov. Steve Beshear said at a ceremonial signing of the bill today.  “This law gives medical staff the security of knowing that an offender will be held accountable for an assault that takes place when they’re brought in for care.”

Under current law, a hospital worker has to swear out a warrant alleging assault. Fourth-degree assault is a Class A misdemeanor, punishable by up to a year in jail.

Police make second raid in a year at pain clinic in Paintsville

As lawmakers wrestle with what to do about prescription pill abuse in Kentucky, law enforcement continues to crack down on so-called "pill mills."

For the second time in less than a year, officers descended upon Care More Pain Management in Paintsville last Wednesday, arresting 29 people outside the clinic. "The raid was part of an ongoing investigation by Attorney General Jack Conway's office and the U.S. Drug Enforcement Administration into doctors who allegedly over-prescribe pain medications," report R.G. Dunlop and Laura Ungar of The Courier-Journal.

"We're been looking forward to this day for almost as long as I've been in office," five years, said Paintsville Mayor Bob Porter. "Hopefully, other people will think twice before they try to get into this business."

Dr. Richard Albert, who had practiced at the clinic, was arrested last Feb. 16 and pleaded guilty in December to conspiring to illegally prescribe about 50,000 Percocet tablets. Conway's office believes Albert was prescribing about 100,000 pills a month and seeing about 55 patients per day. (Read more)