Study to find best ways to prevent opioid overdoses has started testing and interventions in second and last group of 8 counties

Kentucky Health News map shows counties in study; click it to enlarge.

By Elizabeth Chapin
University of Kentucky

The $87 million study to find the best ways to battle the opioid epidemic at the local level in Kentucky is expanding to more communities across the state.

The second wave of the University of Kentucky’s HEALing Communities Study was launched in Bourbon, Campbell, Carter, Greenup, Jefferson, Jessamine, Knox and Mason counties on July 1. The communities will implement new recovery, treatment and prevention strategies proven to reduce opioid-overdose deaths.
 
Launched in 2019 with a federal grant, the four-year study has tested ways to reduce OD deaths in Boyd, Boyle, Clark, Fayette, Floyd, Franklin, Kenton and Madison counties. Starting in 2020, a multidisciplinary team of more than 25 UK researchers worked with local and state behavioral-health and criminal-justice agencies.

Their evidence-based practices include delivery of medication for opioid-use disorder, reducing risky prescribing, education on how to prevent overdoses, and distribution of naloxone, a lifesaving drug that reverses opioids' effects.

Sharon Walsh, Ph.D.

In the second group of eight counties, “The HEALing Communities Study will bring life-changing outreach and access to treatment to thousands of Kentuckians,” said HCS principal investigator Sharon Walsh, a professor in UK’s College of Medicine and College of Pharmacy and director of the Center on Drug and Alcohol Research.

“The intervention will also help us better understand what’s needed in each community and where to focus and ramp up efforts to best support individuals to reduce opioid overdose deaths,” Walsh said. “What we learn will create sustainable solutions for the opioid epidemic in Kentucky that can also be replicated in communities throughout the nation.”

The study's goal is to reduce overdose deaths in the study counties by 40 percent. OD deaths increased 15% in the first eight counties from 2020 to 2021, but that's not a valid measurement of the study's impact, Walsh told Kentucky Health News. She said the metric will be rates in the first group versus the second group after the study period, and "The comparison must be among counties that received the intervention versus those that did not receive the intervention."

In 2021, OD deaths reached an all-time high in Kentucky and the U.S., with the Centers for Disease Control and Prevention reporting 107,000 deaths nationally and 2,250 in Kentucky. The HCS team has been adjusting intervention strategies to address the rapidly evolving opioid crisis, including increasing naloxone distribution and expanding outreach and services in communities of color.

The second wave of counties includes community engagement to assist key stakeholders in applying evidence-based practices and a communications campaign to build demand for treatment and reduce stigma toward people with opioid-use disorder. The HCS team is also working with various pharmacies and health care providers to implement safer opioid prescribing and dispensing.

The first group of counties are now in a sustainability phase, which is intended to build capacity to help community coalitions and partner organizations sustain the evidence-based practices after the study ends.

HCS researchers will  analyze data from all 16 counties, using pre-intervention usual care in the group as a control element. The comparison will show how evidence-based practices work in different settings in each community. The second-wave intervention is expected to end in early 2024.

Feds ease access to most common drug against opioid addiction

Photo from thefix.com

By Danielle Ray and Al Cross
Kentucky Health News

Federal drug rules will soon loosen so that doctors can accommodate nearly triple the number of patients they can treat with the most common drug used to fight opioid addiction.

Under the regulation, which takes effect Aug. 5, doctors who are authorized to prescribe buprenorphine, commonly sold under the brand name Suboxone, can go from having a maximum of 100 patients on the drug to 275.

The Department of Health and Human Services estimates between 10,000 and 90,000 new patients will be able to get buprenorphine in the first year as a result. Another 2,000 to 15,000 new patients should be able to get the treatment in subsequent years, Jayne O'Donnell reports in USA Today.

HHS also wants to eliminate potential financial incentives for doctors who prescribe opioids out of fear that patients will give them low marks in patient-experience surveys if they have pain after procedures.

Federal regulators are pushing Congress for about $1 billion in funding to increase treatment options across the country for the drug epidemic. They say it would get more doctors trained in buprenorphine, particularly in rural areas short of physicians who can prescribe the drug, White House Drug Policy Director Michael Botticelli told reporters. HHS Secretary Sylvia Burwell said the money is needed to combat the epidemic.

House and Senate conferees are debating the Comprehensive Addiction and Recovery Act, which would improve treatment for addiction and overdoses and reform prescribe practices. The House version has no new money while the Senate version has $920 million and Democrats have vowed not to sign a report without significant funding, Botticelli said. The Senate version has bipartisan support and could be a re-election vehicle for some Republican senators and their leader, Mitch McConnell of Kentucky.

Kana Enomoto, principal deputy administrator of HHS's Substance Abuse and Mental Health Services Administration, said current drug law requires some limit on buprenorphine patuents. Many of those who commented on the proposed rule warned about the risk of the drug being diverted for illegal uses, she said.

Experts have cited this limit as a barrier to treatment for what is known as "opioid use disorder." Opioids are controlled substances used to treat pain. The rule aims to increase access to medication-assisted treatment and therapy for tens of thousands of people with opioid-use disorders, while preventing diversion, HHS says.

In another anti-opioid move, the Department of Veterans Affairs will require prescribers and pharmacists to check state prescription-drug monitoring databases before prescribing or dispensing opioids for pain. HHS is also launching more than a dozen new scientific studies on opioid misuse and pain treatment and seeking feedback to improve prescriber education programs.

Free overdose-reversal kits are given to Kentucky hospitals with the highest recent rates of heroin-overdose deaths

Kentucky hospitals with the highest rates of heroin overdose deaths are receiving funding for heroin/opiate overdose reversal kits, which will be provided free of charge to every treated and discharged overdose victim at the pilot project hospitals, according to a state press release.

The funding for these kits is through the Substance Abuse Treatment Advisory Committee, which oversees the distribution of a $32 million pharmaceutical settlement fund that is used to expand treatment in Kentucky. The committee has allocated $105,000 to purchase these kits for the pilot hospitals: the University of Louisville Hospital, the University of Kentucky Medical Center in Lexington, and the St. Elizabeth Healthcare in Northern Kentucky.

In 2013, 230 Kentuckians died from heroin overdoses. Final numbers for heroin overdoses in 2014 are not yet available, but the Office of Drug Control Policy estimates heroin was involved in 30 percent of all drug-overdose deaths, according to the release.

Attorney General Jack Conway chairs the committee and First Lady Jane Beshear serves on it. They announced recently that about 500 of these kits will be made available to the St. Elizabeth system, which treated 545 people in 2013 and 745 people in 2014 for heroin overdoses.

“There is evidence the collaborative efforts in our community are having an effect,” St. Elizabeth interim president and CEO Garren Colvin said in the release. “A report earlier this month indicated that heroin-related overdose deaths are down in Northern Kentucky. ... To continue to battle heroin issues in our community and throughout Kentucky, it is going to take education and collaboration at the local and state levels.”

Naloxone, which is also known as Narcan, is the drug in the free Naloxone Rescue kits and "has no potential for abuse and immediately reverses the effects of heroin overdose by physiologically blocking the effects of opiates," says the release.

One of the challenges for access to these kits is that they are not covered by Medicaid or many private insurance companies and are too expensive for most people to purchase. Health experts anticipate that when the U.S. Food and Drug Administration approves the nasal mist form of the drug, most insurance companies and Medicaid will cover it.

“As Kentuckians expand access to mental health treatment, including addiction recovery, it’s more important than ever to have community access to tools like Narcan,” Jane Beshear said in the release. “Often, an overdose experience is what finally drives people suffering from addiction to seek help.”

UK professor develops nasal spray to deliver standard antidote to painkiller overdose; fast-tracked, in final clinical trials

A new lifesaving product to treat painkiller overdoses is in its final round of clinical trials at the University of Kentucky and is being fast-tracked by the U.S. Food and Drug Administration.

The product is a nasal-spray application of the anti-opoid drug naloxone, developed by Daniel Wermeling, professor in the UK College of Pharmacy, through his startup company AntiOp Inc.

Opioids are the class of pain-killing drugs that are related to morphine, including prescription drugs such as hydrocodone and oxycodone as well as illegal drugs such as heroin. Naloxone is the the standard treatment for suspected opioid overdose, according to a UK news release.

Naloxone is now administered by injection. The spray eliminates the need for needles, with a ready-to-use, single-use delivery device inserted into the nose of an overdose victim. The product delivers a consistent dose, absorbed across the nasal membranes even if the patient is not breathing.

"The goal is to make the medication available to patients at high risk of opioid overdose and to caregivers, including family members, who may lack specialized medical training," Wermeling said. "The treatment could be given in anticipation of EMS arrival, advancing the continuum of care and ultimately saving lives."

Nationwide, deaths from opioid overdose are on the rise, according to the federal Centers for Disease Control and Prevention. Kentucky, with a long history of opoid abuse, ranks third in the nation for drug overdoses, with more than 1,000 dying each year. Heroin abuse is on the rise, with 230 deaths, or 31.9 percent, of autopsied overdose deaths attributed to heroin in 2013.  This is a 60 percent increase from the previous year, according to the Kentucky Office of Drug Control Policy.

Congratulating Wermeling on his success, UK President Eli Capilouto said, "The epidemic of opioid abuse in our state presents an enormous and urgent challenge, not only for health care providers and law enforcement but also for us here at the University of Kentucky. Dr. Wermeling's project is putting a powerful new tool into the hands of those on the front line of the fight against heroin, both here in Kentucky and beyond."

Wermeling's research was supported by a three-year, $3 million grant from the National Institutes of Health through the National Institute on Drug Abuse with additional funding from the Kentucky Science and Technology Corporation. His company partnered with Reckitt Benckiser Pharmaceuticals in May to accelerate the production and worldwide marketing of the product.