Kentucky's first emergency psychiatric unit opens in Lexington

The unit has a separate entrance. (UK photo by Hilary Brown)

By Allison Perry
University of Kentucky

State officials, community leaders and UK HealthCare officials celebrated Tuesday's opening of a new emergency unit in Lexington dedicated to the treatment of patients experiencing a mental health crisis.

The EmPATH (Emergency Psychiatric Assessment, Treatment and Healing) Unit is the first of its kind in Kentucky. It will open at 7 p.m. Tuesday, July 30, on the campus of Eastern State Hospital.

“The EmPATH model is a game-changer for mental-health care, and we are so proud to be the first in the state to open this unit,” said Robert S. DiPaola, UK's co-executive vice president for health affairs. “For many, seeking care for a mental-health issue can be difficult, frustrating and even frightening. With EmPATH, we’re using a proven, evidence-based approach that allows our behavioral health team to provide fast, appropriate evaluation and care that’s easier for patients to access in an environment conducive to healing.”

The U.S. has about 30 EmPATH units. UK HealthCare and New Vista, a mental-health care provider in 17 counties in the Lexington area, have collaborated with leadership from the state Cabinet for Health and Family Services to bring this new model of emergency behavioral health care to Kentucky.

Pioneered by DR. Scott Zeller, an internationally known emergency psychiatry expert , EmPATH units are carefully designed physical environments that help patients experiencing an acute mental health issue receive immediate support. Instead of individual treatment rooms, the units are wide open spaces with comfortable seating. Upon arrival, individuals will interact with supportive health care providers including psychiatrists, nurses, social workers, and even peer support specialists and can stay in the unit for up to 23 hours.

Eastern State Chief Administrative Officer and psychologist Lindsey Jasinski says peer support is one of the main factors that has made the model so successful. Patients will have the chance to speak to others who have deal with taking medication, receiving therapy, and participating in different programs.

“We have those folks here in the unit to say, ‘Can I share my experience with you?’” Jasinski said. “It can be helpful to hear from someone who has been in a difficult place and been able to successfully navigate that. It provides hope, and that’s what the EmPATH model is all about.”

At roughly 11,000 square feet, the EmPATH unit has room for up to 12 patients. Providers and support staff will regularly assess the individual’s symptoms and develop a care plan, which could include a treatment plan and discharge home with connection to appropriate outpatient services, or admission as an inpatient for round-the-clock care.

Studies show that 60 to 70 percent of individuals who come to an EmPATH unit are stabilized and back home within 24 hours; patients treated in these units are also far more likely to continue their care. A study published in Academic Emergency Medicine showed that 60% of individuals in rural areas with suicidal thoughts or ideation sought follow-up care after their initial treatment in an EmPATH unit.

In addition to providing faster, more appropriate care for psychiatric patients, the EmPATH unit will help reduce the load on traditional emergency departments. A 2020 study of emergency-room visits related to mental health showed an increase from 6.6% to 10.9% from 2007 to 2016. Zeller and the physician-owned partnership Vituity, which helps hospitals develop their own EmPATH units, estimate that 12 to 15% of ER visits are related to behavioral health.

While ERs can provide critical care to acute injuries, illnesses, and traumas, they often do not have the resources or staffing to effectively treat individuals in a mental health crisis. Because ERs must prioritize patients with life-threatening issues, those coming to an ER for mental-health care are likely to experience long wait times in an environment that isn’t conducive to helping these individuals.

“Our emergency departments give amazing care and save countless lives every day,” said Dr. Andrew Cooley, a UK HealthCare psychiatrist who has served as chief medical officer for Eastern State Hospital since 2013. “But we know that patients who come in with a life-threatening injury will need to take priority, and patients experiencing a behavioral health crisis will be further down the list to receive treatment. EmPATH is the alternative to that – a patient shows up here, and we immediately greet them and begin care.”

The EmPATH unit is open to adults age 18 and over experiencing a behavioral health crisis, which has a broad definition: any mental-health problem that impairs their ability to perform normal daily functions, take care of themselves, and keep themselves safe. That could include those seeking help for a substance use disorder, those experiencing depression and anxiety, someone who is thinking about self-harm or suicide, and more. Patients may be brought in through emergency medical services, or may self-refer and bring themselves in.

“The patient defines the crisis. We’re very open-door,” said Marc Woods, Eastern State's chief nursing officer. “We immediately try to assess what their needs are – not only for behavioral health, but also their basic needs. It allows our clinicians to say, ‘Are you hungry? Would you like a Coke?’ We’re quickly building a relationship so we can help address not only a mental health issue, but also get them connected to other services to improve their overall health and wellness.”

The EmPATH unit is part of UK HealthCare and will have its own entrance at Eastern State's campus, on Bull Lea Road in Lexington. The entire hospital is owned by the state Department for Behavioral Health, Developmental and Intellectual Disabilities and is managed by UK HealthCare. It operates 195 acute-care beds and provides critical, recovery-focused psychiatric care for adults from a 50-county region of the state.

As part of resetting its relationship with rural hospitals, UK will not build a new hospital at interstate junction in southeast Lexington

By Al Cross

Kentucky Health News

FRANKFORT, Ky. -- The University of Kentucky will not build a hospital in southeast Lexington because it wants to do what its network of rural hospital partners want: focus on its mission as a top-level care facility for the sickest patients, a UK vice president told a legislative subcommittee Wednesday.

Mark D. Birdwhistell (UK photo)

The proposed Hamburg-area hospital "was perceived as us stepping outside of our swim lane" by the university's clinical affiliates out in the state, Senior Vice President for Health and Public Policy Mark Birdwhistell told the Budget Review Subcommittee on Health and Family Services.

"We heard loud and clear, 'We want UK HealthCare to focus on taking care of the sickest of the sick. We don't want UK out doing primary care and secondary care.' . . . That was very eye-opening."

Birdwhistell reiterated, "The message we received loud and clear from our clinical affiliates was, 'When our folks get that sick, we want them to come to UK. We want them on campus. We don't them in a community hospital.'"

UK was in the planning process for a new hospital at the southern junction of Interstates 75 and 64, and had bought the property and done some initial work. Baptist Health is in the process of opening a new hospital on an adjacent site.

Instead of a hospital, UK will build a clinic with specialty services like the one it has built in a former department store in the Turfland Center in southwest Lexington, but larger, Birdwhistell said after the meeting: "Turfland plus."

He told the legislative subcommittee that the university will also build other clinics to serve its employees in Lexington and the Bluegrass region, many of whom are "having to get health care outside the system. . . . We feel like that is our obligation."

Birdwhistell spoke to the subcommittee in a new role, which he said will include centralizing the university's "government-relations activities across campus," including "building a better partnership with the General Assembly. I felt I was uniquely positioned to do that."

 

Previously, Birdwhistell was UK HealthCare's vice president for health system administration and chief of staff. He was secretary of the state Cabinet for Health and Family Services under Republican Gov. Ernie Fletcher, and helped Republican Gov. Matt Bevin propose changes to the federal-state Medicaid program, which he had run before becoming cabinet secretary. He appeared with Angela Dearinger, executive vice dean of the UK College of Medicine, who was briefly health secretary at the end of Bevin's term.

The General Assembly is firmly controlled by Republicans. In the recent legislative session, Birdwhistell was the university's point man in changing legislation that helped Pikeville Medical Center and some other rural trauma hospitals but in its original form would have reduced some of the extra Medcaid payments that UK gets for being a "safety net" hospital.

That relates to UK's recent takeover of other hospitals in Ashland and Morehead, which Birdwhistell discussed at Wednesday's legislative subcommittee meeting. Speaking of UK's absorption of King's Daughters Medical Center in Ashland, he said "Where we failed . . . is when you put that UK brand in front of that name, that brings with it an expectation of service, not predator," which he said was the perception of some.

"And so, we're readjusting a lot of the narratives to say, 'When you have UK in front of your name, you go to a partner and say, 'What can we do to help you be successful?' It's not 'What do we do to crush you?' And this is community health care. This is not our forte, so we've learned that lesson. . . . We can grow the workforce for those providers and not have to do it ourselves."

Birdwhistell said UK can also serve as a backstop for its rural partners, noting that UK doctors rearranged their schedules one weekend to keep open the neonatal intensive-care unit at Pikeville, which would have had to close temporarily due to employee vacations. "That's what we do," he said. "That's where we excel and that's where we need to get back to."

UK's latest acquisition is St. Claire Medical Center in Morehead, where it has run a satellite medical-school program for several years. The College of Medicine also has satellites in Bowling Green and Northern Kentucky, and Dearinger said it has seven residency programs in Bowling Green, the state's third largest city, and is starting residency programs in Ashland and Pikeville.

"We are trying to grow the number of doctors to stay in our state," Dearinger said, calling UK's Rural Physician Leadership Program "one of our crown jewels." She said it has produced 120 doctors, most of whom are practicing in Kentucky, "the vast majority" in rural parts of the state. Later, she said 42 percent of all recent medical-school graduates from UK have stayed in Kentucky, far above the 24% of "a few years ago."

Two Democratic legislators from Louisville, Sen. Karen Berg and Rep. Lisa Willner, asked Dearinger if UK has had fewer applicants for medical school or residencies due to restrictions on medical education, by which they meant the recent state law that bans abortions except in cases of threat to the woman's life or permanent damage to a life-sustaining organ.

Dearinger said "To be honest, we have not seen a decrease." She said she has heard anecdotal reports of students or graduates interested in obstetrics and gynecology going elsewhere, but "We are still inundated with OB applicants to do a residency at the University of Kentucky."

Another Louisville Democrat, Rep. Sarah Stalker, noted a May 16 Kentucky Health News story, from Kentucky Public Radio, that said 15% fewer U.S. medical-school graduates applied to Kentucky residency programs in the 2023-24 academic year, and there was a 23% decline in those for obstetrics and gynecology, according to the Association of American Medical Schools., which blamed the decline on the state's near-total abortion ban.

Dearinger said UK is still getting hundreds of "very good applicants, and we don't have any problems filling our residency programs and fellowship programs with very high-quality young physicians. We are prioritizing as much as we can, Kentucky students, so that they will stay" in the state.

Roll call: Most members of the subcommittee did not attend the late-morning meeting. The chairman, Sen. Donald Douglas of Nicholasville, a physician, noted that at the start of the meeting and made an unusually pointed comment: "I expect my colleagues in the General Assembly to show up."

Coleman reappoints two members to state opioid commission

By Melissa Patrick

Kentucky Health News

Attorney General Russell Coleman has reappointed two members to the state opioid commission, thus not changing the balance of votes on the issue of syringe-exchange programs, which he says he opposes.

Those members are Jason Roop, an assistant professor of business and theology at Campbellsville University, who represents victims of the opioid crisis, and Van Ingram, who works for Gov. Andy Beshear as executive director of the Kentucky Office of Drug Control Policy and fills a slot representing the drug treatment and prevention community. Each of their terms expires in 2026. 

The Kentucky Opioid Abatement Advisory Commission has nine voting and two non-voting members. The legislature created the commission in 2021 to distribute the state's portion of the $900 million in settlements with opioid manufacturers and distributors, with half of the money going to the state and the other half going to local governments. 

The money is provided in installments and so far, the state has awarded 110 grants worth more than $55 million for treatment, prevention and recovery.

Attorney General Russell Coleman

Coleman's opposition to syringe exchanges was revealed when Chris Evans, the commission's executive director and a Coleman employee, passed on a vote approving a grant for the Boyle County Agency for Substance Abuse Prevention because it included help for a syringe exchange. 

In passing, Evans said Coleman doesn't support the exchanges. Coleman, a Republican who was elected in November, later said that was especially the case for programs that are not limited to one-for-one exchanges. His spokesman said Coleman would not base commission appointments on the issue.

As of February, 41 Kentucky counties had syringe-exchange programs that operate under a one-to-one rule and 24 counties have needs-based exchanges, according to the state Department for Public Health. It estimates that the overall return rate of syringes is 85% to 90%. 

Syringe exchanges are supported by research. The Centers for Disease Control and Prevention says injection drug users who have access to exchanges are five times more likely to get treatment than those who don’t. Another study says the exchanges do not encourage drug use or increase the frequency of drug use among current users.

Exchanges were authorized by the state's 2015 anti-heroin law, in an effort to thwart the spread of HIV and hepatitis C, which are commonly spread by the sharing of needles among intravenous drug users. 

They also work to reduce overdose deaths by distributing naloxone; reduce medical harms such as skin, blood stream, and heart valve infections that severely injure substance users and incur large health care costs for society; and connect substance users to treatment and recovery supports in order to achieve sustained abstinence.

Patricia Freeman, a University of Kentucky pharmacy professor, has also been reappointed to the commission – by UK as a representative of the HEALing Communities study team, which is working on reducing drug-overdose deaths. Her term will expire in 2026. 

Two new non-voting members have also been appointed. State Rep. Chris Fugate, R-Chavies (Perry County), was appointed by House Speaker David Osborne to replace retiring Rep. Danny Bentley, R-Russell. Karen Kelly, chief of staff to U.S. Rep. Hal Rogers, R-5th District, was appointed by Senate President Robert Stivers to replace Carlos Cameron. 

Other members of the commission are Republican state Treasurer Mark Metcalf, who also passed on the Boyle County vote; Cabinet for Health and Family Services Secretary Eric Friedlander, who works for Beshear; Von Purdy, a vice president of Simmons College in Louisville, representing citizens at large; Darren "Foot" Allen, a retired state trooper, representing law enforcement; and Karen Butcher, representing citizens at large.

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

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

By Sarah Ladd
Kentucky Lantern

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

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

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

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

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

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

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

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

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

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

For more information on applying, visit this website.

Drug-overdose deaths of Kentuckians fell 9.8% last year, but rate among state's Blacks increased 5%; overall U.S. decline was 3%

Graph by Kentucky Health News from state data

By Al Cross
Kentucky Health News

In 2023, 9.8 percent fewer Kentuckians died from drug overdoses than the year before, according to an annual state report released Thursday.

A preliminary report from the Centers for Disease Comtrol and Prevention last month showed a 7.9% decrease, but the CDC now includes deaths of non-residents. The state Office of Drug Control Policy says in the state report that it uses only resident deaths "to better target harm reduction and prevention activities for Kentuckians." 

The state report was funded by the CDC and prepared for the office by the Kentucky Injury Prevention and Research Center at the University of Kentucky, as an agent for the state Department of Public Health.

It said 79% of the overdose deaths involved fentanyl, a powerful synthetic opioid, and 55% involved methamphetamine, a stimulant with psychedelic properties. The numbers are based on blood tests of victims, who usually have more than one illegal drug in their bloodstream.

“Fentanyl is what’s driving this crisis. If we could ever get a handle on that I think out potential for success is unbelievable,” Van Ingram, director of the drug-control office since 2004, said at an event in the state Capitol rotunda attended by people from the treatment, recovery and law-enforcement communities.

Gov. Andy Beshear told the crowd, “Some of the best news in this report is how much better than we were than the rest of the country,” in which overdose deaths declined 3%, according to the CDC. “Today’s news follows a long list of positive actions we have taken with so many people in this room,” he said.

Earlier, Beshear said, "The sad fact is we still lost 1,984 Kentuckians." That is about the same as in 2020, and much more than 2019. And he noted that overdose deaths among African American residents of the state rose 5% in 2023, from 259 to 264, after rising 22% from 2021 to 2022. While the recent increase was much less, "That is unacceptable," he said.

The rate of drug overdose deaths among Black Kentuckians in 2023 was 68.3 per 100,000, which was 52% greater than the white rate of 45 per 100,000.

The age group with the most overdose deaths was 35-to-44-year-olds, with 571, but the number was 13.4% less than in 2022.

In that year, 2,135 Kentuckians died of drug overdoses. The decline of 9.8% “represents 151 families whose loved ones still have a chance to recover,” said Dr. Jody Jaggers, the Kentucky Pharmacy Education and Research Foundation's director of public health education.

Jaggers demonstrated how easy it is to use naloxone, which stops the effect of an overdose. "It's something that you can even teach a child to do," he said.

Known by the brand Narcan, the nasal spray is now easily available in generic form without a prescription. Jaggers said the key is getting it into the hands of people who are most likely to witness an overdose. 

The report says the state distributed 160,000 doses of Narcan in 2023, and Ingram indicated that the increased availability of naloxone was a factor in the 9.8% drop in overdose deaths. The state recently put up a website, FindNaloxoneNowKY.org, to help Kentuckians find it easily.

Among counties with 10 or more overdose deaths, for which overdose-death rates were calculated, the highest rates were in four counties that adjoin each other. Estill County had 27 overdose deaths for a top rate of 187 per 100,000 residents; second was Lee County, with 11 deaths for a rate of 155.9. Third was Breathitt County, which had 18 for a rate of 150.6. Fourth was Powell, which had 16 for a rate of 121.1. Fifth was Floyd, which nearly adjoins Breathitt; it had 35 deaths for a rate of 109.9 per 100,000.

Other counties with rates higher than 60 per 100,000 (in purple on the map below) were Bourbon, 85.9; Boyd, 94.2; Carter, 90.4; Clark, 72.9; Clay, 68.9; Franklin, 61.9; Garrard, 61.9; Jefferson, 66.3; Knott, 100; Lincoiln, 76.4; Madison, 72.1; Montgomery, 62.8; Perry, 93.3; Pike, 74.5; Rockcastle, 91.8; Rowan, 94.9; Wayne, 59.8; and Whitley, 59.3.

Counties with rates lower than those, but higher than the state average of 45.9 per 100,000, were Bell, 50.7; Boyle, 56.8; Bullitt, 51.6; Harlan, 57.3; Jessamine, 56.2; Johnson, 59.3; Laurel, 54; and Taylor, 50.1.

Map from state report, adapted by Kentucky Health News

Hospital association, state Department of Agriculture start 'Food is Medicine' effort to get more local food into Kentucky hospitals

Logo of the program

Kentucky Health News

The Kentucky Hospital Association and the state Department of Agriculture have started an effort to get more local food into Kentucky hospitals.

"A recent survey completed by representatives of 50 hospital systems across the state found that only about 2 percent of the hospital’s budget is spent on local food," a department news release said. "The overall average percentage of local food being served at these same hospitals was 15 percent."

In their “Food is Medicine” campaign, the department, KHA, eight health systems and other organizations "will study how hospitals can play a key role in prescribing food as medicine to patients by creating more access to healthier and local foods," the release said. They will:
· Look at the food a hospital is serving to patients;
· Create partnerships between hospitals and local farmers;
· Connect patients with resources to a consistent healthy food resource;

· Reach out to patients who need a special diet, such as diabetes patients, and who could benefit from having a resource to fresh food.

“Access to nutritious food is critical to maintain a healthy lifestyle,” Agriculture Commissioner Jonathan Commissioner Shell said. “Advocating that connection between food and health is essential to meeting the goal of less chronic disease and longer lifespans. But it’s more than a message about choosing the right foods, it’s also a message about expanding our food distribution networks within the agriculture industry.”

KHA President and CEO Nancy Galvangni said, "Kentucky’s hospitals work every day to improve the health of our citizens and this new collaboration between KHA and the Department of Agriculture will elevate ways in which hospitals throughout Kentucky can address the social drivers of health facing our commonwealth.”

Hollie Harris, president and CEO of Appalachian Regional Healthcare, said "As the largest provider of care in southeastern Kentucky, our responsibility goes beyond treating illness. We want to help people live healthier lives, and that starts with access to healthy foods. . . . We can create partnerships to address our state’s troubling health statistics and make fresh, locally grown foods more available in our communities."

Despite waiting list, a shortage of nurses and plenty of money, governor and legislature don't fund new building for KSU nursing

Kentucky State University’s nursing program has outgrown the Betty White Health Center, opened in 1971. Nursing classes are spread in buildings across campus. (Kentucky Lantern photo by Jamie Lucke)

By Sarah Ladd
Kentucky Lantern

Kentucky State University requested $50 million this year to build a nursing school for its growing class of future health care providers. The governor and legislature rejected the request, even though the KSU program has a waiting list and Kentucky suffers from a shortage of nurses but enjoys a record surplus.

“The real tragedy is that we had the money to do it,” Rep. George Brown Jr., a Lexington Democrat, told the Lantern last week. He called the omission “a travesty.” Brown and other lawmakers said the decision is part of a long pattern of neglect and underinvestment in historically Black colleges and universities (HBCUs) — a disparity the Biden administration also has highlighted.

It’s “always been the history,” said House Democratic Floor Leader Derrick Graham, a KSU alum who urged Republican legislative leaders to fund the nursing building.

During House debate, Black lawmakers pointed out that Kentucky’s only public HBCU was being denied $50 million for a project they deem critical to its future, while $125 million was quickly found for Northern Kentucky University and the University of Kentucky to open a biomedical center in downtown Covington, where plans also call for NKU to move its law school.

The Senate added the Covington project to House Bill 1, which moves $2.7 billion from the Budget Reserve Trust Fund into one-time spending over the next two years. HB 1 includes other higher education projects: $60 million for a veterinary tech facility at Murray State University, $25 million for a UofL Health cancer center in Bullitt County and $22 million for a livestock innovation center at a UK research farm.

“Kentucky State always seems to suffer and always has to wait,” Brown said March 29 on the House floor. “‘You have to wait your time; it’s not your time.’ … So the question is, when will it be Kentucky State’s time?”

When budget negotiators met in a free conference committee on March 26, Graham asked why KSU’s “top priority” was not included in budget legislation. Graham represents Frankfort where KSU sits on a hill overlooking the capital city. Sen. Chris McDaniel, chairman of the Senate budget committee, said KSU had also revised its budget request by asking for money to deal with failing infrastructure and other maintenance needs.

House Bill 6, the budget bill, sets aside $60 million in bonding for “asset preservation,” described by McDaniel as “cleaning up campus.” House Bill 1 includes $5 million to design a Health Science Center for the nursing program but nothing to build it. McDaniel vowed “full intent” to pay for construction of KSU’s nursing building in the 2026 budget bill. McDaniel’s district includes Covington; he was instrumental in obtaining the $125 million for the downtown project involving NKU.

“We have a great deal of confidence in the new president of Kentucky State,” McDaniel said in the March 26 meeting. He was speaking of Koffi Akakpo, who became KSU’s 19th president last year on July 1. Before that, he was president of Bluegrass Community and Technical College.

HB 6 provides all the public higher-ed institutions with asset preservation funding pools for renovation and maintenance of buildings and other infrastructure.

During the free conference committee meeting, Democratic Senate leaders Gerald Neal of Louisville and Reggie Thomas of Lexington, both of whom are Black, said that expanding KSU’s nursing program is critical to the school’s rebound from recent troubles. The construction delay will cost KSU new students and needed tuition revenue and disrupt Akakpo’s plan for the future, said Neal.

Neal and Thomas urged the budget negotiations to reconsider. Thomas suggested spending less on restoration and maintenance at KSU in this budget to free up $50 million over the next two years to design and build the nursing building.

Senate Republican Floor Leader Damon Thayer of Georgetown responded ​​that KSU was “probably lucky that they get the taxpayer money that they have been getting and continue getting. With the recent numbers and results that have come from K-State, I think we should be dubious moving forward.” He said the “numbers have been pretty embarrassing.”

KSU has faced a series of controversies, including misused funds under a former administration and a 2023 warning from its accreditation body. In 2022, the legislature put KSU under a management improvement plan and provided $23 million to help it recover from a budget deficit.

In an interview with the Lantern last week, Akakpo said he is “grateful” for the $60 million in bonding but that it will “go quickly” as he tackles a list of maintenance needs.

The HVAC system, he said, is “not quite up to par” and the dorms are “in really bad shape.” Sidewalks and entryways need fixing, he said, and “leaky roofs” have caused damage that needs attention. The $60 million does “not quite” cover these needs, he said. “But we will try the best we can.”

A new building for nursing students and money to address maintenance needs were “both equally crucial for us to move forward,” Akakpo told the Lantern.

KSU's 342 nursing students make up 24% of the university's enrollment, and the program is “only going to grow,” said Akakpo. Nursing students study in three separate buildings because no designated building is large enough.

The Betty White Health Center, which is 53 years old, has administrative offices and a learning lab. Students take classes in Bradford Hall, Carver Hall and Hathaway Hall. “The building is needed because the building that is assigned to the nursing program is too small,” Akakpo said. It’s also already full.

Kentucky is thousands of nurses short of what it needs. The state is short 5,391 registered nurses and licensed practical nurses, according to the Kentucky Hospital Association. And, the students going into nursing school aren’t enough to replace those retiring and leaving the workforce.

Brown said KSU’s backlog of maintenance needs stems from historic underinvestment. The historically Black university, he said, is “the redheaded stepchild, if you will” of Kentucky higher education.

The Biden administration last year documented roughly $12 billion in underfunding for HBCUs nationwide when compared with state funding of similar predominantly white institutions.

The study compared land-grant institutions created by Congress in the 19th century, first for white students and later for Black students. KSU and UK are Kentucky’s land-grant universities. In Kentucky the disparity in per student state funding from 1987 to 2020 was $172 million.

U.S. Education Secretary Education Miguel Cardona and Agriculture Secretary Tom Vilsack sent letters to governors, including Kentucky’s, asking for states to right the “historical underinvestment.”

A letter from Cardona to Gov. Andy Beshear cited “unbalanced funding” and “longstanding and ongoing underinvestment” as reasons KSU “has not been able to advance in ways that are on par with University of Kentucky.” It added that “unequitable funding” of KSU put it $172.1 million short of what it would have received in the last 30 years.

The budget Beshear introduced in December did not include money for the KSU nursing building. It did ask lawmakers to allocate about $1.2 million to KSU for nursing and social-work scholarships in 2024-26.

Database lists opioid-settlement payments to local governments

Screenshot of first page of KFF Health News database of settlement
payments in Kentucky through March 4 shows the top 15 recipients.

How much money are your local governments getting from the settlements of lawsuits filed against opioid manufacturers and distributors? You can track it with a new online database from KFF Health News.

Kentucky is getting $478 million from the settlements through 2038, and a like amount is being paid each year to local governments in the state. State government got $100.7 million in 2022 and $17.4 million in 2023. It will get $21.8 million this year and the same amount in 2025, and an average of $24 million a year after that.

The state's money is being allocated by the Kentucky Opioid Abatement Advisory Commission, operated out of the attorney general's office. Local governments' spending is up to their governing bodies.

"This database undercounts the amount of opioid settlement money most places have received and will receive," note Aneri Pattani and Lydia Zuraw and Holly K. Hacker of KFF Health News.

The database reflects only the largest settlement so far, $26 billion to be paid by pharmaceutical distributors AmerisourceBergen (now called Cencora), Cardinal Health, and McKesson, as well as opioid manufacturer Janssen (now known as Johnson & Johnson Innovative Medicine).

It does not include settlements with other drug manufacturers and retailers Walmart, Walgreens, and CVS. Data from these five companies will be added in July, according to BrownGreer, the settlement firm that gets the money and makes the payments. It is not handling some additional settlements such as the agreement between Kentucky and four Midwestern states with regional supermarket chain Meijer.

Other settlements, including with OxyContin manufacturer Purdue Pharma, are pending.

Sports betting has taken off in Kentucky, but counselors for people with a gambling disorder remain in short supply in the state

Churchill Downs Race and Sports Book opened in downtown Louisville in September. (J. Munoz, LPM)

By Jacob Munoz
Louisville Public Media

Legal sports wagering launched in Kentucky in September. Residents can bet online and at brick-and-mortar venues like horse racetrack facilities, no longer needing to cross state lines.

Some experts say the wide legalization and promotion of sports betting could present risks, especially around addiction. The American Psychiatric Association recognizes gambling disorder and defines it as someone showing at least four deeply harmful habits in a year. Those can include constantly thinking about gambling, trying to recoup lost money by gambling more, and being unable to quit.

RonSonlyn Clark is a licensed gambling counselor and the president of the Kentucky Council on Problem Gambling, an advocacy group that connects people struggling with gambling to resources like therapy. She said the accessibility of sports betting can cause a gambler to fall “deeper and deeper into trouble”, and Kentuckians who live far from other states where gambling has been legalized are now at greater risk.

“You can sit in the comfort of your home, while your family is sitting there watching TV at night — most people are playing on their phones — and you can be placing sports bets at any time,” Clark said.

The International Gambling Counselor Certification Board lists Clark as just one of three active counselors in Kentucky, and her organization is looking to boost that number by hosting training sessions. She said she treats patients “from across the state.”

“Because there are so few of us, I do use some telehealth resources,” said Clark, who is based in Owensboro.

The council lists several other certified counselors in the state. Mike Stone, the group’s executive director, said that’s because some earned certification before a merger between the American and International boards.

Calls in Kentucky to a national gambling helpline, answered at RiverValley Behavioral Health in Owensboro, have increased since the state launched sports wagering in September. Gerrimy Keiffer, who works at RiverValley, said in an email that during the first two months of 2024, there were 101 calls seeking help or information on harmful gambling.

Stone attributed the rise in calls to the emergence of sports-betting ads that include the helpline number. He added that legalization has coincided with a shift in what callers say is their preferred method of gambling.

“It has been for years back and forth between lottery scratch-offs and slot machines at casinos. … For the first time in January, the preferred game of choice was sports betting,” Stone said.

An analysis by the council released in 2022 estimated that at least 47,000 Kentuckians could have a gambling addiction, which studies have shown correlates with a high risk of suicide. The council’s analysis also found that at least 102,000 more residents could be at risk of addiction.

Clark said the state has been late in addressing the harms connected to gambling. “I think we should have been focused on problem gambling 25 years ago, when we started” the council, she said.

Guardrails and gaps

Kentucky’s approval of sports betting included a goal to support the state’s permanent pension fund. Revenue from wagers placed at brick-and-mortar venues is taxed at 9.75%, a rate that jumps to 14.25% for online bets.

While some Republicans in the GOP-dominated legislature objected to it on moral grounds, others framed it as a way to regulate an underground industry and prevent residents’ money from going into neighboring states that had already legalized the practice.

Jim Whelan, executive director of the Tennessee Institute for Gambling Education and Research, said that when states legalize the practice, they’re able to better mitigate longstanding risks linked to gambling: “Before the lottery, the idea that you would do public awareness about gambling harms, legislators [and] regulators wouldn't touch.”

Kentucky’s law to legalize sports betting also gave regulatory powers to the Kentucky Horse Racing Commission, an independent state agency. In the last three regular days of their legislative session, Kentucky legislators passed a bill to replace the Horse Racing Commission and the Department of Charitable Gaming with a new regulatory agency to oversee most forms of legal gambling.

Through an emergency amendment last year, the commission set some rules on sports wagering advertisements — including banning them at grade schools — and set up a self-exclusion list that residents can opt into if they believe they have a gambling problem. Sports betting providers can’t offer wagering to people who self-exclude from their product for a set amount of time.

In Kentucky, sports betting runs through racetracks such as Churchill Downs and Keeneland Race Course, which can then partner with sportsbook providers. Regulations require the tracks to regularly report self-exclusions they receive to the commission, which shares the full list with all of them.

But those regulations don't require the tracks and their sportsbooks to prohibit everyone on the list from their betting services. The rules also don’t specify how long Kentuckians should be able to self-exclude from gambling beyond at least a 72-hour “break.” Sports-betting providers offer those short cutoffs alongside longer self-exclusion periods.

At least several providers that operate in Kentucky let residents self-exclude for up to five years, and they don’t reopen accounts unless a user requests it. But the majority don’t say they allow for permanent self-exclusion.

Sharon Custer is concerned that people who opt out temporarily could redevelop unhealthy habits once that period is over. She’s a faculty member at the Institute for Responsible Gaming, Lotteries and Sport at Miami University in Ohio, which makes policy recommendations for gambling industries.

Custer said she likes that Kentucky has a shared self-exclusion list, but wants to see more regulations in place: “It should make it a little bit hard to [re-enter], so that someone really has to think twice, ‘Is this really what's best for me?’”

Some states like Ohio and New Jersey have government programs that allow residents to self-exclude from all sports wagering services, and from other forms of gambling, but Kentucky does not.

Rachel Volberg, a research professor at the University of Massachusetts-Amherst and president of the gambling consulting firm Gemini Research, said that a “strong, independent regulator” is necessary to oversee the gambling industry.

She pointed to the Massachusetts Gaming Commission, a public agency that hired her more than a decade ago to lead an ongoing research project into gambling’s social and economic impacts on the state.

“Gambling regulation is increasingly being viewed as not just about making sure the operators follow the rules to offer a product in a fair and transparent way,” Volberg said, “but also preventing those operators from behaving in ways that are going to cause harm to residents.”

The Kentucky law legalizing sports wagering also established a fund that provides money for people and groups seeking to address unhealthy gambling behaviors. Those funds can be used for activities like public awareness campaigns, gambling counselor trainings and addiction treatment cost support.

The fund receives 2.5% of the collected tax revenue from sports betting. According to the commission, nearly $900 million had been placed on wagers from Sept. to Dec. 2023. That produced more than $15.5 million in tax revenue, on pace to exceed officials’ expectations of $23 million in year one.

Brice Mitchell, a spokesperson for the state Cabinet for Health and Family Services, said about $630,000 has been deposited in the gambling-assistance account after about half of a year of legal sports betting.

A need for resources

The federal government provides funding, resources and training toward addressing substance abuse and mental health issues. But that doesn’t include support for unhealthy gambling.

Whelan, of the Tennessee Institute for Gambling Education and Research, said there aren’t enough resources to treat unhealthy gambling behaviors: “There's not a lot of education being done out there for health service providers, on how to provide treatment, or even how to screen for this. The issue really comes back to money.”

While some research has shown that medicine, such as opioid antagonists, can address people’s symptoms from a gambling disorder, the U.S. Food and Drug Administration has yet to approve any drugs for treatment. Whelan said that behavior-based solutions that target gambling work.

Gamblers are “fundamentally different,” Whelan said, referencing a common belief that they can solve their issues by having “one big win.” He added, “That cognitive behavioral treatment needs to be tailored to the culture and the kind of processes that happen for people when they gamble.”

Clark, of the Kentucky Council on Problem Gambling, said her group hasn’t decided if they will apply for money in the state fund. They hosted a certification session for about 20 people in January.

“This is the first time we’ve had this much interest in becoming a gambling counselor … in a very long time,” Clark said.

She stressed that her group is neutral on gambling itself, and that it can be a healthy practice in moderation: “Gambling is supposed to be fun and entertaining. Take some money that you would use for a night of any other entertainment … That can be the gambling money.”

But she said that people shouldn’t double down on making a profit from it: “Places like Las Vegas, and the casinos and the racetracks, they’re all beautiful, beautiful venues. They didn't build those places off of people's winnings. They built those off of people's losses in those communities.”

If you or someone you know is at risk of problems related to gambling, the national helpline 1-800-GAMBLER can provide resources.

Medical-cannabis 'cleanup' bill passes House; critics disappointed more qualifying conditions not added and say it increases hurdles

By Melissa Patrick

Kentucky Health News

In what the sponsor calls a bill to "clean some things up," more restrictions are being added to the state's medical-marijuana law and provisions were added to allow local school districts to opt out.

State Rep. Jason Nemes

One of the key provisions in House Bill 829, sponsored by Rep. Jason Nemes, R-Middletown, would allow public and private schools to opt out of the program.

Public school boards are required to establish policies related to the use of medical cannabis no later than Dec. 1, 2024. The policies must either prohibit the use of medicinal cannabis on school property, or permit the use with several options for administration, as outlined in the bill. 

The measure would also allow local governments to apply a small local fee to compensate for any additional costs caused by the operation of cannabis businesses; prioritize Kentucky hemp businesses for state contracting; and clarify the powers that the state Cabinet for Health and Family Services has when it comes to inspection. 

It would also abolish the provisional license, which allows someone who makes an application for a license to sell medical marijuana to get the product while the application is pending. Nemes said this "put the cart before the horse."

When the House passed the bill 66-30 on March 12, it allowed the state to move the dates up for licensing, which would allow product to be obtained when the program starts Jan. 1, 2025. 

A floor amendment, filed at the request of the Kentucky League of Cities, was approved to allow cities to be able to opt out of the medical cannabis program before Jan. 1, 2025, even if a licensee had been approved before that date.

The committee substitute for the bill would require a patient to consult with a pharmacist annually to make sure the medical cannabis does not have a negative interaction with the patient's other prescriptions.

That  prompted several Democrats to object in the floor debate, saying the new requirement , with a potential cost of up to $40, imposes another hurdle in accessing medical cannabis.

"It seems like we're adding even more hurdles to make this medicine harder to receive, more expensive for folks to access. . . . I really wish we were back here today to make this medicine more accessible to the people of Kentucky who have been asking us to do this for years," said Rep. Rachel Roberts, D-Newport. 

Rep. Rachel Roarx, D-Louisville, said allowing public school districts to opt out "puts barriers in place" for students who benefit from medical cannabis for conditions such as epilepsy. 

Rep. Josh Bray, R-Mount Vernon, disagreed and supported the opt-out provision for schools, saying that he recognizes the need for this because some schools are concerned about the liability of administering a drug that is not authorized by the U.S. Food and Drug Administration.  

Rep. Cherlynn Stevenson, D-Lexington, said she was disappointed that the bill wouldn't expand the list of qualifying conditions that could be treated with medical cannabis, as was recommended by at "statutory advisory board of doctors and nurses appointed by the state licensing boards."

Stevenson said she hoped these conditions would be added in the Senate, where the bill has not been assigned to a committee.

Kentucky Children's Hospital at UK opens center to treat children who are harmed by abuse and neglect, in which Ky. ranks 14th

University of Kentucky and Kosair for Kids representatives celebrate opening of the Kosair for Kids Center for Safe & Healthy Children & Families at Kentucky Children's Hospital. (Photo by Adam Padgett)

By Hilary Brown
University of Kentucky

Representatives from Kentucky Children’s Hospital and the nonprofit foundation Kosair for Kids cut the ribbon recently on the Kosair for Kids Center for Safe & Healthy Children and Families, a new clinic space for the treatment of children harmed by abuse and neglect at KCH, part of the University of Kentucky. This center was made possible by a $2 million gift from Kosair for Kids.

“I’ve spent the better part of my career looking at the challenges that Kentucky faces, especially when it comes to the ability of vulnerable Kentuckians to get care they desperately need,” said Mark D. Birdwhistell, vice president for health system administration and chief of staff, UK HealthCare. “I’ve seen how hard it can be to effect change for Kentucky’s vulnerable citizens, and that’s why I’m so proud of this new center and of what we’ve been able to accomplish with the partnership of Kosair for Kids.”

Kentucky ranks 14th in the country for child abuse and neglect; according to the state Cabinet for Health and Family Services, in 2022, 11,002 children experienced neglect, 1,146 suffered physical abuse and 756 were victims of sexual abuse. Those numbers have decreased over the years, due largely to the efforts of Kosair for Kids and their partners across the state.

“Today we celebrate opening a center dedicated to giving the best to children who have experienced the worst, said Barry Dunn, Kosair for Kids president and CEO. “Our goal, our aspiration, is that this center serves as a beacon of hope for children who have experienced unfathomable trauma. We stand with them, united in purpose, on the road to healing. We are proud to call them a Kosair Kid, and we want to show them the love and care they deserve. Kosair for Kids is proud of this place, the skilled and dedicated staff on the front lines of this epidemic, and the growing alliance we have formed to protect all children.”

“I’m an ardent believer that you can’t separate physical health from mental and emotional health,” said Dr. Scottie B. Day, physician-in-chief at Kentucky Children’s Hospital. “Maltreatment and childhood trauma have effects that ripple out into adolescence and adulthood and continue to inform patterns of behavior for generations. Through our partnership with Kosair for Kids, we can disrupt generational cycles of abuse and make Kentucky much safer for kids.”

KCH is home to one of only two pediatric forensic medicine programs in Kentucky. Of the five child-abuse pediatricians practicing in Kentucky, four are at KCH’s Division of Pediatric Forensic Medicine along with specially trained advanced nurse practitioners, social workers and psychologists.

Features of the new clinic include:

• Secure and private space to provide trauma-informed care, including three exam rooms and two therapy services rooms
• Proximity to the Makenna David Pediatric Emergency Center and other services such as radiology and sedation with private entrance and egress to those sites
• Space for therapeutic interventions, evidence storage and consultation with law enforcement and other partners
• Technology to consult virtually with the child’s care team which may include state child protective services, guardian ad litem and law enforcement.

The pediatric forensics staff also provides regular education to medical students, family medicine providers as well as community organizations. They developed a core curriculum for the Department of Community Based Services in the Cabinet for Health and Family Services that includes 16 one-hour lectures. Forensics providers lead a multi-hour training to each new class of Kentucky State Police cadets, as well as continued education to healthcare providers in the community.

Children who are abused and neglected may suffer immediate physical injuries, but also may have emotional and psychological problems, such as anxiety or posttraumatic stress. Over the long term, children who are abused or neglected are also at increased risk for experiencing future violence victimization and perpetration, substance abuse, sexually transmitted infections, delayed brain development, lower educational attainment, and limited employment opportunities. Chronic abuse may result in toxic stress, which can change brain development and increase the risk for problems like posttraumatic stress disorder and learning, attention, and memory difficulties.

All Kentuckians are mandated reporters of child abuse and neglect. If you believe a child is being abused or neglected, call the Child Protection Hotline at 1-877-KYSAFE1 or 1-877-597-2331 or report online.

Anthem loses court fight to keep managing Medicaid for 172,000

Kentucky Medicaid dashboard, which has numbers for each county;
FFS means "fee for service," which is separate from managed care.

Kentucky Health News

 

Anthem Kentucky has failed in its attempt to remain as the manager of Medicaid coverage for about 170,000 Kentuckians, because the Kentucky Supreme Court deadlocked on the insurance company's appeal of a Court of Appeals ruling that upheld the state's decision to give the work to five other insurers.

Anthem had questioned the bidding process, and Franklin Circuit Judge Phillip Shepherd ordered rebidding, but some of the other managed-care companies appealed, and in 2022 the state Court of Appeals overturned Shepherd's decision.  

On Anthem's appeal to the Supreme Court, argued last week, the justices were divided 3-3, meaning that the Court of Appeals decision stands. Justices Angela McCormick Bisig of Louisville, Robert Conley of Ashland and Michelle Keller of Northern Kentucky voted to affirm the appeals court, while Justices Debra Hembree Lambert of Somerset, Christopher Shea Nickell of Paducah and Chief Justice Laurance B. VanMeter of Lexington voted to overturn it.

The seventh justice, Justice Kelly Thompson of Bowling Green, did not hear the case and did not vote. He told Kentucky Health News that he was disqualified because he was involved in the case while he was on the Court of Appeals.

Anthem had remained a Medicaid manager pending the outcome of the case. Asked what will happen to the 170,000 Medicaid members whose care the company manages, Cabinet for Health and Family Services spokesman Brice Mitchell said in an email, "The cabinet’s goal is for no Kentuckian to be without health coverage as it is a basic human right. We are responsible for complying with court orders and will do so once the case becomes final." That is usually 30 days after a decision, the deadline for asking the court to rehear the case.

The current managed-care contracts expire at the end of 2024, so Anthem will have another chance to get part of the business from the program, which spends $15 billion a year in Kentucky, more than 70 percent of it federal money.

Website that helps Kentuckians find addiction treatment now helps them find naloxone, the drug that reverses opioid overdoses

Photo from Kelley-Ross Pharmacy Group

Kentucky Health News

The FindHelpNowKy.org website, which helps Kentuckians find addiction treatment, now also can help them find places to get naloxone, which reverses opioid overdose.

The website, which has been used over 240,000 times to facilities since its inception in 2018, now also includes social-services resources and locators for recovery housing and mental-health treatment.

In 2022, a Kentucky survey found that 73 percent of respondents said they didn't know where to get naloxone, often known by the leading brand, Narcan.

“We are making it easier for Kentuckians to find the life-saving help they need,” Gov. Andy Beshear said in a press release. “While there is always more work to be done, we are taking another step forward on our mission to help our families fight and overcome addiction.”

Naloxone has become more available thanks to retailers, grants, reduction of stigma associated with addiction, and proactive distribution by community organizations,local health departments, recovery centers and regional prevention centers, the release said.

In addition to the central hub of FindHelpNowKy.org, some of the services can also be reached at FindMentalHealthNowKy.org; FindRecoveryHousingNowKy.org and FindNaloxoneNowKy.org. The latter website provides overdose prevention and response training relevant to people most likely to witness overdose.

“People can and do recover from addiction and mental health issues,” said state Health Secretary Eric Friedlander said. “And our goal of bundling these services in one central location will only make that journey to recovery easier across the continuum of risk.”

The collaborators on this website are the Kentucky Injury Prevention and Research Center and the state departments for Public Health and Behavioral Health, Developmental and Intellectual Disabilities.

“Addiction and mental health issues affect Kentuckians in every county and every ZIP code,” said Dr. Katie Marks, commisisoner of the latter department. “There should be no shame in seeking help and no barriers to finding evidence-based, compassionate care and treatment. These website updates address that at its core – getting our fellow Kentuckians on their road to recovery with resources that are close in proximity and right for them.”

The National Alliance on Mental Illness says 1 in 20 U.S. adults experience serious mental illness each year. In Kentucky, 189,000 adults are reported as having a serious mental illness, the release said.

If you or a loved one are struggling with addiction, the KY HELP Call Center can connect you to treatment by calling 833-8KY-HELP (833-859-4357). Visit the Kentucky State Police website to find a police post where those suffering from addiction can be paired with a local officer who will assist with locating an appropriate treatment program through KSP’s Angel Initiative. Call, text, or online chat 988 to connect with suicide-prevention, mental-health and substance-use-disorder counselors. They are available to all Kentuckians 24/7/365, the release said.

State health chief says measles risk stems from pandemic's anti-vaccine 'ideologies'; discusses how to lose weight, need for sleep

WKYT news anchor Bill Bryant, left, interviews state Health Commissioner Steven Stack, M.D.

This story has been updated.

By Al Cross
Kentucky Health News

In a wide-ranging TV interview, state Health Commissioner Steven Stack warned Kentuckians that not enough of them are vaccinated for measles, which he said is an outgrowth of reaction to the Covid-19 pandemic and the measures taken against it.

Stack reflected on his work in the pandemic and talked about other health concerns, including the opioid epidemic, weight-loss drugs and the need for Kentuckians to get more sleep, in an interview that aired Sunday, March 10, on WKYT's "Kentucky Newsmakers" with Bill Bryant.

As of March 7, the Centers for Disease Control and Prevention had recorded 45 cases of measles in 17 states: Arizona, California, Florida, Georgia, Illinois, Indiana, Louisiana, Maryland, Michigan, Minnesota, Missouri, New Jersey, New York, Ohio, Pennsylvania, Virginia and Washington.

Stack said measles was declared elimiated in the U.S. in 2000, but it has returned because vaccination rates have dropped to 90 percent. The disease may be the most contagious, and epidemiologists say 95 percent of a population needs to be vaccinated to protect those who can't or won't get the shot.

Stack said the measles-mumps-rubella (German measles) vaccine has been used since 1971, and is very effective. "We’ve got to get the public I hope, to accept that these tools help to prevent us from having far worse problems, like little babies who can't get vaccinated getting seriously ill." Children younger than 6 months are ineligible for vaccination.

Pew Research Center graph, based on Pew polling by party

Why have vaccination rates for contagious diseases dropped? "It's all gotten caught up in the Covid pandemic, in the narrative, in the ideologies that have unfortunately become associated with public health and medical science," said Stack, a physician.

Asked if he and Gov. Andy Beshear made the right calls in the pandemic, he said "I think we did the best we could with what we knew at the time." He said Kentucky outperformed most other states, considering its lower health status, which made it more vulnerable.

Stack said he and Beshear "balanced saving the most poeple [with] other harms that are worse than what you're trying to prevent." He said Kentucky's death toll of 20,000 was "far from what it would have been had we not intervened," noting that an intiial estimate was it could lose 1 to 2 percent of its population: 45,000 to 90,000 people.

Looking ahead, Stack said people 65 and older and those with other risk factors should get a Covid-19 booster this spring, and everyone should get an annual booster, much like has long been done for influenza.

Other health issues

Kentucky leads the nation in the percentage (about 2.1%) of population that has received a prescription for one of the new drugs created to fight obesity and diabetes, which can also aid weight loss.

"Overweight and obesity is a big problem in Kentucky," Stack said, noting that 38% of Kentuckians weigh too much. "That leads to diabetes, it increased your risk of cancer and cardiovasculat disease, like stroke and heart disease. It's really a major issue for us to address."

As for the drugs, "People are understandably desperate to find ways to get it under control," he said. "It's really too early to say what the long-term outcome of those medications will be. Some people have had wonderful benefits from it, have lost a lot of weight and improved their overall performance. Some individuals have had a difficult time tolerating it: persistent nausea, vomiting, or an unlucky small number with pancreatitis, so time will tell on those.

"Right now I think what we really need to do is try to think about ways to improve our environment so it's easier to eat healthier -- fresh fruits and vegetables -- and do mild things, like just go for a walk three or four days a week for 35 to 45 minutes; if you could do simple things like that, most of us could actually lose the small weight that we have to avoid becoming diabetic."

Kentucky is also one of the states most affected by the opioid epidemic. Stack said it has evolved because "The criminals keep getting more creative in the cocktails they put together and they're becomeing more and more lethal for people."

Speaking on the weekend that the nation moved its clocks to daylight saving time, Stack said lack of sleep is also a major health issue, especially for teens, who need more of it.

He said teens and adults "disrupt our sleep" with big and small screens, on TVs and smartphones. "We’ve got to get better sleep hygiene," he said, "and set out the time we need to get that eight hours of sleep."

Bryan Hubbard, who wanted Ky. to help finance research into psychedelic for drug treatment, takes his cause to State of Ohio

Bryan Hubbard (Herald-Leader photo by Alex Acquisto)

Kentucky Health News

The man who wanted Kentucky to use some of its opioid-settlement money for research that could lead to legalizing a psychedelic drug to treat addiction, but lost his job when a new attorney general was elected last fall, is taking his cause to the State of Ohio.

"Bryan Hubbard, former executive director of the Kentucky Opioid Abatement Advisory Commission, has signed a contract with the State of Ohio," report Alex Acquisto and Austin Horn of the Lexington Herald-Leader. "His job: To help build public-private partnerships for potential projects 'related to the treatment of traumatic brain Injury, post-traumatic stress disorder and other related and unrelated mental-health and substance-use conditions,' according to a spokesperson in the office of Ohio Treasurer Robert Sprague. . . . Hubbard will be paid $45,000 for his independent contracting services, according to his contract, which was reviewed by the Herald-Leader."

Brittany Halpin, Prague’s press secretary, told the newspaper in an email, “In part, the work is set to assist the treasurer’s office with determining the feasibility of potential solutions with ResultsOhio and other pay-for-success models.” ResultsOhio uses public and private funding to address Ohio’s “most pressing social and public health challenges,” according to the treasurer’s website. 

Hubbard told the Herald-Leader that as he works with the state to “deliver novel treatment access and research opportunities for veterans and opioid dependent individuals,” he is partnering with an Ohio-based foundation to “create the framework for ibogaine clinical trials in Ohio.”

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-withdawal symptoms while posink risks to the heart. Hubbard wanted the Kentucky commission to spend $42 million, 5 percent of what the state had received in lawsuit settlements from drug makers and distributors, to help fund research that could lead to legalization of the drug as a treatment for addiction.

Hubbard's boss was then-Attorney General Daniel Cameron, who countenanced Hubbard's advocacy but did not endorse it outright as he ran for governor. He was succeeded by Russell Coleman, a former U.S. attorney who was not keen on ibogaine or Hubbard, and asked him to resign.

Hubbard told the Herald-Leader that he was “saddened that a lack of courage and vision from [Coleman] has deprived Kentucky of its opportunity to lead the nation in the development of ibogaine’s revolutionary therapeutic potentials. However, I am strongly encouraged that genuine leaders exist across the river to ensure that ibogaine’s promise has an opportunity to be fulfilled for all who may choose to seek it.” Coleman’s office did not respond to emailed questions from the Herald-Leader.

Hubbard is part of a broader ibogaine effort. Last week, the REID (Reaching Everyone in Distress) Foundation announced that he would “research and raise awareness for emerging therapies such as ibogaine as potential breakthrough treatments for PTSD and opioid addiction in Ohio.”

"The REID Foundation was created by Rex Elsass, who lost his son to addiction in 2019," the Herald-Leader reports. "Elsass is also one of the nation’s premier Republican operatives. In 2016, GQ magazine dubbed him “The Most Powerful Man in the GOP (And You’ve Never Heard Of Him).” His political media and consulting firm is called The Strategy Group. Elsass has been close to Kentucky Sen. Rand Paul, serving as a key adviser in Paul’s 2016 bid for president. As senator, Paul has spearheaded efforts into seeking alternative therapies to treat addiction. A donor with close connections to Paul, Jeff Yass, was the primary funder of outside groups" that helped Cameron's challenge to Democratic Gov. Andy Beshear. "Elsass’ political firm has performed work for those groups."

Yass’ investment firm "has some interest in biopharmaceutical companies with a focus on psychedelic addiction treatments like ibogaine," the Herald-Leader notes. "Elsass’ advocacy for ibogaine can be traced back to Hubbard’s time in Kentucky." He did that at an opioid-commission meeting, and "a former executive assistant at his political operation started a group called the Kentucky Ibogaine Initiative. Elsass and the current president of The Strategy Group, Ryan Rodgers, are still listed as directors" with the Kentucky secretary of state.