Troubling statistics discussed at prescription-drug summit

Staggering statistics were revealed this week at the Orlando-based National Rx Drug Abuse Summit, including one survey that found 2 million people age 12 and older started using prescription pain medicine for non-medical reasons in 2010. A troubling 11 percent of active-duty military personnel reported misusing pain medicine in the past month, Department of Defense research shows. And more than 15,000 people die each year because of pain killers, 1,000 of whom are Kentuckians, reports Laura Ungar of The Courier-Journal.

"Prescription-drug abuse is causing untold misery among our families," Gov. Steve Beshear said at the gathering, which was organized by Eastern Kentucky-based Operation UNITE. The problem is "wasting away the future of many people in the Commonwealth of Kentucky."

As he's done several times now, Beshear asked conference attendees to push legislators to pass House Bill 4, which should be voted on today in Frankfort. The bill would require pain clinics to be owned by doctors, require doctors to participate in the state's prescription-tracking system, and move the system to the attorney genera's office from the Cabinet for Health and Family Services.

Experts said prevention is key, which involves education youth, parents, as well as doctors and pharmacists. U.S. Surgeon General Dr. Regina Benjamin doctors "need to be more cognizant of the problem," Ungar reports, recounting an incident in which a patient stole one of her prescription pads by using her 4-year-old daughter to district Benjamin.

Gil Kerlikowske, known as the country's "drug czar," said general practitioners and family medicine doctors accounted for 27 percent of all prescribers of extended-release, long-acting opioids. Internal medicine physicians were the most common specialists to prescribe, accounting for almost 17 percent of prescriptions of pain pills.

One of the problems, Kerlikowske said, is prescription drug abuse is considered more acceptable than taking other kinds of drugs. Children "see their parents taking it. It's not heroin. It's not coke." (Read more)

Diabetes can cause gum disease and tooth decay

Though it's commonly known that diabetes can affect organ function and eyesight, an oral-health expert points out that the disease can also cause tooth decay and gum disease.

"Diabetics with uncontrolled glucose levels tend to develop more gum disease and may lose more teeth than diabetics who have good control of their glucose levels," writes Dr. John Novak, associate director of University of Kentucky's Center for Oral Health Research, in an op-ed piece for the Lexington Herald-Leader. A high carbohydrate/sugar diet can also lead to high levels of sugar in the blood, which can hamper the way the body deals with infection, he writes. Gum disease may be the result because the gums are inflamed by the increased levels of bacteria living in the mouth.

Diabetes can also cause dry mouth, which "creates the perfect environment for the growth of bacterial plaque and for fungal infections such as thrush," he writes. To avoid these problems, Novak recommends brushing teeth and gums twice a day with a fluoride toothpaste, flossing every day and using fluoride mouth wash before going to bed.

Signs of tooth decay or gum disease include tender gums that bleed easily when brushing or flossing; teeth sensitive to hot or cold temperatures; loose or broken teeth; sores, ulcers or a burning sensation in the mouth; and bad breath or a bad taste. (Read more)

Beshear vetoes parts of budget, but health spending is intact

Though Gov. Steve Beshear vetoed 45 parts of the state budget yesterday evening, health-related spending was safe from the cut.

The budget will help reduce caseloads for social workers who investigate child abuse and neglect, funds colon cancer screenings for 4,000 uninsured Kentuckians, substance-abuse treatment for Medicaid recipients and includes funding for an elder abuse registry to protect senior citizens from unscrupulous caretakers.

"This is the most difficult budget I have ever drafted, and it will also be a challenge to implement and manage over the next two years," the governor said in a statement.

In the two-year, $19 billion budget, Beshear voted more than three dozen line-item appropriations, including "portions of the General Fund budget that limited his ability to manage the state's budget or spent money that doesn't exist," reports Beth Musgrave of the Lexington Herald-Leader.

He also cut some earmarks, including $100,000 for Actors Theatre of Louisville and $150,000 for the International Mystery Writers' Festival in Owensboro. "I am vetoing these parts because they identify new spending earmarks yet the General Assembly failed to appropriate additional funds to finance them," Beshear said. (Read more)

Beshear tells national audience legislature should pass pill-mill bill

Today, Gov. Steve Beshear again called on legislators to pass a bill Thursday that would crack down on so-called pill mills and thus curb prescription drug abuse. Speaking at the National Prescription Drug Abuse Summit in Orlando, Beshear asked for comprehensive collaboration to fight the problem, which kills more Americans than car accidents.

"No state or community is an island. It will take all of us — working across geographical and agency borders — to make headway against prescription drug abuse," he said.

The three-day summit is sponsored by Operation UNITE, which serves Kentucky's Fifth Congressional District, and features 100 leaders and experts, including Surgeon General Regina Benjamin, Office of National Drug Control Policy Director Gil Kerlikowske, Fifth District Rep. Hal Rogers, and Centers for Disease Control Principal Deputy Director Illeana Arias.

Beshear outlined what has already been implemented in Kentucky to combat the problem, including working with Ohio, Tennessee and West Virginia to identify those who exploit the system by crossing state borders and forming a panel of health professionals to develop criteria to identify suspicious drug-prescribing habits. But he also stressed the importance of passing House Bill 4, which would require pain clinics to be owned by doctors, require doctors to participate in the state's prescription-tracking system, and move the system to the attorney general's office from the Kentucky Board of Medical Licensure and the Cabinet for Health and Family Services.

The latter provision continues to draw opposition from the Kentucky Medical Association, which is lobbying hard to make changes to the bill, or perhaps kill it. Beshear has been touting the bill, considered the cornerstone of this year's General Assembly, since before it was filed. Al Cross, director of the University of Kentucky's Institute for Rural Journalism and Community Issues, said on KET's "Comment on Kentucky" Friday night that if the bill does not pass, the legislative session will be a failure. (Read more)

U of L researcher gets $3.4 million to replicate studies of stem cells for heart treatment

Dr. Roberto Bolli of the University of Louisville has received a $3.4 million grant from the National Institutes of Health to test the validity of several recent studies by replicating them. The studies examine whether certain types of stem cells are safe and effective in treating heart failure, heart attacks and other cardiovascular disorders.

"Replicating studies in several locations with a large number of patients is necessary for researchers to ultimately determine which ones can be submitted to the Food and Drug Administration for approval," Jill Scoggins reports in a U of L press release.

Bolli has received more than $100 million in grants for basic research for NIH. This is the first grant he has been awarded for clinical research. (Read more)

Rx Drug Abuse Summit in Florida, organized by Ky. group, set to start as lobbying on 'pill-mill bill' continues to ramp up

By Tara Kaprowy
Kentucky Health News

As a bipartisan group of political leaders pushes the General Assembly to pass a bill Thursday that would crack down on "pill mills" that contribute to prescription drug abuse, Eastern Kentucky's Operation UNITE has organized a national summit in Florida.

The National Rx Drug Abuse Summit aims to "foster understanding and cooperation among those involved in the battle against the epidemic," reports Laura Ungar for The Courier-Journal.

The event starts tomorrow in Orlando and is expected to draw 700 people. "I think it's important because Kentucky's not an island ... This truly needs to be a national effort, standing up against the problem," Karen Kelly, president and CEO of Operation UNITE, which serves Eastern Kentucky's Fifth Congressional District, told Ungar.

Tuesday's agenda will include an address by Gov. Steve Beshear and Dr. Regina M. Benjamin, the U.S. surgeon general. About 1,000 Kentuckians died last year from prescription drug abuse, more than the number of people who died in car accidents.

But while Beshear, Attorney General Jack Conway and key legislators in both parties push to pass a bill that would crack down on the problem, the Kentucky Medical Association is pushing back.

An editorial Sunday in the Lexington Herald-Leader says the KMA "should support the effort to pass this bill and fight this killer." It said, "Drug abuse is not a problem society dumps at the door of physicians. It's one deeply entwined with how we deliver medical care and police the providers."

Today, 15 business lobbying groups issued a press release calling on the legislature to pass the bill, noting that it would "limit direct dispensing of narcotics at a physician’s office to no more than a 48-hour supply. This will help control the supply of narcotics and allow for better monitoring of prescription drug abuse." Dave Adkisson, president and CEO of the Kentucky Chamber of Commerce, said in the release, “Businesses large and small, rural and urban are all experiencing cost increases due to prescription drug abuse. Drug abuse is not only a social problem, it is a bottom-line business issue for Kentucky employers.”

Besides the Chamber, other groups joining in the release were the Kentucky Association of Manufacturers, Associated General Contractors, the Home Builders Association of Kentucky, Kentuckians for Better Transportation, the Kentucky Coal Association, Coal Operators and Associates, the Kentucky chapter of the National Federation of Independent Businesses and local chambers in Louisville, Lexington, Northern Kentucky, Southeast Kentucky, Christian County and Hardin County.

Meanwhile, the legal battle against prescription-pill abuse continues. Last week, a Christian County jury found three men guilty of mailing large amounts of oxycodone from Florida to Kentucky. Peter Nibert, 27, of Pasco County, Fla., is believed to have mailed more than 3,000 pills in 2010. Cary Alder, 24, and Scotty Highsmith, 26, both of Hopkinsville were sentenced 10 and 15 years respectively for their part in the scheme.

Kentucky Health News is a service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Pain-pill problem has spread to new areas from Appalachia

Sales of hydrocodone (the key ingredient of Vicodin, Norco and Lortab) and oxycodone (the main ingredient in OxyContin, Percocet and Percodan) skyrocketed in new parts of the country as the problem spread from its Appalachian roots in the last decade, an Associated Press analysis shows.

Oxycodone sales in Tennessee, New York and Florida were up by more than 499 percent from 2000 to 2010, the highest increases in the country, the study shows. When it came to hydrocodone, South Dakota had the highest increase, with 300 to 399 percent.

In Kentucky, oxycodone sales increased by 171 percent and hydrocodone sales increased 176 percent from 2000 to 2010. Kentucky's increase was not as high because the problem started in the eastern part of the state and in West Virginia, with coal miners needing relief from back and chronic pain, reports the AP's Chris Hawley. The problem also started in affluent suburbs, said Pete Jackson, president of Advocates for the Reform of Prescription Opioids. "Now it's spreading from those two poles," he said.

In 2010, pharmacies dispensed 69 tons of oxycodone and 42 tons of hydrocodone nationwide. "That's enough to give 40 5-milligram Percocets and 24 5-milligram Vicodins to every person in the country," Hawley reports.

As sales increase, so do overdose deaths and pharmacy robberies, Hawley reports. Opioid pain relievers, a category that includes oxycodone and hydrocodone, caused 14,800 overdose deaths in 2008 and numbers are rising, according to the Centers for Disease Control and Prevention.

Part of the increase in sales can be blamed on the fact that the U.S. population is aging, resulting in more pain issues. There is also more of a willingness by doctors to treat pain, said Gregory Bunt, medical director at New York's Daytop Village chain of drug treatment clinics. But they're also increasing because people are addicted. "We all recognized that these drugs can be just as dangerous and deadly as illicit substances when misused or abused," said Gil Kerlikowske, the U.S. drug czar.

The AP analysis used drug data collected four times a year by the Drug Enforcement Adminstration's Automation of Reports and Consolidated Orders System. "The DEA tracks shipments sent from distributors to pharmacies, hospitals, practitioners and teaching institutions and then compiles the data using three-digit ZIP codes," Hawley writes. "Every ZIP code starting with 100-, for example, is lumped together into one figure."

ZIP codes that include military bases or Veterans Affairs hospitals have had large increases because of treatment of injured soldiers. Some areas are affected because mail-order pharmacies have shipping centers there. Areas with large Indian reservations also had larger numbers.

The most sweeping trend, though, is how the pain pill epidemic has spread to areas previously untouched. In 2000, Florida's oxycodone sales were centered around West Palm Beach. By 2010, they were common in almost every part of the state. It has become commonplace in New York City and its suburbs. Staten Island alone saw a sales jump of 1,200 percent. And Tennessee had a five- to six-fold increase in that decade. "We've got a problem. We've got to get a handle on it," said Tommy Farmer, a counterdrug official with the Tennessee Bureau of Investigation. (Read more)

For a view of an interactive map that shows more Kentucky numbers, click here.

Like nurse practitioners in medical field, dental profession needs mid-level providers, expert argues

With 50 million Americans living in poor or rural areas where there are no dentists to go to — and that number expected to rise by more than 5 million if the Affordable Care Act stands — states and the federal government should be training dental therapists to help solve the problem, argues Louis W. Sullivan, a physician and former secretary of the Department of Health and Human Services, in an op-ed piece in The New York Times.

"We have two years to prepare before millions of children will be entitled to access to dental care," he writes of the impending eligibility expansion under the ACA. "Access means more than having an insurance card; it means having professionals available to provide care. Public officials should foster the creation of these mid-level providers — and dentists should embrace the opportunity to broaden the profession so they can expand services to those in need."

Dental therapists provide preventive care and "routine procedures like sealants, fillings and simple extractions outside the confines of a traditional dentist's office," Sullivan writes. While they are "common worldwide," only Alaska and Minnesota allows them to practice. Legislation is pending in five other states. Generally, dentists have been opposed to such changes.

Sullivan points to Alaska as a model example for how these therapists can fill gaps in places like remote villages "only accessible by plane, snowmobile or dogsled, where high school seniors once graduated with full sets of dentures." In 2003, the state sent students to New Zealand to be trained as therapists. Now, therapists serve 35,000 Alaskans. They "travel to small clinics and schools, often carrying their equipment with them. They consult with a supervising dentist from the region but do most procedures themselves. Many were raised in the communities in which they now work, so they understand the culture," Sullivan writes.

Sullivan points out dental disease is the No. 1 chronic childhood disease in the country, responsible for more children needing treatment than asthma. In 2009, more than 830,000 visits to the emergency room were due to preventable dental problems across the nation, he points out. But dentists are in short supply and will be even harder to see if the ACA is upheld by the U.S. Supreme Court. "In a nation obsessed with high-tech medicine, people are not getting preventive care for something as simple as tooth decay," he writes. (Read more)

UK doctors first to perform triple ablation, a special form of cardiac catheterization

Ollie Whitaker of Whitesburg is the first known patient to have undergone triple ablation surgery, in which a catheter is inserted through a patient's blood vessels to remove a faulty electrical pathway and tissue from the patient's heart. The procedure was performed at the University of Kentucky's Gill Heart Institute.  (UK photo of Whitaker, Dr. Sammy Claude Elayi and Dr. Gustavo Morales)

"Typically, the catheter is placed into the patient's femoral artery, internal jugular or subclavian vein. The catheter is guided toward the heart, and high-frequency electrical impulses are used to induce the arrhythmia and then destroy (or ablate) the abnormal tissue causing it," reports Jodi Whitaker for UK Public Relations.

"Performing two ablations during one procedure is commonly done, but three with this complexity is basically unheard of," said Dr. Sammy Claude Elayi, a UK cardiologist. "But in this patient's case, despite the risk, I believed that we could perform three ablations."

"I'm so very pleased," said Whitaker, who had a massive heart attack 30 years ago at age 42 and had been suffering severe after-effects ever since. "I can work in my flower bed outside and do more around the house." (Read more)

Two gene variants identified as risk factors for childhood obesity

The largest ever genome-wide study has identified two new gene variants that increase the risk of common childhood obesity.

"We have definitively identified and characterized a genetic predisposition to common childhood obesity," said lead investigator Struan F.A. Grant, associate director of the Center for Applied Genomics at The Children's Hospital of Philadelphia.

The analysis included 14 previous studies "encompassing 5,530 cases of childhood obesity and 8,300 control subjects, all of European ancestry," reports research-reporting service Newswise.

The study team identified two novel loci, or specific locations of a gene or DNA sequence on a chromosome. One is near the OLFM4 gene on Chromosome 13, the other in the HOXB5 gene on Chromosome 17. There was a degree of evidence for two other gene variants as well. "The known biology of three of the genes hints at a role of the intestine, although their precise functional role in obesity if currently unknown," Newswise reports. (Read more)

Chiropractic clinic to pay $650K for Medicaid and Medicare fraud

A chiropractic clinic in Williamsburg will pay $650,000 to settle claims it improperly billed Medicare and Medicaid, reports Trent Knuckles for The News Journal of Corbin. (News Journal graphic)

Ho Medical Clinic, Kenneth Ho and Ana Moreno allegedly filed false claims when they billed for physician services, though they were performed by a chiropractor (chiropractors are not medical doctors); billed for unnecessary and unreasonable MRI and X-ray services; billed for work performed by unqualified personnel; and received funds for being a rural health clinic when it did not meet Medicare requirements.

Of the $650,000, $525,000 will go to the Medicare and Medicaid trust fund. The remaining sum will go to Danette Freeman, who sued the company under the False Claims Act. The investigation was conducted by the Kentucky attorney general's office, the Department of Health and Human Services' Office of Inspector General and the U.S. attorney's office. (Read more)

Doctors' lobby still working for changes in 'pill mill' legislation

By Al Cross
Kentucky Health News

The Kentucky Medical Association, historically one of the most powerful lobbying interests at the General Assembly, has mounted a last-ditch attempt to change or perhaps kill the bill that would crack down on "pill mills" that contribute to prescription drug abuse.

The bill would require pain clinics to be owned by doctors, require doctors to participate in the state's prescription-tracking system, and move the system to the attorney general's office from the Kentucky Board of Medical Licensure, which is made up almost entirely of doctors and has done little to curb the growing problem.

The tracking system remains the central concern for the KMA, which issued a "call to action" for physicians to contact legislators and argue that it "could infringe on privacy and lead to excessive oversight of legitimate medical practices," reports Mike Wynn of The Courier-Journal. "Other critics have said the bill could make doctors reluctant to provide pain medication for legitimate patients."

KMA President Shawn Jones told Wynn, “We would like to see something come out of this session. We would just like to make sure that it is something that addresses both the needs of law enforcement and at the same time is not overreaching in its imposition on our ability to practice medicine in a professional way.”

The KMA’s call notes that the system "tracks medications such as Xanax, Valium and Klonopin and was placed under the cabinet’s responsibility partly for patient privacy and protection," Wynn notes. Jones told him, “The access to that data really should be limited to government agencies that are charged with public health, and not law enforcement.”

Moving the tracking system to the attorney general's office is "pretty much a cornerstone of this legislation," Senate Majority Floor Leader Robert Stivers, R-Manchester, left, told Ryan Alessi Friday night on cn|2's "Pure Politics" program. He said the medical licensure board "hasn't done a whole lot" about prescription drug abuse, and indicated that part of the bill would stand.

However, Stivers said he and other supporters of the bill might drop the bill's 30-day limit on the length of painkiller prescriptions because of concerns that it would raise costs to patients. Those concerns helped delay the bill on the 59th day of the legislature's 60-day session. House Speaker Greg Stumbo "has said the issue could be resolved with a simple fix in the bill’s language," Wynn notes.

Stivers and Stumbo were among a group of bipartisan political leaders, led by Gov. Steve Beshear, who issued a statement Friday calling on the General Assembly to pass the bill Thursday, when it is scheduled to reconvene. The legislature is in recess, pending possible vetoes of other legislation by Beshear.

KMA "also takes issue with a $50 fee that the attorney general would be able to charge doctors to fund the program," Wynn reports. "Jones said the amount will only continue to climb in coming years to address a societal problem that doctors did not create. Proponents contend that the fee is nominal and is capped by statute except for inflation adjustments." (Read more)

Kentucky Health News is a service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.