Drane named Ky. regional CEO of behavioral-health nonprofit

Abby Drane

Abby Drane has been named Kentucky regional CEO for Centerstone, a non-profit organization that cares for patients with mental, developmental and behavioral issues. She will replace Tony Zipple, who is retiring Nov. 30.

Drane was president and CEO of Uspiritus, which serves abused and neglected youth in Kentucky, and before that was Centerstone's chief operating officer. She has served as chief financial officer for two of Kentucky’s largest community mental health centers, Seven Counties Services (now Centerstone) and Communicare.

Drane earned a bachelor's degree in accounting from Central Missouri State University and her MBA from Western Kentucky University.

Electronic health records, touted as tool for efficiency and better care, are coming between doctors and patients, surgeon writes

Illustration by Ben Wiseman for The New Yorker

Electronic health records were supposed to "make medical care easier and more efficient," says The New Yorker. "But are screens coming between doctors and patients?" Yes, surgeon Atul Gawande writes in the magazine's latest issue, starting with a description of his 2015 training session on the Epic Systems Corp. system, which now has information on more than half of Americans.

"The new system would give us one platform for doing almost everything health professionals needed—recording and communicating our medical observations, sending prescriptions to a patient’s pharmacy, ordering tests and scans, viewing results, scheduling surgery, sending insurance bills. With Epic, paper lab-order slips, vital-signs charts, and hospital-ward records would disappear. We’d be greener, faster, better. But three years later I’ve come to feel that a system that promised to increase my mastery over my work has, instead, increased my work’s mastery over me. I’m not the only one," Gawande writes.

"A 2016 study found that physicians spent about two hours doing computer work for every hour spent face to face with a patient—whatever the brand of medical software. In the examination room, physicians devoted half of their patient time facing the screen to do electronic tasks. And these tasks were spilling over after hours. The University of Wisconsin found that the average workday for its family physicians had grown to eleven and a half hours. The result has been epidemic levels of burnout among clinicians. Forty per cent screen positive for depression, and seven per cent report suicidal thinking—almost double the rate of the general working population. Something’s gone terribly wrong. . . . We’ve reached a point where people in the medical profession actively, viscerally, volubly hate their computers."

Gawande offers many examples to show why. Here's one, gathered by talking to physician Susan Sadoughi: "Piecing together what’s important about the patient’s history is at times actually harder than when she had to leaf through a sheaf of paper records. Doctors’ handwritten notes were brief and to the point. With computers, however, the shortcut is to paste in whole blocks of information—an entire two-page imaging report, say—rather than selecting the relevant details. The next doctor must hunt through several pages to find what really matters. Multiply that by 20-some patients a day, and you can see Sadoughi’s problem."

Patience, counsels Gregg Meyer, chief clinical officer at Partners HealthCare, who supervised the software upgrade at Gawande's hospital. “We think of this as a system for us and it’s not,” he told Gawande. “It is for the patients.”

Gawande writes, "In Meyer’s view, we’re only just beginning to experience what patient benefits are possible. A recent study bolsters his case. Researchers looked at Medicare patients admitted to hospitals for fifteen common conditions, and analyzed how their 30-day death rates changed as their hospitals computerized. The results shifted over time. In the first year of the study, deaths actually increased 0.11 per cent for every new function added—an apparent cost of the digital learning curve. But after that deaths dropped 0.21 per cent a year for every function added."

“I’m playing the long game,” Meyer told Gawande. “I have full faith that all that stuff is just going to get better with time.”

Gawande concludes his long story with an episode involving a patient on whom he had turned his back to do a computer task during a pre-surgery visit. As they headed to surgery, he started to do that again, and thought better of it. He writes: "I angled the screen toward the couple. Side by side, we confirmed that his medical history was up to date, that the correct surgical site was marked on his body, that I’d reviewed his medication allergies. His shoulders began to relax. His wife’s did, too. 'Are you ready? I asked. 'I am,' he said."

UK, Lexington Clinic to team up on cancer treatment

https://www.kentucky.com/news/local/counties/fayette-county/article221137300.html

E-cigarette conference in Louisville Dec. 10 is full; remote viewing locations added in Bowling Green, Hazard, Paducah

The Coalition for a a Smoke-Free Tomorrow will hold a half-day conference on electronic cigarettes Dec. 10 in Louisville, and offer remote viewing locations in Bowling Green, Hazard and Paducah.

The conference, titled "Next Generation Tobacco: The Impact of E-Cigarettes on Kentucky's Future Health," will focus on the recent explosion in the popularity of Juul and other pod e-cigarettes, especially among youth and young adults, and potential policies for preventing associated disease and illness.

Speakers will focus on the role of flavors in encouraging underage vaping; the extent to which e-cigarettes and other vaping devices actually help people quit smoking; what's in vaping products; whether they are a safer alternative to combustible cigarettes; and the evidence that e-cigs are a gateway to smoking for youth and young adults.

The conference will be held Monday, Dec. 10 from 8:30 a.m. to 12:15 p.m. at the office of the Foundation for a Healthy Kentucky, 1640 Lyndon Farm Court in Louisville.

Remote viewing locations will be at the Bowling Green Chamber of Commerce, 710 College St.; Baptist Health Paducah, Barnes Auditorium in the Carson-Myre Heart Center, 2501 Kentucky Ave.; and the University of Kentucky Center of Excellence in Rural Health, Room 214, 750 Morton Blvd. in Hazard (which asks that you use the free parking and shuttle service on Roy Campbell Drive (see map).

The conference is free, but registration is required for all locations. A light breakfast will be served at all locations and continuing education credits have been approved for physicians, physician assistants, nurse practitioners and nurses. Click here to register for the Louisville location, which is fully booked and has a waiting list. Click here to register for the remote viewing locations. Click here for a full agenda.

Kentucky gets approval to expand and improve treatment for substance-use disorder among people on Medicaid

Kentucky has gained more flexibility to provide substance-use-disorder (SUD) services for people on Medicaid as part of the state's new Medicaid plan, most of which was vacated by a judge in June, according to a state news release.

Kaiser Family Foundation map shows ranges of opioid addiction among
Medicaid beneficiaries before the program was expanded in 2014.

The Centers for Medicare and Medicaid Services approved the "substance use disorder implementation protocol" portion of the plan, called Kentucky HEALTH, for "Helping to Engage and Achieve Long Term Health," on Oct. 5. So far, it is the only part of the state's request for a waiver of the rules to overhaul its Medicaid program that has been approved.

“Expanding access to treatment and recovery services for individuals with substance use disorder is critical to our efforts to combat the opioid epidemic in Kentucky,” Health Secretary Adam Meier said in a news release. “We have worked diligently to identify areas within the Medicaid program where care and treatment options can be expanded and improved. This demonstration waiver gives us the opportunity to help more Kentuckians get treatment and start on the path to recovery.”

The approval of this new program will expand access to SUD providers, will allow Medicaid to reimburse for short-term residential stays up to 30 days in mental-health facilities, and will allow Medicaid to pay for methadone, a drug used in medication-assisted treatment for addiction. It will also increase bed capacity for residential treatment facilities and will elevate program standards regarding the types of services, hours of clinical care and staff credentials.

In 2017, 1,565 people died in Kentucky from a drug overdose, up 11.5 percent from the prior year.

Kentucky Voices for Health, a consumer advocacy group, said this about the approval of expanded and improved SUD services in an email to members: "Kentucky Voices for Health and our partners applaud any efforts to combat the substance use disorder epidemic gripping our commonwealth. CMS approval of these services demonstrates that we can leverage our Medicaid program to be innovative and responsive to the needs of our Commonwealth without the harmful barriers the rest of the 1115 waiver would place in the way of Kentuckians struggling with addiction and other basic needs."

FDA says it may limit sale of flavored e-cigarette products to vaping stores to combat 'epidemic' use of products by teens

As teen use of Juul products continues to soar, the head of the Food and Drug Administration says all options are on the table, including limiting sales of flavored e-cigarette products to stores selling smoking-vapor products.

Types of electronic cigarettes

In a recent interview with CNBC, FDA Commissioner Scott Gottlieb noted that teens tend to purchase e-cigarettes at convenience stores and gas stations, and said restricting their sale to vaping stores is a good idea because they generally do a better job checking identification documents for their ages.

Gottlieb estimated that high-school students' reported use of e-cigarettes surged 77 percent last year, and middle schoolers' use grew 50 percent. He said the actual numbers are probably higher because kids don't associate "Juuling" with e-cigarettes. He said next year's National Youth Tobacco Survey will have specific questions about branded products.

"These really are reaching epidemic proportions in terms of the number of youth that are now using e-cigarettes," Gottlieb said. "When all the data comes in, and we're going to be publishing it next month, it's going to look like around 20 percent of American kids are using e-cigarettes and probably almost a third are using some form of tobacco product. ... There's really no good news in this report."

In September the FDA ordered the five major manufacturers of e-cigarettes sold in the United States -- Juul, British American Tobacco, Altria, Imperial Brands and Japan Tobacco -- to submit plans to address teen use of their products within 60 days. "Everyone involved in this market has a shared responsibility to address this public health crisis," Gottlieb ssaid Oct. 31.

The FDA is also considering banning online sales of e-cigarettes, at least temporarily, while it writes regulations for these products, Gottlieb told CNBC.

2 more deaths linked to hepatitis A, making outbreak toll 16; some restaurant workers had it, but no food-borne transmission found

Hepatitis A has been blamed for two more deaths, both in Franklin County, bringing to 16 the statewide toll in the outbreak of the contagious liver disease, which has lasted more than a year.

None of the deaths have been connected to food-service workers, but concern about transmission by them remains a concern. Officials in Franklin and Fayette counties confirmed the disease in two more food-service workers and urged residents to get vaccinated for hepatitis A.

"Since August 2017, more than 2,275 outbreak-associated cases of acute hepatitis A have been reported in 94 of the state’s 120 counties," Chanda Veno reports for The State Journal in Frankfort.

Franklin County Health Director Judy Mattingly "couldn’t give the victims’ age or sex, but she did explain that both cases fit within the statewide profile of those afflicted by hepatitis A, whose mean age is 37.7 years old," Veno reports. Mattingly told her, “As with all Kentucky cases in this outbreak, it is believed that transmission occurred through person-to-person contact — when an infected individual did not thoroughly wash their hands, thereby passing microscopic fecal matter on to another person who unknowingly ingests the virus.”

Friday, Mattingly announced that one of the latest Franklin County residents diagnosed with hepatitis A worked at a Frankfort restaurant Oct. 22-25 while ill. "While rare for restaurant customers to become infected, patrons who ate at the restaurant during that four-day span have until Thursday to receive vaccination to further protect themselves from illness," Veno reports.

The restaurant is KFC, 1229 South U.S. 127. It "voluntarily closed for a thorough cleaning and sanitizing after being notified of the case on Thursday," Veno reports.

Mattingly said a “remote chance” exists that the worker could have been contagious as early as Oct. 8 before experiencing any symptoms. "Those who ate at the restaurant from that date through Oct. 25 are being asked to monitor their health for any hepatitis A symptoms for 50 days after any potential exposure, wash their hands frequently with warm water and soap and stay at home and contact a health-care provider immediately if symptoms develop," Veno reports, noting signs and symptoms of hepatitis A: jaundice (yellowing of the skin or eyes), dark-colored urine, fatigue, abdominal pain, loss of appetite, nausea, diarrhea, fever and gray-colored stools.

In Lexington, an employee of Frisch’s Big Boy on Harrodsburg Road was diagnosed with hepatitis A, marking the first time a restaurant employee was diagnosed with the disease during this outbreak," and worked several days while ill, Mike Stunson and Karla Ward report for the Lexington Herald-Leader.

“If they had improper hand washing at any point in time they could’ve possibly transmitted the virus by not washing their hands and touching either food or any of the door handles or any of the restaurant’s plates and dishes and anything,” said Jessica Cobb, a community health officer for the Lexington-Fayette County Health Department, which advises anyone who ate at the restaurant Oct. 10-28 to get a hepatitis A vaccination. "The employee is not currently working at the restaurant and will remain off work until cleared to return," the Herald-Leader reports.

The health department "said it is relatively uncommon for restaurant customers to become infected with hepatitis A due to an infected food handler, but the health department does recommended the vaccination," the Herald-Leader reports. "In September, the Lexington health department recommended that all Fayette County residents get their hepatitis A vaccinations when the number of cases in the region began to surge."

Fayette Health Commissioner of Health Dr. Kraig Humbaugh said in September, “The vaccine is effective and has an excellent track record. However, most adults have not yet been immunized since the vaccine was not given routinely as part of their childhood schedule of shots.”

Cobb said Frisch’s has been cleaned with an EPA-approved sanitizer, and “they’re also working with us to make sure that their employees get vaccinated.”

Kids who quit pot for a month improved memory, study finds

Photo by Sharon McCutcheon, Unsplash.com

A small-scale study suggests that when young marijuana smokers stop for a month, their memory improves. "The results show that not only does marijuana impair teenagers’ and young adults’ abilities to take in information, but that this memory muddling may be reversible," Science News reports.

One week into the experiment, those who abstained from pot "performed moderately better on memory tests than they had at the beginning of the study," reports Laura Sanders of Science News. "One particular aspect of memory, the ability to take in and remember lists of words, seemed to drive the overall improvement. . . .  Tricky tasks that required close monitoring of number sequences, and the directions and locations of arrows" did not seem to be affected.

"Scientists have struggled to find clear answers about how marijuana affects the developing brain, in part because it’s unethical to ask children to begin using a drug for a study," Sanders notes. So the researchers recruited 88 people 16 to 25 years old who reported using marijuana at least once a week, and offered 62 of them money to quit for a month. "Participants were paid more money as the experiment went along, with top earners banking $585 for their month without pot. . . . Urine tests showed that 55 of the 62 participants stopped using marijuana for the 30 days of the experiment."

The researchers from Massachusetts General Hospital and Harvard Medical School published their study in the Journal of Clinical Psychiatry.

Neuropsychologist April Thames of the University of Southern California told Science News that the study raises many interesting questions, such as whether there is a "point of no return" for the developing brain: “If somebody is using very heavily over a prolonged period of time, is there a point at which these functions may not recover?”

The researchers plan to conduct longer-term studies to answering that and other questions, Sanders reports: "While there’s still much to learn about how marijuana affects developing brains, the latest results suggest caution is needed, especially at a time when, as laws change, marijuana is becoming increasingly available in the United States and other countries."

“We should really be urging kids to delay using cannabis, particularly high-potency products, for as long as possible,” said neuropsychologist Randi Schuster, the lead researcher on the study.

Open enrollment on Healthcare.gov is open until Dec. 15; subsidies make rates about the same as last year

By Melissa Patrick
Kentucky Health News

It's again time to sign up for federally subsidized health insurance through Healthcare.gov. Open enrollment for coverage in 2019 runs through Dec. 15.

It's worth taking a look, because most shoppers in the marketplace will qualify for financial help to lower their costs. About 80 percent of Kentuckians enrolled through the federal exchange qualified for tax credits or subsidies that reduced their premiums, according to a Cabinet for Health and Family Services news release.

"For most of those who qualify, the credits will offset any premium increases, so the cost of insurance in 2019 will be about the same as this year," says the release.

In Kentucky, Anthem Health Plans of Kentucky and CareSource will offer federally subsidized plans on Healthcare.gov, with rate increases of 4.3 percent and 19.4 percent, respectively. Anthem has returned to 34 counties it formerly served, to cover a total of 93. CareSource is covering 61 of the state's 120 counties.

While 34 counties will now have a choice between Anthem and CareSource, the only Anthem plan in 16 of those counties will be the Anthem Pathway Transition HMO, which has a very narrow provider network. The state insurance commissioner has cautioned people in these counties to look closely at provider networks.

Anyone who already has a plan on Healthcare.gov and doesn't choose a new one will be automatically re-enrolled, but there is widespread agreement among experts that it's best to take a look at your options each year to make sure you have the one best suited to your needs.

Margot Sanger-Katz, who writes extensively about health care for The New York Times, offered the following tips on Twitter. She is also part of a Kaiser Health News "What the Health?" podcast discussion on this topic.

• Don't procrastinate; you've only got six weeks to get this done.
• Look at your options as soon as possible, even if you love your current plan.
• If you don't qualify for Medicaid, but earn less than double the poverty level, about $24,000 for a single person, look at the silver plans. "The cheapest one that covers the doctors you care about is almost always your best option," she writes.
• If you qualify for a subsidy, about $48,000 for a single person, look at all the plans.
• Check the deductibles! Even if you get a great premium, make sure you can afford the deductible.
• If you make too much to get a subsidy, first look on Healthcare.gov, then at plans sold directly by insurance companies -- a broker can help.
• Short-term plans are cheaper, but have fewer benefits. "If a short-term plan is all you can afford, you should shop really carefully. Read the fine print. And consider discussing it with someone who has expertise," she writes. Click here for her story on short-term plans.
• Beware of fraudulent plans.

It's also important to take note that Healthcare.gov has scheduled possible maintenance for the program each Sunday morning during the sign-up period, except for the final Sunday, for a total of 60 hours potential of downtime.

Where can I find help?

The state-based call center is available at 855-459-6328 to help assist Kentuckians with where to go for coverage, answer questions and pre-screen for eligibility. The Healthcare.gov customer service center (800-318-2596) is also available 24 hours a day, seven days a week.

Click here to find an application assister or an insurance agent near you.

Healthcare.gov provides a shopping tool to allow you to preview 2019 plans and estimated prices before you log in.

The Kaiser Family Foundation also offers a Health Insurance Marketplace Calculator to provide estimates of health insurance premiums and subsidies for people purchasing insurance on their own on Healthcare.gov. It allows you to enter your income, age and family size to estimate your eligibility for subsidies and how much you should spend on health insurance. It will also allow you to see if you qualify for Medicaid.

FDA approves painkiller 10 times stronger than fentanyl, over objections of UK anesthesiologist and other doctors

The Food and Drug Administration approved a powerful new painkiller Friday over the objections of a Kentucky doctor who co-chairs its advisory committee on such matters, and other physicians.

Dr. Raeford Brown

Dr. Raeford Brown of the University of Kentucky and others argue that sufentanil, 10 times more powerful than fentanyl, "would inevitably be diverted to illicit use and cause more overdose deaths," reports Lenny Bernstein of The Washington Post.

Brown, a professor of anesthesiology and pediatrics, is the longtime chair of the FDA’s Anesthetic and Analgesic Drug Products Advisory Committee. The panel voted 10-3 on Oct. 12 to support approval of the drug, which was developed with millions of dollars from the Pentagon, which wants an easier-to-use painkiller for the battlefield.

The drug, branded as Dsuvia, is "a tablet version of an opioid marketed for intravenous delivery, but is administered under the tongue using a specially developed, single-dose applicator," reports Ed Silverman of Stat. That makes it "well-suited for the military and therefore was a priority for the Pentagon, a point that factored heavily into the decision," according to FDA Commissioner Scott Gottlieb.

“The FDA has made it a high priority to make sure our soldiers have access to treatments that meet the unique needs of the battlefield, including when intravenous administration is not possible for the treatment of acute pain,” Gottlieb wrote in what the Post called "an unusual statement, saying he would seek more authority for the agency to consider whether there are too many similar drugs on the market. That might allow the agency to turn down future applications for new opioid approvals if the drugs are not filling an unmet need."

Gottlieb's words did not satisfy Brown and the advocacy group Public Citizen, who said in a statement that AcelRx, the manufacturer, had not proven the pill's effectiveness or adequately responded to safety concerns. They noted that the FDA did not convene its Drug Safety and Risk Management Advisory Committee to consider the application.

“Clearly, the issue of the safety of the public is not important to the commissioner, despite his attempts to obfuscate and misdirect,” Brown said. “I will continue to hold the agency accountable for their response to the worst public-health problem since the 1918 influenza epidemic.”

Dr. Andrew Kolodny, who heads the Opioid Policy Research Collaborative at Brandeis University and is executive director of Physicians for Responsible Opioid Prescribing, an education and advocacy group, told Stat, “There is absolutely no need for this product. Claiming we need it on the market to help soldiers on the battlefield is ridiculous,” because fentanyl administered under the tongue is available for battlefield use.

Gottlieb said, “There are very tight restrictions being placed on the distribution and use of this product. We’ve learned much from the harmful impact that other oral opioid products can have in the context of the opioid crisis. We’ve applied those hard lessons as part of the steps we’re taking to address safety concerns for Dsuvia.”

The Post reports, "The FDA says that controls on drugs inside medical facilities are tight and the greatest risk of diversion is among medical personnel themselves. A 2016 survey conducted by the federal Substance Abuse and Mental Health Services Administration shows that narcotics are rarely stolen from doctor’s offices, clinics, hospitals or pharmacies. Fewer than 1 percent of people said they acquired opioids that way."

The rate of overdose deaths among health care workers is relatively high, however, according to an August study by the Centers for Disease Control and Prevention, with 876 succumbing to prescription opioids between 2007 and 2012.

Sufentanil is "commonly used after surgery and in emergency rooms," the Post notes. The Dsuvia pills "would not be available in retail pharmacies" and would carry a wholesale price of $50 to $60 per dose. "A spokeswoman said the company is not providing information on expected sales."

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

By Melissa Patrick
Kentucky Health News

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

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

CDC graphic

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

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

Kentucky Injury Prevention and Research Center graphic

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

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

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

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

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

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

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

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

CDC map shows ranges of opioid prescribing by state in 2017

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

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

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

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

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

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

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

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

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

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

Kentucky Department for Public Health graphic

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

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

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

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

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

Parents of overdose victims, and others affected by addiction, gather to support each other and feel like they're not alone

By Sarah Ladd
University of Kentucky School of Journalism and Media

GEORGETOWN, Ky. – A warm scene in a Georgetown home Monday night turned the focus of persons with addictions from alcohol bottles, pill bottles and needles to the intimate struggles those people’s families face.

The group of a dozen or so sat in a circle in the dining room and took turns sharing about their love and loss as they spoke, sometimes tearfully, about their sons and daughters who struggled and continue to struggle with various addictions.

They are members of PAL, Parents of Addicted Loved ones, an organization that “provides hope and support through addiction education for parents dealing with an addicted loved one,” says its website. The members gathered Monday said that as a result of PAL, their journeys have “totally changed” and helped them feel like they’re not alone.

Karen Butcher, the group’s PAL facilitator, referred to the times parents try to help their children out of addictions: “You think at first you can love them out of it, talk them out of it.” Others around the table chimed in with, “pray them out of it, buy them out of it,” but, Butcher said, “You can’t.”

The group laughed, cried and allowed themselves to be vulnerable by each sharing how alone, ashamed and hurt their children’s addictions has made them feel.

One couple, who spoke on the condition of anonymity because of the delicacy in the situation, shared their story and journey as they’ve poured energy, love and financial resources into fighting their child’s alcoholic addiction. Through taxes, rent and bonds, they lost over $20,000. They also lost two houses because their child was not responsible with bills.

“You cannot change them,” they said. “They have to change themselves. But you change too, in your approach.” They said not answering phone calls from their loved one has been a “major accomplishment,” as they learn they can’t fix everything.

Joshua Todd Hall

This meeting, a detour from the group's normal schedule, was held in the home of Kay Combs, Midway University’s interim director of graduate, evening and online admissions, in honor of Combs’ son, Joshua Todd Hall. He died in 2016 after a relapse following two clean years that Combs described as her “miracle” years.

The group wrote inspirational and meaningful messages on rocks painted blue in honor of Hall’s favorite color, and gave them up to the care of Combs’ backyard memorial garden in honor of her son. They sang, “They will know we are Christians by our love” and prayed together after placing the rocks in the garden.

“I don’t think I could have shared last year,” Combs said, telling the group about her struggle learning of her son’s “two lives,” taking time to heal, and finally, “It feels like a blessing this year” after joining PAL and releasing a lantern for her son in Nashville. She said her healing experience has reflected her desire to know “what it looks like to survive.”

“What I learned about this disease was the evilness behind it,” Combs said, citing ways people can acquire drugs, such as the dark web and illicit sources of prescription drugs.

Many said the hardest thing they’ve faced with their children’s addictions are the lies that the children tell their families. “Every day, it’s a different story,” one person said.

“You know they lie, they cheat, they steal, but Jesus loved them anyway,” Combs said. “All through the Bible, he loved them anyway.” She said this was her motivation for loving her son through all he faced.

Many said their children’s addictions started with what they passed off as “college partying” or marijuana use and spread to methamphetamines, heroin and opioids.

“I thought it was just normal college behavior,” one person said, sharing with the group how he was in the dark for 15 years about his child’s addiction. “It’s amazing how you keep learning more and more.”

The group noted a book that has helped them all through their journeys, The Four Seasons of Recovery for Parents of Alcoholics and Addicts, by PAL founder Mike Speakman. Many said they related to the content of the book, which made them realize their journey wasn’t unique.

The book outlines stages of grief,  “But it doesn’t always happen like that,” Combs said. “You have to do what you can live with.” 

Combs read from her son’s 1996 school journal, in which he wrote that he had three wishes: to stay young forever, have a beautiful wife and have a job “that I love and can make a great living at.”  He was an associate youth pastor at Grace Christian Church with his wife when he died at 34. He will indeed be “young forever,” Combs said.

“I believe all our children are treasures,” she told the group, reading from a speech she gave at her son’s funeral: “'He is a diamond in the rough is a familiar way of saying somebody has potential to become far more than he is right now,” she read as the night came to a close.

“But we are much more like opals than diamonds," Combs said. Opal comes from "desert dust, sand and silica, and owes its beauty not to its perfection but to a defect.”