Overdose Awareness Day was opportunity to raise awareness and reduce stigma of drug use; now it's National Recovery Month

By Melissa Patrick
Kentucky Health News

Each year, the last day of August is observed as International Overdose Awareness Day, to raise awareness of overdoses, acknowledge the grief felt by families and friends who have lost someone to a drug overdose, and to reduce the stigma of drug-related deaths. 

Heather Spurlock-Venters, who is a peer-support specialist at Addiction Recovery Care, shared her story of loss in an ARC news release. 

Spurlock-Venters, who is in addiction recovery, said she was sharing the story of her brother-in-law Sean Riley's overdose death to help others battling addiction. The release notes that Riley died a year ago and that Spurlock-Venters was early in her own recovery when she learned of  his overdose death. 

“When you’re in active addiction, you think you’re bulletproof and that nothing like that can happen to you. It never crossed my mind that one day one of us wasn’t going to be here,” she said in the release. “He passed away that day not only because he used, but used alone. He didn’t have anyone there to help him or try to bring him back. That’s what we do as people in recovery. We reach back for the ones still suffering because we know what it is like to suffer. I don’t want anyone else to ever go through that – not if I can help it. . . . We don't have to be a statistic." 

The release adds that with the influx of fentanyl and other synthetic opioids, there has never been a more dangerous time to be using illicit substances. It also provides a one-page list of resources to educate people on overdose risk factors, prevention, signs and symptoms of an overdose and how to respond to an overdose. 

According to the Kentucky Office of Drug Control Policy’s 2022 Overdose Fatality Report, there were 2,135 overdose deaths in Kentucky last year. This was 5% fewer than in 2021. Fentanyl was identified in 1,548 of the deaths, or 72.5%. Nationwide, 109,680 people died as a result of drug overdoses in 2022.

In recognition of Intrenational Overdose Awareness Day, the Kentucky Injury Prevention and Research Center highlighted resources for preventing workplace drug overdoses and supporting recovery from substance-use disorder.  

KIPRC reports that Kentucky had its highest number of workplace overdose fatalities in 2021, with 18, which was triple that of 2019. The number dropped to seven in 2022. 

“We are glad to see that fatal overdoses decreased both in Kentucky residents in the general community and at work,” Rebecca Honaker, program director for KIPRC's Kentucky Occupational Safety and Health Surveillance, said in a news release. "Despite the decrease, workplace overdose deaths remain a significant concern."

To help small businesses address this issue, KIPRC issued a "Hazard Alert" in August about the issue of workplace overdose deaths that included recommendations and resources for employers to help them create a recovery-ready workplace.

And to recognize Drug Overdose Awareness Day, the center released the Kentucky Small Business Toolkit for Hiring Employees in Recovery, which provides additional ways to become a recovery-friendly workplace, including addressing stigma, recruitment, how to use tax credits, bonding programs, community resources, and how to promote a business a recovery-friendly.

Looking forward, September is National Recovery Month.

“Substance use is a dangerous and deadly disease, but treatment is available and recovery is possible,” Matt Brown, president of ARC Healthcare, said in the ARC release. “We remain committed to doing everything we can to reduce overdoses in Kentucky and educate people on the many pathways to recovery.”

People who are struggling with drug abuse or who are concerned about a family member's substance use can search for treatment providers at www.findhelpnowky.org. And for those seeking recovery housing, visit findrecoveryhousingnowky.org. KIPRC also offers a Drug Overdose Prevention Tackle Box, A Guide for Communities.

Cameron declines to give more details of plan for work rules in Medicaid; Beshear says Cameron 'heck-bent' on cutting benefits

At a happier time: In 2019, Gov. Andy Beshear appointed Daniel
Cameron attorney general to succeed him after they each won
offices with different starting dates. (AP photo by Bruce Schreiner)

Kentucky Health News

Gov. Andy Beshear said Thursday that Attorney General Daniel Cameron, his opponent in the Nov. 7 election, appears "heck-bent" on changing the Medicaid program in ways that would lead to some people losing their benefits.

Cameron said at a Kentucky Farm Bureau forum July 26 that "one of the first things I would do as governor" is seek federal approval for a requirement that able-bodied adults on Medicaid work to maintain their coverage. His campaign said later that adults would have to work, be enrolled at least part-time in college or be involved in job training or community service, and quoted him as saying, “We will protect the truly vulnerable but we will not allow able-bodied people to take advantage of taxpayer generosity.”

Cameron said in a KET debate during his May primary campaign that the work requirement could be met by 20 hours a week of "volunteer" work, as was proposed by Beshear's predecessor, Republican Matt Bevin.

Asked Wednesday whether his plan would be substantially similar to Bevin's, or how it would be different, Cameron said, "Well obviously, as I move into the governor's office, I'll obviously consult with my team about the specifics."

The next day, at his weekly press conference, Beshear shot back: "When asked about it, he didn't know how he was going to do it. I guess he's just heck-bent on ensuring that 100,000 Kentuckians can't go to a doctor when they're sick."

The Bevin administration estimated that its plan would reduce the state's Medicaid rolls by 95,000 over five years, largely because some Medicaid beneficiaries would be unwilling or unable to comply with its rules, including paperwork to certify their eligibility. The administration reduced that estimate to about 79,000, but academic health experts said in a lawsuit challenging the plan that a more likely range was 175,000 to 297,500.

The Courier Journal's Joe Sonka asked Cameron how many able-bodied Medicaid recipients in Kentucky are not working.

Cameron replied in an email, "It's not a specific number that matters, but rather the general principle that able-bodied people should work. "Why should a middle-class taxpayer subsidize an able-bodied person because they have become so dependent on the government? Let’s get that person the skills they need and get them back on the job."

Beshear's campaign has been running a television commercial about the issue. Sonka took a close look at the issue and did a fact-check.

Three U.S. appeals court judges hear arguments on new law restricting health care for transgender minors in Kentucky

By Sarah Ladd
Kentucky Lantern

A three-judge federal panel on Friday heard opposing arguments over Kentucky’s ban on gender-affirming medical care for transgender minors, after first hearing arguments in a similar case in Tennessee.

Stephanie Schuster presented arguments for the American Civil Liberties Union of Kentucky and the National Center for Lesbian Rights, which are suing on behalf of seven anonymous transgender minors and their parents seeking to restore access to hormone treatments and puberty blockers for transgender minors in Kentucky.

Attorney General Daniel Cameron’s office is fighting to keep the ban imposed by Senate Bill 150, which the Republican-controlled legislature enacted earlier this year over Democratic Gov. Andy Beshear’s veto.

Schuster argued that SB 150 is inherently discriminatory on the basis of sex because a patient’s biological sex – what was assigned at birth – would need to be known for treatment to be legal or illegal.

Solicitor General Matthew Kuhn argued for Cameron that the law deals with “regulating the practice of medicine” and is not sex-based discrimination. He said the state “has chosen a particular condition and has chosen particular treatments for that condition and restricted that. That is not a a sex-discrimination issue.”

Judges Jeffrey Sutton, Amul Thapar and Helene White heard
arguments at the Cincinnati court. (L.A. Blade photo illustration)

The arguments before a three-judge panel of the 6th Circuit U.S. Court of Appeals in Cincinnati came after the same panel rejected on a 2-1 vote an August request from the ACLU of Kentucky to let transgender minors get certain medical care, such as puberty blockers.

SB 150 also bans gender-related surgeries like phalloplasty, vaginoplasty or hysterectomies and vasectomies on minors. But neither the ACLU nor Kentucky LGBTQ+ organizations are challenging the ban on such surgeries.

Schuster argued, “The evidence in this record shows that withholding treatment – even up until the age of 18 – and allowing puberty to occur consistent with the sex identified at birth is extraordinarily harmful to these children.

“And what this regulates is not just procedures that they can’t get until the age of 18. It’s many aspects of these children’s lives while they’re in school and able to get treatment that is medically indicated and medically necessary for them to live and develop into functioning and happy adults.”

Friday’s arguments — streamed to the press and public with audio only — were heard by Chief Judge Jeffrey Sutton and judges Amul Thapar and Helene White.

One of the judges said “I feel like there’s compassion (in) both directions.”

He continued: “It’s not crazy to say that there’s a compassion component to the other side of this, that maybe this is the kind of thing some people might regret if they do it at age 14, 15.”

Kuhn argued that the law is indeed “a compassion measure.”

“The plaintiffs think that Senate Bill 150 is going to cause harm to children,” Kuhn said in rebuttal. “And the Kentucky General Assembly thinks it’s going to prohibit harm for children.”

September is Prostate Cancer Awareness Month; American Cancer Society provides info on prevention, risk and treatment

By Melissa Patrick

Kentucky Health News

When prostate cancer is detected early, the odds of survival are high. That is the message being spread far and wide in September, which is Prostate Cancer Awareness Month. 

Prostate cancer is the second leading cause of cancer death among men in the United Statesm and Black men are two times more likely to die from it than white men. Black men having the highest death rate for prostate cancer of any racial or ethnic group.

According to the American Cancer Society, more than 288,000 men will be diagnosed with the disease this year, with close to 35,000 deaths. 

The good news is that more than 3.5 million men diagnosed with the disease in the U.S. are still alive today, the ACS reports.

The incidence rate for prostate cancer in Kentucky is 108 cases per 100,000 people, with 28 counties having the highest rates of  between 112.6 and 153.3 cases per 100,000 people. The statewide rate is  below the national rate of 109.9 cases per 100,000 people. 

The death rate for prostate cancer in Kentucky is 18.1 per 100,000, with 24 counties having the highest rates of between 22.5 and 44.9 deaths per 100,000 people. This is about the same as the national rate of 18.8 deaths per 100,000 people. 

For Prostate Cancer Awareness Month, Dr. Lorelei Mucci, director of strategic research partnerships at the ACS, provided information in an ACS news release about the signs and symptoms of prostate cancer,  risk factors, screenings and more.

Prevention: Mucci stressed the importance of Prostate Cancer Awareness Month as a way to promote prevention, early detection and treatment to improve survivorship. In addition, she said it's important to set aside time to reflect on those who have been impacted by prostate cancer and those who have lost their lives to it. Further, she said increased awareness of the disease can prompt officials to invest in more prevention and treatment opportunities. 

Warning signs of prostate cancer: "For some men, prostate cancer may lead to urinary problems, such as having difficulty starting urination or urinating frequently, or pain during ejaculation. This is because of the location of the prostate close to the bladder and urethra. These symptoms and signs also occur with non-cancer conditions, so it is important to follow up with a physician to find out what might be causing these symptoms.

"If a cancer has already grown beyond the prostate, there may be pain in the hips, back, or other areas that does not go away. For most people, however, there are no signs or symptoms indicating prostate cancer and the cancer is diagnosed with a biopsy following an abnormal blood test," she writes. 

Who is at risk: Anyone with a prostate is at risk of prostate cancer. 

However,  she writes that ACS research shows that Black men and those of African ancestry are 70% more likely to be diagnosed with prostate cancer. And, the risk of prostate cancer gets higher with age. In addition, people with a family history of prostate cancer (such as in their brother or father) as well as a family history of breast cancer in a sister or mother, are at higher risk of prostate cancer. 

That said, Mucci notes that "maintaining a healthy body weight, not smoking, and being physically active can help to offset this higher risk." 

Treatment and advancements: "There are effective treatments for prostate cancer," she writes. "When the cancer is still confined to the prostate (localized), surgery (radical prostatectomy) and certain forms of radiation are useful to treat and cure prostate cancer. For men who have a low risk of their prostate cancer metastasizing, active surveillance - in which a patient is closely monitored for signs of cancer progression - can also be an important treatment to consider. When the cancer is more aggressive, there are additional therapies that are used, including therapies that target hormonal pathways, chemotherapy, immunotherapy, and radiopharmaceutical therapies. "

"In fact, this is an exciting time in prostate cancer with substantial progress in the discovery and approval of new therapies over the past 5-10 years, as well as several other therapies being developed," she writes. 

Screening test: The main screening test for prostate cancer involves taking a blood sample and testing it for the level of a marker called prostate-specific antigen (PSA). Higher levels of PSA in the blood can indicate prostate cancer, but also may be higher in benign conditions such as an enlarged prostate, so it is important to follow up with a doctor to discuss the results and the next steps. 

She adds that while there is good evidence showing that regular PSA screening can reduce prostate cancer mortality, there is some controversy with screening for prostate cancer since the test can pick up slower-growing cancers that will never lead to harm. She said researchers are working on more effective screening approaches. 

When should you get screened? The ACS recommends that men at average risk for prostate cancer discuss the benefits and limitations of screening with their healthcare provider at age 50.

Men at high risk (which includes Black men in general and any man with a first-degree relative who had prostate cancer before age 65) should have the conversation at age 45. 

Black men with a family history of breast, ovarian, or prostate cancer, and men with more than one first-degree relative who had prostate cancer at an early age should discuss screening at age 40.

"Detecting prostate cancer early can lead to more effective treatment and improved outcomes," she writes. 

In response to the question, "What is the ACS doing to combat prostate cancer?" Mucci said they have established the "Improving Mortality Toward Prostate Cancer Together" (IMPACT) initiative, which she leads. 

She writes, "This cross-institution initiative will address urgent unmet needs with the goals of significantly improving outcomes for all men including survivorship and survival; reducing disparities; improving diversity in prostate cancer clinical trials; accelerating engagement and awareness and accelerating the implementation of known prevention strategies into at-risk communities." 

Dr. Michael Kuduk, a Winchester pediatrician, is the new president of the Kentucky Medical Association

Michael Kudluk, M.D.

Dr. Michael Kuduk, a Winchester pediatrician, is the new president of the Kentucky Medical Association. He was sworn in as the 173rd president at the organization's annual meeting, held Aug. 25-27 in Louisville. 

Kuduk, a native of New Jersey, is is an assistant professor of pediatrics at the Kentucky Children’s Hospital. He graduated from the Johns Hopkins University and graduated from the University of Medicine and Dentistry of New Jersey (now Rutgers Medical School) in Newark. He completed his residency at Baylor College of Medicine in Houston. 

He previously served as board chair and vice-president of the KMA, as well as chair of its political action committee. He is a 2018 graduate of the Kentucky Physicians Leadership Institute.

In his inaugural address, Kuduk discussed his goals for the year, including a focus on prior authorization reform, which was indicated as one of the leading causes of physician burnout in a KMA membership survey in 2022. The KMA House of Delegates also passed a resolution calling for prior authorization reform, a KMA news release said.  

“I will continue to advocate for prior authorization reform, an issue that we can all agree not only impacts our daily lives, but the lives of our patients. Many of our physicians came to Frankfort to advocate on the issue, and we plan to put an even greater focus on it this year," Kuduk said in the release. "We know that telling a story can be the most effective form of advocacy, and we all have many patient stories to tell showing how prior authorizations negatively impact the health of our patients.”

Baptist Health warns Humana Medicare Advantage policyholders that they could be out of network if negotiations don't work out

Humana Inc. and Baptist Health are negotiating a new contract for patients with Medicare Advantage policies from the Louisville health insurer, and the hospital chain is warning policyholders that Baptist Health providers will be out of Humana's network unless an agreement is reached by Sept. 22.

The issue would not affect hospital services, just doctors and other clinicians at Baptist Health facilities, the company says, adding, "Because insurance coverage varies based on the specific plan you have, we recommend you call Humana at the number on the back of your insurance card to understand if your plan and provider are affected. . . . Only Humana can confirm if the potential out-of-network situation will affect your particular plan’s network."

Humana Medicare Advantage policyholders undergoing treatment for certain medical conditions from a Baptist Health provider will continue to be covered at in-network rates under a program called “Continuity of Care.” These include pregnancy, chronic medical conditions, and treatment such as chemotherapy or dialysis, or home health services. "It's important to note that only Humana can determine if you qualify," Baptist Health says. "To learn more, call the number on the back of your insurance card."

5 things to know about new Medicare negotiations on drug prices

By Arthur Allen, Rachana Pradhan and David Hilzenrath

KFF Health News

The Biden administration has picked the first 10 high-priced prescription drugs subject to federal price negotiations, taking a swipe at the powerful pharmaceutical industry. It marks a major turning point in a long-fought battle to control ever-rising drug prices for seniors and, eventually, other Americans.

Under the 2022 Inflation Reduction Act, Congress gave the federal government the power to negotiate prices for certain high-cost drugs under Medicare. The list of drugs selected by the Centers for Medicare and Medicaid Services will grow over time.

The first eligible drugs treat diabetes, blood clots, blood cancers, arthritis, and heart disease — and accounted for about $50 billion in spending from June 2022 to May 2023.

The United States is clearly an outlier on drug costs, with drugmakers charging Americans many times more than residents of other countries “simply because they could,” Biden said Aug. 29. “I think it’s outrageous. That’s why these negotiations matter.”

Democratic lawmakers cheered the announcement, and the pharmaceutical industry, which has filed a raft of lawsuits against the law, condemned it.

The companies have until Oct. 2 to present data about their drugs to CMS, which will make initial price offers in February, starting negotiations set to end next August. The prices would take effect in January 2026.

Here are five things to know about the impact:

1. How important is this step? Medicare has long been in control of the prices for its services, setting physician payments and hospital payments for about 65 million Medicare beneficiaries. But it was previously prohibited from involvement in pricing prescription drugs, which it started covering in 2006.

Until now the drug industry has successfully fought off price negotiations with Washington, although in most of the rest of the world governments set prices for medicines. While the first 10 drugs selected for negotiations are used by a minority of patients — 9 million — CMS plans by 2029 to have negotiated prices for 50 drugs on the market.

“There’s a symbolic impact, but also Medicare spent $50 billion on these 10 drugs in a 12-month period. That’s a lot of money,” said Juliette Cubanski, deputy director of the Kaiser Family Foundation’s analysis of Medicare policy.

The long-term consequences of the new policy are unknown, said Alice Chen, vice dean for research at University of Southern California’s Sol Price School of Public Policy. The drug industry says the negotiations are essentially price controls that will stifle drug development, but the Congressional Budget Office estimated only a few drugs would not be developed each year as a result of the policy.

Biden administration officials say reining in drug prices is key to slowing the skyrocketing costs of U.S. health care.

2. How will the negotiations affect Medicare patients? In some cases, patients may save a lot of money, but the main thrust of Medicare price negotiation policy is to provide savings to the Medicare program — and taxpayers — by lowering its overall costs.

The drugs selected by CMS range from specialized, hyper-expensive drugs like the cancer pill Imbruvica (used by about 26,000 patients in 2021 at an annual price of $121,000 per patient) to extremely common medications such as Eliquis (a blood thinner for which Medicare paid about $4,000 each for 3.1 million patients).

While the negotiations could help patients whose Medicare drug plans require them to make large copayments for drugs, the relief for patients will come from another segment of the Inflation Reduction Act that caps drug spending by Medicare recipients at $2,000 per year starting in 2025.

3. What do the Medicare price negotiations mean for those not on Medicare? One theory is that reducing the prices drug companies can charge in Medicare will lead them to increase prices for the privately insured.

But that would be true only if companies aren’t already pricing their drugs as high as the private market will bear, said Tricia Neuman, executive director of KFF’s program on Medicare policy.

Another theory is that Medicare price negotiations will equip private health plans to drive a harder bargain. David Mitchell, president of the advocacy group Patients for Affordable Drugs, predicted that disclosure of negotiated Medicare prices “will embolden and arm private sector negotiators to seek that lower price for those they cover.”

Stacie B. Dusetzina, a professor of health policy at Vanderbilt University, said the effect on pricing outside Medicare isn’t clear: “I’d hedge my bet that it doesn’t change.”

Dusetzina described one way it could: Because the government will be selecting drugs for Medicare negotiations based partly on the listed gross prices for the drugs — distinct from the net cost after rebates are taken into account — the process could give drug companies an incentive to lower the list prices and narrow the gap between gross and net. That could benefit people outside Medicare whose out-of-pocket payments are pegged to the list prices, she said.

4. What are drug companies doing to stop this? Even though negotiated prices won’t take effect until 2026, drug companies haven’t wasted time turning to the courts to try to stop the new program in its tracks.

At least six drug companies have filed lawsuits to halt the Medicare drug negotiation program, as have the U.S. Chamber of Commerce and the Pharmaceutical Research and Manufacturers of America, known as PhRMA.

The lawsuits include a variety of legal arguments. Merck & Co., Johnson & Johnson and Bristol Myers Squibb are among the companies arguing their First Amendment rights are being violated because the program would force them to make statements on negotiated prices they believe are untrue. Lawsuits also say the program unconstitutionally coerces drugmakers into selling their products at inadequate prices.

“It is akin to the government taking your car on terms that you would never voluntarily accept and threatening to also take your house if you do not ‘agree’ that the taking was ‘fair’,” Janssen, part of Johnson & Johnson, wrote in its lawsuit.

Nicholas Bagley, a law professor at the University of Michigan, predicted the lawsuits would fail because Medicare is a voluntary program for drug companies, and those wishing to participate must abide by its rules.

5. What if a drug suddenly gets cheaper by 2026? In theory, it could happen. Under guidelines CMS issued this year, the agency will cancel or adjourn negotiations on any drug on its list if a cheaper copycat version enters the market and finds substantial buyers.

According to company statements this year, two biosimilar versions of Stelara, a Johnson & Johnson drug on the list, are prepared to launch in early 2025. If they succeed, it would presumably scotch CMS’ plan to demand a lower price for Stelara.

Other drugs on the list have managed to maintain exclusive rights for decades. For example, Enbrel, which the FDA first approved in 1998 and cost Medicare $1.5 billion in 2021, will not face competition until 2029 at the earliest.

Feds call for first nursing-home staffing minimums, weaker than industry feared, but homes say it would force some to close

Federal officials' proposed minimum standards for nursing-home staffing are weaker than expected, Bridget Early reports for Inside Health Policy.

The nursing-home industry had anticipated a proposal for about 4.1 hours of employee work time per resident day, meaning that a home with 25 residents would require 18 staffers (times 4.1 hours per resident day = 175 hours per week, divided by 40 hours per week = 17.9 employees).

Instead, the Centers for Medicare and Medicaid Services proposed "minimum nurse staffing standards of 0.55 hours per resident for registered nurses and 2.45 HPRD for nurse aides," as well as a requirement to have a registered nurse at the nursing home around the clock.

"The combined three hours falls short of what a government analysis two decades ago said was the optimal level for quality care: 4.1 hours per day. It also falls short of the 3.76 total hours that a government study said nursing homes currently provide on average," reports Christopher Rowland of The Washington Post.

The proposal is "a long-anticipated response to decades of complaints about neglect and abuse in an industry that critics say is unprepared for the tsunami of seniors heading its way from the Baby Boom," Rowland writes. "Much of the rule would kick in within three years for urban facilities and five years for rural facilities."

The regulation would have major implications for Kentucky, which is farther behind on its nursing-home inspections than any other state but Maryland.

"To address concerns in rural areas where workers are scarce, the Biden administration has provided a series of exemptions in the rule for facilities that can prove they can’t find staff even if they made good faith efforts to recruit and retain workers," Rowland reports. "It plans to pump $75 million into programs intended to bolster the nursing home workforce, such as scholarships and tuition reimbursement."

CMS estimates that the rules would make about three-fourths of nursing homes increase staffing, USA Today reports: "Having enough nurses and aides is the strongest predictor of whether nursing home residents will thrive, researchers have found. But a USA Today investigation last year documented how rarely the federal government enforces decades-old staffing guidelines and rules for nursing homes that participate in Medicare and Medicaid."

The regulation "cleared the White House Office of Management and Budget on Tuesday, Aug. 29, the same day a CMS study underpinning the rule was leaked and created a firestorm among stakeholders," Early reports. "The White House budget office also canceled its two remaining stakeholder meetings on the issue in the wake of the leak. The proposed rule had been pending at OMB since May 30. The two meetings were scheduled for the first and second weeks of September. The meetings were requested by the Organization of Nurse Leaders and the Association of Jewish Aging Services."

Early notes, "The nursing-home industry has lobbied hard against staffing minimums and has called for a White House event to explore alternatives, but patient advocates have backed staffing minimums."

LeadingAge, the largest association for nonprofit nursing homes, told USA Today that the propsoed regulation would be impossible for many nursing homes to meet. “There are simply no people to hire—especially nurses,” said Katie Smith Sloan, the group's president and CEO. “America’s under-funded, long-ignored long-term care sector is in a workforce crisis.” Sloan said nursing homes would have to “reduce admissions or even close” if the rule takes effect.

Clinic that serves 33 Ky. counties is first in state to get a grant from program for comprehensive drug treatment and recovery

Owensboro Hope House is one of MCCC's facilities.

Kentucky Health News

A behavioral-health clinic that serves 33 Kentucky counties is the first in the state to receive a grant from a national program that fosters comprehensive drug treatment and recovery centers with a full spectrum of treatment, harm reduction, and recovery support services, especially for people without commercial health insurance.

Mountain Comprehensive Care Center, based in Prestonsburg, is getting the $850,000 grant from the Substance Abuse and Mental Health Services Administration of the U.S. Department of Health and Human Services.

"This grant will allow us to provide treatment for substance-use disorder to persons whose insurance coverage is not sufficient for the treatment required," Promod Bishnoi, CEO of MCCC, said in a press release issued by Eastern Kentucky's congressman, Rep. Hal Rogers.

Rogers said, “This is a life-saving grant program that is needed now, more than ever before. Last year, more than 100,000 Americans died from drug overdoses, so every investment that we make into recovery programs, workforce training, counseling and other resources could mean the difference between life and death for someone.”

Rogers, a Republican from Somerset, announced the grant with Senate Republican Leader Mitch McConnell and Rep. Brett Guthrie of Bowling Green, the ranking Republican on the health subcommittee of the House Energy and Commerce Committee. The release said he recently re-introduced the Comprehensive Opioid Recovery Centers Reauthorization Act of 2023, which would extend the grant program through 2028. It was enacted in 2018.

Guthrie said, “This is welcomed news that Kentucky received its first Comprehensive Opioid Recovery Centers grant. I was proud to lead legislation establishing the Comprehensive Opioid Recovery Center program five years ago. These centers provide targeted resources to communities most impacted by the overdose crisis, including workforce training, medication assisted treatment services, recovery housing, and peer to peer counseling.”

McConnell said, “Kentucky tragically remains one of the states hardest hit by the opioid epidemic. The good news is care centers across the commonwealth are constantly stepping up and finding new ways to combat this crisis. I’m happy to see Kentucky receive its first Comprehensive Opioid Recovery Center grant, which funds crucial services to communities devastated by the opioid epidemic.”

In the eastern third of the state, MCCC has facilities in Bath, Boyd, Carter, Clay, Floyd, Greneup, Johnson, Knott, Lawrence, Lee, Leslie, Letcher, Magoffin, Martin, Mason, Morgan, Pike, Perry, Rowan and Wolfe counties. In Central Kentucky, it is in Bourbon, Clark, Fayette, Garrard, Harrison, Madison and Powell counties. In Western Kentucky, it is in Caldwell, Christian, Daviess, Hopkins, Marshall and McCracken counties.

One-fourth of Kentuckians say they have ever been diagnosed with depression; only W.Va. was higher in national CDC survey

Centers for Disease Conrol and Prevention map, adapted by Kentucky Health News

By Al Cross
Kentucky Health News

One in four Kentucky adults in a poll taken in 2020 said they had ever been diagnosed with depression, a higher share than in any state but West Virginia.

Kentucky's age-adusted percentage was 25%; West Virginia's was 27.5%. The national figure in the poll, taken by the Centers for Disease Control and Prevention, was 18.4%.

The poll was taken by the Behavioral Risk Factor Surveillance System, an ongoing CDC-state project in which state employees do random-digit–dialed landline and cell phone calls to adults. The question was, “Has a doctor, nurse, or other health professional ever told you that you had a depressive disorder, including depression, major depression, dysthymia, or minor depression?”

In Kentucky, the county with the highest age-adjusted percentage of people answering "yes" was Wolfe County, at an estimated 30.7%. (That was the most likely percentage in a range of 28.8% to 32.5%, at a confidence level of 95%, or 19 out of 20 cases.)

The rest of the top 10 were Harlan, 29.7% (27.9-31.6); Jackson, 28.9% (27.1-30.9); Casey, 28.9% (27.1-30.7); Clay and Magoffin, 28.8% (27.1-30.6); Bell and Knox, 28.7% (27-30.5); Letcher, 28.6% (26.9-30.5); and Lewis, 28.6% (26.9-30.4). Figures for all counties can be downloaded here.

The 29 counties with the highest estimated shares of reported depression, and 38 of the top 40, were in Appalachia as defined by the Appalachian Regional Commission, which includes 54 Kentucky counties. The highest estimated rate, 31.9%, was in Logan County, West Virginia.

Phil Galewitz of KFF Health News went to Logan and reports that stigma around the topic of mental health is a major obstacle to addressing the problem. Psychiatrist David Lewis of Coalfield Health Center, who grew up in the and taught high-school math there, told Galewitz that people in the region often view seeking mental-health help as being “weak in faith.”

Most states with the highest levels of reported depression were in Appalachia, the southern Mississippi Valley, Missouri, Oklahoma, and Washington, the CDC said in reporting the data. It noted, "Depression is a major contributor to death, illness, disability, and economic costs."

In Kentucky, the counties with the lowest rates of reported depression were Oldham, 21.9%; Boone, 22%; Lyon, 23.6%; Shelby, 23.8%; Fayette, Hardin and Woodford, 24%; Jefferson, 24.2%; Christian, 24.3%; Nelson, 24.4%; Jessamine, 24.5%; Scott and Spencer, 24.6%; Bullitt, 24.7%; and Boyle, 24.8%.

Generally, high-income counties had lower rates of reported depression, and low-income counties had higher rates. Reported depression was "higher in women, younger adults, and adults with lower education levels," the CDC said.

Having been diagnosed with depression is not the same thing as having had depression. Another CDC survey in 2020 asked people if they had suffered symnptoms of depression, and at one point 31% of Kentuckians in the poll said they had.

Study expands access to naloxone, which blocks drug overdose

The study includes distribution of naloxoone (brand name
Narcan) at public events. (University of Kentucky photo)

By Elizabeth Chapin
University of Kentucky

Thursday, Aug. 31, marks International Overdose Awareness Day, a time when attention is directed toward raising awareness about opioid overdose and ways to reverse the deadly effects.

One such way is naloxone, a medication that has become more available throughout Kentucky in recent years with the University of Kentucky’s HEALing Communities Study playing a significant role.

Naloxone, also known by its brand name Narcan, is a medication that when given in time can quickly reverse the effects of opioids and help restore breathing in someone who is experiencing an overdose.

Increasing access to naloxone is one of the evidence-based strategies implemented by the HEALing Communities Study to reduce opioid deaths in Kentucky. Launched in 2019, the $87 million study is focused on 16 counties hardest hit by the opioid epidemic. The goal is to develop sustainable solutions that can be scaled across the commonwealth.

So far, the study has helped thousands of Kentuckians get access to the lifesaving medication. Since the first unit of naloxone was distributed in April 2020, more than 86,000 units of naloxone have been distributed across the 16 counties participating in HEAL.

To put it into perspective: In 2019, the year before the HEAL intervention was launched, that number was just about 7,000, says Trish Freeman, a professor in the UK College of Pharmacy who leads the HEAL Prevention Team and coordinates HEAL’s naloxone education and distribution efforts.

In 2022, 2,127 Kentuckians died from a drug overdose, with 90% involving opioids. While Kentucky’s overdose death rate decreased by 5% last year, it’s still among the highest in the nation.

“No one should die from an overdose and naloxone is one of the most effective ways to intervene and save a life,” said Freeman. “By getting naloxone into the hands of more Kentuckians, we are saving lives today while informing the blueprint for the most effective way for communities to do so going forward.”

Most of the naloxone distributed by HEAL is delivered through partnerships with various community organizations and agencies including treatment, criminal legal system, social service and public health programs.

The study, which is broken down into two waves of eight counties each, has partnered with 245 agencies across all 16 counties. The HEAL Implementation Team, led by Hannah Knudsen, a professor in the UK College of Medicine, works hand in hand with partner agencies to provide the support needed to implement overdose education and naloxone distribution with their clients.

Knudsen’s team of implementation facilitators meet with a wide range of agencies to share information about HEAL’s overdose education and naloxone distribution program and then work with agencies to establish a workflow and provide technical assistance to ensure effective implementation.

The HEAL Prevention team operates a naloxone distribution hub in the Center on Drug and Alcohol Research for partner agencies that also includes training materials, because education about overdose and how to use the medication is required. Under a standing order agreement, HEAL co-investigator Michelle Lofwall, physician and professor in the College of Medicine, signs the order as the physician of record for all naloxone distributed.

The agency partnerships reach those at highest risk for overdose, especially within the criminal legal system, where HEAL has partnered with jails and prisons, drug court, pretrial services, police departments, and probation/parole programs.

The risk of overdose is increased when people are released from a correctional facility because tolerance for the drug can decrease significantly during a period of abstinence. After release, an attempt to use the same amount of opioid may lead to overdose or death, says Carrie Oser, professor in the UK College of Arts and Sciences and co-lead of the HEAL Criminal Legal System Team.

Most jails partnering with HEAL offer naloxone as part of the discharge process. Some, including the Madison County and Jefferson County detention centers, have opted to install “vending machines” in lobbies or discharge areas. The digital kiosks streamline tracking and mandatory training.

“The agencies we work with choose what works best for them given their unique staffing and organization needs. The most important thing is that people who are discharged are getting access to naloxone during this critical time,” said Oser.

Beyond agency distribution, naloxone is dispensed through the HEALing Communities Study comes from its own outreach team. HEAL prevention specialists reach people directly at venues like community events, social service agencies, businesses, schools and addiction treatment and recovery facilities.

In addition to educating people on how to recognize an overdose and properly administer naloxone, the team addresses a lot of myths and misperceptions people have.

“People need to know it’s safe to use on anyone and won’t hurt someone who isn’t overdosing,” said Gabi Deaton, a HEAL prevention-specialist coordinator. “We also talk about the Good Samaritan law, which protects people from prosecution when they report a drug overdose. Our goal is to make sure they’re confident, equipped and ready to intervene in the case of an opioid emergency if they ever need to.”

Deaton serves as the prevention specialist for Campbell County and organizes the outreach efforts of her colleagues assigned to the seven other counties in the HEAL’s second wave.

While the team generally visits locations with people at higher risk of overdose, they reach a larger cross section of the public compared to the agencies. Their visibility helps reduce the stigma surrounding opioid use disorder and ensure that more family members, friends and bystanders are carrying naloxone.

Deaton says people sometimes reach out to thank her after the naloxone she gave them is used to save a life. There are too many to remember them all, but she still keeps in touch with some who are now in recovery.

Soon, it will be easier to access naloxone nasal spray products, including brand name Narcan and its generic counterparts. These products were recently approved by the U.S. Food and Drug Administration for sale over the counter and should be available in pharmacies and other retail stores that sell OTC products by mid-October.

Overdose education and naloxone distribution by a wide range of agencies will likely still be needed to ensure that cost is not a barrier and that people learn now to effectively use naloxone to respond to an overdose.

Attacking respiratory syncytial virus (RSV) on 3 fronts: Monoclonal antibodies for infants, vaccines for pregnant women and elderly

By Dr. Ilhem Messaoudi
University of Kentucky

After an intense season of respiratory syncytial virus in the commonwealth, we have a new tool to protect children from RSV.

In July 2023, the U.S. Food and Drug Administration approved AstraZeneca’s Beyfortus (nirsevimab-alip) for the prevention of RSV lower respiratory tract disease in neonates and infants born during or entering their first RSV season. It’s also for children up to 24 months of age who remain vulnerable to severe RSV disease through their second RSV season.

RSV is a common respiratory virus that usually causes mild, cold-like symptoms. Most people recover in a week or two, but the virus can be serious, especially for infants and older adults.

Dr. Ilhem Messaoudi on KET's "Kentucky Tonight"

This is not a vaccine for children, but a monoclonal antibody treatment, much like what we saw developed to fight Covid-19 in the early days of the pandemic. The treatment is giving these young immune systems a bunch of antibodies against RSV and helping them fight it off.

The science behind this development is exciting. These types of viruses have been very challenging to make vaccines against, and now we have a great therapy.

To me, as a parent, virologist and immunologist, I see very few downsides of giving Beyfortus to young infants who atre at risk from severe RSV. Anything we can do to protect the smallest, most vulnerable Kentuckians is a step we should take. Because if a child is hospitalized with RSV the only thing we can offer them is supportive care.

RSV protections for pregnant women, elderly adults

Also exciting are the protections we now have for other vulnerable populations: pregnant women and the elderly.

Recently, federal health advisers have shown support of Pfizer’s first-of-its-kind RSV vaccine for pregnant women to protect infants in the first few months of life through the passive transfer of maternal antibodies. This strategy is already used to protect neonates and young infants against pertussis, flu and covid passed using antibodies passed from mom to baby during pregnancy through the placenta and after birth via breastfeeding.

And, back in May, the FDA approved the first-ever vaccine against RSV for older adults from GSK called Arexvy.

It’s amazing that in one year we have a monoclonal antibody treatment for infants and not only one but two different vaccines for pregnant women and older adults.

We now have more tools at our disposal to prevent people of all ages from ending up in the ICU and dying, and it all starts with getting your vaccines and staying up to date on them.

Anyone with questions about treatments for themselves or their children should talk to their primary health-care provider.