In bipartisan way, political leaders push passage of 'pill mill' bill

A bipartisan group of political leaders issued a call today "to pass a bill that will help the state battle one of its most significant threats – prescription drug abuse," a press release from Gov. Steve Beshear's office said. Beshear, Attorney General Jack Conway, House Speaker Greg Stumbo, Senate Republican Floor Leader Robert Stivers, Sen. Jimmy Higdon, R-Lebanon, and House Judiciary Committee Chairman John Tilley, D-Hopkinsville, said the legislature should pass House Bill 4 when it returns to Frankfort for its final day April 12.

"Since the beginning of 2012, more than 400 Kentuckians have been hospitalized because of prescription drug overdoses – a statistic that the leaders say underscores the crucial need to pass this bill in this legislative session," the release said. "Kentucky has the nation’s sixth-highest rate of prescription drug overdose deaths, at nearly 18 deaths per 100,000."

Conway said in the release, “I'm hopeful everyone, including the medical community, can get on board with House Bill 4 to ensure that we don't lose another generation in Kentucky to prescription drug abuse.” The bill would move the Kentucky All Schedule Prescription Electronic Reporting (KASPER) system to Conway's office from the Kentucky Board of Medical Licensure, which is controlled by doctors and has done little to rein in "pill mills" that churn out prescriptions for painkillers.

"Law enforcement members warn that Ohio, Tennessee, West Virginia and Florida have passed legislation similar to HB 4 to address pill mills, and failing to pass similar legislation could create a diversion effect in which Kentucky could become a source state for prescription painkillers," the release said.

Stumbo, who preceded Conway as attorney general, said in the release, “Given the true epidemic we are seeing, we cannot afford to wait another year to try to pass this again.” In October, Stumbo, Beshear and Conway "announced creation of an advisory board of physicians, dentists, nurses, and pharmacists to work with KASPER officials and law enforcement professionals to create guidelines for generally accepted prescribing practices among different medical disciplines," the release said. "These criteria will be used as a guide for when a prescriber or dispenser’s KASPER reports may be flagged for unusual prescribing activity."

The bill would require all prescription providers to register and use KASPER, require pain management clinics to be owned by a licensed medical practitioner, make medical licensure boards investigate prescribing complaints within four months. 

Body-mass index fails to identify some as obese, mainly women

Many Americans, particularly women, are actually obese though they think their weight is healthy because of weaknesses in the body-mass index formula.

A study comparing people's BMIs to a blood test and body scan found that the height-to-weight ratio formula was wrong in half of women and 1 in 4 men.

"It's commonly acknowledged that the BMI can produce inaccurate results for athletes and others with a lot of muscle mass,"  Misti Crane reports for The Columbus Dispatch . "But this research illuminates a problem on the other end of the scale: people who think they're fine but are carrying a lot of fat and little muscle."

"Particularly women, as they age, their muscles become inserted with fat, even though they stay thin and beautiful in a dress," said Dr. Eric Braverman, a New York physician who co-wrote the study.

Braverman and co-author New York State Health Commissioner Nirav R. Shah propose that the BMI cutoff for determining obesity should be 24 for women and 28 for men. Now, it's 30 for both sexes. "They also say that doctors should consider blood tests to measure leptin, a hormone that goes up with increased body fat, and DXA scans. The scans are commonly used to assess bone density but can be used to analyze body fat," Crane reports.

Though experts know the BMI calculation is not perfect, there is one major advantage: It's free. "You have to understand that BMI is an estimate of fatness, it's not a measure of fatness. But there are very few screening-tool estimates we have that are as simple to use," said Dr. Patricia Choban, medical director of the bariatric-surgery problem at Mount Carmel West Hospital. (Read more)

Obesity adds more health-care costs than smoking, study finds

Obesity costs the health care system more than smoking does, a new study has found. The annual health costs for someone who is obese average $1,850 more than for a person a normal weight. The excess costs were up to $5,500 per year for people who are morbidly obese. Smokers' health costs averaged $1,275 more than those of nonsmokers.

Researchers studied the additional costs "of smoking and obesity among more than 30,000 Mayo Clinic employees and retirees. All had continuous health insurance coverage between 2001 and 2007," reports research-reporting service Newswise. The findings were published in the Journal of Occupational and Environmental Medicine.

The additional costs associated with obesity appeared to be lower after they were adjusted for other related health problems. "This may lead to underestimation of the true incremental costs, since obesity is a risk factor for developing chronic conditions," said James P. Moriary and his fellow researchers. (Read more)

Doctor groups say to do 45 common tests, procedures less often

Doctors should perform 45 common tests and procedures less often, a group of nine medical specialty boards recommended today. The move will "likely alter treatment standards in hospitals and doctors' offices nationwide," reports Roni Caryn Rabin for The New York Times.

"Overuse is one of the most serious crises in American medicine," said Dr. Lawrence Smith, physician-in-chief at North Shore-LIJ Health System and dean of the Hofstra North Shore-LIJ School of Medicine, who was not involved in the effort. "Many people have thought that the organizations most resistant to this idea would be the specialty organizations, so this is a very powerful message."

Some estimates show unnecessary treatment accounts for one-third of medical spending in the United States.

The American Board of Internal Medicine Foundation is advising against physicians testing with EKGs during a physical when there is no sign of heart trouble; MRIs ordered whenever a patient has back pain; and antibiotics for mild sinusitis. "The American College of Cardiology is urging heart specialists not to perform routine stress cardiac imaging in asymptomatic patients, and the American College of Radiology is telling radiologists not to run imaging scans on patients suffering from simple headaches. The American Gastroenterological Association is urging its physicians to prescribe the lowest doses of medication needed to control acid reflux disease," Rabin reports.

Oncologists will also be urged to reduce the number of scans for patients with early stage breast cancer and prostate cancers that aren't likely to spread.

Some specialists are cautious, however. "These all sound reasonable, but don't forget that every person you're looking after is unique," said Dr. Eric Topol, chief academic officer of Scripps Health. "This kind of one-size-fits-all approach can be a real detriment to good care."

Others applauded the effort. "It's courageous that these societies are stepping up," said Dr. John Santa, director of the health ratings center of Consumer Reports. "I am a primary care internist myself, and I'm anticipating running into some of my colleagues who will say, 'Y'know, John, we all know we've done EKGs that weren't necessary and bone density tests that weren't necessary, but, you know, that was a little bit of extra money for us.'" (Read more)

This is Child Abuse Awareness Month; tips for prevention

April is child abuse awareness month, and the state Cabinet for Health and Family Services is reminding Kentuckians that it's the law to report suspected child abuse or neglect.

"Protecting our children should be everyone's number one priority, and during the month of April, we are raising awareness about the warning signs of child abuse and how to report it," Gov. Steve Beshear said. "The cabinet works year round to educate our families and investigate every aspect of abuse. Together, we can make Kentucky a safer place for all our children."

To report child abuse, Kentuckians should call 800-KYSAFE1. Calls are anonymous. If the report meets the criteria for abuse, an investigation is conducted within 24 hours in most cases or, if the child is suspected to be in immediate danger, they are conducted within the hour.

Callers should try to know the child's name, approximate age, address, parents' names and location of the child when the call is made. They should also have names and phone numbers of other people who have information about the suspected abuse.

The ultimate goal is to reunite families when circumstances improve. "We want children to return home to a stronger, safer family," said Jim Grace, assistant director of the Department for Community Based Services' Division of Protection and Permanency.

The cabinet's handling of child abuse investigations and its reluctance to release records pertaining to child abuse deaths and near deaths has been a hot-button issue in the past year. The Courier-Journal and Lexington Herald-Leader both sued the cabinet for refusing to turn over records and a judge twice ruled the cabinet was wrong not to do so. Since, it has released hundreds of pages of records, but has chosen to redact, or omit, some of the information therein. In January, Beshear acknowledged the cabinet had been accused of "operating under a veil of secrecy in a supposed attempt to protect inept workers and a poorly designed system."  Legislators have since heard hours of arguments about the issue, and a bill that would create an external panel to review child abuse cases involving fatalities and near-fatalities, while imposing more secrecy, is one of the few measures that could pass the General Assembly when it re-convenes for one day next Thursday to end its legislative session.

In its effort to increase awareness about child abuse, the cabinet offered strategies for parents to prevent abuse, including:

• never discipling a child when a parent's anger is out of control

• never leaving a child unattended, especially in a car

• learning the signs of physical abuse, nothing bruises, cuts, burns or other injuries a child can't explain

• teaching children the difference between "good touches," "bad touches" and "confusing touches"

• listening to a child when he or she doesn't want to go with something

• noting a change in a child's behavior or attitude

• teaching children what if he or she gets lost

• teaching children the correct name for private body parts

• being alert for talk that indicates premature sexual understanding

• paying attention when someone shows an unusual interest in a child

• making sure a child's school or daycare will only release him or her to a designated person
(Read more)

What will high court do on health law? 4 most possible scenarios

Last week, U.S. Supreme Court justices heard arguments about the constitutionality of the federal health-care reform law. At the center of the debate is whether the government can force people to buy health insurance, a provision often referred to as the individual mandate. There are four likely scenarios that will be the outcome of the justices' decisions, asserts Jennifer Haberkorn for Politico, all of which come with their own problems.

Scenario 1: The individual mandate is struck down, as well as insurance reforms: If these parts of the Affordable Care Act are scrapped, "Insurance companies will still be able to deny coverage based on customers' costly pre-existing conditions and charge more to older and sicker — or female patients," Haberkorn reports.

If that happens, the Obama administration and Democrats would likely blame Republicans for promoting a lawsuit that puts insurance companies in charge again. If reaction from the public is strong, Republicans may feel obligated to enact insurance reforms without an individual mandate. Ideas for doing this include "charging more if a person buys insurance at the last minute, tax incentives and a promise that if a person buys coverage, that person wouldn't lose it if he or she were to get sick and need it," Haberkorn reports.

Scenario 2: The mandate is struck down, but insurance reforms stay intact: Part of the reason why insurance companies agreed to stop denying coverage based on pre-existing conditions is they could offset the losses because the law would enlarge their insurance pool by 30 million people — the number of Americans who lack coverage.

If insurance companies are still required to stop denying coverage based on pre-existing conditions but the individual mandate is struck down "They could start a mini revolt over having to cover expensive patients without the mandate," Haberkorn reports.

Scenario 3: The entire law, or the majority of it, is axed: That would mean unpopular parts of the law would be trashed, but so would popular ones, including the pre-existing conditions piece as well as a provision that allows young adults to stay on their parents' health insurance until the age of 26.

In 2010, 26 provisions took effect and another 17 did last year. Nine new provisions are taking place this year. "Lawmakers designed the phase-in, in part, with the thought that the public would become more supportive of the law once certain provisions began to take hold," report Michael Doyle and David Lightman for McClatchy Newspapers.

Scrapping the law entirely could cause the most political fallout. "Republicans would try to move quickly to enact a small-scale health reform legislation aimed at restoring some of the popular pieces of the health law," Haberkorn reports. "But Democrats won't want to support something far less comprehensive than the Affordable Care Act, not with some 50 million Americans uninsured."

Scenario 4: The law stands: Though this is the hope of the Obama administration, "The mandate is considered relatively weak: The penalty for not obeying it starts at $95 in 2014 — that's nothing compared with the cost of insurance premiums," Haberkorn reports. The amount increases to $695 by 2016.

As for what the justices will do, "at least some of the court's conservatives seem prepared to kill the whole bill," report Doyle and Lightman. "My approach would be, if you take the heart out of the statue, the statute is gone," Justice Antonin Scalia said.

Justice Elena Kagan countered, "Half a loaf is better than no loaf," while Justice Ruth Bader Ginsburg suggested, "It's a question between a wrecking operation and a salvage job."

Some justices said the whole bill should be sacked, "on the theory that members of Congress would not have voted for it without the mandate," Adam Liptak reports for The New York Times. But Justice Sonia Sotomayor said killing the whole law "would be too broad an assertion of judicial power," Liptak notes. Justice Anthony Kennedy, the likely swing vote, said "We would be exercising the judicial power, if one provision was stricken and the others remained, to impose a risk on insurance companies that Congress had never intended."

The justices probably decided the future of the law Friday morning, reports Mark Sherman for The Associated Press. Typically, an initial vote is "followed soon after by the assignment of a single justice to write a majority opinion, or in a case this complex, perhaps two or more justices to tackle different issues. That's where the hard work begins, with the clock ticking toward the end of the court's work in early summer," Sherman writes.

In Kentucky, health advocates and officials are watching closely to see what happens. "I think the entire health-care sector and insurance sector are watching this closely because it has significant implications on both industries," said Stephen Williams, chief executive officer of Norton Healthcare. "This is very far-reaching."

In Kentucky, the law extends coverage for 35,000 young adults, reports Laura Ungar for The Courier-Journal. (Read more)

2012 county health rankings released; meant to spur local change

By Tara Kaprowy

Kentucky Health News

Meant to be a conversation starter to fuel change for better health, the third-annual County Health Rankings were released today, a health-evaluation tool that assesses the country's counties on everything from their smoking to early mortality rates. Kentucky's rankings did not change significantly from last year, with Oldham and Boone counties at the top and Owsley, Magoffin and Wolfe counties at the bottom of the list.

Kentuckians who are the least healthy live in the Appalachian swath of the state, the rankings show. Fulton County in Kentucky's southwestern tip ranks low, though is not surrounded by other low-ranked areas. Counties that hug urban centers — Louisville, Lexington and Cincinnati — have the highest rankings. The data are compiled by the University of Wisconsin Population Health Institute in collaboration with the Robert Wood Johnson Foundation.

Kentucky's breakdown is not unusual, but part of a nationwide pattern in which the least healthy counties are often in rural, sparsely populated areas, said Dr. Patrick Remington, lead researcher and associate dean for public health at UW's School of Medicine and Public Health. "At the other end, you see urban centers as having similar problems and often ranking at the bottom of the list," he said. "Another pattern is some of the suburban communities, ring communities, are some of the healthiest communities."

Counties are ranked in two ways: health outcomes (such as premature death rates, low birthweight, how good or bad people feel physically and mentally) and health factors (such as smoking, obesity and binge-drinking rates). In health outcomes, graphic above, Oldham, Boone and Calloway ranked first, second and third respectively. Owsley County was ranked last, preceded by Martin and Wolfe counties.

In health factors, left, Woodford County ranked first, followed by Oldham and Boone. Clay County (labeled CY) was in last place, preceded by Magoffin and Wolfe counties (MG and WO).

Though Kentucky's counties are ranked from 1 to 120, because of the small sample sizes in many of them, the rankings do not "represent statistically significant differences from county to county," the rankings website reads. Sources for the data also change, so direct comparisons from year to year are also inexact, Remington said. This year, researchers tracked the number of fast-food restaurants in a county and levels of physical inactivity. They also used premature death rate trends over 10 years, a hard number that alone can indicate progress, Remington said.

Though Remington said he would "be naive to say the competitive element doesn't pique interest in the rankings," they are "not really intended to be a race to the top." Instead, rankings should be used as a "Polaroid snapshot of community health," Remington said. The data should be used by officials to pinpoint problem areas, drill down and make policy changes in turn, he said.

That's what Chip Johnson, mayor of Hernando, Miss., did. Participating in a teleconference about the rankings, Johnson talked about how policies aimed at improving health have changed his city. Officials have required sidewalks in all new and re-developments, he said. All new streets should be biking and pedestrian accessible. The city has partnered with schools so people can use their gyms to work out. And Johnson encouraged a local bank to donate land for a 37-acre park. "Banks are sitting on land they've repossessed and don't know what to do with it," he said. "We're naming the park after the bank."

The goal is to create infrastructure that will make it easier for people to make healthy decisions, he said, pointing out, "You can't exercise your personal responsible for good health if your city or county does not give you that atmosphere or opportunity." Johnson said he responded to this reality by strategically placing the city's only farmers' market, community garden and community center in its lowest-income area.

As indicated by the data assessed and Johnson's efforts, "Much of what influences our health happens outside of the doctor's office," foundation President Risa Lavizzo-Mourey said, and factors like education rates, income levels and access to healthy food all play a part, researchers found. Data also show where someone lives can influence health. Excessive drinking, for example, is highest in Northern states. Rates of teen births, sexually transmitted infections and children living in poverty are highest in Southern states.

The rankings are based on several sources of data, from vital statistics to the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System, the world's largest, on-going telephone health survey. "We found even though the data are available nationally, it requires a lot of time and effort," Remington said. "This is one-stop shopping, not just for death and disease rates but for all of the factors that lead to a healthy community. Combining them allows people to start the conversation pretty easily."

Susan Zepeda, CEO of the Foundation for a Healthy Kentucky, applauded the effort. "Local health data can spur communities to action to create better health outcomes for all Kentuckians," she said.

'One Text or Call Could Wreck It All' traffic safety campaign being promoted this month

A new traffic campaign with the slogan of "One Text or Call Could Wreck It All" is being sponsored by the National Highway Traffic Safety Administration this month.

April has been designated Distract Driving Awareness Month, with Kentucky law-enforcement agencies committed to spreading the word. In 2009, nearly 5,500 people were killed and another half a million people were hurt in accidents caused by distracted driving, according to national safety administration figures.

The national effort "focuses on ways to change the behavior of drivers through legislation, enforcement, public awareness and education — the same activities that have curbed drunken driving and increased seat belt use," The Courier-Journal reports.

Officials said they want to reach teen drivers especially with the effort, since that group has the highest proportion of distracted drivers who were involved in fatal crashes. (Read more)

This week is National Public Health Week; this year's focus is on prevention and wellness

With a focus on prevention and wellness this year, the Kentucky Department of Public Health is promoting national Public Health Week, which kicked off yesterday and will be observed until Sunday. The prevention theme was chosen to underscore the impact of chronic disease on the American population.

Americans miss 2.5 billion days of work because of diseases like heart disease, cancer and diabetes, which costs the country $1 trillion. Unintentional injuries, such as those stemming from motor vehicle accidents, poisonings and burns, rank within the top 10 causes of death for people 44 and younger, according to a DPH press release.

"Often, these horrible diseases and injuries could have been prevented with more attention to lifestyle choices like physical activity and nutrition or preventive safety measures," said Dr. Steve Davis, acting DPH commissioner. "The health care community — as well as the individual — must work to understand the risk for developing chronic disease and avoiding injury so that we can prevent complications. This is key to improving the health of our state."

Public health is also crucial in emergency response, as witnessed with recent tornadoes that struck the state. "The contribution of public health is tremendous — both on a day-to-day basis and in times of crisis," Davis said. "I encourage everyone to go online to read more about our public health programs; talk to your health care provider about chronic disease and injury prevention; or, better yet, visit your local health department to learn more about how public health can — and does — improve your life." (Read more)

Bill amendment could make dental, vision care more expensive

A last-minute amendment to a bill intended to limit when insurance companies could terminate policies may end up costing Kentuckians more out-of-pocket dental and vision expenses, Courier-Journal political writer Joseph Gerth writes in his weekly column.

The implications of House Bill 497 changed when Sen. Tom Buford, R-Nicholasville, "filed a one-paragraph amendment that was brought to him at the last minute by a lobbyist for the Kentucky Dental Association," Gerth writes. "That amendment said that if you have vision or vision insurance, your insurance provider can't require your health care provider to give you discounted rates on services that aren't paid for by the insurance plan."

That could mean that low-cost plans that only cover a few procedures but offer "added benefit by making sure you're not paying inflated prices for other services" may no longer be available, Gerth reports. Opponents say insurance companies will stop offering such plans because people won't buy them without the discounts. And people who can't afford more expensive plans will sacrifice dental and vision insurance.

On Tuesday, the Senate adopted the amendment and passed the bill. The bill cleared the House the next day. Gov. Steve Beshear has not indicated if he will sign or veto it.

Advocates say the bill will save in dental and vision care costs. Opponents say people will have difficulty having access to case. As for who's right, Gerth writes: "Bill advocates have presented no evidence to suggest that, and there have been no full-fledged hearings for the dentists behind the bill to make their case or to answer the questions that need to be asked." (Read more)

Three of four UK's research professorships fund work in health

Three of the four University of Kentucky research professorships awarded for the 2012-13 school year will fund health-related work. Each award is worth $40,000.

Mark Filmore, right, who teaches in UK's Department of Psychology, will research the role that cognitive processes have in promoting risk-taking behavior. It will have an emphasis on recreational drug use, including alcohol abuse and dependence.

Douglas Andres, left, professor and vice chair of the Department of Molecular and Cellular Biochemistry,  "had begun to define the molecular pathways that control adult neurogenesis, and have shown that Rit, a Ras family G-protein, plays a critical role in the survival of newborn adult neurons following traumatic brain injury," a press release reads. If that is the case, strategies that target Rit activation may be effective in helping recover or repair the injury.

In the Department of Internal Medicine, Mark Dignan, right, leads a program that focuses on cancer prevention and control in community settings using community-based participatory methods. Using the funds of his professorship, he plans to expand his training, "allowing him to conduct translational research with teams that include basic and clinical scientists as they continue their work to reduce cancer health disparities," the press release reads.

Christopher Pool, professor in the Department of Anthropology, is the fourth professorship recipient. (Read more)

Need for painkillers and social support, shortage of treatment programs, feeds prescription drug abuse in Appalachian Ky.

By Ivy Brashear
Kentucky Health News

Taking opioids is still the best way to treat patients with pain, but the drugs are addictive because they do more than just alleviate physical suffering — they cause patients to feel good too. That's causing big problems in Kentucky, the state with the highest rate of opioid use and overdose.

In Perry County, for example, prescription medicines are the drugs of choice, second only to marijuana, and users may get more of them from relatives than from doctors. And their drug use appears to be part of a social support system.

Those were the findings of three separate studies presented at the second annual Appalachian Health Summit in Lexington last week.

Prescription-drug abuse is "an epidemic" that "seems to have started in rural Appalachia," Jennifer Havens, an associate professor in the University of Kentucky Department of Behavioral Science, said in presenting a study showing how disease spreads through the region.

Havens’ study of Hazard and Perry County found that prescription drug abuse in the county is second to marijuana use, and that painkiller abuse among high school seniors is at the same rate as in adults.

Though it’s not clear why prescription drug abuse is so rampant in the region, Havens speculated that lack of availability of other “hard” drugs, like heroin and cocaine, has led Appalachian drug users to turn to prescription medicine to get high. There are few drug-treatment options for users in the region, and many hospitals aren’t “financially viable” to care for drug abusers, she said.

An earlier study in which Havens was involved revealed that rural adults use more “alternate” methods to take drugs, including snorting and injecting. The study compared drug users in Perry County to those in Louisville and found that more than 40 percent of adults in the Hazard area were injecting prescription drugs to get high, and youth there were 25 percent more likely than those in Louisville to abuse such drugs.

The study found high rates of sharing drug-taking instruments, which increases risk for diseases such as hepatitis and HIV, Havens said. Almost 90 percent of participants said they shared snorting straws, and almost 1 in 3 said they shared syringes. No cases of HIV were found among the participants, but almost 43.7 percent of the 500 interviewed had hepatitis-C, and 11.5 percent had herpes-2.

Eighty percent were lifetime users, and about half first abused Oxycontin through injection. Havens said 28 percent of users had overdosed, and 58 percent had witnessed an overdose.

The study also found that a person’s likelihood of continuing drug use correlated with higher levels of social support, which Havens said contradicts long-held assumptions that drug users continue to abuse prescription pills because of low social support.

“Most people in the study depended on people also using drugs for social support,” Havens said. “As you can imagine, that’s not a good idea.”

No good alternative to prescribing painkillers

Despite widespread opioid abuse in Appalachia, such drugs are “still the best pain therapy,” UK physiology professor Karin Westlund High reported.

The purpose of her study was to determine what effect a high-fat and alcohol diet would have on “visceral pain” in the pancreas, and then what effect opioid gene therapy would have on the organ.

There are clusters of Appalachian counties at high risk for pancreatitis, which can lead to pancreatic cancer. Severe abdominal pain is associated with both, and morphine is typically used to treat it. However, High said, patients usually develop a tolerance to the drug over time.

She and other researchers used rats to test an opioid gene therapy involving herpes simplex-1, which 90 percent of Americans already have, to see if it would reduce pancreatitis pain without building tolerance in the rats. After 10 weeks of treatment, there was no tolerance present and the therapy seemed to be reversing damaged sections of the pancreas caused by the disease.

While opioids are effective in alleviating pain, "There are lots of different kinds of pain, but most opioids act as if they treat the same pain,” said Michelle Lofwall, a UK psychiatry and behavioral science assistant professor. Lofwall set out to discover how pain affects prescription drug abuse, since that is the main reason such drugs are prescribed or first used.

Her study participants, who were all drug users, placed one arm in a cooler of ice to elicit pain, and then were asked about pain levels. The test was repeated after a dose of painkiller.  Researchers were attempting to give the drug to treat patients’ pain only, and not to have the patient feel a high when the drug was in their system, but that failed.

“Unfortunately, in my patients I wanted to say, ‘Yes, let’s treat your pain and you won’t feel any good effects’,” Lofwall said. “I wasn’t able to say that to them.” She said they are now trying to help doctors better prescribe pain medication so that habits aren’t formed.

One of the biggest habit-forming painkillers is Oxycontin, which was introduced in 1996 but wasn’t abused on a large scale until doctors had to start documenting pain in 1999, Lofwall said. Sales of, treatment for, and death from prescription drug abuse have increased since then. She noted that Kentucky has the highest rates of opioid use and overdose.

The makers of Oxycontin have reformulated the drug to make it harder to crush, mix with water and snort, but a new drug has risen to take its place: Opana. Lofwall said researchers have been trying to study Opana use, but can’t get a study supply because it is in such high demand. She said she has seen more of a rise in heroin use by her patients because even heroin is easier to get than Opana.

Though legislators are grappling to curb the proliferation of "pill mills" in the state, Lofwall said "doctor shopping" may not be the problem it's been billed to be. According to the National Household Survey on Drug Use and Health, 56 percent of users get their supply from a relative, of whom 85 percent have a prescription from one doctor. The drug abuser may get the drug from the relative as a gift, by paying for it or by stealing it.

Asked about the Kentucky All Schedule Prescription Electronic Reporting system, which allows doctors to search a database for “doctor shoppers” before prescribing pain pills, Lofwall said KASPER is limited because it only covers Kentucky, but “I think the state’s ready to make it better.”

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.